1
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Magaret CA, Li L, deCamp AC, Rolland M, Juraska M, Williamson BD, Ludwig J, Molitor C, Benkeser D, Luedtke A, Simpkins B, Heng F, Sun Y, Carpp LN, Bai H, Dearlove BL, Giorgi EE, Jongeneelen M, Brandenburg B, McCallum M, Bowen JE, Veesler D, Sadoff J, Gray GE, Roels S, Vandebosch A, Stieh DJ, Le Gars M, Vingerhoets J, Grinsztejn B, Goepfert PA, de Sousa LP, Silva MST, Casapia M, Losso MH, Little SJ, Gaur A, Bekker LG, Garrett N, Truyers C, Van Dromme I, Swann E, Marovich MA, Follmann D, Neuzil KM, Corey L, Greninger AL, Roychoudhury P, Hyrien O, Gilbert PB. Quantifying how single dose Ad26.COV2.S vaccine efficacy depends on Spike sequence features. Nat Commun 2024; 15:2175. [PMID: 38467646 PMCID: PMC10928100 DOI: 10.1038/s41467-024-46536-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 02/29/2024] [Indexed: 03/13/2024] Open
Abstract
In the ENSEMBLE randomized, placebo-controlled phase 3 trial (NCT04505722), estimated single-dose Ad26.COV2.S vaccine efficacy (VE) was 56% against moderate to severe-critical COVID-19. SARS-CoV-2 Spike sequences were determined from 484 vaccine and 1,067 placebo recipients who acquired COVID-19. In this set of prespecified analyses, we show that in Latin America, VE was significantly lower against Lambda vs. Reference and against Lambda vs. non-Lambda [family-wise error rate (FWER) p < 0.05]. VE differed by residue match vs. mismatch to the vaccine-insert at 16 amino acid positions (4 FWER p < 0.05; 12 q-value ≤ 0.20); significantly decreased with physicochemical-weighted Hamming distance to the vaccine-strain sequence for Spike, receptor-binding domain, N-terminal domain, and S1 (FWER p < 0.001); differed (FWER ≤ 0.05) by distance to the vaccine strain measured by 9 antibody-epitope escape scores and 4 NTD neutralization-impacting features; and decreased (p = 0.011) with neutralization resistance level to vaccinee sera. VE against severe-critical COVID-19 was stable across most sequence features but lower against the most distant viruses.
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Affiliation(s)
- Craig A Magaret
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Li Li
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Allan C deCamp
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Morgane Rolland
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, USA
| | - Michal Juraska
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Brian D Williamson
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Biostatistics Division, Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - James Ludwig
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Cindy Molitor
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - David Benkeser
- Departments of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Alex Luedtke
- Department of Statistics, University of Washington, Seattle, WA, USA
| | - Brian Simpkins
- Department of Computer Science, Pitzer College, Claremont, CA, USA
| | - Fei Heng
- University of North Florida, Jacksonville, FL, USA
| | - Yanqing Sun
- University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Lindsay N Carpp
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Hongjun Bai
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, USA
| | - Bethany L Dearlove
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, USA
| | - Elena E Giorgi
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Mandy Jongeneelen
- Johnson & Johnson Innovative Medicine, Janssen Vaccines & Prevention B.V, Leiden, The Netherlands
| | - Boerries Brandenburg
- Johnson & Johnson Innovative Medicine, Janssen Vaccines & Prevention B.V, Leiden, The Netherlands
| | - Matthew McCallum
- Department of Biochemistry, University of Washington, Seattle, WA, USA
| | - John E Bowen
- Department of Biochemistry, University of Washington, Seattle, WA, USA
| | - David Veesler
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Howard Hughes Medical Institute, University of Washington, Seattle, WA, USA
| | - Jerald Sadoff
- Johnson & Johnson Innovative Medicine, Janssen Vaccines & Prevention B.V, Leiden, The Netherlands
| | - Glenda E Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - Sanne Roels
- Janssen R&D, a division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - An Vandebosch
- Janssen R&D, a division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - Daniel J Stieh
- Johnson & Johnson Innovative Medicine, Janssen Vaccines & Prevention B.V, Leiden, The Netherlands
| | - Mathieu Le Gars
- Johnson & Johnson Innovative Medicine, Janssen Vaccines & Prevention B.V, Leiden, The Netherlands
| | - Johan Vingerhoets
- Janssen R&D, a division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - Beatriz Grinsztejn
- Evandro Chagas National Institute of Infectious Diseases-Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Paul A Goepfert
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Leonardo Paiva de Sousa
- Evandro Chagas National Institute of Infectious Diseases-Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Mayara Secco Torres Silva
- Evandro Chagas National Institute of Infectious Diseases-Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Martin Casapia
- Facultad de Medicina Humana, Universidad Nacional de la Amazonia Peru, Iquitos, Peru
| | - Marcelo H Losso
- Hospital General de Agudos José María Ramos Mejia, Buenos Aires, Argentina
| | - Susan J Little
- Division of Infectious Diseases, University of California San Diego, La Jolla, CA, USA
| | - Aditya Gaur
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Observatory, Cape Town, South Africa
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Carla Truyers
- Janssen R&D, a division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - Ilse Van Dromme
- Janssen R&D, a division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - Edith Swann
- Vaccine Research Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Mary A Marovich
- Vaccine Research Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Dean Follmann
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lawrence Corey
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Alexander L Greninger
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Biochemistry, University of Washington, Seattle, WA, USA
| | - Pavitra Roychoudhury
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Biochemistry, University of Washington, Seattle, WA, USA
| | - Ollivier Hyrien
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Peter B Gilbert
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.
- Department of Biostatistics, University of Washington School of Public Health, Seattle, WA, USA.
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Imran S, Rao MS, Shah MH, Gaur A, Guernaoui AE, Roy S, Roy S, Bharadwaj HR, Awuah WA. Evolving perspectives in reverse cardio-oncology: A review of current status, pathophysiological insights, and future directives. Curr Probl Cardiol 2024; 49:102389. [PMID: 38184129 DOI: 10.1016/j.cpcardiol.2024.102389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/08/2024]
Abstract
Cardiovascular disease (CVD) and cancer are leading causes of mortality worldwide, traditionally linked through adverse effects of cancer therapies on cardiovascular health. However, reverse cardio-oncology, a burgeoning field, shifts this perspective to examine how cardiovascular diseases influence the onset and progression of cancer. This novel approach has revealed a higher likelihood of cancer development in patients with pre-existing cardiovascular conditions, attributed to shared risk factors such as obesity, a sedentary lifestyle, and smoking. Underlying mechanisms like chronic inflammation and clonal hematopoiesis further illuminate the connections between cardiovascular ailments and cancer. This comprehensive narrative review, spanning a broad spectrum of studies, outlines the syndromic classification of cardio-oncology, the intersection of cardiovascular risk factors and oncogenesis, and the bidirectional dynamics between CVD and cancer. Additionally, the review also discusses the pathophysiological mechanisms underpinning this interconnection, examining the roles of cardiokines, genetic factors, and the effects of cardiovascular therapies and biomarkers in cancer diagnostics. Lastly, it aims to underline future directives, emphasising the need for integrated healthcare strategies, interdisciplinary research, and comprehensive treatment protocols.
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Affiliation(s)
- Shahzeb Imran
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Medha Sridhar Rao
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Muhammad Hamza Shah
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom; Centre for Anatomy, Deanery of Biomedical Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Aditya Gaur
- School of Medicine, University of Central Lancashire, Preston, United Kingdom
| | - Abderrahmane El Guernaoui
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Subham Roy
- Hull York Medical School, University of York, York, United Kingdom
| | - Sakshi Roy
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
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Magaret C, Li L, deCamp A, Rolland M, Juraska M, Williamson B, Ludwig J, Molitor C, Benkeser D, Luedtke A, Simpkins B, Carpp L, Bai H, Deariove B, Greninger A, Roychoudhury P, Sadoff J, Gray G, Roels S, Vandebosch A, Stieh D, Le Gars M, Vingerhoets J, Grinsztejn B, Goepfert P, Truyers C, Van Dromme I, Swann E, Marovich M, Follmann D, Neuzil K, Corey L, Hyrien O, Paiva de Sousa L, Casapia M, Losso M, Little S, Gaur A, Bekker LG, Garrett N, Heng F, Sun Y, Gilbert P. Quantifying how single dose Ad26.COV2.S vaccine efficacy depends on Spike sequence features. Res Sq 2023:rs.3.rs-2743022. [PMID: 37398105 PMCID: PMC10312950 DOI: 10.21203/rs.3.rs-2743022/v1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
It is of interest to pinpoint SARS-CoV-2 sequence features defining vaccine resistance. In the ENSEMBLE randomized, placebo-controlled phase 3 trial, estimated single-dose Ad26.COV2.S vaccine efficacy (VE) was 56% against moderate to severe-critical COVID-19. SARS-CoV-2 Spike sequences were measured from 484 vaccine and 1,067 placebo recipients who acquired COVID-19 during the trial. In Latin America, where Spike diversity was greatest, VE was significantly lower against Lambda than against Reference and against all non-Lambda variants [family-wise error rate (FWER) p < 0.05]. VE also differed by residue match vs. mismatch to the vaccine-strain residue at 16 amino acid positions (4 FWER p < 0.05; 12 q-value ≤ 0.20). VE significantly decreased with physicochemical-weighted Hamming distance to the vaccine-strain sequence for Spike, receptor-binding domain, N-terminal domain, and S1 (FWER p < 0.001); differed (FWER ≤ 0.05) by distance to the vaccine strain measured by 9 different antibody-epitope escape scores and by 4 NTD neutralization-impacting features; and decreased (p = 0.011) with neutralization resistance level to vaccine recipient sera. VE against severe-critical COVID-19 was stable across most sequence features but lower against viruses with greatest distances. These results help map antigenic specificity of in vivo vaccine protection.
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Affiliation(s)
| | - Li Li
- Fred Hutchinson Cancer Center
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- Evandro Chagas National Institute of Infectious Diseases-Fundacao Oswaldo Cruz
| | - Paul Goepfert
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham
| | | | | | | | - Mary Marovich
- National Institute of Allergy and Infectious Diseases
| | | | | | | | | | | | | | | | - Susan Little
- Department of Medicine, University of California, San Diego, CA 92903
| | | | | | - Nigel Garrett
- Centre for the AIDS Program of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa 4041
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4
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Meeran T, Gaur A, Sinha S, Kamat N, Phadke A, Bunage R, Mulay A. Post-Cardiac Transplant Rejection Surveillance Utilizing a Novel Low-Cost Liquid Biopsy Technique Analyzing Dd-cfDNA and Dd-cfRNA. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1220] [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: 04/05/2023] Open
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5
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Kamat N, Gaur A, Phadke A, Waje N, Bunage R, Meeran T, Sinha S, Chavan A, Haji J, Rathod A, Mulay A. Utility of Intraoperative Cytokine Hemoadsorption Therapy During Cardiac Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1655] [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: 04/05/2023] Open
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6
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Allega A, Anderson MR, Andringa S, Antunes J, Askins M, Auty DJ, Bacon A, Barros N, Barão F, Bayes R, Beier EW, Bezerra TS, Bialek A, Biller SD, Blucher E, Caden E, Callaghan EJ, Cheng S, Chen M, Cleveland B, Cookman D, Corning J, Cox MA, Dehghani R, Deloye J, Deluce C, Depatie MM, Dittmer J, Dixon KH, Di Lodovico F, Falk E, Fatemighomi N, Ford R, Frankiewicz K, Gaur A, González-Reina OI, Gooding D, Grant C, Grove J, Hallin AL, Hallman D, Heintzelman WJ, Helmer RL, Hu J, Hunt-Stokes R, Hussain SMA, Inácio AS, Jillings CJ, Kaluzienski S, Kaptanoglu T, Khaghani P, Khan H, Klein JR, Kormos LL, Krar B, Kraus C, Krauss CB, Kroupová T, Lam I, Land BJ, Lawson I, Lebanowski L, Lee J, Lefebvre C, Lidgard J, Lin YH, Lozza V, Luo M, Maio A, Manecki S, Maneira J, Martin RD, McCauley N, McDonald AB, Mills C, Morton-Blake I, Naugle S, Nolan LJ, O'Keeffe HM, Orebi Gann GD, Page J, Parker W, Paton J, Peeters SJM, Pickard L, Ravi P, Reichold A, Riccetto S, Richardson R, Rigan M, Rose J, Rosero R, Rumleskie J, Semenec I, Skensved P, Smiley M, Svoboda R, Tam B, Tseng J, Turner E, Valder S, Virtue CJ, Vázquez-Jáuregui E, Wang J, Ward M, Wilson JR, Wilson JD, Wright A, Yanez JP, Yang S, Yeh M, Yu S, Zhang Y, Zuber K, Zummo A. Evidence of Antineutrinos from Distant Reactors Using Pure Water at SNO. Phys Rev Lett 2023; 130:091801. [PMID: 36930908 DOI: 10.1103/physrevlett.130.091801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/14/2022] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
The SNO+ Collaboration reports the first evidence of reactor antineutrinos in a Cherenkov detector. The nearest nuclear reactors are located 240 km away in Ontario, Canada. This analysis uses events with energies lower than in any previous analysis with a large water Cherenkov detector. Two analytical methods are used to distinguish reactor antineutrinos from background events in 190 days of data and yield consistent evidence for antineutrinos with a combined significance of 3.5σ.
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Affiliation(s)
- A Allega
- Department of Physics, Engineering Physics and Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - M R Anderson
- Department of Physics, Engineering Physics and Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - S Andringa
- Laboratório de Instrumentação e Física Experimental de Partículas (LIP), Avenida Professor Gama Pinto, 2, 1649-003, Lisboa, Portugal
| | - J Antunes
- Laboratório de Instrumentação e Física Experimental de Partículas (LIP), Avenida Professor Gama Pinto, 2, 1649-003, Lisboa, Portugal
- Universidade de Lisboa, Instituto Superior Técnico (IST), Departamento de Física, Avenida Rovisco Pais, 1049-001, Lisboa, Portugal
| | - M Askins
- Department of Physics, University of California, Berkeley, California 94720, USA
- Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Berkeley, California 94720-8153, USA
| | - D J Auty
- Department of Physics, University of Alberta, 4-181 CCIS, Edmonton, Alberta T6G 2E1, Canada
| | - A Bacon
- Department of Physics & Astronomy, University of Pennsylvania, 209 South 33rd Street, Philadelphia, Pennsylvania 19104-6396, USA
| | - N Barros
- Laboratório de Instrumentação e Física Experimental de Partículas (LIP), Avenida Professor Gama Pinto, 2, 1649-003, Lisboa, Portugal
- Universidade de Lisboa, Faculdade de Ciéncias (FCUL), Departamento de Física, Campo Grande, Edifício C8, 1749-016, Lisboa, Portugal
| | - F Barão
- Laboratório de Instrumentação e Física Experimental de Partículas (LIP), Avenida Professor Gama Pinto, 2, 1649-003, Lisboa, Portugal
- Universidade de Lisboa, Instituto Superior Técnico (IST), Departamento de Física, Avenida Rovisco Pais, 1049-001, Lisboa, Portugal
| | - R Bayes
- School of Natural Sciences, Laurentian University, 935 Ramsey Lake Road, Sudbury, Ontario P3E 2C6, Canada
| | - E W Beier
- Department of Physics & Astronomy, University of Pennsylvania, 209 South 33rd Street, Philadelphia, Pennsylvania 19104-6396, USA
| | - T S Bezerra
- Physics & Astronomy, University of Sussex, Pevensey II, Falmer, Brighton, BN1 9QH, United Kingdom
| | - A Bialek
- School of Natural Sciences, Laurentian University, 935 Ramsey Lake Road, Sudbury, Ontario P3E 2C6, Canada
- SNOLAB, Creighton Mine #9, 1039 Regional Road 24, Sudbury, Ontario P3Y 1N2, Canada
| | - S D Biller
- University of Oxford, The Denys Wilkinson Building, Keble Road, Oxford, OX1 3RH, United Kingdom
| | - E Blucher
- The Enrico Fermi Institute and Department of Physics, The University of Chicago, Chicago, Illinois 60637, USA
| | - E Caden
- School of Natural Sciences, Laurentian University, 935 Ramsey Lake Road, Sudbury, Ontario P3E 2C6, Canada
- SNOLAB, Creighton Mine #9, 1039 Regional Road 24, Sudbury, Ontario P3Y 1N2, Canada
| | - E J Callaghan
- Department of Physics, University of California, Berkeley, California 94720, USA
- Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Berkeley, California 94720-8153, USA
| | - S Cheng
- Department of Physics, Engineering Physics and Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - M Chen
- Department of Physics, Engineering Physics and Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - B Cleveland
- School of Natural Sciences, Laurentian University, 935 Ramsey Lake Road, Sudbury, Ontario P3E 2C6, Canada
- SNOLAB, Creighton Mine #9, 1039 Regional Road 24, Sudbury, Ontario P3Y 1N2, Canada
| | - D Cookman
- University of Oxford, The Denys Wilkinson Building, Keble Road, Oxford, OX1 3RH, United Kingdom
| | - J Corning
- Department of Physics, Engineering Physics and Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - M A Cox
- Laboratório de Instrumentação e Física Experimental de Partículas (LIP), Avenida Professor Gama Pinto, 2, 1649-003, Lisboa, Portugal
- Department of Physics, University of Liverpool, Liverpool L69 3BX, United Kingdom
| | - R Dehghani
- Department of Physics, Engineering Physics and Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - J Deloye
- School of Natural Sciences, Laurentian University, 935 Ramsey Lake Road, Sudbury, Ontario P3E 2C6, Canada
| | - C Deluce
- School of Natural Sciences, Laurentian University, 935 Ramsey Lake Road, Sudbury, Ontario P3E 2C6, Canada
| | - M M Depatie
- Department of Physics, Engineering Physics and Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
- School of Natural Sciences, Laurentian University, 935 Ramsey Lake Road, Sudbury, Ontario P3E 2C6, Canada
| | - J Dittmer
- Technische Universität Dresden, Institut für Kern und Teilchenphysik, Zellescher Weg 19, Dresden 01069, Germany
| | - K H Dixon
- Department of Physics, King's College London, Strand Building, Strand, London WC2R 2LS, United Kingdom
| | - F Di Lodovico
- Department of Physics, King's College London, Strand Building, Strand, London WC2R 2LS, United Kingdom
| | - E Falk
- Physics & Astronomy, University of Sussex, Pevensey II, Falmer, Brighton, BN1 9QH, United Kingdom
| | - N Fatemighomi
- SNOLAB, Creighton Mine #9, 1039 Regional Road 24, Sudbury, Ontario P3Y 1N2, Canada
| | - R Ford
- School of Natural Sciences, Laurentian University, 935 Ramsey Lake Road, Sudbury, Ontario P3E 2C6, Canada
- SNOLAB, Creighton Mine #9, 1039 Regional Road 24, Sudbury, Ontario P3Y 1N2, Canada
| | - K Frankiewicz
- Department of Physics, Boston University, 590 Commonwealth Avenue, Boston, Massachusetts 02215, USA
| | - A Gaur
- Department of Physics, University of Alberta, 4-181 CCIS, Edmonton, Alberta T6G 2E1, Canada
| | - O I González-Reina
- Universidad Nacional Autónoma de México (UNAM), Instituto de Física, Apartado Postal 20-364, México D.F. 01000, México
| | - D Gooding
- Department of Physics, Boston University, 590 Commonwealth Avenue, Boston, Massachusetts 02215, USA
| | - C Grant
- Department of Physics, Boston University, 590 Commonwealth Avenue, Boston, Massachusetts 02215, USA
| | - J Grove
- Department of Physics, Engineering Physics and Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - A L Hallin
- Department of Physics, University of Alberta, 4-181 CCIS, Edmonton, Alberta T6G 2E1, Canada
| | - D Hallman
- School of Natural Sciences, Laurentian University, 935 Ramsey Lake Road, Sudbury, Ontario P3E 2C6, Canada
| | - W J Heintzelman
- Department of Physics & Astronomy, University of Pennsylvania, 209 South 33rd Street, Philadelphia, Pennsylvania 19104-6396, USA
| | - R L Helmer
- TRIUMF, 4004 Wesbrook Mall, Vancouver, British Columbia V6T 2A3, Canada
| | - J Hu
- Department of Physics, University of Alberta, 4-181 CCIS, Edmonton, Alberta T6G 2E1, Canada
| | - R Hunt-Stokes
- University of Oxford, The Denys Wilkinson Building, Keble Road, Oxford, OX1 3RH, United Kingdom
| | - S M A Hussain
- School of Natural Sciences, Laurentian University, 935 Ramsey Lake Road, Sudbury, Ontario P3E 2C6, Canada
| | - A S Inácio
- Laboratório de Instrumentação e Física Experimental de Partículas (LIP), Avenida Professor Gama Pinto, 2, 1649-003, Lisboa, Portugal
- Universidade de Lisboa, Faculdade de Ciéncias (FCUL), Departamento de Física, Campo Grande, Edifício C8, 1749-016, Lisboa, Portugal
| | - C J Jillings
- School of Natural Sciences, Laurentian University, 935 Ramsey Lake Road, Sudbury, Ontario P3E 2C6, Canada
- SNOLAB, Creighton Mine #9, 1039 Regional Road 24, Sudbury, Ontario P3Y 1N2, Canada
| | - S Kaluzienski
- Department of Physics, Engineering Physics and Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - T Kaptanoglu
- Department of Physics, University of California, Berkeley, California 94720, USA
- Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Berkeley, California 94720-8153, USA
| | - P Khaghani
- School of Natural Sciences, Laurentian University, 935 Ramsey Lake Road, Sudbury, Ontario P3E 2C6, Canada
| | - H Khan
- School of Natural Sciences, Laurentian University, 935 Ramsey Lake Road, Sudbury, Ontario P3E 2C6, Canada
| | - J R Klein
- Department of Physics & Astronomy, University of Pennsylvania, 209 South 33rd Street, Philadelphia, Pennsylvania 19104-6396, USA
| | - L L Kormos
- Physics Department, Lancaster University, Lancaster LA1 4YB, United Kingdom
| | - B Krar
- Department of Physics, Engineering Physics and Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - C Kraus
- School of Natural Sciences, Laurentian University, 935 Ramsey Lake Road, Sudbury, Ontario P3E 2C6, Canada
- SNOLAB, Creighton Mine #9, 1039 Regional Road 24, Sudbury, Ontario P3Y 1N2, Canada
| | - C B Krauss
- Department of Physics, University of Alberta, 4-181 CCIS, Edmonton, Alberta T6G 2E1, Canada
| | - T Kroupová
- Department of Physics & Astronomy, University of Pennsylvania, 209 South 33rd Street, Philadelphia, Pennsylvania 19104-6396, USA
| | - I Lam
- Department of Physics, Engineering Physics and Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - B J Land
- Department of Physics & Astronomy, University of Pennsylvania, 209 South 33rd Street, Philadelphia, Pennsylvania 19104-6396, USA
| | - I Lawson
- School of Natural Sciences, Laurentian University, 935 Ramsey Lake Road, Sudbury, Ontario P3E 2C6, Canada
- SNOLAB, Creighton Mine #9, 1039 Regional Road 24, Sudbury, Ontario P3Y 1N2, Canada
| | - L Lebanowski
- Department of Physics, University of California, Berkeley, California 94720, USA
- Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Berkeley, California 94720-8153, USA
- Department of Physics & Astronomy, University of Pennsylvania, 209 South 33rd Street, Philadelphia, Pennsylvania 19104-6396, USA
| | - J Lee
- Department of Physics, Engineering Physics and Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - C Lefebvre
- Department of Physics, Engineering Physics and Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - J Lidgard
- University of Oxford, The Denys Wilkinson Building, Keble Road, Oxford, OX1 3RH, United Kingdom
| | - Y H Lin
- Department of Physics, Engineering Physics and Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
- School of Natural Sciences, Laurentian University, 935 Ramsey Lake Road, Sudbury, Ontario P3E 2C6, Canada
| | - V Lozza
- Laboratório de Instrumentação e Física Experimental de Partículas (LIP), Avenida Professor Gama Pinto, 2, 1649-003, Lisboa, Portugal
- Universidade de Lisboa, Faculdade de Ciéncias (FCUL), Departamento de Física, Campo Grande, Edifício C8, 1749-016, Lisboa, Portugal
| | - M Luo
- Department of Physics & Astronomy, University of Pennsylvania, 209 South 33rd Street, Philadelphia, Pennsylvania 19104-6396, USA
| | - A Maio
- Laboratório de Instrumentação e Física Experimental de Partículas (LIP), Avenida Professor Gama Pinto, 2, 1649-003, Lisboa, Portugal
- Universidade de Lisboa, Faculdade de Ciéncias (FCUL), Departamento de Física, Campo Grande, Edifício C8, 1749-016, Lisboa, Portugal
| | - S Manecki
- Department of Physics, Engineering Physics and Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
- School of Natural Sciences, Laurentian University, 935 Ramsey Lake Road, Sudbury, Ontario P3E 2C6, Canada
- SNOLAB, Creighton Mine #9, 1039 Regional Road 24, Sudbury, Ontario P3Y 1N2, Canada
| | - J Maneira
- Laboratório de Instrumentação e Física Experimental de Partículas (LIP), Avenida Professor Gama Pinto, 2, 1649-003, Lisboa, Portugal
- Universidade de Lisboa, Faculdade de Ciéncias (FCUL), Departamento de Física, Campo Grande, Edifício C8, 1749-016, Lisboa, Portugal
| | - R D Martin
- Department of Physics, Engineering Physics and Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - N McCauley
- Department of Physics, University of Liverpool, Liverpool L69 3BX, United Kingdom
| | - A B McDonald
- Department of Physics, Engineering Physics and Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - C Mills
- Physics & Astronomy, University of Sussex, Pevensey II, Falmer, Brighton, BN1 9QH, United Kingdom
| | - I Morton-Blake
- University of Oxford, The Denys Wilkinson Building, Keble Road, Oxford, OX1 3RH, United Kingdom
| | - S Naugle
- Department of Physics & Astronomy, University of Pennsylvania, 209 South 33rd Street, Philadelphia, Pennsylvania 19104-6396, USA
| | - L J Nolan
- School of Physics and Astronomy, Queen Mary University of London, 327 Mile End Road, London E1 4NS, United Kingdom
| | - H M O'Keeffe
- Physics Department, Lancaster University, Lancaster LA1 4YB, United Kingdom
| | - G D Orebi Gann
- Department of Physics, University of California, Berkeley, California 94720, USA
- Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Berkeley, California 94720-8153, USA
| | - J Page
- Physics & Astronomy, University of Sussex, Pevensey II, Falmer, Brighton, BN1 9QH, United Kingdom
| | - W Parker
- University of Oxford, The Denys Wilkinson Building, Keble Road, Oxford, OX1 3RH, United Kingdom
| | - J Paton
- University of Oxford, The Denys Wilkinson Building, Keble Road, Oxford, OX1 3RH, United Kingdom
| | - S J M Peeters
- Physics & Astronomy, University of Sussex, Pevensey II, Falmer, Brighton, BN1 9QH, United Kingdom
| | - L Pickard
- University of California, Davis, 1 Shields Avenue, Davis, California 95616, USA
| | - P Ravi
- School of Natural Sciences, Laurentian University, 935 Ramsey Lake Road, Sudbury, Ontario P3E 2C6, Canada
| | - A Reichold
- University of Oxford, The Denys Wilkinson Building, Keble Road, Oxford, OX1 3RH, United Kingdom
| | - S Riccetto
- Department of Physics, Engineering Physics and Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - R Richardson
- School of Natural Sciences, Laurentian University, 935 Ramsey Lake Road, Sudbury, Ontario P3E 2C6, Canada
| | - M Rigan
- Physics & Astronomy, University of Sussex, Pevensey II, Falmer, Brighton, BN1 9QH, United Kingdom
| | - J Rose
- Department of Physics, University of Liverpool, Liverpool L69 3BX, United Kingdom
| | - R Rosero
- Chemistry Department, Brookhaven National Laboratory, Building 555, P.O. Box 5000, Upton, New York 11973-500, USA
| | - J Rumleskie
- School of Natural Sciences, Laurentian University, 935 Ramsey Lake Road, Sudbury, Ontario P3E 2C6, Canada
| | - I Semenec
- Department of Physics, Engineering Physics and Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - P Skensved
- Department of Physics, Engineering Physics and Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - M Smiley
- Department of Physics, University of California, Berkeley, California 94720, USA
- Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Berkeley, California 94720-8153, USA
| | - R Svoboda
- University of California, Davis, 1 Shields Avenue, Davis, California 95616, USA
| | - B Tam
- Department of Physics, Engineering Physics and Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - J Tseng
- University of Oxford, The Denys Wilkinson Building, Keble Road, Oxford, OX1 3RH, United Kingdom
| | - E Turner
- University of Oxford, The Denys Wilkinson Building, Keble Road, Oxford, OX1 3RH, United Kingdom
| | - S Valder
- Physics & Astronomy, University of Sussex, Pevensey II, Falmer, Brighton, BN1 9QH, United Kingdom
| | - C J Virtue
- School of Natural Sciences, Laurentian University, 935 Ramsey Lake Road, Sudbury, Ontario P3E 2C6, Canada
| | - E Vázquez-Jáuregui
- Universidad Nacional Autónoma de México (UNAM), Instituto de Física, Apartado Postal 20-364, México D.F. 01000, México
| | - J Wang
- University of Oxford, The Denys Wilkinson Building, Keble Road, Oxford, OX1 3RH, United Kingdom
| | - M Ward
- Department of Physics, Engineering Physics and Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - J R Wilson
- Department of Physics, King's College London, Strand Building, Strand, London WC2R 2LS, United Kingdom
| | - J D Wilson
- Department of Physics, University of Alberta, 4-181 CCIS, Edmonton, Alberta T6G 2E1, Canada
| | - A Wright
- Department of Physics, Engineering Physics and Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - J P Yanez
- Department of Physics, University of Alberta, 4-181 CCIS, Edmonton, Alberta T6G 2E1, Canada
| | - S Yang
- Department of Physics, University of Alberta, 4-181 CCIS, Edmonton, Alberta T6G 2E1, Canada
| | - M Yeh
- Chemistry Department, Brookhaven National Laboratory, Building 555, P.O. Box 5000, Upton, New York 11973-500, USA
| | - S Yu
- School of Natural Sciences, Laurentian University, 935 Ramsey Lake Road, Sudbury, Ontario P3E 2C6, Canada
| | - Y Zhang
- Department of Physics, University of Alberta, 4-181 CCIS, Edmonton, Alberta T6G 2E1, Canada
- Research Center for Particle Science and Technology, Institute of Frontier and Interdisciplinary Science, Shandong University, Qingdao 266237, Shandong, China
- Key Laboratory of Particle Physics and Particle Irradiation of Ministry of Education, Shandong University, Qingdao 266237, Shandong, China
| | - K Zuber
- Technische Universität Dresden, Institut für Kern und Teilchenphysik, Zellescher Weg 19, Dresden 01069, Germany
- MTA Atomki, 4001 Debrecen, Hungary
| | - A Zummo
- Department of Physics & Astronomy, University of Pennsylvania, 209 South 33rd Street, Philadelphia, Pennsylvania 19104-6396, USA
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7
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Pettit AC, Pichon LC, Ahonkhai AA, Robinson C, Randolph B, Gaur A, Stubbs A, Summers NA, Truss K, Brantley M, Devasia R, Teti M, Gimbel S, Dombrowski JC. Comprehensive Process Mapping and Qualitative Interviews to Inform Implementation of Rapid Linkage to HIV Care Programs in a Mid-Sized Urban Setting in the Southern United States. J Acquir Immune Defic Syndr 2022; 90:S56-S64. [PMID: 35703756 PMCID: PMC9204789 DOI: 10.1097/qai.0000000000002986] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 02/23/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Rapid antiretroviral therapy (ART) initiation, in which people living with HIV start ART within days of diagnosis, is a key component of the US Ending the HIV Epidemic initiative. SETTING The Memphis Metropolitan Statistical Area ranked fourth in the United States for the highest HIV incidence per 100,000 population in 2018. Rapid ART programs are limited in the Memphis Metropolitan Statistical Area, and our objective was to identify local implementation barriers. METHODS We conducted participatory process mapping and in-depth interviews to detail steps between HIV testing at the municipal health department's Sexually Transmitted Infections Clinic and ART prescription from a nearby high-volume Ryan White-funded HIV Clinic. RESULTS Process mapping identified 4 modifiable, rate-limiting rapid ART barriers: (1) requiring laboratory-based confirmatory HIV results, (2) eligibility documentation requirements for Ryan White-funded services, (3) insufficient HIV Clinic medical provider availability, and (4) variability in ART initiation timing among HIV Clinic providers. Staff at both sites highlighted suboptimal communication and sense of shared management between facilities, limited resources to address important social determinants of health, and lack of Medicaid expansion in Tennessee as key barriers. In-depth interview themes negatively affecting rapid ART initiation included clinic burden; provider knowledge, attitudes, and beliefs; and client psychosocial needs. CONCLUSIONS Our preimplementation work identified modifiable and systemic barriers to systems flow and patient-level outcomes. This work will inform the design and implementation of a locally relevant rapid ART program in Memphis, a community disproportionately affected by the HIV epidemic.
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Affiliation(s)
| | | | | | | | | | - Aditya Gaur
- St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Andrea Stubbs
- St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Nathan A. Summers
- University of Tennessee Health Science Center and Regional One Health, Adult Special Care Clinic, Memphis, Tennessee
| | | | | | - Rose Devasia
- Tennessee Department of Health, Nashville, Tennessee
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8
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Kumar D, Sudha K, Gaur A, Sharma A, Vandana, Sharma S. Assistive ultrasonic sensor based smart blind stick using fuzzy logic. Journal of Information and Optimization Sciences 2022. [DOI: 10.1080/02522667.2022.2039475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Divij Kumar
- Department of Electrical and Electronics Engineering, Bharati Vidyapeeth’s College of Engineering, New Delhi, India
| | - K. Sudha
- Department of Electrical and Electronics Engineering, Bharati Vidyapeeth’s College of Engineering, New Delhi, India
| | - Aditya Gaur
- Department of Electrical and Electronics Engineering, Bharati Vidyapeeth’s College of Engineering, New Delhi, India
| | - Ajay Sharma
- Department of Electrical and Electronics Engineering, Bharati Vidyapeeth’s College of Engineering, New Delhi, India
| | - Vandana
- Department of Electrical and Electronics Engineering, Bharati Vidyapeeth’s College of Engineering, New Delhi, India
| | - Sandeep Sharma
- Department of Electrical and Electronics Engineering, Bharati Vidyapeeth’s College of Engineering, New Delhi, India
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9
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Gaur A, Sharma N, Garg P. Chronic groin pain in Desarda versus Lichtenstein hernia repair - a randomised controlled study. S AFR J SURG 2022. [DOI: 10.17159/2078-5151/sajs3738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Chronic pain after inguinal hernia repair is a common complication. This study compared the difference between Desarda repair and Lichtenstein repair for inguinal hernia in chronic groin pain. METHODS: One hundred patients with unilateral uncomplicated inguinal hernia were randomised to either Desarda repair (n = 50) or Lichtenstein repair (n = 50) under local anaesthesia and were evaluated for pain postoperatively. Operative time, surgical complications, time to return to normal gait and work, and overall patient satisfaction were recorded. The patient was blinded to the procedure. Any pain at three months (numerical rating scale 1 or more) was considered chronic pain. RESULTS: Mean operation time was approximately 5 minutes less for Desarda (p = 0.33). There was no significant difference in terms of pain level postoperatively between Lichtenstein and Desarda groups. Twenty-two (44%) patients in the Lichtenstein group had chronic pain, and twenty-one (45.7%) patients had chronic pain in the Desarda group (p = 0.871). No significant difference was observed in haematoma formation, wound infection, recurrence rate, seroma, or foreign body sensation. The mean time for patients to return to normal gait was approximately 0.5 day earlier for the Desarda group (p = 0.29). The mean time for patients to return to normal work was comparable (p = 0.99). Desarda group had a slightly higher satisfaction rate than the Lichtenstein group (9.1%). CONCLUSION: Desarda repair is not inferior to Lichtenstein repair in the short-term concerning complications or pain.
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10
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Green AM, Souquette A, Agrawal M, Wolf J, Wolf J, Gaur A, Allison KJ, Estepp J, Allen E, Thomas P, Smallwood H. 437. Longitudinal Plasma Cytokine Profiles Differentiating COVID-19 Severity Groups. Open Forum Infect Dis 2021. [PMCID: PMC8644557 DOI: 10.1093/ofid/ofab466.636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), an infection with widely varying clinical severity. Severe COVID-19 was initially proposed to be secondary to cytokine storm syndrome (CSS). However, studies since showed that patients with severe COVID-19 rarely display CSS cytokine phenotypes, and may have more limited inflammatory responses instead.
Methods
Prospective cohorts, aged 0-90 years of age who tested positive by polymerase chain reaction (PCR) for SARS-CoV-2 were enrolled from inpatient hospitals and outpatient testing centers in Memphis, TN from May 2020-January 2021. Longitudinal blood samples were obtained including acute, sub-acute and convalescent timepoints. Severity scores of asymptomatic, mild, moderate, and severe COVID-19 were assigned at time of convalescent assessment. Plasma was analyzed with a quantitative human magnetic 38-plex cytokine assay.
Results
: 169 participants were enrolled, including 8 asymptomatic, 117 mild, 22 moderate and 17 severe cases, and 5 children with post-COVID-19 multisystem inflammatory syndrome in children (MIS-C). All moderate and severe patients were hospitalized and received treatment (39%). Clear distinctions were seen between asymptomatic-mild cases and moderate-severe cases at acute timepoints and during disease progression for GCSF, IL-8, IL-10, IL-15, IL-1Ra, IP-10, MIP-1a, MIP-1β, and TGFα. There was a significant difference between participants who did and did not require hospitalization for acute timepoint levels of IL-10, IL-15, MIP-1 β and TGFα (p< 0.01). Only 4 participants with active COVID-19 were found to meet criteria for CSS (2%), only 3 of which were severe. MIS-C participants showed nearly universally elevated cytokine levels compared to those with active COVID-19.
Temporal and severity associations of IL-10 and IP-10
Figure 1. Temporal and severity associations of IL-10 and IP-10 Examples of differentiating cytokine profiles by severity and time. Among SARS-CoV-2 PCR positive participants, IL-10 and IP-10 displayed increased levels in their acute plasma samples as clinical severity increased [A,C]. IL-10 and IP-10 also showed distinct time-dependent responses (ln(Cytokine level (pg/mL)) that differentiated the more severe from the less severe groups [B,D].
Conclusion
Moderate and severe acute COVID-19 has a distinct cytokine profile from asymptomatic and mild cases, as detected from acute, subacute and convalescent plasma.
Disclosures
Joshua Wolf, MBBS, PhD, FRACP, Karius Inc. (Research Grant or Support) Joshua Wolf, MBBS, PhD, FRACP, Nothing to disclose Paul Thomas, PhD, Cytoagents (Consultant)Immunoscape (Consultant)
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Affiliation(s)
- Amanda M Green
- St Jude Children’s Research Institute, Memphis, Tennessee
| | | | - Mona Agrawal
- University of Tennessee Health Science Center, Memphis, Tennessee
| | - Joshua Wolf
- St. Jude’s Children’s Research Hospital, Memphis, TN
| | - Joshua Wolf
- St. Jude’s Children’s Research Hospital, Memphis, TN
| | - Aditya Gaur
- St Jude Children’s Research Hospital, Memphis, Tennessee
| | | | - Jeremie Estepp
- St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Emma Allen
- St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Paul Thomas
- St Jude Children’s Research Institute, Memphis, Tennessee
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Baker Z, Javanbakht M, Moore J, Brosnan H, Squires K, Bunge K, Zimet G, Mensch B, Soto-Torres L, Kapogiannis B, Levy L, Hoesley C, Reirden D, Gaur A, Mayer K, Futterman D, Gorbach P. Qualitative Study on the Acceptability of and Adherence to a Vaginal Ring for HIV Prophylaxis Among Adolescent Girls. J Acquir Immune Defic Syndr 2021; 87:944-950. [PMID: 33675614 PMCID: PMC8192420 DOI: 10.1097/qai.0000000000002674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/30/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aims to assess the product-related, relationship-related, and sex-related factors that act as facilitators and barriers to the acceptability of a vaginal ring (VR) for HIV prevention among adolescent girls. DESIGN Qualitative study. METHODS Ninety-six girls aged 15-17 years from 6 urban US sites were enrolled in MTN-023/IPM 030, a 24-week randomized controlled trial, for assessing the safety and acceptability of a dapivirine VR for HIV prevention. At week 24, 21 girls were randomly selected to participate in in-depth interviews. Interviews were transcribed verbatim and data analyzed using a thematic analysis approach. Facilitators and barriers to VR acceptability related to participants' relationships, sexual activity, and characteristics of the VR product were identified. RESULTS Factors related to relationships rarely seemed to act as barriers to VR acceptability; most participants disclosed VR use to sexual partners, and positive reactions from sexual partners, which were common, seemed to facilitate VR acceptability. Emotional and/or physical discomfort surrounding VR use during sex was mentioned occasionally as a barrier to VR acceptability. Product characteristics were most frequently mentioned as barriers to VR acceptability. Many participants reported concerns about the large size of the VR on first impression. Although most found the VR comfortable, some reported pain with VR insertion. Several participants were concerned about VR cleanliness, particularly during menstruation. CONCLUSION Product considerations, specifically size and use during menstruation, were the most commonly reported barriers to VR acceptability in this study. Adolescent girls may require additional counseling to assuage product concerns regarding a VR for HIV prevention.
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Affiliation(s)
- Zoë Baker
- Division of Urology, Children's Hospital Los Angeles, Los Angeles, CA
| | - Marjan Javanbakht
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Janell Moore
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Hannah Brosnan
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Kathleen Squires
- Division of Infectious Diseases, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
- Global Center of Scientific Affairs, Merck Research Labs, Rahway, NJ
| | - Katherine Bunge
- Department of Obstetrics, Gynecology & Reproductive Services, University of Pittsburgh, Pittsburgh, PA
| | - Gregory Zimet
- Department of Pediatrics, Indiana University, Bloomington, IA
| | | | - Lydia Soto-Torres
- National Institute of Allergy and Infectious Diseases, Division of AIDS, Bethesda, MD
| | - Bill Kapogiannis
- Maternal and Pediatric Infectious Disease Branch, National Institute of Child Health and Human Development, Bethesda, MD
| | | | - Craig Hoesley
- Division of Infectious Diseases, University of Alabama, Birmingham, AL
| | - Daniel Reirden
- Department of Adolescent Medicine, Children's Hospital Colorado, Aurora, CO
| | - Aditya Gaur
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN
| | - Kenneth Mayer
- Department of Global Health and Population, Harvard School of Public Health, The Fenway Institute, Boston, MA; and
| | - Donna Futterman
- Department of Pediatrics, Albert Einstein College of Medicine, the Bronx, NY
| | - Pamina Gorbach
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA
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12
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Jacobson DL, Lindsey JC, Gordon C, Hazra R, Spiegel H, Ferreira F, Amaral FR, Pagano-Therrien J, Gaur A, George K, Benson J, Siberry GK. Alendronate Improves Bone Mineral Density in Children and Adolescents Perinatally Infected With Human Immunodeficiency Virus With Low Bone Mineral Density for Age. Clin Infect Dis 2021; 71:1281-1288. [PMID: 31573608 DOI: 10.1093/cid/ciz957] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 09/25/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Children and adolescents with perinatal human immunodeficiency virus (HIV) infection and with low bone mineral density (BMD) may be at higher risk of osteoporosis and fractures in later life than their uninfected peers. Bisphosphonate therapy has been shown to reduce fractures in adults with osteoporosis, but has not been formally studied in youths living with HIV. METHODS Fifty-two children and adolescents (aged 11-24 years) perinatally infected with HIV with low lumbar spine (LS) BMD (Z score < -1.5) were randomized to receive once-weekly alendronate or placebo in a double-blind cross-over study designed to assess the safety and efficacy of 48 and 96 weeks of alendronate in the United States and Brazil. All participants received daily calcium carbonate and vitamin D supplementation and were asked to engage in regular weight-bearing exercise. Safety and efficacy are summarized for the initial 48 weeks of the trial. RESULTS Grade 3 or higher abnormal laboratory values, signs, or symptoms developed in 5 of 32 (16%) participants on alendronate and 2 of 18 (11%) on placebo (P > .99). No cases of jaw osteonecrosis, atrial fibrillation, or nonhealing fractures were reported. Mean increases (95% confidence interval) in LS BMD over 48 weeks were significantly larger on alendronate (20% [14%-25%]) than placebo (7% [5%-9%]) (P < .001). Similar improvements were seen for whole body BMD. CONCLUSIONS In this small study in children and adolescents perinatally infected with HIV with low LS BMD, 48 weeks of alendronate was well-tolerated, showed no safety concerns, and significantly improved LS and whole body BMD compared to participants on vitamin D/calcium supplementation and exercise alone. CLINICAL TRIALS REGISTRATION NCT00921557.
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Affiliation(s)
- Denise L Jacobson
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jane C Lindsey
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Catherine Gordon
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Rohan Hazra
- Maternal and Pediatric Infectious Diseases Branch, Division of Extramural Research, Department of Health and Human Services, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Hans Spiegel
- Kelly Government Solutions, contractor to National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
| | - Flavia Ferreira
- Department of Pediatrics, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Fabiana R Amaral
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Aditya Gaur
- St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Kathy George
- Family Health International 360, Durham, North Carolina, USA
| | - Jane Benson
- Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - George K Siberry
- Office of HIV/AIDS, US Agency for International Development, Arlington, Virginia, USA; for the International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) P1076 Study Team
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13
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Marzinke MA, Grinsztejn B, Fogel JM, Piwowar-Manning E, Li M, Weng L, McCauley M, Cummings V, Ahmed S, Haines CD, Bushman LR, Petropoulos C, Persaud D, Adeyeye A, Kofron R, Rinehart A, St Clair M, Rooney JF, Pryluka D, Coelho L, Gaur A, Middelkoop K, Phanuphak N, Cohen MS, Hendrix CW, Anderson P, Hanscom B, Donnell D, Landovitz RJ, Eshleman SH. Characterization of HIV infection in cisgender men and transgender women who have sex with men receiving injectable cabotegravir for HIV prevention: HPTN 083. J Infect Dis 2021; 224:1581-1592. [PMID: 33740057 DOI: 10.1093/infdis/jiab152] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [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: 01/15/2021] [Accepted: 03/18/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION The HIV Prevention Trials Network (HPTN) 083 trial demonstrated that long-acting cabotegravir (CAB-LA) was more effective than tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) for HIV prevention in cisgender men and transgender women who have sex with men. We characterized HIV infections that occurred in the blinded phase of HPTN 083. METHODS Retrospective testing included HIV testing, viral load testing, quantification of study drugs and HIV drug resistance testing. RESULTS Fifty-eight infections were evaluated, including 51 incident infections (12 CAB, 39 TDF/FTC). In many cases (5 CAB, 37 TDF/FTC), infection was associated with low or unquantifiable study drug concentrations. In four cases, infection occurred with on-time CAB-LA injections and expected plasma CAB concentrations. CAB exposure was associated with prolonged viral suppression and delayed antibody expression. In some cases, delayed HIV diagnosis resulted in CAB provision to participants with undetected infection, delayed antiretroviral treatment (ART), and emergence of drug resistance; most of these infections would have been detected earlier with viral load testing. CONCLUSIONS Early detection of HIV infection and prompt ART initiation could improve clinical outcomes in persons who become infected despite CAB-LA prophylaxis. Further studies are needed to elucidate the correlates of HIV protection in persons receiving CAB-LA.
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Affiliation(s)
- Mark A Marzinke
- Dept. of Pathology, Johns Hopkins Univ. School of Medicine, Baltimore, MD, USA
| | - Beatriz Grinsztejn
- Instituto de Pesquisa Clinica Evandro Chagas-Fiocruz, Rio de Janeiro, Brazil
| | - Jessica M Fogel
- Dept. of Pathology, Johns Hopkins Univ. School of Medicine, Baltimore, MD, USA
| | | | - Maoji Li
- Fred Hutchinson Cancer Research Center, Seattle, WA, , USA
| | - Lei Weng
- Fred Hutchinson Cancer Research Center, Seattle, WA, , USA
| | | | - Vanessa Cummings
- Dept. of Pathology, Johns Hopkins Univ. School of Medicine, Baltimore, MD, USA
| | - Shahnaz Ahmed
- Dept. of Pathology, Johns Hopkins Univ. School of Medicine, Baltimore, MD, USA
| | - Casey D Haines
- Dept. of Pathology, Johns Hopkins Univ. School of Medicine, Baltimore, MD, USA
| | | | | | - Deborah Persaud
- Dept. of Pediatrics, Johns Hopkins Univ. School of Medicine, Baltimore, MD, USA
| | - Adeola Adeyeye
- Prevention Science Program, DAIDS, NIAID, NIH, Rockville, MD, USA
| | - Ryan Kofron
- Dept. of Medicine, Univ. of California at Los Angeles, Los Angeles, CA, USA
| | | | | | | | | | - Lara Coelho
- Instituto de Pesquisa Clinica Evandro Changas-Fiocruz, Rio de Janeiro, Brazil
| | - Aditya Gaur
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Keren Middelkoop
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Nittaya Phanuphak
- Institute of HIV Research and Innovation, Bangkok, Thailand; Center of Excellence in Transgender Health, Chulalongkorn University, Bangkok, Thailand
| | | | - Craig W Hendrix
- Dept. of Pathology, Johns Hopkins Univ. School of Medicine, Baltimore, MD, USA
| | | | - Brett Hanscom
- Fred Hutchinson Cancer Research Center, Seattle, WA, , USA
| | | | - Raphael J Landovitz
- Center for Clinical AIDS Research & Education, Univ. of California, Los Angeles, Los Angeles, CA, USA
| | - Susan H Eshleman
- Dept. of Pathology, Johns Hopkins Univ. School of Medicine, Baltimore, MD, USA
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Lu YS, Sohn J, Lee K, Jung K, Babu G, Liu MC, Srimuninnimit V, Yap Y, Chow L, Gaur A, Wang Y, Gao M, Im SA. 47MO Efficacy and quality of life (QOL) in premenopausal Asian patients (pts) with hormone receptor–positive (HR+), HER2-negative (HER2-) advanced breast cancer (ABC) treated in the MONALEESA (ML)-7 study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.067] [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: 10/22/2022] Open
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Powles T, Oudard S, Grünwald V, Calvo E, Michaelson M, Burotto M, Melichar B, Tyagi R, Hilmi F, Gaur A, Hirschberg Y, Heng D. 718P A phase II study of patients with advanced or metastatic renal cell carcinoma (mRCC) receiving pazopanib after previous checkpoint inhibitor treatment. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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16
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Sharma A, Parkar S, Gaur A, Bagri B. Impact of incarceration on nutritional status and oral health among male inmates of central jail of Jaipur city, India. Rev Esp Sanid Penit 2020; 22:96-103. [PMID: 33300940 PMCID: PMC7754537 DOI: 10.18176/resp.00018] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/05/2019] [Indexed: 02/05/2023]
Abstract
AIM Prison is an especially difficult environment for promoting oral health and leads to the exacerbation of unhealthy behaviors. This study set out to assess the impact of incarceration on nutritional status and oral health among the male prison inmates of Central Jail of Jaipur city, Rajasthan, India. MATERIAL AND METHOD A cross sectional study was conducted among 181 male inmates. Dental caries and periodontal status were assessed by using modified the Decayed Missing Filled Teeth (DMFT) index and Community Periodontal Index (CPI) and Loss of Attachment (LOA) index as per the WHO methodology 1997. Nutritional status was assessed by Body Mass Index (BMI) and weight (kg)/height (m2). RESULTS Out of 181 inmates, 141 (77.90%) had normal BMI. The majority (n=128, 70.70%) of inmates were incarcerated for less than 6 years. A significant difference (P<0.05) was found between age and periodontal status. A significant difference was observed (P<0.05) in the CPI score 3 and LOA 0 and 1 score. However, no significant difference (P>0.05) was observed in DMFT and period of incarceration. Age was the significant (P<0.001) risk factor for CPI and LOA. DISCUSSION Dental caries and periodontal health deteriorates with age and period of incarceration. Oral hygiene maintenance along with comprehensive oral care can be accomplished by establishing dental care facilities in prisons.
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Affiliation(s)
- A Sharma
- Department of Public Health Dentistry, Government Dental College and Hospital, Jaipur, India
| | - S Parkar
- Department of Public Health Dentistry, Siddhpur Dental College and Hospital, Siddhpur, Patan, India
| | - A Gaur
- Department of Public Health Dentistry, Government Dental College and Hospital, Jaipur, India
| | - B Bagri
- Central Jail Hospital, Jaipur, India
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Sharma K, Gupta KK, Gaur A, Sharma AK, Pathania V, Thakur VB. A cross-sectional study to assess the prevalence of early childhood caries and associated risk factors in preschool children in district Mandi, Himachal Pradesh. J Indian Soc Pedod Prev Dent 2019; 37:339-344. [PMID: 31710007 DOI: 10.4103/jisppd.jisppd_95_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM The aim of this cross-sectional study is to investigate the prevalence and related risk factors of early childhood caries (ECC) in preschool children of district Mandi, Himachal Pradesh, India. MATERIALS AND METHODS A total sample of 2859 children aged between 2 and 6 years were selected from various parts of district Mandi. The status of dental caries and decayed missing and filled teeth (DMFT) score was recorded. RESULTS ECC increased significantly with age. Boys had significantly higher caries prevalence and mean DMFT score as compared to girls. Children who belonged to low socioeconomic group showed higher caries prevalence and mean DMFT score. Children aged 3-6 years who brushed their teeth twice daily had the least prevalence of dental caries as well as DMFT score when compared to children with one time and no brushing. CONCLUSION The early identification of poor oral hygiene and improper feeding habits should be considered in preventive health promotion in low socioeconomic communities of district Mandi, Himachal Pradesh.
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Affiliation(s)
- K Sharma
- Department of Pedodontics and Preventive Dentistry, Himachal Dental College, Himachal Pradesh University, Mandi, Himachal Pradesh, India
| | - K K Gupta
- Department of Pedodontics and Preventive Dentistry, Himachal Dental College, Himachal Pradesh University, Mandi, Himachal Pradesh, India
| | - A Gaur
- Department of Pedodontics and Preventive Dentistry, Himachal Dental College, Himachal Pradesh University, Mandi, Himachal Pradesh, India
| | - A K Sharma
- Department of Pedodontics and Preventive Dentistry, Himachal Dental College, Himachal Pradesh University, Mandi, Himachal Pradesh, India
| | - V Pathania
- Department of Pedodontics and Preventive Dentistry, Himachal Dental College, Himachal Pradesh University, Mandi, Himachal Pradesh, India
| | - V B Thakur
- Department of Pedodontics and Preventive Dentistry, Himachal Dental College, Himachal Pradesh University, Mandi, Himachal Pradesh, India
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18
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Amico KR, Dunlap A, Dallas R, Lindsey J, Heckman B, Flynn P, Lee S, Horvath K, West Goolsby R, Hudgens M, Filipowicz T, Polier M, Hill E, Mueller Johnson M, Miller J, Neilan A, Ciaranello A, Gaur A. Triggered Escalating Real-Time Adherence Intervention to Promote Rapid HIV Viral Suppression Among Youth Living With HIV Failing Antiretroviral Therapy: Protocol for a Triggered Escalating Real-Time Adherence Intervention. JMIR Res Protoc 2019; 8:e11416. [PMID: 30882360 PMCID: PMC6441855 DOI: 10.2196/11416] [Citation(s) in RCA: 10] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/05/2018] [Accepted: 01/23/2019] [Indexed: 01/19/2023] Open
Abstract
Background Youth living with HIV (YLWH) are confronted with many self-care challenges that can be experienced as overwhelming in the context of normal developmental processes that characterize adolescence and young adulthood. A sizable minority of YLWH have unsuppressed viral loads in the United States attributable to antiretroviral therapy (ART) nonadherence. Interventions to promote sustained viral suppression in YLWH are needed. Objective The aim of this study is to evaluate the efficacy of the Triggered Escalating Real-Time Adherence (TERA) intervention in comparison with standard of care (SOC) in YLWH (aged 13-24 years) failing ART on (1) primary outcome measures—HIV viral suppression (VLS), defined as both <200 copies/ml and <50 copies/ml at 12 weeks, and (2) secondary outcome measures—VLS rates and rates of ART adherence at 24, 36, and 48 weeks as well as patterns of adherence over time as measured by an electronic dose monitoring (EDM) device. Methods The TERA study is a phase 2, multisite clinical trial conducted with 120 YLWH failing ART (randomized 1:1 to TERA or SOC) at participating clinical sites within the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN). Participants are followed for a total of 48 weeks. For TERA arm participants, the first 12 weeks involve delivery of the intervention. For all participants, clinical outcomes are collected throughout follow-up, and adherence is assessed using EDM over the full 48 weeks. During the 12-week intervention period, TERA arm participants receive 3 remote coaching sessions delivered in clinic via videoconferencing timed to coincide with baseline and follow-up clinical visits, text message reminders when the EDM has not been opened at dose time (which escalate to 2-way theory-informed short message service coaching interactions in response to real-time nonadherence), and review of dosing graphs produced by EDM at follow-up visits. Results Launch dates for enrollment varied by site. Enrollment began in April 2018 and is expected to be completed by August 2019, with results presented by the second quarter of 2021. Conclusions Effective, generalizable, and scalable approaches to rapidly assist YLWH failing to achieve and sustain VLS may have a substantial impact on individual health and efforts to curb transmission. Coaching for a brief but intensive period from remote coaches and using communication channels common to youth may offer multiple unique advantages in promoting self-care. Trial Registration ClinicalTrials.gov NCT03292432; https://clinicaltrials.gov/ct2/show/NCT03292432 (Archived by WebCite at http://www.webcitation.org/768J8ijjp). International Registered Report Identifier (IRRID) DERR1-10.2196/11416
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Affiliation(s)
- K Rivet Amico
- School of Public Health, Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, United States
| | - Amanda Dunlap
- School of Public Health, Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, United States
| | - Ronald Dallas
- St. Jude Children's Research Hospital, Department of Infectious Diseases, Memphis, TN, United States
| | - Jane Lindsey
- Chan School of Public Health, Department of Biostatistics, Harvard University, Boston, MA, United States
| | - Barbara Heckman
- Frontier Science and Technology Research Foundation, Amherst, NY, United States
| | - Patricia Flynn
- St. Jude Children's Research Hospital, Department of Infectious Diseases, Memphis, TN, United States
| | - Sonia Lee
- National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States
| | - Keith Horvath
- School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, United States
| | - Rachel West Goolsby
- Gillings School of Public Health, Department of Biostatistics, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Michael Hudgens
- Gillings School of Public Health, Department of Biostatistics, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Teresa Filipowicz
- Gillings School of Public Health, Department of Biostatistics, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Melissa Polier
- Gillings School of Public Health, Department of Biostatistics, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Emily Hill
- School of Public Health, Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, United States
| | - Megan Mueller Johnson
- School of Public Health, Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, United States
| | - Jessica Miller
- School of Public Health, Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, United States
| | - Anne Neilan
- Massachusetts General Hospital, Division of Infectious Diseases, Boston, MA, United States
| | - Andrea Ciaranello
- Massachusetts General Hospital, Division of Infectious Diseases, Boston, MA, United States
| | - Aditya Gaur
- St. Jude Children's Research Hospital, Department of Infectious Diseases, Memphis, TN, United States
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Rusley JC, Monroe A, Matson P, Gebo KA, Nonyane BAS, Minkovitz CS, Agwu A, Emerson M, Moore R, Rutstein R, Aberg J, Nijhawan A, Boswell S, Sanders R, Edelstein H, Baranoski A, Allen S, Beil R, Felsen U, Urbina A, Korthuis PT, Akbar M, Gaur A, Somboonwit C, Valenti W, Mathews WC, Hellinger F, Fleishman J, Fraser I, Mills R, Malitz F, Keruly J, Gebo K, Voss C, Collins C, Diaz-Reyes R. Discontinuity in Medicaid Coverage Among Young Adults with HIV. AIDS Patient Care STDS 2019; 33:89-92. [PMID: 30844306 DOI: 10.1089/apc.2018.0272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jack C. Rusley
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Anne Monroe
- Division of General Internal Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Pamela Matson
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kelly A. Gebo
- Division of Infectious Diseases, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Cynthia S. Minkovitz
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Allison Agwu
- Divisions of Adult and Pediatric Infectious Diseases, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mark Emerson
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Richard Moore
- Division of Infectious Diseases, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Richard Rutstein
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Judith Aberg
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ank Nijhawan
- Department of Medicine, University of Texas Southwestern, Dallas, Texas
| | - Stephen Boswell
- Fenway Health and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Renata Sanders
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Tripathy D, Campos-Gomez S, Lu YS, Franke F, Bardia A, Wheatley-Price P, Cruz FM, Hegg R, Cardoso F, Gaur A, Kong O, Diaz-Padilla I, Miller M, Hurvitz S. Abstract P6-18-04: Ribociclib with a non-steroidal aromatase inhibitor and goserelin in premenopausal women with hormone receptor-positive, HER2-negative advanced breast cancer: MONALEESA-7 age subgroup analysis. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-18-04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Younger patients (pts) with breast cancer may experience more aggressive disease and are more likely to die from their cancer vs older pts. In the Phase III MONALEESA-7 study (NCT02278120), the addition of ribociclib (RIB; cyclin-dependent kinase 4/6 inhibitor) to a non-steroidal aromatase inhibitor (NSAI) or tamoxifen (TAM) + goserelin significantly prolonged progression-free survival (PFS) in premenopausal women with hormone receptor-positive (HR+), HER2-negative (HER2–) advanced breast cancer (ABC; hazard ratio 0.553; p<0.0001). RIB treatment benefit was observed irrespective of endocrine partner (NSAI or TAM). Here we report results from a MONALEESA-7 subgroup analysis in pts aged <40 yrs and ≥40 yrs who received RIB or placebo (PBO) in combination with an NSAI + goserelin.
Methods: Pre- or perimenopausal women with HR+, HER2– ABC who had received no prior endocrine therapy and ≤1 line of chemotherapy for ABC were enrolled. Of the 672 pts randomized, 495 (74%) received RIB (600 mg/day, 3-weeks-on/1-week-off) or PBO + an NSAI (letrozole [2.5 mg/day] or anastrozole [1 mg/day]) and goserelin (3.6 mg every 28 days). The primary endpoint was locally assessed PFS; secondary endpoints included overall response rate (ORR), clinical benefit rate (CBR), and safety. A prespecified subgroup analysis was performed in pts aged <40 yrs and ≥40 yrs.
Results: A total of 144 pts were aged <40 yrs (RIB vs PBO arm: 78 vs 66) and 351 were aged ≥40 yrs (170 vs 181). As of August 20, 2017, in the RIB vs PBO arms, treatment was ongoing in 50% vs 23% of pts aged <40 yrs and 54% vs 43% of pts aged ≥40 yrs; disease progression was the most common reason for treatment discontinuation (<40 yrs: 37% vs 68%; ≥40 yrs: 35% vs 44%). Median PFS was prolonged in the RIB vs PBO arms both in pts aged <40 yrs (not reached vs 10.8 months; hazard ratio 0.435; 95% confidence interval [CI] 0.276–0.686) and in pts aged ≥40 yrs (27.5 vs 19.1 months; hazard ratio 0.625; 95% CI 0.449–0.870). In pts with measurable disease, the ORR (RIB vs PBO arm) was 49% vs 32% in pts aged <40 yrs and 51% vs 38% in pts aged ≥40 yrs; CBR was 81% vs 61% and 82% vs 65%, respectively. The most common Grade 3 adverse events (AEs; ≥5% of pts in either arm; RIB vs PBO arm) were neutropenia (<40 yrs: 47% vs 5%; ≥40 yrs: 58% vs 3%), leukopenia (<40 yrs: 18% vs 2%; ≥40 yrs: 14% vs 1%), diarrhea (<40 yrs: 5% vs 0; ≥40 yrs: 1% vs 0), and increased alanine aminotransferase (<40 yrs: 4% vs 2%; ≥40 yrs: 5% vs 1%); neutropenia was the only Grade 4 AE occurring in ≥5% of pts in either arm (<40 yrs: 15% vs 0; ≥40 yrs: 8% vs 1%). New post-baseline QTcF >480 ms (RIB vs PBO arm) occurred in 3% vs 2% of pts aged <40 yrs and 7% vs 1% of pts aged ≥40 yrs.
Conclusions: Consistent treatment benefit was observed with RIB + NSAI vs PBO + NSAI in premenopausal women with HR+, HER2– ABC irrespective of age. RIB + NSAI had a manageable safety profile in pts aged <40 yrs and in those aged ≥40 yrs, with a safety profile similar to that observed in the full study population.
Citation Format: Tripathy D, Campos-Gomez S, Lu Y-S, Franke F, Bardia A, Wheatley-Price P, Cruz FM, Hegg R, Cardoso F, Gaur A, Kong O, Diaz-Padilla I, Miller M, Hurvitz S. Ribociclib with a non-steroidal aromatase inhibitor and goserelin in premenopausal women with hormone receptor-positive, HER2-negative advanced breast cancer: MONALEESA-7 age subgroup analysis [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-18-04.
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Affiliation(s)
- D Tripathy
- The University of Texas MD Anderson Cancer Center, Houston, TX; Centro Oncológico Estatal, Instituto de Seguridad Social del Estado de México y Municipios, Toluca, Mexico; National Taiwan University Hospital, Taipei, Taiwan; Hospital de Caridade de Ijuí, CACON, Ijuí, Brazil; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Hospital Pérola Byington, São Paulo, Brazil; Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal; Novartis Healthcare Pvt. Ltd., Hyderabad, India; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma AG, Basel, Switzerland; UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - S Campos-Gomez
- The University of Texas MD Anderson Cancer Center, Houston, TX; Centro Oncológico Estatal, Instituto de Seguridad Social del Estado de México y Municipios, Toluca, Mexico; National Taiwan University Hospital, Taipei, Taiwan; Hospital de Caridade de Ijuí, CACON, Ijuí, Brazil; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Hospital Pérola Byington, São Paulo, Brazil; Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal; Novartis Healthcare Pvt. Ltd., Hyderabad, India; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma AG, Basel, Switzerland; UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - Y-S Lu
- The University of Texas MD Anderson Cancer Center, Houston, TX; Centro Oncológico Estatal, Instituto de Seguridad Social del Estado de México y Municipios, Toluca, Mexico; National Taiwan University Hospital, Taipei, Taiwan; Hospital de Caridade de Ijuí, CACON, Ijuí, Brazil; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Hospital Pérola Byington, São Paulo, Brazil; Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal; Novartis Healthcare Pvt. Ltd., Hyderabad, India; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma AG, Basel, Switzerland; UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - F Franke
- The University of Texas MD Anderson Cancer Center, Houston, TX; Centro Oncológico Estatal, Instituto de Seguridad Social del Estado de México y Municipios, Toluca, Mexico; National Taiwan University Hospital, Taipei, Taiwan; Hospital de Caridade de Ijuí, CACON, Ijuí, Brazil; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Hospital Pérola Byington, São Paulo, Brazil; Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal; Novartis Healthcare Pvt. Ltd., Hyderabad, India; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma AG, Basel, Switzerland; UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - A Bardia
- The University of Texas MD Anderson Cancer Center, Houston, TX; Centro Oncológico Estatal, Instituto de Seguridad Social del Estado de México y Municipios, Toluca, Mexico; National Taiwan University Hospital, Taipei, Taiwan; Hospital de Caridade de Ijuí, CACON, Ijuí, Brazil; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Hospital Pérola Byington, São Paulo, Brazil; Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal; Novartis Healthcare Pvt. Ltd., Hyderabad, India; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma AG, Basel, Switzerland; UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - P Wheatley-Price
- The University of Texas MD Anderson Cancer Center, Houston, TX; Centro Oncológico Estatal, Instituto de Seguridad Social del Estado de México y Municipios, Toluca, Mexico; National Taiwan University Hospital, Taipei, Taiwan; Hospital de Caridade de Ijuí, CACON, Ijuí, Brazil; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Hospital Pérola Byington, São Paulo, Brazil; Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal; Novartis Healthcare Pvt. Ltd., Hyderabad, India; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma AG, Basel, Switzerland; UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - FM Cruz
- The University of Texas MD Anderson Cancer Center, Houston, TX; Centro Oncológico Estatal, Instituto de Seguridad Social del Estado de México y Municipios, Toluca, Mexico; National Taiwan University Hospital, Taipei, Taiwan; Hospital de Caridade de Ijuí, CACON, Ijuí, Brazil; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Hospital Pérola Byington, São Paulo, Brazil; Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal; Novartis Healthcare Pvt. Ltd., Hyderabad, India; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma AG, Basel, Switzerland; UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - R Hegg
- The University of Texas MD Anderson Cancer Center, Houston, TX; Centro Oncológico Estatal, Instituto de Seguridad Social del Estado de México y Municipios, Toluca, Mexico; National Taiwan University Hospital, Taipei, Taiwan; Hospital de Caridade de Ijuí, CACON, Ijuí, Brazil; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Hospital Pérola Byington, São Paulo, Brazil; Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal; Novartis Healthcare Pvt. Ltd., Hyderabad, India; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma AG, Basel, Switzerland; UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - F Cardoso
- The University of Texas MD Anderson Cancer Center, Houston, TX; Centro Oncológico Estatal, Instituto de Seguridad Social del Estado de México y Municipios, Toluca, Mexico; National Taiwan University Hospital, Taipei, Taiwan; Hospital de Caridade de Ijuí, CACON, Ijuí, Brazil; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Hospital Pérola Byington, São Paulo, Brazil; Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal; Novartis Healthcare Pvt. Ltd., Hyderabad, India; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma AG, Basel, Switzerland; UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - A Gaur
- The University of Texas MD Anderson Cancer Center, Houston, TX; Centro Oncológico Estatal, Instituto de Seguridad Social del Estado de México y Municipios, Toluca, Mexico; National Taiwan University Hospital, Taipei, Taiwan; Hospital de Caridade de Ijuí, CACON, Ijuí, Brazil; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Hospital Pérola Byington, São Paulo, Brazil; Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal; Novartis Healthcare Pvt. Ltd., Hyderabad, India; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma AG, Basel, Switzerland; UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - O Kong
- The University of Texas MD Anderson Cancer Center, Houston, TX; Centro Oncológico Estatal, Instituto de Seguridad Social del Estado de México y Municipios, Toluca, Mexico; National Taiwan University Hospital, Taipei, Taiwan; Hospital de Caridade de Ijuí, CACON, Ijuí, Brazil; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Hospital Pérola Byington, São Paulo, Brazil; Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal; Novartis Healthcare Pvt. Ltd., Hyderabad, India; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma AG, Basel, Switzerland; UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - I Diaz-Padilla
- The University of Texas MD Anderson Cancer Center, Houston, TX; Centro Oncológico Estatal, Instituto de Seguridad Social del Estado de México y Municipios, Toluca, Mexico; National Taiwan University Hospital, Taipei, Taiwan; Hospital de Caridade de Ijuí, CACON, Ijuí, Brazil; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Hospital Pérola Byington, São Paulo, Brazil; Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal; Novartis Healthcare Pvt. Ltd., Hyderabad, India; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma AG, Basel, Switzerland; UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - M Miller
- The University of Texas MD Anderson Cancer Center, Houston, TX; Centro Oncológico Estatal, Instituto de Seguridad Social del Estado de México y Municipios, Toluca, Mexico; National Taiwan University Hospital, Taipei, Taiwan; Hospital de Caridade de Ijuí, CACON, Ijuí, Brazil; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Hospital Pérola Byington, São Paulo, Brazil; Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal; Novartis Healthcare Pvt. Ltd., Hyderabad, India; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma AG, Basel, Switzerland; UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - S Hurvitz
- The University of Texas MD Anderson Cancer Center, Houston, TX; Centro Oncológico Estatal, Instituto de Seguridad Social del Estado de México y Municipios, Toluca, Mexico; National Taiwan University Hospital, Taipei, Taiwan; Hospital de Caridade de Ijuí, CACON, Ijuí, Brazil; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil; Hospital Pérola Byington, São Paulo, Brazil; Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal; Novartis Healthcare Pvt. Ltd., Hyderabad, India; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma AG, Basel, Switzerland; UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA
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Yardley DA, Chan A, Nusch A, Sonke GS, Yap YS, Bachelot T, Esteva FJ, Slamon DJ, Burris HA, Gaur A, Kong O, Diaz-Padilla I, Rodriguez Lorenc K, Wheatley-Price P. Abstract P6-18-07: Ribociclib + endocrine therapy in patients with hormone receptor-positive, HER2-negative advanced breast cancer presenting with visceral metastases: Subgroup analysis of phase III MONALEESA trials. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-18-07] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Patients (pts) with advanced breast cancer (ABC) who present with visceral metastases (mets) have a poorer prognosis vs pts with non-visceral disease. In the Phase III MONALEESA (ML) trials, ribociclib (RIB) + endocrine therapy (ET) prolonged progression-free survival (PFS) vs placebo (PBO) + ET in hormone receptor-positive (HR+), HER2-negative (HER2–) ABC. Here we show data for pts with and without visceral mets from the ML-2, -3, and -7 trials.
Methods: Data were collated from 3 trials in HR+, HER2– ABC: in ML-2 (NCT01958021; data cutoff [DCO] Jan 2/4, 2017), postmenopausal pts (no prior ET for ABC) received RIB or PBO + letrozole; in ML-3 (NCT02422615; DCO Nov 3, 2017), postmenopausal pts (no prior ET for ABC subgroup only) received RIB or PBO + fulvestrant; in ML-7 (NCT02278120; DCO Aug 20, 2017), premenopausal pts (no prior ET and ≤1 chemotherapy for ABC) received RIB or PBO + goserelin + anastrozole/letrozole. Endpoints; primary: local PFS; secondary: overall response rate (ORR), clinical benefit rate (CBR), safety.
Results: Of all 820 pts treated with RIB + ET, 484 (59%) had visceral mets (ML-2 197/334; ML-3 137/238; ML-7 150/248); of all 710 pts treated with PBO + ET, 416 (59%) had visceral mets (ML-2 196/334; ML-3 77/129; ML-7 143/247). Median PFS was prolonged for RIB vs PBO in pts with and without visceral mets (Table). ORR and CBR were also higher for RIB vs PBO in pts with and without visceral mets. The most common (≥10% of pts in any arm) Grade [G] 3 and 4 adverse events (AEs) for each trial are shown in the table; no G4 AEs occurred in ≥10% of pts in ML-3.
Visceral metsNo visceral metsML-2 Median PFS (RIB/PBO), months (95% CI)24.9 (22.2–30.9)/13.4 (12.7–16.5)25.3 (22.2–NR)/18.2 (15.0–24.6)Hazard ratio (95% CI)0.538 (0.408–0.709)0.634 (0.448–0.897) ORR (RIB/PBO),* %48/3735/17 CBR (RIB/PBO),† %79/7282/75 Most common (≥10% in any arm) G3 AEs (RIB/PBO), %Neutropenia56/147/1Leukopenia19/121/<1Hypertension11/1115/15 Most common (≥10% in any arm) G4 AEs (RIB/PBO), %Neutropenia10/09/0 ML-3 Median PFS (RIB/PBO), months (95% CI)NR (19.1–NR)/16.5 (9.0–NR)NR (NR–NR)/21.9 (14.8–NR)Hazard ratio (95% CI)0.610 (0.403–0.926)0.521 (0.295–0.921) ORR (RIB/PBO),* %46/2931/21 CBR (RIB/PBO),† %74/6075/81 Most common (≥10% in any arm) G3 AEs (RIB/PBO), %Neutropenia50/045/0Leukopenia12/010/0Increased ALT6/012/0 ML-7 Median PFS (RIB/PBO), months (95% CI)23.8 (14.8–NR)/10.4 (7.2–12.9)27.5 (NR–NR)/19.3 (16.5–NR)Hazard ratio (95% CI)0.507 (0.367–0.700)0.609 (0.377–0.984) ORR (RIB/PBO),* %45/3630/19 CBR (RIB/PBO),† %79/5783/81 Most common (≥10% in any arm) G3 AEs (RIB/PBO), %Neutropenia54/356/4Leukopenia14/116/1 Most common (≥10% in any arm) G4 AEs (RIB/PBO), %Neutropenia11/<19/0CI, confidence interval; NR, not reached. *ORR = complete response + partial response; †CBR = complete response + partial response + (stable disease + non-complete response/non-progressive disease ≥24 weeks).
Conclusions: Although the presence of visceral mets is associated with a poorer prognosis, RIB + ET is an effective and well-tolerated treatment option for pts with HR+, HER2– ABC irrespective of the presence of visceral mets.
Citation Format: Yardley DA, Chan A, Nusch A, Sonke GS, Yap Y-S, Bachelot T, Esteva FJ, Slamon DJ, Burris HA, Gaur A, Kong O, Diaz-Padilla I, Rodriguez Lorenc K, Wheatley-Price P. Ribociclib + endocrine therapy in patients with hormone receptor-positive, HER2-negative advanced breast cancer presenting with visceral metastases: Subgroup analysis of phase III MONALEESA trials [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-18-07.
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Affiliation(s)
- DA Yardley
- Sarah Cannon Research Institute and Tennessee Oncology PLLC, Nashville, TN; Breast Cancer Research Centre, Nedlands, Western Australia, Australia; Practice for Haematology and Internal Oncology, Velbert, Germany; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; National Cancer Centre Singapore, Singapore, Singapore; Centre Léon Bérard, Lyon, France; NYU Langone Health, New York, NY; UCLA Medical Center, Santa Monica, CA; Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN; Novartis Healthcare Pvt. Ltd., Hyderabad, India; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma AG, Basel, Switzerland; University of Ottawa, Ottawa, ON, Canada
| | - A Chan
- Sarah Cannon Research Institute and Tennessee Oncology PLLC, Nashville, TN; Breast Cancer Research Centre, Nedlands, Western Australia, Australia; Practice for Haematology and Internal Oncology, Velbert, Germany; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; National Cancer Centre Singapore, Singapore, Singapore; Centre Léon Bérard, Lyon, France; NYU Langone Health, New York, NY; UCLA Medical Center, Santa Monica, CA; Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN; Novartis Healthcare Pvt. Ltd., Hyderabad, India; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma AG, Basel, Switzerland; University of Ottawa, Ottawa, ON, Canada
| | - A Nusch
- Sarah Cannon Research Institute and Tennessee Oncology PLLC, Nashville, TN; Breast Cancer Research Centre, Nedlands, Western Australia, Australia; Practice for Haematology and Internal Oncology, Velbert, Germany; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; National Cancer Centre Singapore, Singapore, Singapore; Centre Léon Bérard, Lyon, France; NYU Langone Health, New York, NY; UCLA Medical Center, Santa Monica, CA; Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN; Novartis Healthcare Pvt. Ltd., Hyderabad, India; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma AG, Basel, Switzerland; University of Ottawa, Ottawa, ON, Canada
| | - GS Sonke
- Sarah Cannon Research Institute and Tennessee Oncology PLLC, Nashville, TN; Breast Cancer Research Centre, Nedlands, Western Australia, Australia; Practice for Haematology and Internal Oncology, Velbert, Germany; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; National Cancer Centre Singapore, Singapore, Singapore; Centre Léon Bérard, Lyon, France; NYU Langone Health, New York, NY; UCLA Medical Center, Santa Monica, CA; Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN; Novartis Healthcare Pvt. Ltd., Hyderabad, India; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma AG, Basel, Switzerland; University of Ottawa, Ottawa, ON, Canada
| | - Y-S Yap
- Sarah Cannon Research Institute and Tennessee Oncology PLLC, Nashville, TN; Breast Cancer Research Centre, Nedlands, Western Australia, Australia; Practice for Haematology and Internal Oncology, Velbert, Germany; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; National Cancer Centre Singapore, Singapore, Singapore; Centre Léon Bérard, Lyon, France; NYU Langone Health, New York, NY; UCLA Medical Center, Santa Monica, CA; Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN; Novartis Healthcare Pvt. Ltd., Hyderabad, India; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma AG, Basel, Switzerland; University of Ottawa, Ottawa, ON, Canada
| | - T Bachelot
- Sarah Cannon Research Institute and Tennessee Oncology PLLC, Nashville, TN; Breast Cancer Research Centre, Nedlands, Western Australia, Australia; Practice for Haematology and Internal Oncology, Velbert, Germany; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; National Cancer Centre Singapore, Singapore, Singapore; Centre Léon Bérard, Lyon, France; NYU Langone Health, New York, NY; UCLA Medical Center, Santa Monica, CA; Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN; Novartis Healthcare Pvt. Ltd., Hyderabad, India; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma AG, Basel, Switzerland; University of Ottawa, Ottawa, ON, Canada
| | - FJ Esteva
- Sarah Cannon Research Institute and Tennessee Oncology PLLC, Nashville, TN; Breast Cancer Research Centre, Nedlands, Western Australia, Australia; Practice for Haematology and Internal Oncology, Velbert, Germany; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; National Cancer Centre Singapore, Singapore, Singapore; Centre Léon Bérard, Lyon, France; NYU Langone Health, New York, NY; UCLA Medical Center, Santa Monica, CA; Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN; Novartis Healthcare Pvt. Ltd., Hyderabad, India; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma AG, Basel, Switzerland; University of Ottawa, Ottawa, ON, Canada
| | - DJ Slamon
- Sarah Cannon Research Institute and Tennessee Oncology PLLC, Nashville, TN; Breast Cancer Research Centre, Nedlands, Western Australia, Australia; Practice for Haematology and Internal Oncology, Velbert, Germany; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; National Cancer Centre Singapore, Singapore, Singapore; Centre Léon Bérard, Lyon, France; NYU Langone Health, New York, NY; UCLA Medical Center, Santa Monica, CA; Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN; Novartis Healthcare Pvt. Ltd., Hyderabad, India; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma AG, Basel, Switzerland; University of Ottawa, Ottawa, ON, Canada
| | - HA Burris
- Sarah Cannon Research Institute and Tennessee Oncology PLLC, Nashville, TN; Breast Cancer Research Centre, Nedlands, Western Australia, Australia; Practice for Haematology and Internal Oncology, Velbert, Germany; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; National Cancer Centre Singapore, Singapore, Singapore; Centre Léon Bérard, Lyon, France; NYU Langone Health, New York, NY; UCLA Medical Center, Santa Monica, CA; Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN; Novartis Healthcare Pvt. Ltd., Hyderabad, India; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma AG, Basel, Switzerland; University of Ottawa, Ottawa, ON, Canada
| | - A Gaur
- Sarah Cannon Research Institute and Tennessee Oncology PLLC, Nashville, TN; Breast Cancer Research Centre, Nedlands, Western Australia, Australia; Practice for Haematology and Internal Oncology, Velbert, Germany; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; National Cancer Centre Singapore, Singapore, Singapore; Centre Léon Bérard, Lyon, France; NYU Langone Health, New York, NY; UCLA Medical Center, Santa Monica, CA; Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN; Novartis Healthcare Pvt. Ltd., Hyderabad, India; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma AG, Basel, Switzerland; University of Ottawa, Ottawa, ON, Canada
| | - O Kong
- Sarah Cannon Research Institute and Tennessee Oncology PLLC, Nashville, TN; Breast Cancer Research Centre, Nedlands, Western Australia, Australia; Practice for Haematology and Internal Oncology, Velbert, Germany; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; National Cancer Centre Singapore, Singapore, Singapore; Centre Léon Bérard, Lyon, France; NYU Langone Health, New York, NY; UCLA Medical Center, Santa Monica, CA; Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN; Novartis Healthcare Pvt. Ltd., Hyderabad, India; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma AG, Basel, Switzerland; University of Ottawa, Ottawa, ON, Canada
| | - I Diaz-Padilla
- Sarah Cannon Research Institute and Tennessee Oncology PLLC, Nashville, TN; Breast Cancer Research Centre, Nedlands, Western Australia, Australia; Practice for Haematology and Internal Oncology, Velbert, Germany; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; National Cancer Centre Singapore, Singapore, Singapore; Centre Léon Bérard, Lyon, France; NYU Langone Health, New York, NY; UCLA Medical Center, Santa Monica, CA; Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN; Novartis Healthcare Pvt. Ltd., Hyderabad, India; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma AG, Basel, Switzerland; University of Ottawa, Ottawa, ON, Canada
| | - K Rodriguez Lorenc
- Sarah Cannon Research Institute and Tennessee Oncology PLLC, Nashville, TN; Breast Cancer Research Centre, Nedlands, Western Australia, Australia; Practice for Haematology and Internal Oncology, Velbert, Germany; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; National Cancer Centre Singapore, Singapore, Singapore; Centre Léon Bérard, Lyon, France; NYU Langone Health, New York, NY; UCLA Medical Center, Santa Monica, CA; Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN; Novartis Healthcare Pvt. Ltd., Hyderabad, India; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma AG, Basel, Switzerland; University of Ottawa, Ottawa, ON, Canada
| | - P Wheatley-Price
- Sarah Cannon Research Institute and Tennessee Oncology PLLC, Nashville, TN; Breast Cancer Research Centre, Nedlands, Western Australia, Australia; Practice for Haematology and Internal Oncology, Velbert, Germany; Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands; National Cancer Centre Singapore, Singapore, Singapore; Centre Léon Bérard, Lyon, France; NYU Langone Health, New York, NY; UCLA Medical Center, Santa Monica, CA; Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN; Novartis Healthcare Pvt. Ltd., Hyderabad, India; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma AG, Basel, Switzerland; University of Ottawa, Ottawa, ON, Canada
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Gaur A, Nitin Nair N, Shrivastava B, Das B, Chakrabortty M, Jha S, Bhattacharyya D. Study of distorted octahedral structure in 3d transition metal complexes using XAFS. Chem Phys Lett 2018. [DOI: 10.1016/j.cplett.2017.12.067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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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Wolf J, Connell T, Allison KJ, Tang L, Richardson J, Branum K, Borello E, Gaur A, Hakim H, Su Y, Mechinaud F, Hayden R, Monagle P, Worth L, Curtis N, Flynn PM. Ethanol Lock Treatment and Secondary Prophylaxis for Central Line-Associated Bloodstream Infection in Pediatric Hematology and Oncology: A Randomized, Double-Blind, Placebo-Controlled, Intervention Trial. Open Forum Infect Dis 2017. [PMCID: PMC5631007 DOI: 10.1093/ofid/ofx180.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Central line-associated bloodstream infection (CLABSI) commonly affects children with cancer and hematological disorders, with significant attributable costs and morbidity. Treatment failure, comprising persistent infection, infection relapse or new infection, occurs in ~50% of cases. Adjunctive ethanol lock therapy (ELT) has been proposed to prevent failure, but has never been tested in a prospective controlled study. Methods A prospective, dual-center, double-blind, block-randomized, placebo-controlled trial of ELT (70% ethanol in water) for CLABSI, given as treatment (2 hours per lumen per day) for 5 days, followed by secondary prophylaxis (2 hours per lumen up to 3 days per week) for 24 weeks, in children with oncologic or hematologic disorders (NCT01472965). Risk of treatment failure was compared between intervention and control groups according to proportional and cumulative incidence models, using intention-to-treat and per-protocol analyses. The study was discontinued at a pre-specified futility analysis. Results Of 94 evaluable participants, 48 were randomized to ELT and 46 to placebo; groups were similar at baseline for all measured variables. Forty-one (43.6%) participants had treatment failure (11 early failure, 9 relapse, and 21 reinfection). There was no difference between patients receiving ELT or placebo for risk of treatment failure (43.8% vs. 43.5%; P = 0.9) or for cumulative incidence of treatment failure in intention to treat (Figure 1) and per-protocol analyses (Figure 2). Catheter occlusion was significantly more common in participants receiving ethanol (58.3% vs. 32.6%, P = 0.01) but other adverse events, including LFT elevations (14.6% vs. 26.1%) and infusion reactions (18.8% vs. 8.7%), were not significantly different between groups. Conclusion Although observational studies suggested ELT might be effective for treatment of CLABSI in pediatric oncology, we found no benefit in treatment outcome and an increase in adverse effects. These results may not apply to patients receiving dialysis or with fungal CLABSI as these were not well-represented. Routine use of ELT for CLABSI in children with oncologic or hematologic disorders is not recommended. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Joshua Wolf
- Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Tom Connell
- Clinical Paediatrics, Murdoch Children’s Research Institute, Parkville, Australia
| | - Kim J Allison
- St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Li Tang
- Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Julie Richardson
- Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Kristen Branum
- Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Eloise Borello
- Oncology, Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
| | - Aditya Gaur
- Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Hana Hakim
- St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Yin Su
- Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Francoise Mechinaud
- Oncology, Royal Childrens Hospital Melbourne, Parkville, Victoria, Australia
| | - Randall Hayden
- St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Paul Monagle
- Hematology, Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
| | - Leon Worth
- Peter MacCallum Cancer Ctr., Melbourne, Australia
| | - Nigel Curtis
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
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Sood I, Gupta K, Sharma AK, Gaur A, Pathania V, Thakur VBS. Assessment of knowledge and awareness among medical doctors toward emergency management of dental trauma in State of Himachal Pradesh: A survey. Indian J Dent Sci 2017. [DOI: 10.4103/ijds.ijds_72_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Griffith D, Farmer C, Rutstein R, Mathews WC, Beil R, Korthuis PT, Berry S, Nijhawan AE, Gaur A, Gebo K, Agwu A, Network HIVR. Uptake and Virologic Outcomes of 1-Pill versus Multipill Antiretroviral Therapy Among Treatment-Naive Nonperinatally HIV-Infected Youth (2006–2014). Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- David Griffith
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Charles Farmer
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | | | | | - Stephen Berry
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ank E Nijhawan
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Aditya Gaur
- St Jude's Children's Research Hospital, Memphis, TN
| | - Kelly Gebo
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allison Agwu
- Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
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Gaur A, Klysubun W, Soni B, Shrivastava B, Prasad J, Srivastava K. Identification of different coordination geometries by XAFS in copper(II) complexes with trimesic acid. J Mol Struct 2016. [DOI: 10.1016/j.molstruc.2016.05.066] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Sure S, Ackland ML, Gaur A, Gupta P, Adholeya A, Kochar M. Probing Synechocystis-Arsenic Interactions through Extracellular Nanowires. Front Microbiol 2016; 7:1134. [PMID: 27486454 PMCID: PMC4949250 DOI: 10.3389/fmicb.2016.01134] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 07/07/2016] [Indexed: 11/13/2022] Open
Abstract
Microbial nanowires (MNWs) can play an important role in the transformation and mobility of toxic metals/metalloids in environment. The potential role of MNWs in cell-arsenic (As) interactions has not been reported in microorganisms and thus we explored this interaction using Synechocystis PCC 6803 as a model system. The effect of half maximal inhibitory concentration (IC50) [~300 mM As (V) and ~4 mM As (III)] and non-inhibitory [4X lower than IC50, i.e., 75 mM As (V) and 1 mM As (III)] of As was studied on Synechocystis cells in relation to its effect on Chlorophyll (Chl) a, type IV pili (TFP)-As interaction and intracellular/extracellular presence of As. In silico analysis showed that subunit PilA1 of electrically conductive TFP, i.e., microbial nanowires of Synechocystis have putative binding sites for As. In agreement with in silico analysis, transmission electron microscopy analysis showed that As was deposited on Synechocystis nanowires at all tested concentrations. The potential of Synechocystis nanowires to immobilize As can be further enhanced and evaluated on a large scale and thus can be applied for bioremediation studies.
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Affiliation(s)
- Sandeep Sure
- TERI-Deakin Nano biotechnology Centre, The Energy and Resources Institute Gurgaon, India
| | - M L Ackland
- Centre for Cellular & Molecular Biology, Deakin University, Melbourne VIC, Australia
| | - Aditya Gaur
- TERI-Deakin Nano biotechnology Centre, The Energy and Resources Institute Gurgaon, India
| | - Priyanka Gupta
- TERI-Deakin Nano biotechnology Centre, The Energy and Resources Institute Gurgaon, India
| | - Alok Adholeya
- TERI-Deakin Nano biotechnology Centre, The Energy and Resources Institute Gurgaon, India
| | - Mandira Kochar
- TERI-Deakin Nano biotechnology Centre, The Energy and Resources Institute Gurgaon, India
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Gaur A, Klysubun W, Joshi SK, Soni B, Shrivastava BD, Prasad J, Srivastava K. XAFS study of copper(II) diethylenetriamine complexes having different coordination geometries. ACTA ACUST UNITED AC 2016. [DOI: 10.1088/1742-6596/712/1/012084] [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: 11/11/2022]
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Daga V, Narayanan MK, Dedhia JD, Gaur P, Crick H, Gaur A. Cadaveric feasibility study on the use of ultrasound contrast to assess spread of injectate in the serratus anterior muscle plane. Saudi J Anaesth 2016; 10:198-201. [PMID: 27051373 PMCID: PMC4799614 DOI: 10.4103/1658-354x.168825] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 11/04/2022] Open
Abstract
BACKGROUND The Serratus anterior muscle plane (SAP) block has recently been described for the purpose of perioperative pain management following cases of trauma and breast surgery. It might prove a safer alternative to the other regional thoracic paravertebral and central neuraxial blockade techniques. There are no descriptive cadaveric studies in the pre-existing literature to delineate the anatomical plane for this novel technique. The main objectives for our study were to examine the location of the Serratus anterior muscle belly, assess the efficacy of achieving adequate delineation of the muscle plane utilising ultrasound imaging with agitated water as the contrast agent, and finally, to observe the extent of the cepahlo-caudal spread of the injectate in the SAP. MATERIALS AND METHODS Seven cadavers were studied. 20 mls of saline was injected into posterior axillary line (PAL) at the level of the 4-5(th) rib under ultrasound guidance. This was followed by injection of 10 mls of water with air (8 mls water and 2 mls of air). The presence of hyperechoic air bubbles in the fluid distended SAP (hypoechoic) area demonstrated the spread of water and air. RESULTS In 36% of cadavers, fully formed Serratus Anterior muscle belly was identified at the midaxillary line (MAL), 14% in PAL, and remaining 50% between PAL and MAL. The lower most limit of air-water spread was identified at the subcostal margin. Cephalad spread of contrast was noted in 2(nd) intercostal space ICS (7%), 3(rd) ICS (71%), and 4(th) ICS (22%). CONCLUSION This study describes that the serratus anterior muscle is well-formed near the PAL and the injectate spread can be determined with the help of agitated water contrast on ultrasound. Furthermore, there was variability in the cephalad spread of the injectate.
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Affiliation(s)
- V Daga
- Specialist Registrar Anaesthetics, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - MK Narayanan
- Consultant Anaesthetics, Frimley Park Hospital NHS Foundation Trust, Frimley, Surrey, UK
| | - JD Dedhia
- Consultant Anaesthetics, United Lincolnshire Hospitals NHS Trust, Lincoln, UK
| | - P Gaur
- Medical student, University College London, London, UK
| | - H Crick
- Medical and Social Care Education, University of Leicester, Leicester, UK
| | - A Gaur
- Consultant Anaesthetics, University Hospitals of Leicester NHS Trust, Leicester, UK
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Sure S, Torriero AAJ, Gaur A, Li LH, Chen Y, Tripathi C, Adholeya A, Ackland ML, Kochar M. Identification and topographical characterisation of microbial nanowires in Nostoc punctiforme. Antonie Van Leeuwenhoek 2016; 109:475-80. [PMID: 26754102 DOI: 10.1007/s10482-015-0644-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 12/30/2015] [Indexed: 11/28/2022]
Abstract
Extracellular pili-like structures (PLS) produced by cyanobacteria have been poorly explored. We have done detailed topographical and electrical characterisation of PLS in Nostoc punctiforme PCC 73120 using transmission electron microscopy (TEM) and conductive atomic force microscopy (CAFM). TEM analysis showed that N. punctiforme produces two separate types of PLS differing in their length and diameter. The first type of PLS are 6-7.5 nm in diameter and 0.5-2 µm in length (short/thin PLS) while the second type of PLS are ~20-40 nm in diameter and more than 10 µm long (long/thick PLS). This is the first study to report long/thick PLS in N. punctiforme. Electrical characterisation of these two different PLS by CAFM showed that both are electrically conductive and can act as microbial nanowires. This is the first report to show two distinct PLS and also identifies microbial nanowires in N. punctiforme. This study paves the way for more detailed investigation of N. punctiforme nanowires and their potential role in cell physiology and symbiosis with plants.
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Affiliation(s)
- Sandeep Sure
- TERI-Deakin Nanobiotechnology Centre, TERI Gram, The Energy and Resources Institute, Gual Pahari, Gurgaon-Faridabad Road, Gurgaon, Haryana, 122 001, India
| | - Angel A J Torriero
- Centre for Cellular & Molecular Biology, Deakin University, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia
| | - Aditya Gaur
- TERI-Deakin Nanobiotechnology Centre, TERI Gram, The Energy and Resources Institute, Gual Pahari, Gurgaon-Faridabad Road, Gurgaon, Haryana, 122 001, India
| | - Lu Hua Li
- Institute for Frontier Materials, Deakin University, Geelong Waurn Ponds Campus, Geelong, VIC, 3216, Australia
| | - Ying Chen
- Institute for Frontier Materials, Deakin University, Geelong Waurn Ponds Campus, Geelong, VIC, 3216, Australia
| | - Chandrakant Tripathi
- TERI-Deakin Nanobiotechnology Centre, TERI Gram, The Energy and Resources Institute, Gual Pahari, Gurgaon-Faridabad Road, Gurgaon, Haryana, 122 001, India
| | - Alok Adholeya
- TERI-Deakin Nanobiotechnology Centre, TERI Gram, The Energy and Resources Institute, Gual Pahari, Gurgaon-Faridabad Road, Gurgaon, Haryana, 122 001, India
| | - M Leigh Ackland
- Centre for Cellular & Molecular Biology, Deakin University, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia
| | - Mandira Kochar
- TERI-Deakin Nanobiotechnology Centre, TERI Gram, The Energy and Resources Institute, Gual Pahari, Gurgaon-Faridabad Road, Gurgaon, Haryana, 122 001, India.
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Sure S, Torriero AAJ, Gaur A, Li LH, Chen Y, Tripathi C, Adholeya A, Ackland ML, Kochar M. Inquisition of Microcystis aeruginosa and Synechocystis nanowires: characterization and modelling. Antonie Van Leeuwenhoek 2015; 108:1213-25. [PMID: 26319534 DOI: 10.1007/s10482-015-0576-2] [Citation(s) in RCA: 18] [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] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 08/24/2015] [Indexed: 10/23/2022]
Abstract
Identification of extracellular conductive pilus-like structures (PLS) i.e. microbial nanowires has spurred great interest among scientists due to their potential applications in the fields of biogeochemistry, bioelectronics, bioremediation etc. Using conductive atomic force microscopy, we identified microbial nanowires in Microcystis aeruginosa PCC 7806 which is an aerobic, photosynthetic microorganism. We also confirmed the earlier finding that Synechocystis sp. PCC 6803 produces microbial nanowires. In contrast to the use of highly instrumented continuous flow reactors for Synechocystis reported earlier, we identified simple and optimum culture conditions which allow increased production of nanowires in both test cyanobacteria. Production of these nanowires in Synechocystis and Microcystis were found to be sensitive to the availability of carbon source and light intensity. These structures seem to be proteinaceous in nature and their diameter was found to be 4.5-7 and 8.5-11 nm in Synechocystis and M. aeruginosa, respectively. Characterization of Synechocystis nanowires by transmission electron microscopy and biochemical techniques confirmed that they are type IV pili (TFP) while nanowires in M. aeruginosa were found to be similar to an unnamed protein (GenBank : CAO90693.1). Modelling studies of the Synechocystis TFP subunit i.e. PilA1 indicated that strategically placed aromatic amino acids may be involved in electron transfer through these nanowires. This study identifies PLS from Microcystis which can act as nanowires and supports the earlier hypothesis that microbial nanowires are widespread in nature and play diverse roles.
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Affiliation(s)
- Sandeep Sure
- TERI-Deakin Nanobiotechnology Centre, TERI Gram, The Energy and Resources Institute, Gual Pahari, Gurgaon Faridabad Road, Gurgaon, 122 001, Haryana, India
| | - Angel A J Torriero
- Centre for Cellular and Molecular Biology, Deakin University, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia
| | - Aditya Gaur
- TERI-Deakin Nanobiotechnology Centre, TERI Gram, The Energy and Resources Institute, Gual Pahari, Gurgaon Faridabad Road, Gurgaon, 122 001, Haryana, India
| | - Lu Hua Li
- Institute for Frontier Materials, Deakin University, Geelong Waurn Ponds Campus, Geelong, VIC, 3216, Australia
| | - Ying Chen
- Institute for Frontier Materials, Deakin University, Geelong Waurn Ponds Campus, Geelong, VIC, 3216, Australia
| | - Chandrakant Tripathi
- TERI-Deakin Nanobiotechnology Centre, TERI Gram, The Energy and Resources Institute, Gual Pahari, Gurgaon Faridabad Road, Gurgaon, 122 001, Haryana, India
| | - Alok Adholeya
- TERI-Deakin Nanobiotechnology Centre, TERI Gram, The Energy and Resources Institute, Gual Pahari, Gurgaon Faridabad Road, Gurgaon, 122 001, Haryana, India
| | - M Leigh Ackland
- Centre for Cellular and Molecular Biology, Deakin University, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia
| | - Mandira Kochar
- TERI-Deakin Nanobiotechnology Centre, TERI Gram, The Energy and Resources Institute, Gual Pahari, Gurgaon Faridabad Road, Gurgaon, 122 001, Haryana, India.
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Penkert R, Adderson E, Branum K, Sealy R, Jones B, Surman S, Freiden P, Slobod K, Gaur A, Hayden R, Allison K, Howlett N, Utech J, Allay J, Knight J, Sleep S, Meagher M, Russell C, Portner A, Hurwitz J. Sendai virus is a safe and immunogenic Jennerian vaccine for human parainfluenza virus-type 1 in 3-6 year old children (VAC8P.1053). The Journal of Immunology 2015. [DOI: 10.4049/jimmunol.194.supp.144.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Human parainfluenza viruses are responsible for tens of thousands of hospitalizations and hundreds of thousands of emergency room visits each year in the United States. Included in this group of viruses is human parainfluenza virus-type 1 (hPIV-1), the main causative agent of laryngotracheobronchitis (croup) in young children, for which there is currently no licensed vaccine. In response to this need, we have developed a Jennerian vaccine that employs the use of murine PIV-1 (Sendai virus, SeV) to produce cross-reactive antibodies towards hPIV-1. The vaccine was administered as a single intranasal dose to healthy, hPIV-1 seropositive, 3-6 year old children in a dose escalation study (5 x 105, 5 x 106 or 5 x 107 EID50). Importantly, the vaccine was well tolerated by all participants. No replication of the viral vaccine was detected in the airway of any participant. Within four weeks of vaccination, most participants showed an increase in binding and neutralizing antibodies towards hPIV-1. For several participants, antibody responses remained elevated at six months post-vaccination. The results of this study suggest that hPIV-1 vaccination may be beneficial to boost immunity in seropositive children, and encourage testing of the vaccine in young, seronegative children who are most at risk for respiratory virus disease.
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Affiliation(s)
- Rhiannon Penkert
- 2Infectious Diseases, St. Jude Children's Res. Hosp., Memphis, TN
| | | | - Kristen Branum
- 2Infectious Diseases, St. Jude Children's Res. Hosp., Memphis, TN
| | - Robert Sealy
- 2Infectious Diseases, St. Jude Children's Res. Hosp., Memphis, TN
| | - Bart Jones
- 2Infectious Diseases, St. Jude Children's Res. Hosp., Memphis, TN
| | - Sherri Surman
- 2Infectious Diseases, St. Jude Children's Res. Hosp., Memphis, TN
| | - Pamela Freiden
- 2Infectious Diseases, St. Jude Children's Res. Hosp., Memphis, TN
| | - Karen Slobod
- 2Infectious Diseases, St. Jude Children's Res. Hosp., Memphis, TN
| | - Aditya Gaur
- 2Infectious Diseases, St. Jude Children's Res. Hosp., Memphis, TN
| | | | - Kim Allison
- 2Infectious Diseases, St. Jude Children's Res. Hosp., Memphis, TN
| | - Nanna Howlett
- 2Infectious Diseases, St. Jude Children's Res. Hosp., Memphis, TN
| | - Jill Utech
- 2Infectious Diseases, St. Jude Children's Res. Hosp., Memphis, TN
| | | | | | | | | | - Charles Russell
- 2Infectious Diseases, St. Jude Children's Res. Hosp., Memphis, TN
- 4Microbiology, Immunology and Biochemistry, Univ. of Tennessee Hlth. Sci. Ctr., Memphis, TN
| | - Allen Portner
- 2Infectious Diseases, St. Jude Children's Res. Hosp., Memphis, TN
| | - Julia Hurwitz
- 2Infectious Diseases, St. Jude Children's Res. Hosp., Memphis, TN
- 4Microbiology, Immunology and Biochemistry, Univ. of Tennessee Hlth. Sci. Ctr., Memphis, TN
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Giannini MA, Williams S, Johnson S, Gaur A, Hakim H. Is Frequency of Accessing Central Venous Catheters Associated with Central Line Associated Bloodstream Infection in Children with Cancer? Am J Infect Control 2014. [DOI: 10.1016/j.ajic.2014.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Srinivasan A, Wang WC, Gaur A, Smith T, Gu Z, Kang G, Leung W, Hayden RT. Prospective evaluation for respiratory pathogens in children with sickle cell disease and acute respiratory illness. Pediatr Blood Cancer 2014; 61:507-11. [PMID: 24123899 PMCID: PMC4632201 DOI: 10.1002/pbc.24798] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 09/11/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Human rhinovirus (HRV), human coronavirus (hCoV), human bocavirus (hBoV), and human metapneumovirus (hMPV) infections in children with sickle cell disease have not been well studied. PROCEDURE Nasopharyngeal wash specimens were prospectively collected from 60 children with sickle cell disease and acute respiratory illness, over a 1-year period. Samples were tested with multiplexed-PCR, using an automated system for nine respiratory viruses, Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Bordetella pertussis. Clinical characteristics and distribution of respiratory viruses in patients with and without acute chest syndrome (ACS) were evaluated. RESULTS A respiratory virus was detected in 47 (78%) patients. Nine (15%) patients had ACS; a respiratory virus was detected in all of them. The demographic characteristics of patients with and without ACS were similar. HRV was the most common virus, detected in 29 of 47 (62%) patients. Logistic regression showed no association between ACS and detection of HRV, hCoV, hBoV, hMPV, and other respiratory pathogens. Co-infection with at least one additional respiratory virus was seen in 14 (30%) infected patients, and was not significantly higher in patients with ACS (P = 0.10). Co-infections with more than two respiratory viruses were seen in seven patients, all in patients without ACS. Bacterial pathogens were not detected. CONCLUSION HRV was the most common virus detected in children with sickle cell disease and acute respiratory illness, and was not associated with increased morbidity. Larger prospective studies with asymptomatic controls are needed to study the association of these emerging respiratory viruses with ACS in children with sickle cell disease.
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Affiliation(s)
- Ashok Srinivasan
- Department of Bone Marrow Transplantation and Cellular Therapy (BMTCT)St. Jude Children's Research HospitalMemphisTennessee,Department of PediatricsUniversity of Tennessee Health Science CenterMemphisTennessee
| | - Winfred C. Wang
- Department of PediatricsUniversity of Tennessee Health Science CenterMemphisTennessee,Department of HematologySt. Jude Children's Research HospitalMemphisTennessee
| | - Aditya Gaur
- Department of PediatricsUniversity of Tennessee Health Science CenterMemphisTennessee,Department of Infectious DiseasesSt. Jude Children's Research HospitalMemphisTennessee
| | - Teresa Smith
- BMTCT Clinical Research OfficeSt. Jude Children's Research HospitalMemphisTennessee
| | - Zhengming Gu
- Department of PathologySt. Jude Children's Research HospitalMemphisTennessee
| | - Guolian Kang
- Department of BiostatisticsSt. Jude Children's Research HospitalMemphisTennessee
| | - Wing Leung
- Department of Bone Marrow Transplantation and Cellular Therapy (BMTCT)St. Jude Children's Research HospitalMemphisTennessee,Department of PediatricsUniversity of Tennessee Health Science CenterMemphisTennessee
| | - Randall T. Hayden
- Department of PathologySt. Jude Children's Research HospitalMemphisTennessee
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Abstract
Gitelman's syndrome is an autosomal recessive disorder characterized by hypokalemic metabolic alkalosis, hypokalemia, hypomagnesaemia, hypocalciuria, hyperreninemia and without hypertension. Gitelman's syndrome is caused by mutations of the SLC12A3 gene, which encodes the Na/Cl co-transporter (NCCT) in the distal convoluted tubule. Majority of cases manifest during adolescence or adulthood and growth retardation is not the common feature. We report a rare presentation of Gitelman's syndrome in a four-year-old boy with growth retardation.
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Affiliation(s)
- A Gaur
- Department of Pediatrics, Gajraraja Medical College and Kamla Raja Hospital, Gwalior, Madhya Pradesh, India
| | - R Ambey
- Department of Pediatrics, Gajraraja Medical College and Kamla Raja Hospital, Gwalior, Madhya Pradesh, India
| | - B K Gaur
- Department of Pediatrics, Gajraraja Medical College and Kamla Raja Hospital, Gwalior, Madhya Pradesh, India
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Ghosh AN, Bhatta DR, Ansari MT, Tiwari HK, Mathuria JP, Gaur A, Supram HS, Gokhale S. Application of WHONET in the Antimicrobial Resistance Surveillance of Uropathogens: A First User Experience from Nepal. J Clin Diagn Res 2013; 7:845-8. [PMID: 23814725 DOI: 10.7860/jcdr/2013/5193.2955] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 03/07/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION WHONET is a freely downloadable, Windows-based database software which is used for the management and analysis of microbiology data, with a special focus on the analysis of antimicrobial susceptibility test results. Urinary Tract Infections (UTI) are a common medical problem and they are responsible for notable morbidity among young and sexually active women. OBJECTIVES The major objective of this study was the utilization and application of the WHONET program for the Antimicrobial Resistance (AMR) surveillance of uropathogens. METHODS A total of 3209 urine samples were collected from patients who visited Manipal Teaching Hospital with a clinical suspicion of UTI, during December 2010 to July 2011. The isolation and characterization of the isolates were done by conventional methods. Antimicrobial Susceptibility Testing (AST) was performed by Kirby Bauer's disc diffusion method. The data entry and analysis were done by using the WHONET 5.6 software. RESULTS Out of the 3209 specimens, 497 bacterial isolates were obtained and they were subjected to AST. Escherichia coli (66.2%) was the commonest bacterial isolate, followed by Enterococcus species (9.3%), Staphylococcus aureus (5.0%), and Klebsiella pneumoniae (4.2%). Among the gram-negative enteric bacilli, a high prevalence of resistance was observed against ampicillin and ciprofloxacin. The gram negative nonfermenters exhibited a high degree of resistance to ceftazidime. Staphylococcus species. showed a moderately high resistance to co-trimoxazole. One isolate was Vancomycin Resistant Enterococci (VRE). CONCLUSION This study, a first of its kind which was done in Nepal, was carried out by using the WHONET software to monitor, analyze and share the antimicrobial susceptibility data at various levels. This study was also aimed at building a surveillance network in Nepal, with the National Public Health Laboratory, Nepal, acting as a nodal centre. This would help in the formulation of antibiotic policies and in identifying hospital and community outbreaks at the nodal centre, as well as in sharing information with the clinicians at the local level.
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Affiliation(s)
- A N Ghosh
- Department of Microbiology, Gujarat Adani Institute of Medical Sciences (GAIMS), G K General Hospital , Bhuj, Kutch, Gujarat, India - 370001
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Shuldiner AR, Relling MV, Peterson JF, Hicks JK, Freimuth RR, Sadee W, Pereira NL, Roden DM, Johnson JA, Klein TE, Shuldiner AR, Vesely M, Robinson SW, Ambulos N, Stass SA, Kelemen MD, Brown LA, Pollin TI, Beitelshees AL, Zhao RY, Pakyz RE, Palmer K, Alestock T, O'Neill C, Maloney K, Branham A, Sewell D, Relling MV, Crews K, Hoffman J, Cross S, Haidar C, Baker D, Hicks JK, Bell G, Greeson F, Gaur A, Reiss U, Huettel A, Cheng C, Gajjar A, Pappo A, Howard S, Hudson M, Pui CH, Jeha S, Evans WE, Broeckel U, Altman RB, Gong L, Whirl-Carrillo M, Klein TE, Sadee W, Manickam K, Sweet KM, Embi PJ, Roden D, Peterson J, Denny J, Schildcrout J, Bowton E, Pulley J, Beller M, Mitchell J, Danciu I, Price L, Pereira NL, Weinshilboum R, Wang L, Johnson JA, Nelson D, Clare-Salzler M, Elsey A, Burkley B, Langaee T, Liu F, Nessl D, Dong HJ, Lesko L, Freimuth RR, Chute CG. The Pharmacogenomics Research Network Translational Pharmacogenetics Program: overcoming challenges of real-world implementation. Clin Pharmacol Ther 2013; 94:207-10. [PMID: 23588301 DOI: 10.1038/clpt.2013.59] [Citation(s) in RCA: 138] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 03/14/2013] [Indexed: 11/09/2022]
Affiliation(s)
- A R Shuldiner
- Program in Personalized and Genomic Medicine and Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
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Lehrnbecher T, Phillips R, Alexander S, Alvaro F, Carlesse F, Fisher B, Hakim H, Santolaya M, Castagnola E, Davis BL, Dupuis LL, Gibson F, Groll AH, Gaur A, Gupta A, Kebudi R, Petrilli S, Steinbach WJ, Villarroel M, Zaoutis T, Sung L. Guideline for the management of fever and neutropenia in children with cancer and/or undergoing hematopoietic stem-cell transplantation. J Clin Oncol 2012; 30:4427-38. [PMID: 22987086 DOI: 10.1200/jco.2012.42.7161] [Citation(s) in RCA: 239] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To develop an evidence-based guideline for the empiric management of pediatric fever and neutropenia (FN). METHODS The International Pediatric Fever and Neutropenia Guideline Panel is a multidisciplinary and multinational group composed of experts in pediatric oncology and infectious disease as well as a patient advocate. The Panel was convened for the purpose of creating this guideline. We followed previously validated procedures for creating evidence-based guidelines. Working groups focused on initial presentation, ongoing management, and empiric antifungal therapy. Each working group developed key clinical questions, conducted systematic reviews of the published literature, and compiled evidence summaries. The Grades of Recommendation Assessment, Development, and Evaluation approach was used to generate summaries, and evidence was classified as high, moderate, low, or very low based on methodologic considerations. RESULTS Recommendations were made related to initial presentation (risk stratification, initial evaluation, and treatment), ongoing management (modification and cessation of empiric antibiotics), and empiric antifungal treatment (risk stratification, evaluation, and treatment) of pediatric FN. For each recommendation, the strength of the recommendation and level of evidence are presented. CONCLUSION This guideline represents an evidence-based approach to FN specific to children with cancer. Although some recommendations are similar to adult-based guidelines, there are key distinctions in multiple areas. Implementation will require adaptation to the local context.
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Bhattacharjee A, Sen MR, Prakash P, Gaur A, Anupurba S, Nath G. Observation on integron carriage among clinical isolates of Klebsiella pneumoniae producing extended-spectrum beta-lactamases. Indian J Med Microbiol 2010; 28:207-10. [PMID: 20644307 DOI: 10.4103/0255-0857.66472] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PURPOSE Klebsiella pneumoniae is considered an important pathogen causing nosocomial and community-acquired infections and is often associated with the production of extended-spectrum beta-lactamases (ESBL) belonging to SHV and CTX-M families, which are frequently described as a part of complex integrons, facilitate their horizontal transfer to other related as well as unrelated microbes. The present study was undertaken to investigate the occurrence and characterization of integrons among K pneumoniae isolates producing ESBL in a tertiary referral hospital. MATERIALS AND METHODS A total of 136 clinical isolates of K pneumoniae were investigated for the presence of ESBL. Their ESBL genes were characterized by multiplex polymerase chain reaction (PCR). Integrase gene PCR was performed to detect the presence of integron. The isolates were further typed by random amplification of polymorphic DNA (RAPD). RESULT Out of 136 K pneumoniae isolates, 63 (46%) were confirmed to be ESBL producers. SHV (68%) and CTX-M (67%) ESBL genes were the most common in our study. Of the 63 ESBL-positive isolates, 58 (92%) strains carried integrons; 52 strains (82%) carried only class 1 integron, whereas 6 (9%) isolates harboured both class 2 integrons and the class 1 gene. However, in ESBL negatives, only 29 (40%) strains were positive for class 1 integron and none for class 2 integron. CONCLUSION The presence of class 2 integron amongst ESBL-producing K pneumoniae is being described for the first time in this part of the world. The findings of this study strongly suggest that integrons have a role in the dissemination of ESBL-mediated resistance among the nosocomial isolates of K pneumonia.
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Affiliation(s)
- A Bhattacharjee
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221 005, India
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Gaur A, Pujahari AK. Role of Prophylactic Antibiotics in Laparoscopic Cholecystectomy. Med J Armed Forces India 2010; 66:228-30. [PMID: 27408307 DOI: 10.1016/s0377-1237(10)80043-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 01/05/2010] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Antibiotic prophylaxis is routinely administered in laparoscopic cholecystetomy but its role is debatable. METHODS From January 2004 to August 2008, 417 patients were randomized into 208 in antibiotic group (AG) and 209 in non antibiotic group (NAG). AG received one dose each of injection ciprofloxacin (200 mg) and metronidazole (500mg) preoperatively. NAG was given only intravenous fluids. Besides routine care, all underwent abdominal sonography and liver function tests at least once during the 30 postoperative days. RESULT Age, sex and co-morbidity distribution were similar in both the groups. One patient who was on weekly 5mg methotraxate (NAG) had erythema around umbilical port. Other three having umbilical discharge recovered without antibiotics. Nine patients had subhepatic collection (5 AG and 4 NAG). One from NAG underwent re-laparoscopy and drainage. Ten patients had fever. Two from AG had basal lung collapse and were given antibiotics. CONCLUSION Antibiotic prophylaxis is not needed for laparoscopic cholecystectomy.
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Affiliation(s)
- A Gaur
- Resident, Command Hospital (AF), Bangalore-07
| | - A K Pujahari
- Senior Advisor (Surgery), Command Hospital (AF), Bangalore-07
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Bhattacharjee A, Sen MR, Prakash P, Gaur A, Anupurba S. Increased prevalence of extended spectrum beta lactamase producers in neonatal septicaemic cases at a tertiary referral hospital. Indian J Med Microbiol 2009; 26:356-60. [PMID: 18974490 DOI: 10.4103/0255-0857.43578] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Emergence of extended spectrum beta lactamases (ESBLs) producing strains of gram negative bacteria, as one of the leading cause of septicaemia often complicates the clinical and therapeutic outcome. The present study was undertaken to investigate the prevalence of ESBLs in bacteria isolated from neonatal septicaemic cases along with their antimicrobial sensitivity pattern. Blood samples were collected from 243 suspected cases of neonatal septicaemia. Apart from susceptibility testing, all the gram negative isolates were subjected to phenotypic tests for ESBL production. Amongst the positive test samples (n = 115), 84 were gram negative rods. ESBL was detected in 26 (32%) isolates. Results indicate that routine ESBL detection should be made imperative and empirical use of third generation cephalosporins must be discouraged.
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Affiliation(s)
- A Bhattacharjee
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India.
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Greenough TC, Cunningham CK, Muresan P, McManus M, Persaud D, Fenton T, Barker P, Gaur A, Panicali D, Sullivan JL, Luzuriaga K. Safety and immunogenicity of recombinant poxvirus HIV-1 vaccines in young adults on highly active antiretroviral therapy. Vaccine 2008; 26:6883-93. [PMID: 18940219 PMCID: PMC2845914 DOI: 10.1016/j.vaccine.2008.09.084] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Revised: 09/17/2008] [Accepted: 09/25/2008] [Indexed: 02/05/2023]
Abstract
A trial to evaluate the safety and immunogenicity of recombinant modified vaccinia Ankara (MVA) and fowlpox (FP) vectors expressing multiple HIV-1 proteins was conducted in twenty HIV-1 infected youth with suppressed viral replication on HAART. The MVA and FP-based multigene HIV-1 vaccines were safe and well tolerated. Increased frequencies of HIV-1 specific CD4+ proliferative responses and cytokine secreting cells were detected following immunization. Increased frequencies and breadth of HIV-1 specific CD8 T-cell responses were also detected. Plasma HIV-1-specific antibody levels and neutralizing activity were unchanged following vaccination. Poxvirus-based vaccines may merit further study in therapeutic vaccine protocols.
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Affiliation(s)
- Thomas C Greenough
- Pediatrics and Molecular Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
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Bhattacharjee A, Sen MR, Prakash P, Gaur A, Anupurba S. INCREASED PREVALENCE OF EXTENDED SPECTRUM βLACTAMASE PRODUCERS IN NEONATAL SEPTICAEMIC CASES AT A TERTIARY REFERRAL HOSPITAL. Indian J Med Microbiol 2008. [DOI: 10.1016/s0255-0857(21)01814-4] [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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Kaur J, Gaur A, Lin E, Dias JJ, Ahmed A, Jones MJ. 562. Supraclavicular Brachial Plexus Block in Lateral Position - Gaur Approach. Reg Anesth Pain Med 2008. [DOI: 10.1136/rapm-00115550-200809001-00211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gaur A, Garg A, Prakash P, Anupurba S, Mohapatra TM. Observations on carbapenem resistance by minimum inhibitory concentration in nosocomial isolates of Acinetobacter species: an experience at a tertiary care hospital in North India. J Health Popul Nutr 2008; 26:183-188. [PMID: 18686551 PMCID: PMC2740671] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Acinetobacter species are emerging as an important nosocomial pathogen. Multidrug-resistant Acinetobacter spp. has limited the option for effective treatment. Although carbapenems are effective for the treatment of such infections, resistance to this drug has recently been reported. This study was undertaken to assess resistance to carbapenem in clinical isolates of Acinetobacter spp. from hospitalized patients by both disc-diffusion and minimum inhibitory concentration (MIC) methods. All clinical samples from suspected cases of nosocomial infections were processed, and 265 isolates were identified as Acinetobacter species. These isolates were tested for antibiotic resistance by the disc-diffusion method with 14 antimicrobials, including meropenem and imipenem. Thereafter, all Acinetobacter species were subjected to MIC for meropenem. More than 80% resistance to second- and third-generation cephalosporins, aminoglycosides, and quinolones was recorded. Thirty percent of the strains were resistant to cefoperazone/sulbactam. Resistance to meropenem was observed in 6.4% of Acinetobacter spp. while 8.3% of the isolates showed intermediate resistance detected by MIC. All carbapenem-resistant/intermediate strains were also resistant to other (>10) antibiotics tested by the disc-diffusion method. The rising trend of resistance to carbapenem poses an alarming threat to the treatment for such infections. Regular monitoring, judicious prescription, and early detection of resistance to carbapenem are necessary to check further dissemination of drug resistance in Acinetobacter spp.
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Affiliation(s)
- A Gaur
- Department of Microbiology, Institute of Medical Science, Banaras Hindu University, Varanasi (UP) 221 005, India
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Bhattacharjee A, Anupurba S, Gaur A, Sen MR. Prevalence of inducible AmpC beta-lactamase-producing Pseudomonas aeruginosa in a tertiary care hospital in northern India. Indian J Med Microbiol 2008; 26:89-90. [PMID: 18227612 DOI: 10.4103/0255-0857.38872] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bhattacharjee A, Anupurba S, Gaur A, Sen MR. Prevalence of Inducible AmpC β-lactamase-Producing Pseudomonas aeruginosa in a Tertiary Care Hospital in Northern India. Indian J Med Microbiol 2008. [DOI: 10.1016/s0255-0857(21)02006-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Legionella spp. infections are often considered in the differential diagnosis of pneumonia in adults. This case report describes a pediatric stem cell transplant recipient presenting with cavitary pulmonary disease secondary to Legionella bozemanii infection. Also highlighted with this atypical clinical presentation are challenges in diagnosing legionellosis and concerns of increased vulnerability for such infections when severely immunocompromised patients are changed to nontrimethoprim-sulfamethoxazole Pneumocystis jiroveci pneumonia prophylaxis.
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Affiliation(s)
- Martha L Miller
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
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