1
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Dogan M, Watkins C, Ingram H, Moore N, Rucker GM, Gower EG, Eason JD, Bhalla A, Talwar M, Nezakatgoo N, Eymard C, Helmick R, Vanatta J, Bajwa A, Kuscu C, Kuscu C. Unveiling APOL1 haplotypes in a predominantly African-American cohort of kidney transplant patients: a novel classification using probe-independent quantitative real-time PCR. Front Med (Lausanne) 2024; 11:1325128. [PMID: 38660426 PMCID: PMC11039853 DOI: 10.3389/fmed.2024.1325128] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 03/20/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Apolipoprotein-L1 (APOL1) is a primate-specific protein component of high-density lipoprotein (HDL). Two variants of APOL1 (G1 and G2), provide resistance to parasitic infections in African Americans but are also implicated in kidney-related diseases and transplant outcomes in recipients. This study aims to identify these risk variants using a novel probe-independent quantitative real-time PCR method in a high African American recipient cohort. Additionally, it aims to develop a new stratification approach based on a haplotype-centric model. Methods Genomic DNA was extracted from recipient PBMCs using SDS lysis buffer and proteinase K. A quantitative PCR assay with modified forward primers and a common reverse primer enabled us to quantitatively identify single nucleotide polymorphisms (SNPs) and the 6-bp deletion. Additionally, we used Sanger sequencing to verify our QPCR findings. Results Our novel probe-independent qPCR effectively distinguished homozygous wild-type, heterozygous SNPs/deletions, and homozygous SNPs/deletions, with at least 4-fold differences. A high prevalence of APOL1 variants was observed (18% two-risk alleles, 34% one-risk allele) in our recipient cohort. Intriguingly, no significant impact of recipient APOL1 variants on transplant outcomes was observed up to 12-month of follow-ups. Ongoing research will encompass more time points and a larger patient cohort, allowing for a comprehensive evaluation of G1/G2 variant subgroups categorized by new haplotype scores, enriching our understanding. Conclusion Our cost-effective and rapid qPCR technique facilitates APOL1 genotyping within hours. Prospective and retrospective studies will enable comparisons with long-term allograft rejection, potentially predicting early/late-stage transplant outcomes based on haplotype evaluation in this diverse group of kidney transplant recipients.
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Affiliation(s)
- Murat Dogan
- Transplant Research Institute, Memphis, TN, United States
- Department of Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Christine Watkins
- Transplant Research Institute, Memphis, TN, United States
- Department of Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Holly Ingram
- Transplant Research Institute, Memphis, TN, United States
- Department of Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Nicholas Moore
- Transplant Research Institute, Memphis, TN, United States
| | - Grace M. Rucker
- Transplant Research Institute, Memphis, TN, United States
- Department of Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | | | | | - Anshul Bhalla
- Transplant Research Institute, Memphis, TN, United States
- Department of Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
- Methodist Hospital, Memphis, TN, United States
| | - Manish Talwar
- Transplant Research Institute, Memphis, TN, United States
- Department of Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
- Methodist Hospital, Memphis, TN, United States
| | - Nosratollah Nezakatgoo
- Transplant Research Institute, Memphis, TN, United States
- Department of Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
- Methodist Hospital, Memphis, TN, United States
| | - Corey Eymard
- Transplant Research Institute, Memphis, TN, United States
- Department of Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
- Methodist Hospital, Memphis, TN, United States
| | - Ryan Helmick
- Transplant Research Institute, Memphis, TN, United States
- Department of Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
- Methodist Hospital, Memphis, TN, United States
| | - Jason Vanatta
- Transplant Research Institute, Memphis, TN, United States
- Department of Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
- Methodist Hospital, Memphis, TN, United States
| | - Amandeep Bajwa
- Transplant Research Institute, Memphis, TN, United States
- Department of Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Canan Kuscu
- Transplant Research Institute, Memphis, TN, United States
- Department of Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Cem Kuscu
- Transplant Research Institute, Memphis, TN, United States
- Department of Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
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Yamauchi J, Azhar A, Hall IE, Bhalla A, Potluri VS, Tanriover B, Gupta G, Imlay H, Truax C, Balaraman V, Raghavan D, Zimmerman M, Campsen J, Rofaiel G, Baker T, Molnar MZ. Comparison of Short-Term Outcomes in Kidney Transplant Recipients from SARS-CoV-2-Infected versus Noninfected Deceased Donors. Clin J Am Soc Nephrol 2023; 18:1466-1475. [PMID: 37574663 PMCID: PMC10637460 DOI: 10.2215/cjn.0000000000000275] [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: 03/31/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Acceptable post-transplant outcomes were reported in kidney transplant recipients from donors with coronavirus disease 2019 (COVID-19); however, there are no comparative studies with well-matched controls. METHODS This multicenter, prospective observational study, which included three transplant centers in the United States, enrolled 61 kidney recipients from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected deceased donors. Using optimal matching methods, we matched every recipient to three comparators receiving kidneys from SARS-CoV-2-negative deceased donors with otherwise highly similar characteristics in the same transplant centers to compare 6-month eGFR. RESULTS Among recipients of SARS-CoV-2-infected donor kidneys, one recipient died with a functional graft within 6 months. Mean 6-month eGFR was not significantly different between SARS-CoV-2-infected and noninfected donor groups (55±21 and 57±25 ml/min per 1.73 m 2 , respectively; P = 0.61). Six-month eGFR in recipients from SARS-CoV-2-infected donors who died of reasons other than COVID-19 was not significantly different from those from SARS-CoV-2-negative donors (58±22 and 56±25 ml/min per 1.73 m 2 , respectively; P = 0.51). However, recipients from donors who died of COVID-19 had significantly lower 6-month eGFR than those from SARS-CoV-2-negative donors (46±17 and 58±27 ml/min per 1.73 m 2 , respectively; P = 0.03). No donor-to-recipient SARS-CoV-2 transmission was observed. CONCLUSIONS Six-month eGFR was not significantly different between recipients of kidneys from SARS-CoV-2-infected and noninfected donors. However, those receiving kidneys from donors who died of COVID-19 had significantly lower 6-month eGFR. Donor-to-recipient SARS-CoV-2 transmission was not observed.
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Affiliation(s)
- Junji Yamauchi
- Department of Internal Medicine, Division of Nephrology and Hypertension, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah
| | - Ambreen Azhar
- Virginia Commonwealth University, Richmond, Virginia
| | - Isaac E. Hall
- Department of Internal Medicine, Division of Nephrology and Hypertension, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah
| | - Anshul Bhalla
- Department of Internal Medicine, Division of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Vishnu S. Potluri
- Department of Internal Medicine, Division of Nephrology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bekir Tanriover
- Department of Internal Medicine, University of Arizona, Tucson, Arizona
| | - Gaurav Gupta
- Virginia Commonwealth University, Richmond, Virginia
| | - Hannah Imlay
- Department of Internal Medicine, Division of Infectious Diseases, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah
| | - Crystal Truax
- Department of Pharmacy, University of Utah Health, Salt Lake City, Utah
| | - Vasanthi Balaraman
- Department of Internal Medicine, Division of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Divya Raghavan
- Department of Internal Medicine, Division of Nephrology and Hypertension, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah
| | - Michael Zimmerman
- Department of Surgery, Division of Transplantation and Advanced Hepatobiliary Surgery, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah
| | - Jeffrey Campsen
- Department of Surgery, Division of Transplantation and Advanced Hepatobiliary Surgery, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah
| | - George Rofaiel
- Department of Surgery, Division of Transplantation and Advanced Hepatobiliary Surgery, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah
| | - Talia Baker
- Department of Surgery, Division of Transplantation and Advanced Hepatobiliary Surgery, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah
| | - Miklos Z. Molnar
- Department of Internal Medicine, Division of Nephrology and Hypertension, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah
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3
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Dogan M, Watkins C, Ingram H, Moore N, Rucker GM, Gower EG, Eason JD, Bhalla A, Talwar M, Nezakatgoo N, Eymard C, Helmick R, Vanatta J, Bajwa A, Kuscu C, Kuscu C. Unveiling APOL1 Haplotypes: A Novel Classification Through Probe-Independent Quantitative Real-Time PCR. bioRxiv 2023:2023.10.16.562539. [PMID: 37905084 PMCID: PMC10614821 DOI: 10.1101/2023.10.16.562539] [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] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Introduction Apolipoprotein-L1 (APOL1) is a primate-specific protein component of high- density lipoprotein (HDL). Two variants of APOL1 (G1 and G2), provide resistance to parasitic infections in African Americans but are also implicated in kidney-related diseases and transplant outcomes in recipients. This study aims to identify these risk variants using a novel probe- independent quantitative real-time PCR method in a high African American recipient cohort. Additionally, it aims to develop a new stratification approach based on haplotype-centric model. Methods Genomic DNA was extracted from recipient PBMCs using SDS lysis buffer and proteinase K. Quantitative PCR assay with modified forward primers and a common reverse primer enabled us to identify single nucleotide polymorphisms (SNPs) and the 6-bp deletion quantitatively. Additionally, we used sanger sequencing to verify our QPCR findings. Results Our novel probe-independent qPCR effectively distinguished homozygous wild-type, heterozygous SNPs/deletion, and homozygous SNPs/deletion, with at least 4-fold differences. High prevalence of APOL1 variants was observed (18% two-risk alleles, 34% one-risk allele) in our recipient cohort. Intriguingly, up to 12-month follow-up revealed no significant impact of recipient APOL1 variants on transplant outcomes. Ongoing research will encompass more time points and a larger patient cohort, allowing a comprehensive evaluation of G1/G2 variant subgroups categorized by new haplotype scores, enriching our understanding. Conclusions Our cost-effective and rapid qPCR technique facilitates APOL1 genotyping within hours. Prospective and retrospective studies will enable comparisons with long-term allograft rejection, potentially predicting early/late-stage transplant outcomes based on haplotype evaluation in this diverse group of kidney transplant recipients.
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SAMRA T, Kumar V, Mahajan V, Ramachandran R, Puri G, Pal A, Naik B, Bhalla A, Dixit R. WCN23-0857 Utility of urinary biomarkers for diagnosis of acute kidney injury (AKI) in COVID-19. Kidney Int Rep 2023. [PMCID: PMC10025671 DOI: 10.1016/j.ekir.2023.02.989] [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: 03/22/2023] Open
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Azhar A, Tsujita M, Talwar M, Balaraman V, Bhalla A, Eason JD, Nouer SS, Sumida K, Remport A, Hall IE, Griffin R, Rofaiel G, Molnar MZ. CMV specific T cell immune response in hepatitis C negative kidney transplant recipients receiving transplant from hepatitis C viremic donors and hepatitis C aviremic donors. Ren Fail 2022; 44:831-841. [PMID: 35546431 PMCID: PMC9103398 DOI: 10.1080/0886022x.2022.2072744] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/12/2022] [Accepted: 04/22/2022] [Indexed: 12/03/2022] Open
Abstract
Kidney transplants (KT) from hepatitis C (HCV) viremic donors to HCV negative recipients has shown promising renal outcomes, however, high incidence of cytomegalovirus (CMV) viremia were reported. We performed a prospective cohort study of 52 HCV negative KT recipients from Methodist University Hospital including 41 receiving transplants from HCV aviremic donors and 11 from HCV viremic donors. CMV specific CD4+ and CD8 + T cell immunity was measured by intracellular flow cytometry assay. Primary outcome was the development of positive CMV specific CD4+ and CD8 + T cell immune response in the entire cohort and each subgroup. The association between donor HCV status and CMV specific CD4+ and CD8 + T cell immune response was analyzed by Cox proportional hazard models. Mean recipient age was 48 ± 13 years, with 73% male and 82% African American. Positive CMV specific CD4+ and CD8 + T cell immune response was found in 53% and 47% of the cohort at 1 month, 65% and 70% at 2 months, 80% and 75% at 4 months, 89% and 87% at 6 months, and 94% and 94% at 9 months post-transplant, respectively. There was no significant difference in the incidence of positive CMV specific T cell immune response between recipients of transplants from HCV aviremic donors compared to HCV viremic donors in unadjusted (for CD8+: HR = 1.169, 95%CI: 0.521-2.623; for CD4+: HR = 1.208, 95%CI: 0.543-2.689) and adjusted (for CD8+: HR = 1.072, 95%CI: 0.458-2.507; for CD4+: HR = 1.210, 95%CI: 0.526-2.784) Cox regression analyses. HCV viremia in donors was not associated with impaired development of CMV specific T cell immunity in this cohort.
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Affiliation(s)
- Ambreen Azhar
- Department of Medicine, Division of Nephrology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Makoto Tsujita
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA
- Department of Surgery, Division of Transplant Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Manish Talwar
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA
- Department of Surgery, Division of Transplant Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Vasanthi Balaraman
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA
- Department of Surgery, Division of Transplant Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Anshul Bhalla
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA
- Department of Surgery, Division of Transplant Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - James D. Eason
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA
- Department of Surgery, Division of Transplant Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Simonne S. Nouer
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Keiichi Sumida
- Department of Medicine, Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Adam Remport
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Isaac E. Hall
- Department of Medicine, Division of Nephrology & Hypertension, University of Utah, Salt Lake City, UT, USA
| | - Randi Griffin
- Office of Clinical Research, University of Tennessee Health Science Center, Memphis, TN, USA
| | - George Rofaiel
- Department of Surgery, Division of Transplantation and Advanced Hepatobiliary Surgery, University of Utah, Salt Lake City, UT, USA
| | - Miklos Z. Molnar
- Department of Medicine, Division of Nephrology & Hypertension, University of Utah, Salt Lake City, UT, USA
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Abstract
OBJECTIVE Although the elderly population remains at high risk for tuberculosis, studies addressing tuberculous meningitis (TBM) in this age group are scarce. The present study aimed to evaluate the spectrum and outcome of geriatric TBM and document differences between older and young patients. METHODS A prospective cohort study was conducted in the adult TBM patients admitted at PGIMER, Chandigarh (India). Consecutive older patients aged 60 years and above were enrolled from January 2019 to December 2020, and young adults aged 18-59 years were enrolled from July 2019 to December 2019. RESULTS Fifty-five older patients with a mean age of 66.6 years and 73 young patients with a mean age of 35.1 years were enrolled. At admission, older patients were more likely to have altered mental status (96.4% vs. 78.1%, P = 0.003) and advanced disease with British medical research council staging 2 or 3 (98.2% vs. 89.0%, P = 0.043); however, headache (38.2% vs. 67.1%, P = 0.001), vomiting (18.2% vs. 35.6%, P = 0.030) and fever (80.0% vs. 91.8%, P = 0.052) were less common. Cerebrospinal fluid (CSF) abnormalities were less marked in older patients, with a significant difference in median total cells (70 vs. 110/µl, P = 0.013). Hydrocephalous and infarct were common neuroimaging abnormalities in both groups; however, tuberculomas were significantly less in the elderly (15.1% vs. 35.2%, P = 0.012). Older patients had a significantly low survival rate (56.4% vs. 76.7%, P = 0.021). CONCLUSION Significant differences in clinical, CSF and radiological characteristics exist between elderly and young TBM patients, with survival remains dismal in the elderly.
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Affiliation(s)
- N Rahman
- From the 1Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, 4th floor, F block, Sector 12, Chandigarh 160012, India
| | - A K Pannu
- From the 1Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, 4th floor, F block, Sector 12, Chandigarh 160012, India
| | - R Yadav
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Research Block A, Sector 12, Chandigarh 160012, India
| | - S Sethi
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Research Block A, Sector 12 , Chandigarh 160012, India
| | - A Saroch
- From the 1Department of Internal Medicine , Postgraduate Institute of Medical Education and Research, Nehru Hospital, 4th floor, F block, Sector 12, Chandigarh 160012, India
| | - M Garg
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Sector 12, Chandigarh 160012, India
| | - D Kumar
- From the 1Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, 4th floor, F block, Sector 12, Chandigarh 160012, India
| | - A Bhalla
- From the 1Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, 4th floor, F block, Sector 12, Chandigarh 160012, India
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7
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Arora N, Gulati P, Suri V, Bhalla A, Singh H. Hemolytic anemia in expanded dengue syndrome. QJM 2022; 115:103-104. [PMID: 34850225 DOI: 10.1093/qjmed/hcab298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- N Arora
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - P Gulati
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - V Suri
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - A Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - H Singh
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
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8
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Molnar MZ, Potluri VS, Schaubel DE, Sise ME, Concepcion BP, Forbes RC, Blumberg E, Bloom RD, Shaffer D, Chung RT, Strohbehn IA, Elias N, Azhar A, Shah M, Sawinski D, Binari LA, Talwar M, Balaraman V, Bhalla A, Eason JD, Besharatian B, Trofe-Clark J, Goldberg DS, Reese PP. Association of donor hepatitis C virus infection status and risk of BK polyomavirus viremia after kidney transplantation. Am J Transplant 2022; 22:599-609. [PMID: 34613666 PMCID: PMC8968853 DOI: 10.1111/ajt.16834] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 02/12/2021] [Revised: 08/01/2021] [Accepted: 09/03/2021] [Indexed: 02/03/2023]
Abstract
Kidney transplantation (KT) from deceased donors with hepatitis C virus (HCV) into HCV-negative recipients has become more common. However, the risk of complications such as BK polyomavirus (BKPyV) remains unknown. We assembled a retrospective cohort at four centers. We matched recipients of HCV-viremic kidneys to highly similar recipients of HCV-aviremic kidneys on established risk factors for BKPyV. To limit bias, matches were within the same center. The primary outcome was BKPyV viremia ≥1000 copies/ml or biopsy-proven BKPyV nephropathy; a secondary outcome was BKPyV viremia ≥10 000 copies/ml or nephropathy. Outcomes were analyzed using weighted and stratified Cox regression. The median days to peak BKPyV viremia level was 119 (IQR 87-182). HCV-viremic KT was not associated with increased risk of the primary BKPyV outcome (HR 1.26, p = .22), but was significantly associated with the secondary outcome of BKPyV ≥10 000 copies/ml (HR 1.69, p = .03). One-year eGFR was similar between the matched groups. Only one HCV-viremic kidney recipient had primary graft loss. In summary, HCV-viremic KT was not significantly associated with the primary outcome of BKPyV viremia, but the data suggested that donor HCV might elevate the risk of more severe BKPyV viremia ≥10 000 copies/ml. Nonetheless, one-year graft function for HCV-viremic recipients was reassuring.
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Affiliation(s)
- Miklos Z. Molnar
- Division of Nephrology & Hypertension, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Vishnu S. Potluri
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, Philadelphia, PA
| | - Douglas E. Schaubel
- Department of Biostatistics, Epidemiology and Bioinformatics, Perelman School of Medicine, Philadelphia, PA
| | - Meghan E. Sise
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, MA
| | - Beatrice P. Concepcion
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN
| | - Rachel C. Forbes
- Department of Surgery, Division of Kidney and Pancreas Transplantation, Vanderbilt University Medical Center, Nashville, TN
| | - Emily Blumberg
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, Philadelphia, PA
| | - Roy D. Bloom
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, Philadelphia, PA
| | - David Shaffer
- Department of Surgery, Division of Kidney and Pancreas Transplantation, Vanderbilt University Medical Center, Nashville, TN
| | - Raymond T. Chung
- Department of Medicine, Division of Gastroenterology, Massachusetts General Hospital, Boston, MA
| | - Ian A. Strohbehn
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, MA
| | - Nahel Elias
- Department of Surgery, Transplant Center, Massachusetts General Hospital, Boston MA
| | - Ambreen Azhar
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mital Shah
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, Philadelphia, PA
| | - Deirdre Sawinski
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, Philadelphia, PA
| | - Laura A. Binari
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN
| | - Manish Talwar
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Vasanthi Balaraman
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Anshul Bhalla
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - James D. Eason
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Behdad Besharatian
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, Philadelphia, PA
| | | | - David S. Goldberg
- Division of Digestive Health and Liver Disease, Department of Medicine, University of Miami Miller School of Medicine, FL
| | - Peter P. Reese
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, Philadelphia, PA
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Bhalla A, Pannu AK. Are Ayurvedic medications store house of heavy metals? Toxicol Res (Camb) 2022; 11:179-183. [PMID: 35237422 PMCID: PMC8882783 DOI: 10.1093/toxres/tfab124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/25/2021] [Accepted: 12/09/2021] [Indexed: 01/17/2023] Open
Abstract
Ayurvedic formulations are widely used and perceived as safer medicine and subjected to be self-prescribed. However, recent reports have demonstrated adulterating these drugs with toxic quantities of heavy metals. To study the magnitude of the problem in Indian-manufactured Ayurvedic medications, we randomly collected common over-the-counter Ayurvedic preparations from the licensed Ayurvedic shops in the local markets of Chandigarh in 2017. The samples were analyzed to identify and quantify eight metal ions, including mercury, arsenic, lead, cadmium, zinc, iron, copper, and chromium, using inductively coupled plasma mass spectrometry in Postgraduate Institute of Medical Education and Research, Chandigarh. The permissible limit set by the Food and Agriculture Organization/World Health Organization (FAO/WHO) for herbal medicines was followed to define the high metal concentrations. Out of 43 Ayurvedic preparations, 42 were analyzed. Heavy metals were detected in all formulations. The median (range) concentrations (in μg/g or mg/kg) of the metals were quantified as follows- mercury, 13.52 (0.00-61 095.99); arsenic, 0.00 (0.00-1038.83); lead, 1.40 (0.00-57.09); zinc, 84.2200 (26.48-22 519.03); iron, 1356.21 (128.24-136 835.25); copper, 17.1450 (0.00-12 756.86) and chromium, 20.9050 (0.00-2717.58). The metal contents above the FAO/WHO-mandated limit for zinc, mercury, arsenic, and lead were detected in 35, 29, 6, and 2 formulations, respectively. All medications contained detectable quantities of zinc and iron. Copper was detected in all except one. Cadmium was not found in any sample. Ayurvedic medications have a high prevalence of heavy metals. An evaluation of the sources of contamination and the necessary drug safety regulations are required.
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Affiliation(s)
- A Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, 4th Floor, F Block, Nehru Hospital, PGIMER, Chandigarh 160012, India
| | - A K Pannu
- Correspondence address. Ashok Kumar Pannu, Room no. 26, 4th Floor, F Block, Nehru Hospital, PGIMER, Chandigarh, 160012, India. Tel: +919914291115, +918264786277; E-mail:
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10
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Pannu AK, Jhuria L, Bhalla A, Sharma N. OUP accepted manuscript. Toxicol Res (Camb) 2022; 11:361-366. [PMID: 35510238 PMCID: PMC9052320 DOI: 10.1093/toxres/tfac015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/15/2022] [Accepted: 02/19/2022] [Indexed: 11/14/2022] Open
Abstract
Introduction We recently derived a simplified 3-point PGI score (representing blood pH < 7.25, Glasgow coma scale [GCS] score < 13, and impaired systolic blood pressure [SBP] < 90 mm Hg), which accurately predicted in-hospital case fatality ratio (CFR) in acute aluminum phosphide poisoning. The present study aimed to validate the PGI score and compare it with Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II score, Sequential Organ Failure Assessment score (SOFA), and Simplified Acute Physiology Score (SAPS) II scores. Patients and Methods We performed a prospective cohort study in adult patients with aluminum phosphide ingestion admitted in PGIMER, Chandigarh (India), from April 2013 to August 2014. A univariant analysis detected the association of various baseline variables with CFR. Correlation of the PGI score with SOFA, SAPS-II, and APACHE-II scores was performed using Spearman's correlation (rs , range -1 to +1) and scatter plots. Results Seventy-six patients were enrolled (mean age, 28.3 years; 41 males). CFR was 60.5%. PGI score variables-pH, GCS, and impaired SBP predicted CFR (P-value <0.001). Among patients with a total PGI score of 3 or 2, 100% died, compared with 50% in score 1 and 10.7% in score 0. Baseline PGI, SOFA, SAPS-II, and APACHE-II scores predicted CFR (P-value <0.001). There was a positive correlation between the PGI score and SOFA score (rs , 0.855), SAPS-II score (rs , 0.861), and APACHE-II score (rs , 0.883). The P-value for all rs values was <0.001. Conclusion The PGI score is a validated toxidrome-specific and simplified risk-stratification tool. Validation in other populations is warranted to confirm its routine use.
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Affiliation(s)
| | | | | | - N Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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11
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Hu X, Lucas E, Hammer S, Gopal P, Bhalla A, Panarelli N, Westerhoff M, Cheng J, Nalbantoglu I. H. pylori Pattern Gastritis with Negative Helicobacter Immunohistochemical Stain: Does A Specific Comment in Pathology Report Impact Clinical Management? Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction/Objective
The clinical significance of H. pylori (HP) pattern of gastritis with a negative Helicobacter IHC stain on gastric biopsy is unclear. Some pathologists report this pattern in cases that are highly suggestive of HP infection with a comment raising the possibility of HP infection; however, the subsequent clinical management of these patients has not been well described.
Methods/Case Report
We conducted a retrospective comparison study of patients with gastric biopsy between 2016 and 2019. Group 1 included patients with chronic active or chronic inactive gastritis and negative HP IHC with a comment stating the gastritis pattern is suggestive of HP. Group 2 included patients with chronic active or chronic inactive gastritis and negative HP IHC with no comment about HP pattern.
Results (if a Case Study enter NA)
We identified 60 patients in Group 1 which were compared to 63 patients in Group 2. Group 1 more frequently had history of HP (48.3% vs. 29.1%, p<0.05). After diagnosis, Group 1 more frequently received treatment (51.7% vs. 20.6%, p<0.001). Of those who received treatment, Group 1 more frequently received HP treatment (triple or quadruple therapy; 21.7% vs. 1.6%, p<0.001). History of HP did not affect whether a patient was treated (p>0.05). Following post-biopsy HP treatment, more patients in Group 1 received fecal antigen test (23.7% vs. 5.5%, p<0.01). Age, gender, NSAID and PPI use did not differ between groups.
Conclusion
Adding the diagnostic comment raising the possibility of HP for patients with HP pattern gastritis with negative HP IHC changes clinical management and it is independent of patients’ prior HP history.
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Affiliation(s)
- X Hu
- Pathology, UT Southwestern Medical Center, Plano, Texas, UNITED STATES
| | - E Lucas
- Pathology, UT Southwestern Medical Center, Plano, Texas, UNITED STATES
| | - S Hammer
- Pathology, UT Southwestern Medical Center, Plano, Texas, UNITED STATES
| | - P Gopal
- Pathology, UT Southwestern Medical Center, Plano, Texas, UNITED STATES
| | - A Bhalla
- Pathology, Albert Einstein/Montefiore Medical Center, The Bronx, New York, UNITED STATES
| | - N Panarelli
- Pathology, Albert Einstein/Montefiore Medical Center, The Bronx, New York, UNITED STATES
| | - M Westerhoff
- Pathology, University of Michigan, Ann Arbor, Michigan, UNITED STATES
| | - J Cheng
- Pathology, University of Michigan, Ann Arbor, Michigan, UNITED STATES
| | - I Nalbantoglu
- Yale School of Medicine, New Haven, Connecticut, UNITED STATES
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12
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Azhar A, Binari LA, Joglekar K, Tsujita M, Talwar M, Balaraman V, Bhalla A, Eason JD, Hall IE, Rofaiel G, Forbes RC, Shaffer D, Concepcion BP, Molnar MZ. Association between ezetimibe usage and hepatitis C RNA levels in uninfected kidney transplant recipients who received hepatitis C infected kidneys. Clin Transplant 2021; 35:e14485. [PMID: 34523744 DOI: 10.1111/ctr.14485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/24/2021] [Accepted: 09/10/2021] [Indexed: 11/30/2022]
Abstract
Kidney transplantation (KT) from hepatitis C virus infected (HCV+) donors to HCV negative recipients achieve excellent graft function but have relatively higher rates of post-KT co-infections presumably due to prolonged HCV viremia in transmission-and-treat approach. Ezetimibe acts as an antagonist of Niemann-Pick C1-Like 1 receptor required for HCV entry and theoretically can reduce HCV viremia. However, no data is available to examine the role of ezetimibe as a bridge therapy between KT surgery and direct acting antiviral (DAA) initiation. A retrospective cohort study including 70 HCV+ to HCV negative KT recipients from Methodist University Hospital and Vanderbilt University Medical Center was performed to determine the association between ezetimibe usage and HCV viremia. Twenty patients received ezetimibe daily while 50 patients did not. Primary outcome of study was mean HCV RNA level at 1-2 weeks post-KT and before initiation of DAA. Median (IQR) viral load (VL) in log copies/ml was one log lower in ezetimibe group versus non-ezetimibe group (4.1 [3.7-5.3] vs. 5.1 [4.4-5.5], P = .01), and highest VL was also lower in ezetimibe group (4.2 [3.7-5.4] vs. 5.4 [4.7-5.9], P = .006). We concluded that ezetimibe bridge therapy might be associated with reduction in HCV VL while waiting for DAA initiation in HCV+ to HCV negative KT recipients.
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Affiliation(s)
- Ambreen Azhar
- Division of Nephrology, Department of Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Laura A Binari
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kiran Joglekar
- Division of Gastroenterology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Makoto Tsujita
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Manish Talwar
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Vasanthi Balaraman
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Anshul Bhalla
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - James D Eason
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Isaac E Hall
- Division of Nephrology & Hypertension, Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - George Rofaiel
- Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Rachel C Forbes
- Department of Surgery, Division of Kidney and Pancreas Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David Shaffer
- Department of Surgery, Division of Kidney and Pancreas Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Beatrice P Concepcion
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Miklos Z Molnar
- Division of Nephrology & Hypertension, Department of Medicine, University of Utah, Salt Lake City, Utah, USA
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13
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Agbim U, Cseprekal O, Yazawa M, Talwar M, Balaraman V, Bhalla A, Podila PSB, Maliakkal B, Nair S, Eason JD, Molnar MZ. Factors associated with hepatitis C antibody seroconversion after transplantation of kidneys from hepatitis C infected donors to hepatitis C naïve recipients. Ren Fail 2021; 42:767-775. [PMID: 32729359 PMCID: PMC7472509 DOI: 10.1080/0886022x.2020.1798784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background We aimed to assess the probability and factors associated with the presence of hepatitis C virus (HCV) antibody among HCV seronegative kidney transplant recipients receiving HCV-infected (nucleic acid testing positive) donor kidneys. Methods This is a retrospective review examining HCV antibody seroconversion of all kidney transplant recipients receiving an organ from an HCV-infected donor between 1 March 2018 and 2 December 2019 at a high-volume kidney transplant center in the southeast United States. Results Of 97 patients receiving HCV-infected kidneys, the final cohort consisted of 85 recipients with 5 (5.9%) recipients noted to have HCV antibody seroconversion in the setting of HCV viremia. The HCV RNA level at closest time of antibody measurement was higher in the seroconverted patients versus the ones who never converted [median and (interquartile range): 1,091,500 (345,000–8,360,000) vs 71,500 (73–313,000), p = 0.02]. No other significant differences including type of immunosuppression were noted between the HCV antibody positive group and HCV antibody negative group. Donor donation after cardiac death status [Odds Ratio (OR) and 95% Confidence Interval (CI) was: 8.22 (1.14–59.14)], donor age [OR (95% CI) (+5 years) was: 3.19 (1.39–7.29)] and Kidney Donor Profile Index [OR (95% CI) (+1) was:1.07 (1.01–1.15)] showed a statistically significant association with HCV seroconversion. Conclusions HCV antibody should not be considered routine screening for presence of infection in previously HCV naïve kidney transplant recipients receiving kidneys from HCV-infected donors, as only a modest percentage have antibody despite active viremia. The assessment of HCV viral load should be routine in all transplant recipients receiving organs from public health service increased risk donors.
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Affiliation(s)
- Uchenna Agbim
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA
| | - Orsolya Cseprekal
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Masahiko Yazawa
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.,Division of Nephrology and Hypertension, St. Marianna University School of Medicine, Tokyo, Japan
| | - Manish Talwar
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Vasanthi Balaraman
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Anshul Bhalla
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Pradeep S B Podila
- Faith and Health Division, Methodist Le Bonheur Healthcare, Memphis, TN, USA.,Division of Health Systems Management and Policy, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Benedict Maliakkal
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Satheesh Nair
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - James D Eason
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Miklos Z Molnar
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
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14
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Tsujita M, Azhar A, Joglekar K, Talwar M, Balaraman V, Bhalla A, Eason JD, Molnar MZ. The incidence of hepatitis B coinfection after deceased-donor kidney transplantation from hepatitis C infected donors to hepatitis C negative recipients. Transpl Int 2021; 34:986-987. [PMID: 33834561 DOI: 10.1111/tri.13877] [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: 10/21/2022]
Affiliation(s)
- Makoto Tsujita
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Kidney Transplantation, Masuko Memorial Hospital, Aichi, Japan
| | - Ambreen Azhar
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kiran Joglekar
- Division of Gastroenterology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Manish Talwar
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Vasanthi Balaraman
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Anshul Bhalla
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - James D Eason
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Miklos Z Molnar
- Division of Nephrology & Hypertension, Department of Medicine, University of Utah, Salt Lake City, Utah, USA
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15
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Gupta S, Mohindra R, Chauhan P, Singla V, Goyal K, Sahni V, Gaur R, Verma D, Ghosh A, Soni R, Suri V, Bhalla A, Singh M. SARS-CoV-2 Detection in Gingival Crevicular Fluid. J Dent Res 2021; 100:187-193. [PMID: 33138663 PMCID: PMC7642823 DOI: 10.1177/0022034520970536] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Understanding the pathophysiology of the coronavirus disease 2019 (COVID-19) infection remains a significant challenge of our times. The gingival crevicular fluid being representative of systemic status and having a proven track record of detecting viruses and biomarkers forms a logical basis for evaluating the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The study aimed to assess gingival crevicular fluid (GCF) for evidence of SARS-CoV-2 in 33 patients who were deemed to be COVID-19 positive upon nasopharyngeal sampling. An attempt was also made to comparatively evaluate it with saliva in terms of its sensitivity, as a diagnostic fluid for SARS-CoV-2. GCF and saliva samples were collected from 33 COVID-19-confirmed patients. Total RNA was extracted using NucliSENS easyMAG (bioMérieux) and eluted in the elution buffer. Envelope gene (E gene) of SARS-CoV-2 and human RNase P gene as internal control were detected in GCF samples by using the TRUPCR SARS-CoV-2 RT qPCR kit V-2.0 (I) in an Applied Biosystems 7500 real-time machine. A significant majority of both asymptomatic and mildly symptomatic patients exhibited the presence of the novel coronavirus in their GCF samples. Considering the presence of SARS-CoV-2 RNA in the nasopharyngeal swab sampling as gold standard, the sensitivity of GCF and saliva, respectively, was 63.64% (confidence interval [CI], 45.1% to 79.60%) and 64.52% (CI, 45.37% to 80.77%). GCF was found to be comparable to saliva in terms of its sensitivity to detect SARS-CoV-2. Saliva samples tested positive in 3 of the 12 patients whose GCF tested negative, and likewise GCF tested positive for 2 of the 11 patients whose saliva tested negative on real-time reverse transcription polymerase chain reaction. The results establish GCF as a possible mode of transmission of SARS-CoV-2, which is the first such report in the literature, and also provide the first quantifiable evidence pointing toward a link between the COVID-19 infection and oral health.
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Affiliation(s)
- S. Gupta
- Unit of Periodontics, Oral Health
Sciences Centre, Post Graduate Institute of Medical Education and Research (PGIMER),
Chandigarh, India
| | - R. Mohindra
- Department of Internal Medicine, PGIMER,
Chandigarh, India
| | - P.K. Chauhan
- Department of Virology, PGIMER,
Chandigarh, India
| | - V. Singla
- Department of Internal Medicine, PGIMER,
Chandigarh, India
| | - K. Goyal
- Department of Virology, PGIMER,
Chandigarh, India
| | - V. Sahni
- Dr. Harvansh Singh Judge Institute of
Dental Sciences & Hospital, Panjab University, Chandigarh, India
| | - R. Gaur
- Department of Virology, PGIMER,
Chandigarh, India
| | - D.K. Verma
- Department of Virology, PGIMER,
Chandigarh, India
| | - A. Ghosh
- Department of Virology, PGIMER,
Chandigarh, India
| | - R.K. Soni
- Department of Internal Medicine, PGIMER,
Chandigarh, India
| | - V. Suri
- Department of Internal Medicine, PGIMER,
Chandigarh, India
| | - A. Bhalla
- Department of Internal Medicine, PGIMER,
Chandigarh, India
| | - M.P. Singh
- Department of Virology, PGIMER,
Chandigarh, India
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16
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Tembhre MK, Parihar AS, Sharma VK, Imran S, Bhari N, Lakshmy R, Bhalla A. Enhanced expression of angiotensin-converting enzyme 2 in psoriatic skin and its upregulation in keratinocytes by interferon-γ: implication of inflammatory milieu in skin tropism of SARS-CoV-2. Br J Dermatol 2020; 184:577-579. [PMID: 33155280 DOI: 10.1111/bjd.19670] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/31/2020] [Accepted: 11/03/2020] [Indexed: 12/23/2022]
Affiliation(s)
- M K Tembhre
- Department of Dermatology and Venereology, AIIMS, New Delhi, India.,Department of Cardiac Biochemistry, AIIMS, New Delhi, India
| | - A S Parihar
- Department of Dermatology and Venereology, AIIMS, New Delhi, India
| | - V K Sharma
- Department of Dermatology and Venereology, AIIMS, New Delhi, India
| | - S Imran
- Department of Dermatology and Venereology, AIIMS, New Delhi, India
| | - N Bhari
- Department of Dermatology and Venereology, AIIMS, New Delhi, India
| | - R Lakshmy
- Department of Cardiac Biochemistry, AIIMS, New Delhi, India
| | - A Bhalla
- Department of Biotechnology, APS University, Rewa, India
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17
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Molnar MZ, Azhar A, Tsujita M, Talwar M, Balaraman V, Bhalla A, Podila PSB, Kothadia J, Agbim UA, Maliakkal B, Satapathy SK, Kovesdy CP, Nair S, Eason JD. Transplantation of Kidneys From Hepatitis C Virus-Infected Donors to Hepatitis C Virus-Negative Recipients: One-Year Kidney Allograft Outcomes. Am J Kidney Dis 2020; 77:739-747.e1. [PMID: 33333148 DOI: 10.1053/j.ajkd.2020.10.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 07/10/2020] [Accepted: 10/21/2020] [Indexed: 01/26/2023]
Abstract
RATIONALE & OBJECTIVE Transplant centers in the United States are increasingly willing to transplant kidneys from hepatitis C virus (HCV)-infected (HCV+) donors into HCV- recipients. We studied the association between donor HCV infection status and kidney allograft function and posttransplantation allograft biopsy findings. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS We examined 65 HCV- recipients who received a kidney from a HCV+ donor and 59 HCV- recipients who received a kidney from a HCV- donor during 2018 at a single transplant center. EXPOSURE Predictor(s) of donor infection with HCV. OUTCOMES Kidney allograft function and allograft biopsy findings during the first year following transplantation. ANALYTICAL APPROACH We compared estimated glomerular filtration rate (eGFR), findings on for-cause and surveillance protocol biopsies, development of de novo donor-specific antibodies (DSAs), and patient and allograft outcomes during the first year following transplantation between recipients of HCV+ and HCV- kidneys. We used linear regression to estimate the independent association between allograft function and HCV viremic status of the kidney donor. RESULTS The mean age of recipients was 52 ± 11 (SD) years, 43% were female, 19% and 80% of recipients were White and Black, respectively. Baseline characteristics were similar between the HCV+ and HCV- groups. There were no statistically significant differences between the HCV+ and HCV- groups in delayed graft function rates (12% vs 8%, respectively); eGFRs at 3, 6, 9, and 12 months post-transplantation; proportions of patients with cellular rejection (6% vs 7%, respectively); and proportions with antibody-mediated rejection (7% vs 10%, respectively) or de novo DSAs (31% vs 20%, respectively). HCV viremic status was not associated with eGFR at 3, 6, 9, or 12 months. LIMITATIONS Generalizability from a single-center study and small sample size was limited. CONCLUSIONS Recipients of kidneys from donors infected with HCV had similar kidney allograft function and probability of rejection in the first year after transplantation compared to those who received kidneys from donors without HCV infection.
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Affiliation(s)
- Miklos Z Molnar
- Division of Nephrology & Hypertension, Department of Medicine, University of Utah, Salt Lake City, UT.
| | - Ambreen Azhar
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN; Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - Makoto Tsujita
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN; Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - Manish Talwar
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN; Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - Vasanthi Balaraman
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN; Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - Anshul Bhalla
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN; Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - Pradeep S B Podila
- Faith and Health Division, Methodist Le Bonheur Healthcare, Memphis, TN; Division of Health Systems Management and Policy, School of Public Health, The University of Memphis, Memphis, TN
| | - Jiten Kothadia
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN; Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - Uchenna A Agbim
- Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - Benedict Maliakkal
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN; Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - Sanjaya K Satapathy
- Department of Medicine, Sandra Atlas Bass Center for Liver Diseases and Transplantation, Zucker School of Medicine at Hofstra University, Northshore University Hospital/Northwell Health, Manhasset, NY
| | - Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN; Nephrology Section, Memphis Veterans' Affairs Medical Center, Memphis, TN
| | - Satheesh Nair
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN; Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - James D Eason
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN; Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
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18
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Yazawa M, Fülöp T, Cseprekal O, Talwar M, Balaraman V, Bhalla A, Azhar A, Kovesdy CP, Eason JD, Molnar MZ. The incidence of cytomegalovirus infection after deceased-donor kidney transplantation from hepatitis-C antibody positive donors to hepatitis-C antibody negative recipients. Ren Fail 2020; 42:1083-1092. [PMID: 33100098 PMCID: PMC7594852 DOI: 10.1080/0886022x.2020.1835675] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 09/16/2020] [Accepted: 10/05/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Deceased-donor kidney transplantation (KT) from hepatitis C (HCV)-infected donors into HCV-uninfected recipients (HCV D+/R-) could become standard care in the near future. However, HCV viral replication by viral transmission might lead to a higher incidence of cytomegalovirus (CMV) infection in these recipients. METHODS A national-registry-based retrospective cohort study was conducted using the Scientific Registry of Transplant Recipients (SRTR) data set. We assessed the incidence of CMV infection in HCV antibody (Ab) negative recipients receiving kidneys from HCV Ab positive (HCVAb D+/R-) and negative (HCVAb D-/R-) donors. The risk of CMV infection was analyzed by Cox regression analysis in a propensity score (PS) matched-cohort of HCVAb D+/R- (n = 950) versus HCVAb D-/R- (n = 950). Sensitivity analysis was also conducted in the entire cohort (n = 181 082). RESULTS The mean age at baseline was 54 years, 75% were male, and 55% of the patients were African American in PS-matched cohort. Compared to the HCVAb D-/R - patients, recipients with HCVAb D+/R - showed identical probability for the incidence of CMV infection (Hazard Ratio (HR) = 1.00, 95% Confidence Interval (CI): 0.82-1.22). In the sensitivity analysis, compared to the HCVAb D-/R - patients, the HCVAb D+/R - group had a significantly lower risk of CMV infection in the unadjusted analysis (HR = 0.75, 95%CI: 0.65-0.85), while this risk difference disappeared after the adjusted analysis (HR = 0.99, 95%CI: 0.87-1.14). CONCLUSION The incidence of CMV infection was similar in recipients who received HCVAb D + and HCVAb D - KT. Further studies are needed to assess this association in KT from HCV nucleic acid positive donors.
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Affiliation(s)
- Masahiko Yazawa
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA
- Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Tibor Fülöp
- Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
- Medicine Service, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Orsolya Cseprekal
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Manish Talwar
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA
- Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Vasanthi Balaraman
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA
- Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Anshul Bhalla
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA
- Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ambreen Azhar
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA
- Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Csaba P. Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, TN, USA
| | - James D. Eason
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA
- Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Miklos Z. Molnar
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA
- Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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19
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Molnar MZ, Bhalla A, Azhar A, Tsujita M, Talwar M, Balaraman V, Sodhi A, Kadaria D, Eason JD, Hayek SS, Coca SG, Shaefi S, Neyra JA, Gupta S, Leaf DE, Kovesdy CP. Outcomes of critically ill solid organ transplant patients with COVID-19 in the United States. Am J Transplant 2020; 20:3061-3071. [PMID: 32844546 PMCID: PMC7460925 DOI: 10.1111/ajt.16280] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/11/2020] [Accepted: 08/17/2020] [Indexed: 01/25/2023]
Abstract
National data on patient characteristics, treatment, and outcomes of critically ill coronavirus disease 2019 (COVID-19) solid organ transplant (SOT) patients are limited. We analyzed data from a multicenter cohort study of adults with laboratory-confirmed COVID-19 admitted to intensive care units (ICUs) at 68 hospitals across the United States from March 4 to May 8, 2020. From 4153 patients, we created a propensity score matched cohort of 386 patients, including 98 SOT patients and 288 non-SOT patients. We used a binomial generalized linear model (log-binomial model) to examine the association of SOT status with death and other clinical outcomes. Among the 386 patients, the median age was 60 years, 72% were male, and 41% were black. Death within 28 days of ICU admission was similar in SOT and non-SOT patients (40% and 43%, respectively; relative risk [RR] 0.92; 95% confidence interval [CI]: 0.70-1.22). Other outcomes and requirement for organ support including receipt of mechanical ventilation, development of acute respiratory distress syndrome, and receipt of vasopressors were also similar between groups. There was a trend toward higher risk of acute kidney injury requiring renal replacement therapy in SOT vs. non-SOT patients (37% vs. 27%; RR [95% CI]: 1.34 [0.97-1.85]). Death and organ support requirement were similar between SOT and non-SOT critically ill patients with COVID-19.
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Affiliation(s)
- Miklos Z. Molnar
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee, USA,Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA,Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA,Correspondence Miklos Z. Molnar
| | - Anshul Bhalla
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee, USA,Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Ambreen Azhar
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee, USA,Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Makoto Tsujita
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee, USA,Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Manish Talwar
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee, USA,Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Vasanthi Balaraman
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee, USA,Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Amik Sodhi
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Dipen Kadaria
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - James D. Eason
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee, USA,Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Salim S. Hayek
- Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Steven G. Coca
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shahzad Shaefi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Javier A. Neyra
- Division of Nephrology, Bone and Mineral Metabolism, Department of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Shruti Gupta
- Division of Renal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - David E. Leaf
- Division of Renal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Csaba P. Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA,Nephrology Section, Memphis VA Medical Center, Memphis, Tennessee, USA
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20
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Pannu AK, Bhalla A, Vishnu RI, Dhibar DP, Sharma N, Vijayvergiya R. Organophosphate induced delayed neuropathy after an acute cholinergic crisis in self-poisoning. Clin Toxicol (Phila) 2020; 59:488-492. [PMID: 33078989 DOI: 10.1080/15563650.2020.1832233] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Despite organophosphate pesticide is the most prevalent cause of acute poisoning in low- and middle-income countries, data on organophosphate induced delayed neuropathy (OPIDN) are limited. We aimed to characterize organophosphates' long-term effects on the peripheral nervous system after an acute cholinergic crisis in adults. METHODS We performed a prospective observational study in an academic hospital of north India in patients aged 13-40 years with acute organophosphate ingestion. After resolving the cholinergic crisis, the patients were followed for six months with neurologic assessments, including history, neurologic examination, and nerve conduction study (NCS). RESULTS Twenty-three patients were recruited to the study. All but one had normal neurological examination and NCS at discharge from hospital a median duration of six days (interquartile range, 3-10) after self-poisoning. Eight (34.8%) developed OPIDN during the six-month follow-up. Three patients had symptomatic neuropathy, and NCS detected subclinical peripheral nerve involvement in five. All cases were associated with chlorpyrifos ingestion (8/17 total chlorpyrifos cases). Two OPIDN cases had foot drop and gait ataxia at three-month which persist at six-month. One patient had distal paresthesia at three months, which improved at a six-month follow-up. NCS in OPIDN cases invariably revealed axonal degeneration, injury to motor fibers more than sensory fibers, and frequent peroneal nerve involvement. None of the baseline characteristics, including the ingested amount, predicted clinical or subclinical OPIDN in chlorpyrifos self-poisoned patients on a univariant analysis. CONCLUSION Peripheral nerve involvement is not uncommon after recovery from a cholinergic crisis in chlorpyrifos self-poisoning and debilitating in some patients. Detection of subclinical injury on NCS may provide an early window to prevent severe symptomatic neuropathy.
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Affiliation(s)
- A K Pannu
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R I Vishnu
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - D P Dhibar
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - N Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Vijayvergiya
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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21
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Yazawa M, Balaraman V, Tsujita M, Azhar A, Talwar M, Bhalla A, Potukuchi PK, Eason JD, Kovesdy CP, Molnar MZ. Donor hepatitis C antibody positivity misclassifies kidney donor profile index in non-hepatitis C-infected donors: time to revise the kidney donor profile index - a retrospective cohort study. Transpl Int 2020; 33:1732-1744. [PMID: 32935416 DOI: 10.1111/tri.13743] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/13/2020] [Accepted: 09/07/2020] [Indexed: 12/25/2022]
Abstract
The kidney donor profile index (KDPI) defines an hepatitis C (HCV) positive donor based on HCV antibody (Ab) and/or nucleic acid amplification test (NAT) positivity, with donors who are not actively infected (Ab+/NAT-) also classified as HCV positive. From Scientific Registry of Transplant Recipients dataset, we identified HCV-negative recipients, who received a kidney transplant from HCV Ab+/NAT- (n = 116) and HCV Ab-/NAT- (n = 25 574) donor kidneys. We then compared recipients' estimated glomerular filtration rate (eGFR) at 6 months in matched cohorts, using combined exact matching (based on KDPI) and propensity score matching. We created two separate matched cohorts: for the first cohort, we used the allocation KDPI, while for the second cohort we used an optimal KDPI, where the HCV component of KDPI was considered negative in Ab+/NAT- patients. The mean ± SD age of the allocation KDPI-matched cohort at baseline was 59 ± 10 years, 69% were male, 61% were white. Recipients' eGFR at 6 months after transplantation was significantly higher in the HCV Ab+/NAT- group compared to the HCV Ab-/NAT- group (61.1 ± 17.9 vs. 55.6 ± 18.8 ml/min/1.73 m2 , P = 0.011) in the allocation KDPI-matched cohort, while it was similar (61.8 ± 19.5 vs. 62.1 ± 20.1 ml/min/1.73 m2 , P = 0.9) in the optimal KDPI-matched cohort. Recipients who received HCV Ab positive, but NAT-negative donor kidneys did not experience worse 6-month eGFR than correctly matched HCV Ab-/NAT- recipients.
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Affiliation(s)
- Masahiko Yazawa
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.,Divison of Nephrology and Hypertension, St. Marianna University School of Medicine, Tokyo, Japan
| | - Vasanthi Balaraman
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Makoto Tsujita
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ambreen Azhar
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Manish Talwar
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Anshul Bhalla
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Praveen K Potukuchi
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,IHOP, College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN, USA
| | - James D Eason
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Nephrology Section, Memphis VA Medical Center, Memphis, TN, USA
| | - Miklos Z Molnar
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.,Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
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22
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Jhuria L, Muthu V, Gupta S, Singh MP, Biswal M, Goyal K, Pannu AK, Kumari S, Bhalla A, Mohindra R, Suri V. Coinfection of H1N1 Influenza and Scrub Typhus-A Review. QJM 2020; 113:465-468. [PMID: 32031635 DOI: 10.1093/qjmed/hcaa021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/25/2019] [Indexed: 11/13/2022] Open
Abstract
The H1N1 influenza infection usually coincides with the typical scrub typhus season in North India. This leads to diagnostic difficulties due to their similar and non-specific symptoms. We describe three patients with confirmed co-infection of pandemic (H1N1) influenza and scrub typhus who had presented with acute respiratory distress syndrome. A systematic review of database yielded one case of scrub typhus and H1N1 influenza co-infection reported from South Korea. Co-infection of influenza with tropical infections may not be uncommon in endemic countries and hence a high index of suspicion on the part of physicians coupled with appropriate investigations are needed. The true burden of co-infections needs to be evaluated during outbreaks of influenza in a systematic manner.
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Affiliation(s)
- L Jhuria
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India
| | - V Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India
| | - S Gupta
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India
| | - M P Singh
- Department of Virology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India
| | - M Biswal
- Department of Virology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India
| | - K Goyal
- Department of Virology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India
| | - A K Pannu
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India
| | - S Kumari
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India
| | - A Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India
| | - R Mohindra
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India
| | - V Suri
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India
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23
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Bhalla A, Zhao N, Rivas DD, Ho T, Perez de Llano L, Mukherjee M, Nair P. Exacerbations of Severe Asthma While on Anti-IL-5 Biologics. J Investig Allergol Clin Immunol 2020; 30:307-316. [PMID: 32573459 DOI: 10.18176/jiaci.0628] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Anti-interleukin 5 (IL-5) and anti-IL-5 receptor α monoclonal antibodies markedly decrease airway and peripheral blood eosinophil numbers and are thus highly effective in reducing asthma exacerbations. Nonetheless, these biologics do not completely resolve exacerbations. There is very little information on the cellular nature of exacerbations during treatment with biologics. Using illustrative clinical case scenarios, we highlight the importance of carefully characterizing asthmatics at the time of exacerbation and recognizing neutrophilic causes of exacerbations to ensure optimal management. While an eosinophilic exacerbation may improve with more corticosteroids or by switching to another anti-IL-5 monoclonal antibody, a noneosinophilic exacerbation will likely not. An infective exacerbation needs to be recognized, and the pathogen must be identified and treated with the appropriate antimicrobial agent.
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Affiliation(s)
- A Bhalla
- Firestone Institute for Respiratory Health, St Joseph's Healthcare & Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - N Zhao
- Firestone Institute for Respiratory Health, St Joseph's Healthcare & Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - D D Rivas
- Department of Respiratory Medicine, Lucus Augusti University Hospital, EOXI, Lugo Cervo, Monforte, Spain
| | - T Ho
- Firestone Institute for Respiratory Health, St Joseph's Healthcare & Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - L Perez de Llano
- Department of Respiratory Medicine, Lucus Augusti University Hospital, EOXI, Lugo Cervo, Monforte, Spain
| | - M Mukherjee
- Firestone Institute for Respiratory Health, St Joseph's Healthcare & Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - P Nair
- Firestone Institute for Respiratory Health, St Joseph's Healthcare & Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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24
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Molnar MZ, Talwar M, Balaraman V, Bhalla A, Azhar A, Yazawa M, Tsujita M, Podila P, Nair S, Eason J. SO029FIRST YEAR RENAL OUTCOME OF TRANSPLANTATIONS OF KIDNEYS FROM HEPATITIS C INFECTED DONORS TO HEPATITIS C NEGATIVE RECIPIENTS. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa139.so029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Transplant centers in US are increasingly willing to transplant kidneys from hepatitis C infected donors to hepatitis C negative recipients. Long-term renal outcome data from non-prophylactic treatment approach outside clinical trials is missing.
Method
We compared kidney graft function of 132 hepatitis C negative recipients, who received HCV infected (NAT+ and antibody+/-; HCV+) versus HCV negative (NAT- and antibody-; HCV-) in 2018, in a single center, retrospective, observational study. Categorical variables were compared using χ2 tests and continuous variables were compared using t-tests or Mann–Whitney U-tests, as appropriate. Linear regression was applied to assess independent association between graft function and HCV viremic status.
Results
The mean±SD age of recipients was 52±11 years, 44% were female, 20% and 79% of recipients were Caucasian and African-American, respectively. Baseline characteristics were similar between HCV+ vs HCV- groups, except dialysis duration, donors race, KDPI and cold ischemic time (Table). The DGF rate, estimated GFRs at post-transplant 3, 6, 9 and 12 months was similar between HCV+ and HCV- groups (Table). HCV viremic status was not a predictor of 3, 6, 9 and 12 months eGFR in our unadjusted model and after adjustment for donor and recipient characteristics.
Conclusion
Recipients of HCV-viremic kidneys have similar renal allograft function in the first year after transplantation compared to those who received from HCV-non-viremic kidneys.
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Affiliation(s)
- Miklos Zsolt Molnar
- Methodist University Hospital, James D Eason Transplant Institute, Memphis, United States of America
- University of Tennessee Health Science Center, Surgery, Memphis, United States of America
| | - Manish Talwar
- Methodist University Hospital, James D Eason Transplant Institute, Memphis, United States of America
- University of Tennessee Health Science Center, Surgery, Memphis, United States of America
| | - Vasanthi Balaraman
- Methodist University Hospital, James D Eason Transplant Institute, Memphis, United States of America
- University of Tennessee Health Science Center, Surgery, Memphis, United States of America
| | - Anshul Bhalla
- Methodist University Hospital, James D Eason Transplant Institute, Memphis, United States of America
- University of Tennessee Health Science Center, Surgery, Memphis, United States of America
| | - Ambreen Azhar
- Methodist University Hospital, James D Eason Transplant Institute, Memphis, United States of America
- University of Tennessee Health Science Center, Surgery, Memphis, United States of America
| | - Masahiko Yazawa
- Methodist University Hospital, James D Eason Transplant Institute, Memphis, United States of America
- University of Tennessee Health Science Center, Surgery, Memphis, United States of America
- St. Marianna University School of Medicine, Divison of Nephrology and Hypertension, Japan
| | - Makoto Tsujita
- Methodist University Hospital, James D Eason Transplant Institute, Memphis, United States of America
- University of Tennessee Health Science Center, Surgery, Memphis, United States of America
- Nagoya Daini Red Cross Hospital, Division of Nephrology and Hypertension, Japan
| | - Pradeep Podila
- Methodist Le Bonheur Healthcare, Memphis, United States of America
| | - Satheesh Nair
- Methodist University Hospital, James D Eason Transplant Institute, Memphis, United States of America
- University of Tennessee Health Science Center, Surgery, Memphis, United States of America
| | - James Eason
- Methodist University Hospital, James D Eason Transplant Institute, Memphis, United States of America
- University of Tennessee Health Science Center, Surgery, Memphis, United States of America
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25
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Kant S, Bhalla A, Alasfar S, Alachkar N. Ten-year outcome of Eculizumab in kidney transplant recipients with atypical hemolytic uremic syndrome- a single center experience. BMC Nephrol 2020; 21:189. [PMID: 32434487 PMCID: PMC7238522 DOI: 10.1186/s12882-020-01847-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/10/2020] [Indexed: 11/29/2022] Open
Abstract
Background Atypical hemolytic uremic syndrome (aHUS) can result in severe kidney dysfunction, secondary to thrombotic microangiopathy. Eculizumab has been used to treat this disorder, and has resulted in favourable outcomes in both, native and transplanted kidneys. There is limited long term follow up data in kidney transplant recipients (KTRs) who received prevention and treatment with Eculizumab. We report our long term follow up data from our center to address safety and efficacy of this therapy in KTRs. Methods We performed a retrospective analysis of KTRs between January 2009 and December 2018. Clinical diagnosis of aHUS established with presence of thrombotic microangiopathy, acute kidney injury, absence of alternate identifiable etiology. We reviewed clinical data, including genetic testing for complement factor mutations, post-transplant course, and response to therapy including therapeutic and prophylactic use of eculizumab. Results Nineteen patients with aHUS received a total of 36 kidney transplants; 10 of them had 2 or more prior kidney transplants. Median age at time of last transplant was 37 years (range 27–59), 72% were female (n = 14), 78% Caucasian (n = 15), with 61% had live donor transplant (n = 12) as the last transplant. Eculizumab prophylaxis was given to 10/19 (56%) at the time of transplantation, with no aHUS recurrence during the follow up. Median duration of follow up was 46 (range 6–237) months. Mean estimated glomerular filtration rate (eGFR) at the time of last follow up was 59.5 ml/min/m2. No infections secondary to encapsulated organisms or other major infectious complications occurred during the follow up. Conclusions Eculizumab prophylaxis is safe and effective in KTRs with aHUS. Long term follow up demonstrates that it may be possible to discontinue prophylaxis carefully in selected patients with no evidence of complement mutations.
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Affiliation(s)
- Sam Kant
- Department of Medicine, Division of Nephrology, The Johns Hopkins University School of Medicine, 600 N Wolfe St, Carnegie 344B, Baltimore, Maryland, 21287, USA
| | - Anshul Bhalla
- Department of Surgery, Division of Transplant Surgery, James D. Eason Transplant Institute, Methodist University Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sami Alasfar
- Department of Medicine, Division of Nephrology, The Johns Hopkins University School of Medicine, 600 N Wolfe St, Carnegie 344B, Baltimore, Maryland, 21287, USA
| | - Nada Alachkar
- Department of Medicine, Division of Nephrology, The Johns Hopkins University School of Medicine, 600 N Wolfe St, Carnegie 344B, Baltimore, Maryland, 21287, USA.
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26
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Talwar M, Balaraman V, Bhalla A, Cseprekal O, Yazawa M, Podila PSB, Azhar A, Cossey LN, Eason JD, Molnar MZ. Validation of Prognostic Index for Allograft Outcome in Kidney Transplant Recipients With Transplant Glomerulopathy. Kidney Int Rep 2020; 5:915-920. [PMID: 32518874 PMCID: PMC7271004 DOI: 10.1016/j.ekir.2020.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/02/2020] [Accepted: 03/30/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Manish Talwar
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee, USA.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Vasanthi Balaraman
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee, USA.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Anshul Bhalla
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee, USA.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Orsolya Cseprekal
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Masahiko Yazawa
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee, USA.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Divison of Nephrology and Hypertension, St. Marianna University School of Medicine, Tokyo, Japan
| | - Pradeep S B Podila
- Faith & Health Division, Methodist Le Bonheur Healthcare, Memphis, Tennessee, USA.,Division of Health Systems Management & Policy, School of Public Health, The University of Memphis, Memphis, Tennessee, USA
| | - Ambreen Azhar
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee, USA.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | - James D Eason
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee, USA.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Miklos Z Molnar
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee, USA.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary.,Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Pannu AK, Bhalla A, Gantala J, Sharma N, Kumar S, Dhibar DP. Glucose-insulin-potassium infusion for the treatment of acute aluminum phosphide poisoning: an open-label pilot study. Clin Toxicol (Phila) 2020; 58:1004-1009. [DOI: 10.1080/15563650.2020.1719131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- A. K. Pannu
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A. Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - J. Gantala
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - N. Sharma
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S. Kumar
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - D. P. Dhibar
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Bhalla A, Alachkar N, Alasfar S. Complement-Based Therapy in the Management of Antibody-Mediated Rejection. Adv Chronic Kidney Dis 2020; 27:138-148. [PMID: 32553246 DOI: 10.1053/j.ackd.2019.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/11/2019] [Accepted: 12/11/2019] [Indexed: 02/07/2023]
Abstract
Antibody-mediated rejection (AMR) is one of the leading causes of kidney allograft failure and is usually mediated by anti-human leukocyte antigen donor-specific antibodies (DSAs). Activation of classical pathway of the complement system is responsible for downstream effects of DSA and account for significant manifestations of AMR. Currently, the treatment of AMR is based on strategies to remove preformed antibodies or to prevent their production; however, these strategies are often unsuccessful. It is theoretically possible to inhibit complement activity to prevent the effect of DSA on kidney allograft function. Complement inhibitors such as eculizumab, a complement 5 monoclonal antibody, and complement 1 esterase inhibitors (C1 INHs) have been used in prevention and treatment of AMR with variable success. Eculizumab and C1 INH seem to reduce the incidence of early AMR and allow transplantation in highly sensitized kidney transplant recipients, but data on their long-term effect on kidney allograft function are limited. Several case reports described the successful use of eculizumab in the treatment of AMR, but there are no randomized controlled studies that showed efficacy. Treatment of AMR with C1 INH, in addition to standard of care, did not change short-term outcome but long-term studies are underway.
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Affiliation(s)
- R Golla
- From the Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Mukherjee
- From the Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - R K Gone
- From the Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - H Singh
- From the Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A K Pannu
- From the Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - V Suri
- From the Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Bhalla
- From the Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Singh H, Pannu AK, Dahiya N, Suri V, Bhalla A, Kumari S. 'Crochetage' sign of atrial septal defect. QJM 2020; 113:133-134. [PMID: 31179495 DOI: 10.1093/qjmed/hcz142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H Singh
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, 4th Floor, F Block, Chandigarh, India
| | - A K Pannu
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, 4th Floor, F Block, Chandigarh, India
| | - N Dahiya
- Departments of Internal Medicine and Cardiology, Post Graduate Institute of Medical Education and Research, 4th Floor, F Block, Chandigarh, India
| | - V Suri
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, 4th Floor, F Block, Chandigarh, India
| | - A Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, 4th Floor, F Block, Chandigarh, India
| | - S Kumari
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, 4th Floor, F Block, Chandigarh, India
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Arshad H, Butt S, Bhalla A, Umar R, Khawaja US. COPD, HEART FAILURE A BAD COMBO. COMPARISON OF OUTCOMES IN PATIENTS WITH HEART FAILURE WITH ACUTE EXACERBATION WITH VERSUS WITHOUT CHRONIC OBSTRUCTIVE PULMONARY DISEASE; NATIONWIDE STUDY FROM 2007-2014. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.456] [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] Open
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32
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Affiliation(s)
- A Agarwal
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Soni
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Chaudhary
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A K Pannu
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - V Suri
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Kumari
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Thomas PW, Blackwell JEM, Herrod PJJ, Peacock O, Singh R, Williams JP, Hurst NG, Speake WJ, Bhalla A, Lund JN. Long-term outcomes of biological mesh repair following extra levator abdominoperineal excision of the rectum: an observational study of 100 patients. Tech Coloproctol 2019; 23:761-767. [PMID: 31392530 PMCID: PMC6736926 DOI: 10.1007/s10151-019-02056-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 03/29/2019] [Accepted: 07/29/2019] [Indexed: 02/08/2023]
Abstract
Background Current evidence suggests that pelvic floor reconstruction following extralevator abdominoperineal excision of rectum (ELAPER) may reduce the risk of perineal herniation of intra-abdominal contents. Options for reconstruction include mesh and myocutaneous flaps, for which long-term follow-up data is lacking. The aim of this study was to evaluate the long-term outcomes of biological mesh (Surgisis®, Biodesign™) reconstruction following ELAPER. Methods A retrospective review of all patients having ELAPER in a single institution between 2008 and 2018 was perfomed. Clinic letters were scrutinised for wound complications and all available cross sectional imaging was reviewed to identify evidence of perineal herniation (defined as presence of intra-abdominal content below a line between the coccyx and the lower margin of the pubic symphysis on sagittal view). Results One hundred patients were identified (median age 66, IQR 59–72 years, 70% male). Median length of follow-up was 4.9 years (IQR 2.3–6.7 years). One, 2- and 5-year mortality rates were 3, 8 and 12%, respectively. Thirty three perineal wounds had not healed by 1 month, but no mesh was infected and no mesh needed to be removed. Only one patient developed a symptomatic perineal hernia requiring repair. On review of imaging a further 7 asymptomatic perineal hernias were detected. At 4 years the cumulative radiologically detected perineal hernia rate was 8%. Conclusions This study demonstrates that pelvic floor reconstruction using biological mesh following ELAPER is both safe and effective as a long-term solution, with low major complication rates. Symptomatic perineal herniation is rare following mesh reconstruction, but may develop sub clinically and be detectable on cross-sectional imaging.
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Affiliation(s)
- P W Thomas
- Department of Colorectal Surgery, Royal Derby Hospital, Derby, DE22 3NE, UK
| | - J E M Blackwell
- Department of Colorectal Surgery, Royal Derby Hospital, Derby, DE22 3NE, UK
| | - P J J Herrod
- Department of Colorectal Surgery, Royal Derby Hospital, Derby, DE22 3NE, UK. .,Medical Research Council-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Nottingham, Royal Derby Hospital, Derby, DE22 3DT, UK.
| | - O Peacock
- Department of Colorectal Surgery, Royal Derby Hospital, Derby, DE22 3NE, UK
| | - R Singh
- Department of Radiology, Royal Derby Hospital, Derby, DE22 3NE, UK
| | - J P Williams
- Department of Colorectal Surgery, Royal Derby Hospital, Derby, DE22 3NE, UK.,Medical Research Council-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Nottingham, Royal Derby Hospital, Derby, DE22 3DT, UK
| | - N G Hurst
- Department of Colorectal Surgery, Royal Derby Hospital, Derby, DE22 3NE, UK
| | - W J Speake
- Department of Colorectal Surgery, Royal Derby Hospital, Derby, DE22 3NE, UK
| | - A Bhalla
- Department of Colorectal Surgery, Royal Derby Hospital, Derby, DE22 3NE, UK
| | - J N Lund
- Department of Colorectal Surgery, Royal Derby Hospital, Derby, DE22 3NE, UK.,Medical Research Council-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Nottingham, Royal Derby Hospital, Derby, DE22 3DT, UK
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Mohan K, Kaushal T, Garg S, Pannu AK, Bhalla A, Suri V, Kumari S. Primary hyperparathyroid bone disease. QJM 2019; 112:545. [PMID: 30629246 DOI: 10.1093/qjmed/hcz012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Mohan
- Department of Internal Medicine, Post-Graduate Institute of Medical Education and Research, 4th floor, F block, Chandigarh 160012, Punjab, India
| | - T Kaushal
- Department of Internal Medicine, Post-Graduate Institute of Medical Education and Research, 4th floor, F block, Chandigarh 160012, Punjab, India
| | - S Garg
- Department of Internal Medicine, Post-Graduate Institute of Medical Education and Research, 4th floor, F block, Chandigarh 160012, Punjab, India
| | - A K Pannu
- Department of Internal Medicine, Post-Graduate Institute of Medical Education and Research, 4th floor, F block, Chandigarh 160012, Punjab, India
| | - A Bhalla
- Department of Internal Medicine, Post-Graduate Institute of Medical Education and Research, 4th floor, F block, Chandigarh 160012, Punjab, India
| | - V Suri
- Department of Internal Medicine, Post-Graduate Institute of Medical Education and Research, 4th floor, F block, Chandigarh 160012, Punjab, India
| | - S Kumari
- Department of Internal Medicine, Post-Graduate Institute of Medical Education and Research, 4th floor, F block, Chandigarh 160012, Punjab, India
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Zheng L, Cockerham G, Hoffman J, Heydlauf M, Peterson D, Bhalla A. A statistical analysis solution to measure the impact of sample processing methods on diagnostic laboratory turnaround time. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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36
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Singh H, Pannu AK, Suri V, Bhalla A, Kumari S. Pericardial effusion and electrical alternans. QJM 2019; 112:135-136. [PMID: 30165695 DOI: 10.1093/qjmed/hcy191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- H Singh
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, 4th floor, F block, Chandigarh, India
| | - A K Pannu
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, 4th floor, F block, Chandigarh, India
| | - V Suri
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, 4th floor, F block, Chandigarh, India
| | - A Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, 4th floor, F block, Chandigarh, India
| | - S Kumari
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, 4th floor, F block, Chandigarh, India
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Bhalla A. Strategies and Intervention for Cancer Screening at Village Level. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.93500] [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: 11/20/2022] Open
Abstract
Background: Cancer is a leading cause of death globally. The World Health Organization estimates that 7.6 million people died of cancer in 2005 and 84 million people will die in the next 10 years if action is not taken. More than 70% of all cancer deaths occur in low- and middle-income countries, where resources available for prevention, diagnosis and treatment of cancer are limited or nonexistent. There are 3 common cancers found in wide range in India (oral, breast and cervical). In India the maximum people die due to oral cancer in men and breast cancer in female. Method: The current cancer screening and intervention approaches for the early prevention and detection of cancer, and to outline strategies for future interventions and research at village level. Results and Conclusion: The cancer screening plan is agreed upon by the stakeholders, it should be given the widest possible distribution within the country In resource constrained countries, a plan is more likely to be implemented if it includes fewer, yet sustainable interventions in line with evidence-based priorities, ranging from prevention to end-of-life care, with measurable process and outcome objectives that can be monitored and evaluated if basic information systems are in place. For example, prevention strategies (such as tobacco control and hepatitis B immunization), and treatment interventions linked to early diagnosis (awareness of early signs and symptoms) of a few cancer types (such as cervical and breast cancers) would be key feasible interventions.
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Affiliation(s)
- A A Gawalkar
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Tale
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - B A Chhabria
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Bhalla
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Affiliation(s)
- B A Chhabria
- From the Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A K Pannu
- From the Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Bhalla
- From the Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Baker BG, Bhalla A, Doleman B, Yarnold E, Simons S, Lund JN, Williams JP. Simulation fails to replicate stress in trainees performing a technical procedure in the clinical environment. Med Teach 2017; 39:53-57. [PMID: 27631579 DOI: 10.1080/0142159x.2016.1230188] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Simulation-based training (SBT) has become an increasingly important method by which doctors learn. Stress has an impact upon learning, performance, technical, and non-technical skills. However, there are currently no studies that compare stress in the clinical and simulated environment. We aimed to compare objective (heart rate variability, HRV) and subjective (state trait anxiety inventory, STAI) measures of stress theatre with a simulated environment. METHODS HRV recordings were obtained from eight anesthetic trainees performing an uncomplicated rapid sequence induction at pre-determined procedural steps using a wireless Polar RS800CX monitor © in an emergency theatre setting. This was repeated in the simulated environment. Participants completed an STAI before and after the procedure. RESULTS Eight trainees completed the study. The theatre environment caused an increase in objective stress vs baseline (p = .004). There was no significant difference between average objective stress levels across all time points (p = .20) between environments. However, there was a significant interaction between the variables of objective stress and environment (p = .045). There was no significant difference in subjective stress (p = .27) between environments. DISCUSSION Simulation was unable to accurately replicate the stress of the technical procedure. This is the first study that compares the stress during SBT with the theatre environment and has implications for the assessment of simulated environments for use in examinations, rating of technical and non-technical skills, and stress management training.
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Affiliation(s)
- B G Baker
- a Division of Surgery, Royal Derby Hospital , Derby , UK
| | - A Bhalla
- a Division of Surgery, Royal Derby Hospital , Derby , UK
| | - B Doleman
- b Division of Medical Sciences and Graduate Entry Medicine , University of Nottingham , Derby , UK
| | - E Yarnold
- b Division of Medical Sciences and Graduate Entry Medicine , University of Nottingham , Derby , UK
| | - S Simons
- b Division of Medical Sciences and Graduate Entry Medicine , University of Nottingham , Derby , UK
| | - J N Lund
- a Division of Surgery, Royal Derby Hospital , Derby , UK
- b Division of Medical Sciences and Graduate Entry Medicine , University of Nottingham , Derby , UK
| | - J P Williams
- a Division of Surgery, Royal Derby Hospital , Derby , UK
- b Division of Medical Sciences and Graduate Entry Medicine , University of Nottingham , Derby , UK
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White PM, Lenthall R, McConachie N, Bhalla A, James M, Dinsmore J, Rodgers H, Rowland-Hill C. Commentary on: Implementing mechanical thrombectomy for acute ischaemic stroke in the UK. Clin Radiol 2016; 72:123-125. [PMID: 27989377 DOI: 10.1016/j.crad.2016.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 11/07/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022]
Affiliation(s)
- P M White
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; British Society of Neuroradiologists, UK; UK Neurointerventional Group, UK.
| | - R Lenthall
- British Society of Neuroradiologists, UK; Department of Neuroradiology, Queen's Medical Centre, Nottingham, UK
| | - N McConachie
- Department of Neuroradiology, Queen's Medical Centre, Nottingham, UK; UK Neurointerventional Group, UK
| | - A Bhalla
- Stroke Medicine, Guys and St Thomas Hospital, London, UK; British Association of Stroke Physicians, UK
| | - M James
- British Association of Stroke Physicians, UK; Stroke Medicine, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - J Dinsmore
- Department of Anaesthesia, St George's Hospital, London, UK; Neuro Anaesthesia & Critical Care Society of Great Britain and Ireland, UK
| | - H Rodgers
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; British Association of Stroke Physicians, UK
| | - C Rowland-Hill
- British Society of Neuroradiologists, UK; Neuroradiology Department, Hull and East Yorkshire Hospitals NHS Trust, UK
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White PM, Bhalla A, Dinsmore J, James M, McConachie N, Roffe C, Young G. Standards for providing safe acute ischaemic stroke thrombectomy services (September 2015). Clin Radiol 2016; 72:175.e1-175.e9. [PMID: 27974152 DOI: 10.1016/j.crad.2016.11.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Doleman B, Blackwell J, Karangizi A, Butt W, Bhalla A, Lund JN, Williams JP. Anaesthetists stress is induced by patient ASA grade and may impair non-technical skills during intubation. Acta Anaesthesiol Scand 2016; 60:910-6. [PMID: 26940201 DOI: 10.1111/aas.12716] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/29/2016] [Accepted: 02/07/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND The aims of this study were to determine if patient ASA grade was associated with increased stress in anaesthetists with a subsequent effect on non-technical skills. METHODS Stress was measured using a validated objective (heart rate variability or heart rate) and subjective tool. We studied eight consultant anaesthetists at baseline (rest) and during 16 episodes of intubation with an ASA 1 or 2 patient vs. an ASA 3 or 4 patient. The primary outcome for the study was objective and subjective stress between both patient groups. Secondary outcomes were non-technical skill ratings and the association between stress measurements. RESULTS ASA 3 or 4 patients were associated with increases in objective stress when compared to baseline (mean 4.6 vs. 6.7; P = 0.004). However, ASA 1 or 2 patients were not associated with increases in stress when compared to baseline (mean 4.6 vs. 4.7; P = 1). There was no significant difference in subjective stress between the groups (P = 0.18). Objective stress negatively affected situational awareness (P = 0.03) and decision-making (P = 0.03); however, these did not decline to a clinically significant threshold. Heart rate variability (r = 0.60; P = 0.002) better correlated with subjective stress when compared to heart rate (r = 0.30; P = 0.15). Agreement between raters for Anaesthetic Non-Technical Skills (ANTS) scores was acceptable (ICC = 0.51; P = 0.003). CONCLUSION This study suggests that higher patient ASA grade can increase stress in anaesthetists, which may impair non-technical skills.
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Affiliation(s)
- B. Doleman
- Division of Medical Sciences and Graduate Entry Medicine; Royal Derby Hospital; University of Nottingham; Derby UK
| | - J. Blackwell
- Division of Medical Sciences and Graduate Entry Medicine; Royal Derby Hospital; University of Nottingham; Derby UK
| | - A. Karangizi
- Division of Medical Sciences and Graduate Entry Medicine; Royal Derby Hospital; University of Nottingham; Derby UK
| | - W. Butt
- Division of Medical Sciences and Graduate Entry Medicine; Royal Derby Hospital; University of Nottingham; Derby UK
| | - A. Bhalla
- Division of Medical Sciences and Graduate Entry Medicine; Royal Derby Hospital; University of Nottingham; Derby UK
| | - J. N. Lund
- Division of Medical Sciences and Graduate Entry Medicine; Royal Derby Hospital; University of Nottingham; Derby UK
| | - J. P. Williams
- Division of Medical Sciences and Graduate Entry Medicine; Royal Derby Hospital; University of Nottingham; Derby UK
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Miller J, Drew L, Green O, Dukovski D, McEwan B, Villella A, Patel N, Bastos C, Cullen M, Danh H, Wachi S, Giuliano K, Longo K, Bhalla A, Qiu D, Zou C, Ivarsson M, Munoz B, Mehmet H. WS13.5 CFTR amplifiers are mutation-agnostic modulators that increase CFTR protein levels and complement other CF therapeutic modalities. J Cyst Fibros 2016. [DOI: 10.1016/s1569-1993(16)30137-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Biswal M, Kumar A, Sharma N, Bhalla A, Singhi S, Sethi S. Genetic diversity of Orientia tsutsugamushi strains from patients in North India. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.395] [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: 11/28/2022] Open
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Abstract
Introduction: Sepsis is common presenting illness to the emergency services and one of the leading causes of hospital mortality. Researchers and clinicians have realized that the systemic inflammatory response syndrome concept for defining sepsis is less useful and lacks specificity. The predisposition, infection (or insult), response and organ dysfunction (PIRO) staging of sepsis similar to malignant diseases (TNM staging) might give better information. Materials and Methods: A prospective observational study was conducted in emergency medical services attached to medicine department of a tertiary care hospital in Northern India. Patients with age 18 years or more with proven sepsis were included in the first 24 hours of the diagnosis. Two hundred patients were recruited. Multivariate logistic regression analysis was done to assess the factors that predicted in-hospital mortality. Results: Two hundred patients with proven sepsis, admitted to the emergency medical services were analysed. Male preponderance was noted (M: F ratio = 1.6:1). Mean age of study cohort was 50.50 ± 16.30 years. Out of 200 patients, 116 (58%) had in-hospital mortality. In multivariate logistic regression analysis, the factors independently associated with in-hospital mortality for predisposition component of PIRO staging were age >70 years, chronic obstructive pulmonary disease, chronic liver disease, cancer and presence of foley's catheter; for infection/insult were pneumonia, urinary tract infection and meningitis/encephalitis; for response variable were tachypnea (respiratory rate >20/minute) and bandemia (band >5%). Organ dysfunction variables associated with hospital mortality were systolic blood pressure <90mm Hg, prolonged activated partial thromboplastin time, raised serum creatinine, partial pressure of oxygen in arterial blood/fraction of inspired oxygen (PaO2/FiO2) ratio <300, decreased urine output in first two hours of emergency presentation and Glasgow coma scale ≤9. Each of the components of PIRO had good predictive capability for in-hospital mortality but the total score was more accurate than the individual score and increasing PIRO score was associated with higher in-hospital mortality. The area under receiver operating characteristic curve for cumulative PIRO staging system as a predictor of in-hospital mortality was 0.94. Conclusion: This study finds PIRO staging as an important tool to stratify and prognosticate hospitalised patients with sepsis at a tertiary care center. The simplicity of score makes it more practical to be used in busy emergencies as it is based on four easily assessable components.
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Affiliation(s)
| | - S Kumar
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Naranje P, Gorsi U, Gupta L, Bhalla A, Khandelwal N. Primary Aortoenteric fistula : An alarming entity warranting early diagnosis. Trop Gastroenterol 2016; 37:67-70. [PMID: 29668185 DOI: 10.7869/tg.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Das B, Kharbanda P, Bhalla A, Goyal M, Lal V, Prabhakar S, Khandalwal N. Status epilepticus in emergency: our experience in a tertiary care centre in north-western india. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.498] [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]
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Affiliation(s)
- A Bhalla
- Department of Colorectal Surgery, Royal Derby Hospital NHS Trust, Uttoxeter Road, Derby, DE22 3NE, UK.
| | - O Peacock
- Department of Colorectal Surgery, Royal Derby Hospital NHS Trust, Uttoxeter Road, Derby, DE22 3NE, UK
| | - J N Lund
- Department of Colorectal Surgery, Royal Derby Hospital NHS Trust, Uttoxeter Road, Derby, DE22 3NE, UK
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Bhalla A, Peacock O, Tierney GM, Tou S, Hurst NG, Speake WJ, Williams JP, Lund JN. Day-case closure of ileostomy: feasible, safe and efficient. Colorectal Dis 2015; 17:820-3. [PMID: 25808587 DOI: 10.1111/codi.12961] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 02/19/2015] [Indexed: 02/08/2023]
Abstract
AIM Over 5000 loop ileostomy closures were performed in the UK in 2013 with a median inpatient stay of 5 days. Previously we have successfully implemented a 23-h protocol for loop ileostomy closure which was modified for same-day discharge. We present our early experience of day-case loop ileostomy closure. METHOD A specific patient pathway for day-case discharge following loop ileostomy closure was implemented with inclusion criteria to conform with British Association of Day Surgery guidelines. Exclusion criteria included postoperative chemoradiotherapy, multiple comorbidities and social care needs. Follow-up consisted of telephone contact (24 and 72 h after discharge) and a routine outpatient appointment. Patients were provided with a 24-h contact point in case of emergency. RESULTS Fifteen (12 male) patients were enrolled of median age 67 (39-80) years. The median operating time was 41 (23-80) min. The indication for ileostomy formation was to cover a low anterior resection for adenocarcinoma (13), reversal of Hartmann's procedure (1) and functional bowel disorder (1). The median interval from the primary procedure to day-case loop ileostomy closure was 8 (3-14) months. Every patient was discharged on the day of surgery. There were no complications related to the surgery and there was one readmission due to a urinary tract infection. The median length of follow-up was 4 (2-16) months. CONCLUSION Our early experience shows that day-case loop ileostomy closure is feasible, safe and efficient. This protocol will become standard within our institution for suitable patients, saving on average five inpatient bed days per patient.
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Affiliation(s)
- A Bhalla
- Department of Colorectal Surgery, Royal Derby Hospital NHS Trust, Derby, UK.,School of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, UK
| | - O Peacock
- Department of Colorectal Surgery, Royal Derby Hospital NHS Trust, Derby, UK
| | - G M Tierney
- Department of Colorectal Surgery, Royal Derby Hospital NHS Trust, Derby, UK
| | - S Tou
- Department of Colorectal Surgery, Royal Derby Hospital NHS Trust, Derby, UK
| | - N G Hurst
- Department of Colorectal Surgery, Royal Derby Hospital NHS Trust, Derby, UK
| | - W J Speake
- Department of Colorectal Surgery, Royal Derby Hospital NHS Trust, Derby, UK
| | - J P Williams
- School of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, UK.,Department of Anaesthesia, Royal Derby Hospital NHS Trust, Derby, UK
| | - J N Lund
- Department of Colorectal Surgery, Royal Derby Hospital NHS Trust, Derby, UK.,School of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, UK
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