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Bhattasali O, Torres F, Rahimian J, Scharnweber R, Beighley A, Kesbeh Y, Chen JCT, Miller M, Lodin K, Girvigian MR. Risk Factors Associated with Development of Peritumoral Edema Following Stereotactic Radiosurgery and Radiotherapy for Intracranial Meningioma. Int J Radiat Oncol Biol Phys 2023; 117:e88-e89. [PMID: 37786205 DOI: 10.1016/j.ijrobp.2023.06.844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Peritumoral edema (PTE) is a potential adverse effect following radiotherapy for intracranial meningioma. The purpose of this study is to identify which baseline factors may increase risk for PTE. MATERIALS/METHODS A retrospective chart review was conducted of 431 patients who underwent primary radiotherapy to 480 radiographically-defined intracranial meningiomas between January 2008 and December 2021 within an integrated health care system. Patients with prior surgical management were excluded. Patients were treated with frameless LINAC-based image-guided single fraction stereotactic radiosurgery (SRS) (32.9%), 5 fraction SRS (FSRS) (30.8%), or fractionated stereotactic radiotherapy (FSRT) (36.3%). Pre- and post-radiotherapy MRI studies were reviewed to evaluate for PTE following treatment. An event was defined as new or worsening PTE compared to pre-radiotherapy imaging or development of new symptoms post-radiotherapy. Univariate and stepwise logistics regression analyses were performed to compare the risk of PTE between groups. RESULTS Median follow-up was 85.8 months (IQR: 49.4-125.4). Median patient age was 66 years (IQR: 56-73). Patients treated with SRS (median age: 61 years) were younger than those treated with FSRS/FSRT (median age: 68 years) (p<0.001). Lesions treated with SRS (median volume: 1.33cc) were smaller than those treated with FSRS/FSRT (median volume: 6.36cc) (p<0.001). For all-comers, 68 (14.2%) lesions developed any PTE, and 27 (5.6%) developed symptomatic PTE (SPTE). Of these, 4 patients developed symptoms post-treatment without radiographic evidence of new or worsening PTE. Incidence of PTE/SPTE by site was as follows: base of skull (BOS): 10.3%/6.1%, convexity: 22.7%/7.6%, falcine: 17.6%/4.1%, parasagittal: 27.8%/8.3%, posterior fossa/tentorium 7.0%/0.0%. Incidence of PTE/SPTE by technique was as follows: SRS: 6.3%/3.8%, FSRS: 20.9%/7.4%, FSRT: 15.5%/5.7%. On univariate analysis, age >65 (OR = 2.17 (95% CI: 1.26-3.77) p = 0.006), tumor volume (OR = 1.05 (1.02-1.08), p = 0.003), pre-treatment PTE (OR = 6.82 (95% CI: 3.59-12.94) p<0.001), and convexity/falcine/parasagittal (CFPS) location (OR = 2.52 (95% CI: 1.49-4.23) p<0.001) were associated with increased incidence of PTE. On multivariate analysis, age >65 (OR = 1.91 (95% CI: 1.05-3.45) p<0.03), tumor volume (OR = 1.04 (95% CI: 1.00-1.08) p = 0.03), pre-treatment PTE (OR = 4.64 (95% CI: 2.33-9.24) p<0.001), and CFPS location (OR = 2.53 (95% CI: 1.41-4.52) p = 0.002) were associated with increased incidence of PTE. Two patients with PTE underwent resection for local failure which revealed atypical meningioma. CONCLUSION Age >65, larger tumor volume, presence of pre-treatment PTE, and CFPS location were associated with increased incidence of PTE following radiotherapy. Patients with these risk factors should be counseled regarding post-treatment effects. Infrequently, PTE following treatment may be an indicator of higher-grade meningioma.
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Affiliation(s)
- O Bhattasali
- Southern California Permanente Medical Group, Los Angeles, CA
| | - F Torres
- Southern California Permanente Medical Group, Los Angeles, CA
| | - J Rahimian
- Southern California Permanente Medical Group, Los Angeles, CA
| | - R Scharnweber
- Southern California Permanente Medical Group, Los Angeles, CA
| | - A Beighley
- Southern California Permanente Medical Group, Los Angeles, CA
| | - Y Kesbeh
- Southern California Permanente Medical Group, Los Angeles, CA
| | | | - M Miller
- Southern California Permanente Medical Group, Los Angeles, CA
| | - K Lodin
- Southern California Permanente Medical Group, Los Angeles, CA
| | - M R Girvigian
- Southern California Permanente Medical Group, Los Angeles, CA
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Beighley A, Rahimian J, Wong A, Torres F, Fong C, Rajamohan A, Vinci JP, Miller M, Lodin K, Girvigian MR, Bhattasali O. Impact of Concurrent Targeted Therapy and Immunotherapy on the Incidence of Radiation Necrosis Following Stereotactic Radiosurgery for Brain Metastases. Int J Radiat Oncol Biol Phys 2023; 117:e86. [PMID: 37786200 DOI: 10.1016/j.ijrobp.2023.06.839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The management of metastatic disease has evolved with the advent of immunotherapy (IT) and targeted therapies (TT). Yet, there is limited understanding of the toxicity associated with combining these agents with stereotactic radiosurgery (SRS). We retrospectively evaluated the impact of concurrent systemic therapy (ST) on the risk of radiation necrosis (RN) following LINAC-based SRS for brain metastases (BM). MATERIALS/METHODS A retrospective study was conducted within an integrated health care system from March 2017 to December 2021 of 313 patients who underwent SRS or fractionated SRS in 3 or 5 treatments to a total of 1,644 intact BM. Post-operative cavity SRS and re-irradiated lesions were excluded. RN was diagnosed using perfusion MRI, contrast clearance MRI, or serial standard MRI and graded using CTCAE (v.5). Concurrent ST was defined as administration within 1 month preceding or following SRS. Overall survival (OS) and risk of RN were estimated by the Kaplan-Meier method. Logistics regression analyses were performed to compare risk of RN in patients who received concurrent systemic therapy to those who did not, adjusted for PTV volume and receipt of whole brain radiotherapy (WBRT). RESULTS Median follow-up was 12.2 months. Median age was 64 years (range: 24-92). Primary sites per patient included lung (48.9%), breast (18.2%), melanoma (11.5%), kidney (6.1%), and other (15.3%). Median total lesions treated was 3 (range: 1-44); 65.9% of patients underwent 1 course of SRS, 23.4% underwent 2 courses, 6.2% underwent 3 courses, 4.5% underwent >4 courses. Seventy-six (24.2%) patients received WBRT. Overall, 70.6% of lesions received concurrent ST including chemotherapy (CT) (32.5%), IT (26.8%), and TT (27.6%); 16.4% received a combination of ST. Median OS was 12.9 months (95% CI: 10.4-15.5). RN was observed in 50 (3.0%) lesions in 42 (13.4%) patients. The 1-year risk of RN was 4.0% per lesion and 15.4% per patient. Symptomatic RN (SRN) was observed in 31 (1.9%) lesions in 24 (7.7%) patients. The 1-year risk of SRN was 2.7% per lesion and 10.1% per patient. When compared to lesions treated without concurrent systemic therapy, there was no increased risk of RN observed in lesions treated with concurrent CT (adjusted OR = 0.86 (95% CI: 0.43-1.73) p = 0.68), concurrent IT (adjusted OR = 0.84 (95% CI: 0.41-1.71) p = 0.84), or concurrent TT (adjusted OR = 0.57 (95% CI: 0.25-1.30) p = 0.18). Treatments of SRN included dexamethasone (96.8%), bevacizumab (22.6%), and laser interstitial thermal therapy (6.5%). CONCLUSION Concurrent IT and TT appears well-tolerated in patients who undergo SRS for treatment of BM. No increased risk of RN was observed in lesions treated with concurrent IT or TT compared to lesions treated in the absence of concurrent ST. Further prospective and agent-specific evaluation is necessary to confirm these findings.
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Affiliation(s)
- A Beighley
- Southern California Permanente Medical Group, Los Angeles, CA
| | - J Rahimian
- Southern California Permanente Medical Group, Los Angeles, CA
| | - A Wong
- Southern Kaiser Permanente Medical Group, Los Angeles, CA
| | - F Torres
- Southern California Permanente Medical Group, Los Angeles, CA
| | - C Fong
- Southern Kaiser Permanente Medical Group, Los Angeles, CA
| | - A Rajamohan
- Southern Kaiser Permanente Medical Group, Los Angeles, CA
| | - J P Vinci
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - M Miller
- Southern California Permanente Medical Group, Los Angeles, CA
| | - K Lodin
- Southern California Permanente Medical Group, Los Angeles, CA
| | - M R Girvigian
- Southern California Permanente Medical Group, Los Angeles, CA
| | - O Bhattasali
- Southern California Permanente Medical Group, Los Angeles, CA
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Rahimian J, Bhattasali O, Girvigian MR. Adaptive Dose-Staged Stereotactic Ablative Body Radiotherapy for Treatment of Large Central NSCLC Lung Tumors: A Dosimetric Simulation Study. Int J Radiat Oncol Biol Phys 2023; 117:e709. [PMID: 37786074 DOI: 10.1016/j.ijrobp.2023.06.2204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Adaptive dose-staged Stereotactic Radiosurgery (SRS) treatment of cranial AVM and personalized ultrafractionated stereotactic ablative radiotherapy (PULSAR) proposed by Timmerman et al. for lung cancer has been shown to be an effective technique with lower toxicities in the management of large lesions. The PULSAR technique requires periodic functional PET imaging or tumor biopsy more than one week apart post stereotactic ablative body radiotherapy (SABR) PULSE to utilize the tumor biological response feedback to delineate the residual active disease for subsequent (SABR) PULSES' adaptive treatment planning. The purpose of this study is to explore dosimetrically the benefit of SABR PULSES for the treatment of large central lungs tumors. MATERIALS/METHODS A retrospective simulation study of five anonymized patients with large NSCLC was performed. Tumors were located centrally in left (N = 3) and right (N = 2) lungs. The PTVs generated by 5mm symmetric margin to the ITV, the ITV and PTV volumes were 30.0±21.4cc (10.6-64.5cc) and 65.4±35.2cc (30.7-121.0cc), respectively. Depending on the total PTV volume, 4 other adaptive PTVs were simulated by generating a symmetric reduction of the PTV volumes by 2 or 3mm assuming given enough time shrinking the original volume after each PULSE due to biological response during the time between the initial and subsequent SABR PULSES. The organs-at-risk (OARs) were contoured and 3 VMAT arcs plans were generated and optimized for each PTV with the same VMAT objective functions. The original PTV plan with 50 Gy in 5 consecutive fractions was compared with the sum of the 5 PULSES in 10 Gy per PULSE with adaptive volumes. A statistical analysis and a paired t-test of the 50 Gy plan in 5 consecutive fractions were compared with the 5 PULSES summed dose for the ITV, PTV, and the OARs. RESULTS The t-test showed the 5 PULSES plans significantly lowered the doses to the ipsilateral, and contralateral lungs and heart when compared to 5 consecutive 10 Gy/fraction plans (p-Values, 0.031, 0.01, 0.02, respectively). The 11 Gy ipsilateral lung volume, a precursor for developing normal lung tissue fibrosis about one-year post SABR was significantly lower for the 5 PULSES (136±44cc Vs. 241±83cc) (p-Value, 0.01). The mean and maximum dose to the original PTV was significantly lower in 5 PULSES technique (p-Value, 0.0001, 0.046). The dose to the spinal canal was not statistically different between the two techniques (p-Value, 0.12). CONCLUSION The current management of large central lung tumors is conventional fractionation with chemotherapy or delivering lower fractional SABR dose to meet the OAR dose constraints that may hinder the successful radioablation and local control. The PULSAR treatments using SABR dosimetrically provides significant sparing of normal tissue. Dose escalation for larger central lung tumors may be possible using this technique for effective local control and better overall survivorship.
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Affiliation(s)
- J Rahimian
- Southern California Permanente Medical Group, Los Angeles, CA
| | - O Bhattasali
- Southern California Permanente Medical Group, Los Angeles, CA
| | - M R Girvigian
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
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Beighley A, Rahimian J, Gabikian P, Scharnweber R, Jamshidi A, Vinci JP, Liu X, Farol HY, Lodin K, Girvigian MR, Bhattasali O. Clinical Outcomes Following Postoperative Cavity Stereotactic Radiosurgery for Brain Metastases. Int J Radiat Oncol Biol Phys 2023; 117:e131-e132. [PMID: 37784694 DOI: 10.1016/j.ijrobp.2023.06.932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) We evaluated outcomes of patients with brain metastases (BM) treated with surgical resection and postoperative cavity stereotactic radiosurgery (SRS) to identify which baseline characteristics and treatment factors may increase risk for local recurrence (LR). MATERIALS/METHODS From June 2017 to December 2021, 68 patients underwent surgical resection for BM followed by single-fraction SRS (n = 15) or fractionated SRS (FSRS) in 3 (n = 24) or 5 (n = 29) fractions to the postoperative cavity using frameless LINAC-based technique. Patients treated with surgery alone or surgery with postoperative whole brain radiotherapy (WBRT) were excluded. Median prescription doses were 1600 cGy (range: 1440-1875) in 1 fraction, 2400 cGy (range: 2100-2700) in 3 fractions, and 3000 cGy (range: 2500-3000) in 5 fractions. Local control (LC) and overall survival (OS) were estimated by the Kaplan-Meier method. Cox proportional hazards models were used to compare groups. RESULTS Median follow-up was 19.5 months (IQR: 9.0-34.7). Median patient age was 62.5 years (range: 24-80), and 38 (55.9%) patients were male. Primary tumors were lung (n = 29), including NSCLC (n = 28) and SCLC (n = 1), melanoma (n = 12), breast (n = 11), and other (n = 16). Median preoperative tumor maximal dimension was 3.5cm (range: 1.1-6.3). Median planning treatment volume (PTV) was larger in the FSRS group (26.2cc (range: 6.5-151.8)) than in the SRS group (7.7cc (range: 1.1-11.5)) (p<0.001). Median number of concurrently treated intact lesions was 0 (range: 0-13). Median time from surgery to SRS was 32 days (range: 14-77). Forty-eight (70.6%) patients were treated with immunotherapy or targeted therapy. Median OS was 22.3 months (95% CI: 14.4-30.9). The 1-year and 2-year OS rates were 70% and 48%, respectively. The 1-year and 2-year LC rates were 86% and 73%, respectively. Median time to LR was 8.4 months (95% CI: 4.4-11.0). Among the 14 patients with LR, 11 had undergone salvage therapy at last follow-up which included repeat SRS (n = 4), WBRT (n = 3), palliative local radiotherapy (n = 2), surgery followed by repeat SRS (n = 1), and systemic therapy (n = 1). Eleven (16.2%) patients ultimately underwent WBRT post-SRS for local and/or distant failure. No difference in LC was observed based on primary tumor, time interval between resection and SRS, PTV volume, prescription dose, or fractionation regimen (SRS v. FSRS). However, all LR in the 3-fraction group occurred in patients who received less than 2700 cGy. CONCLUSION Favorable LC and OS outcomes were observed following postoperative cavity SRS for resected BM in a modern cohort with a large percentage of patients receiving immunotherapy or targeted therapy. No prognostic factors were identified for LC which may be attributable to the cohort size and small number of events observed. However, our findings suggest that patients who undergo 3-fraction FSRS should be treated to a total dose of 2700 cGy to maximize LC.
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Affiliation(s)
- A Beighley
- Southern California Permanente Medical Group, Los Angeles, CA
| | - J Rahimian
- Southern California Permanente Medical Group, Los Angeles, CA
| | - P Gabikian
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - R Scharnweber
- Southern California Permanente Medical Group, Los Angeles, CA
| | - A Jamshidi
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - J P Vinci
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - X Liu
- Department of Radiation Oncology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - H Y Farol
- Southern California Permanente Medical Group, Los Angeles, CA
| | - K Lodin
- Southern California Permanente Medical Group, Los Angeles, CA
| | - M R Girvigian
- Southern California Permanente Medical Group, Los Angeles, CA
| | - O Bhattasali
- Southern California Permanente Medical Group, Los Angeles, CA
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Minkove SJ, Geiger G, Llibre JM, Montgomery MW, West NE, Chida NM, Antar AAR, Dandachi D, Weld ED, Karmen-Tuohy S, Carlucci PM, Zacharioudakis IM, Rahimian J, Zervou FN, Rebick G, Stachel A, Tang S, Ding D, Jones JL, Farley JE, Dooley KE, Wilgus BE, Sanchez M, Chow J, Kitchell E, Koh S, Maxwell D, Lau A, Brooks S, Chu J, Estrada J, Lazarte SM, Arinze F, Francis A, Paranjape N, Sax PE, Wanjalla CN, Kheshti AN, Bailin S, Koethe J, Kelly SG, Raffanti SP, Patel SM, Xu TH, Goebel M, Santiago ADD, Ray M, Slim J, Kratz AMP, Koren DE, Hiryak K, Hill B, Dare RK, Bordelon S, Bailey B, Baddley JW, Matthew Shoemaker D, Rodriguez-Nava G, Shweta FNU, Chu C, Pearson C, Treakle A, Furin JJ, Bogorodskaya M, Desai S, Osterholzer D, Arquiette J, Ford ES, Ching PR, Sun L, Buggy BP, Tirmizi A, Argentine S, Desai B, Swartz TH, Latimer D, Camazine M. Clinical outcomes after IL-6 blockade in patients with COVID-19 and HIV: a case series. AIDS Res Ther 2022; 19:6. [PMID: 35148782 PMCID: PMC8832430 DOI: 10.1186/s12981-022-00430-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/22/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In hospitalized people with HIV (PWH) there is an increased risk of mortality from COVID-19 among hospitalized PWH as compared to HIV-negative individuals. Evidence suggests that tocilizumab-a humanized monoclonal interleukin (IL)-6 receptor inhibitor (IL-6ri) antibody-has a modest mortality benefit when combined with corticosteroids in select hospitalized COVID-19 patients who are severely ill. Data on clinical outcomes after tocilizumab use in PWH with severe COVID-19 are lacking. CASE PRESENTATION We present a multinational case series of 18 PWH with COVID-19 who were treated with IL-6ri's during the period from April to June 2020. Four patients received tocilizumab, six sarilumab, and eight received an undocumented IL-6ri. Of the 18 patients in the series, 4 (22%) had CD4 counts < 200 cells/mm3; 14 (82%) had a suppressed HIV viral load. Eight patients (44%), all admitted to ICU, were treated for secondary infection; 5 had a confirmed organism. Of the four patients with CD4 counts < 200 cells/mm3, three were treated for secondary infection, with 2 confirmed organisms. Overall outcomes were poor-12 patients (67%) were admitted to the ICU, 11 (61%) required mechanical ventilation, and 7 (39%) died. CONCLUSIONS In this case series of hospitalized PWH with COVID-19 and given IL-6ri prior to the common use of corticosteroids, there are reports of secondary or co-infection in severely ill patients. Comprehensive studies in PWH, particularly with CD4 counts < 200 cells, are warranted to assess infectious and other outcomes after IL-6ri use, particularly in the context of co-administered corticosteroids.
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Batra A, Yang S, Zheng C, Jiang D, Rahimian J, Girvigian M, Gould M, Ryoo J. Patterns of Care for Brain Metastasis Radiotherapy (RT) in an Integrated Healthcare System: Does Increasing Utilization of Stereotactic Radiosurgery (SRS) Compared to Whole Brain RT (WBRT) Lead to Excessive Use at the End of Life (EOL)? Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Glazener E, Chen J, Lodin K, Miller M, Rahimian J, Frager M, Girvigian M. Long-Term Outcomes Of Hypofractionated Stereotactic Radiotherapy For Treatment Of Arteriovenous Malformation. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.114] [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: 10/23/2022]
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Rahimian J. A Novel Brachytherapy Endoscopic Tandem and Inflatable Ovoids Applicator for Cervical and Uterine Neoplasms. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Frager M, Glazener E, Rahimian J, Girvigian M, Zhi M, Lodin K, Feng L, Chen J. An Outcomes Comparison of Patients Treated for Arteriovenous Malformation with LINAC-based Stereotactic Radiosurgery by a Standard Frame-Based Technique or a Frameless Technique Utilizing 3-Dimensional Rotational Angiography. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Carlucci PM, Ahuja T, Petrilli C, Rajagopalan H, Jones S, Rahimian J. Zinc sulfate in combination with a zinc ionophore may improve outcomes in hospitalized COVID-19 patients. J Med Microbiol 2020; 69:1228-1234. [PMID: 32930657 PMCID: PMC7660893 DOI: 10.1099/jmm.0.001250] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/12/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction. COVID-19 has rapidly emerged as a pandemic infection that has caused significant mortality and economic losses. Potential therapies and prophylaxis against COVID-19 are urgently needed to combat this novel infection. As a result of in vitro evidence suggesting zinc sulphate may be efficacious against COVID-19, our hospitals began using zinc sulphate as add-on therapy to hydroxychloroquine and azithromycin.Aim. To compare outcomes among hospitalized COVID-19 patients ordered to receive hydroxychloroquine and azithromycin plus zinc sulphate versus hydroxychloroquine and azithromycin alone.Methodology. This was a retrospective observational study. Data was collected from medical records for all patients with admission dates ranging from 2 March 2020 through to 11 April 2020. Initial clinical characteristics on presentation, medications given during the hospitalization, and hospital outcomes were recorded. The study included patients admitted to any of four acute care NYU Langone Health Hospitals in New York City. Patients included were admitted to the hospital with at least one positive COVID-19 test and had completed their hospitalization. Patients were excluded from the study if they were never admitted to the hospital or if there was an order for other investigational therapies for COVID-19.Results. Patients taking zinc sulphate in addition to hydroxychloroquine and azithromycin (n=411) and patients taking hydroxychloroquine and azithromycin alone (n=521) did not differ in age, race, sex, tobacco use or relevant comorbidities. The addition of zinc sulphate did not impact the length of hospitalization, duration of ventilation or intensive care unit (ICU) duration. In univariate analyses, zinc sulphate increased the frequency of patients being discharged home, and decreased the need for ventilation, admission to the ICU and mortality or transfer to hospice for patients who were never admitted to the ICU. After adjusting for the time at which zinc sulphate was added to our protocol, an increased frequency of being discharged home (OR 1.53, 95 % CI 1.12-2.09) and reduction in mortality or transfer to hospice among patients who did not require ICU level of care remained significant (OR 0.449, 95 % CI 0.271-0.744).Conclusion. This study provides the first in vivo evidence that zinc sulphate may play a role in therapeutic management for COVID-19.
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Affiliation(s)
- Philip M. Carlucci
- New York University Grossman School of Medicine, Department of Medicine, New York, NY, USA
| | - Tania Ahuja
- New York University Langone Health, Department of Pharmacy, New York, NY, USA
| | - Christopher Petrilli
- New York University Grossman School of Medicine, Department of Medicine, New York, NY, USA
- NYU Langone Health, New York, NY, USA
| | | | - Simon Jones
- Division of Healthcare Delivery Science, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
- Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, NY, USA
| | - Joseph Rahimian
- New York University Grossman School of Medicine, Department of Medicine, New York, NY, USA
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Dandachi D, Geiger G, Montgomery MW, Karmen-Tuohy S, Golzy M, Antar AAR, Llibre JM, Camazine M, Díaz-De Santiago A, Carlucci PM, Zacharioudakis IM, Rahimian J, Wanjalla CN, Slim J, Arinze F, Kratz AMP, Jones JL, Patel SM, Kitchell E, Francis A, Ray M, Koren DE, Baddley JW, Hill B, Sax PE, Chow J. Characteristics, Comorbidities, and Outcomes in a Multicenter Registry of Patients with HIV and Coronavirus Disease-19. Clin Infect Dis 2020; 73:e1964-e1972. [PMID: 32905581 PMCID: PMC7499544 DOI: 10.1093/cid/ciaa1339] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Indexed: 12/24/2022] Open
Abstract
Background People with HIV (PWH) may have numerous risk factors for acquiring Coronavirus disease-19 (COVID-19) and developing severe outcomes, but current data are conflicting. Methods Healthcare providers enrolled consecutively by non-random sampling PWH with lab-confirmed COVID-19, diagnosed at their facilities between April 1st and July 1st, 2020. De-identified data were entered into an electronic Research Electronic Data Capture (REDCap). The primary endpoint was severe outcome, defined as a composite endpoint of intensive care unit (ICU) admission, mechanical ventilation, or death. The secondary outcome was the need for hospitalization. Results 286 patients were included; the mean age was 51.4 years (SD, 14.4), 25.9% were female, and 75.4% were African-American or Hispanic. Most patients (94.3%) were on antiretroviral therapy (ART), 88.7% had HIV virologic suppression, and 80.8% had comorbidities. Within 30 days of positive SARS-CoV-2 testing, 164 (57.3%) patients were hospitalized, and 47 (16.5%) required ICU admission. Mortality rates were 9.4% (27/286) overall, 16.5% (27/164) among those hospitalized, and 51.5% (24/47) among those admitted to an ICU. The primary composite endpoint occurred in 17.5% (50/286) of all patients and 30.5% (50/164) of hospitalized patients. Older age, chronic lung disease, and hypertension were associated with severe outcomes. A lower CD4 count (<200 cells/mm³) was associated with the primary and secondary endpoints. There was no association between the antiretroviral regimen or lack of viral suppression and predefined outcomes. Conclusion Severe clinical outcomes occurred commonly in PWH and COVID-19. The risk for poor outcomes was higher in those with comorbidities and lower CD4 cell counts, despite HIV viral suppression.
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Affiliation(s)
- Dima Dandachi
- Division of Infectious Diseases, University of Missouri-Columbia, MO
| | - Grant Geiger
- School of Medicine, University of Missouri-Columbia, MO
| | - Mary W Montgomery
- Department of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
| | | | - Mojgan Golzy
- Department of Health Management and Informatics, University of Missouri-Columbia, MO
| | - Annukka A R Antar
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Josep M Llibre
- Infectious Diseases and Fight AIDS Foundation, University Hospital Germans Trias, Badalona, Spain
| | | | - Alberto Díaz-De Santiago
- Internal Medicine Department, HIV Infection Unit. Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | - Philip M Carlucci
- School of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Ioannis M Zacharioudakis
- Division of Infectious Diseases and Immunology, New York University Grossman School of Medicine, New York, NY
| | - Joseph Rahimian
- Division of Infectious Diseases and Immunology, New York University Grossman School of Medicine, New York, NY
| | - Celestine N Wanjalla
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN
| | - Jihad Slim
- Division of Infectious Diseases, Saint Michael's Medical Center, Newark, NJ
| | - Folasade Arinze
- Department of Internal Medicine, Wellstar Health System, Atlanta, GA
| | | | - Joyce L Jones
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shital M Patel
- Section of Infectious Diseases, Medicine, Baylor College of Medicine, TX
| | - Ellen Kitchell
- Division of Infectious Diseases, UT Southwestern Medical Center, TX
| | - Adero Francis
- Department of Internal Medicine, Wellstar Health System, Atlanta, GA
| | - Manoj Ray
- Division of Infectious Diseases, Santa Clara Valley Health & Hospital System, CA
| | - David E Koren
- Department of Pharmacy, Temple University Health System, PA
| | - John W Baddley
- Division of Infectious Disease, University of Maryland, Baltimore, MD
| | - Brannon Hill
- Department of Pharmacy, University of Arkansas for Medical Sciences, AR
| | - Paul E Sax
- Department of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
| | - Jeremy Chow
- Division of Infectious Diseases, UT Southwestern Medical Center, TX
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Glazener E, Lodin K, Miller M, Frager M, Rahimian J, Chen J, Girvigian M. Long-Term Outcomes for Arteriovenous Malformations treated with LINAC-based Stereotactic Radiosurgery in the Pediatric Population. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1077] [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: 10/26/2022]
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13
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Beard B, Rahimian J. A Dosimetric Comparison of Preoperative Versus Postoperative Stereotactic Radiosurgery for Brain Metastases. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.786] [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: 10/26/2022]
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14
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Frager M, Glazener E, Rahimian J, Girvigian M, Miller M, Lodin K, Fang L, Chen J. An Outcomes-based Analysis of Patients Treated for Arteriovenous Malformation by Frameless LINAC-based Stereotactic Radiosurgery Using 3-Dimensional Rotational Angiography. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1292] [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: 10/26/2022]
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15
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Rahimian J, Jiang D, Girvigian M, Wang R, Chang C, Lekht I. Stereotactic Ablative Radiosurgery (SABR) of Dorsal Sacral Lateral Nerve Branches for Treatment of Sacroiliac Pain – a Dosimetric Feasibility Study Exploring the Role of Noninvasive SABR in Place of Bipolar Radiofrequency Ablation. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.918] [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: 10/26/2022]
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16
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Jiang D, Rahimian J, Girvigian M, Chang C, Lekht I. Radiosurgery Ablation of Medial Branch Nerves of the Lumbar Spine for Facetogenic Back Pain: A Dosimetric Evaluation of Targeting and Safety. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1294] [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: 11/26/2022]
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Cnossen N, Jiang D, Girvigian M, Rahimian J. Radiosurgical Pulmonary Vein Isolation for the Treatment of Atrial Fibrillation: A Dosimetric Optimization and Dynamic Phantom Study. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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18
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Jiang D, Cnossen N, Rahimian J, Girvigian M. Treatment of Multiple Brain Metastases Using Single Isocentric Technique with Forward Planned Dynamic Arcs. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.860] [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: 12/01/2022]
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Khodayari B, Rahimian R, Rahimian J, Wang R, Girvigian M. Metachronous Versus Synchronous Versus Single Tumor Non–small Cell Lung Cancers: Is There a Difference in Outcomes? Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Khodayari B, Rahimian R, Rahimian J, Girvigian M. Cardiac Maximum Point Dose Predicts for Patient Survival in Early Stage Non–small Cell Lung Cancer Patients Treated with Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.585] [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: 11/27/2022]
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Wang R, Rahimian J, Girvigian M, Miller M, Mariscal L. Quantitative Analysis of Stereotactic Body Radiation Therapy (SBRT)-Induced Lung Injuries. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.2315] [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: 11/26/2022]
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Chang-Halpenny C, Zhi M, Girvigian M, Chen J, Miller M, Feng L, Lodin K, Rahimian J. Frameless Stereotactic Radiosurgery of Arteriovenous Malformations Using High-Resolution 3-Dimensional Rotational Angiography. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.795] [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: 10/20/2022]
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Rahimian J, Torossian A, Shenasa M. A Feasibility and Proof of Concept Dosimetric Study of Noninvasive Radiosurgical Ablation of Pulmonary Vein Antra to Treat Atrial Fibrillation. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.2220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zhi M, Girvigian M, Miller M, Chen J, Rahimian J, Lodin K. Long-Term Outcomes of Atypical Meningioma After Gross Total Resection (GTR) or Subtotal Resection (STR) With or Without Postoperative Radiation Therapy (PORT). Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chang-Halpenny C, Rahimian J. Single Isocenter Volumetric Modulated Arc Radiosurgery for Multiple Brain Metastases. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.2036] [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: 11/28/2022]
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Liu X, Rahimian J, Goy B, Cosmatos H, Qian Y. SU-E-T-12: A Comparative Dosimetric Study of Pre and Post Prostate Iodine-125 Permanent Seed Implants. Med Phys 2015. [DOI: 10.1118/1.4924373] [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: 11/07/2022] Open
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Rahimian J, Khan R, LaScalea KA. Does Nasal Colonization or Mupirocin Treatment Affect Recurrence of Methicillin-Resistant Staphylococcus aureus Skin and Skin Structure Infections? Infect Control Hosp Epidemiol 2015; 28:1415-6. [DOI: 10.1086/523273] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Accepted: 07/26/2007] [Indexed: 11/03/2022]
Abstract
Some patients with community-associated methicillin-resistant Staphylococcus aureus skin and skin structure infections have experienced frequent recurrences. We performed a retrospective study and determined that the presence of nasal colonization did not affect recurrence and nasal mupirocin treatment marginally decreased recurrence
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Erickson K, Rahimian J. A Technique to Quantify and Reduce Backscatter Due to Metallic Dental Restoration in Head and Neck Radiation Therapy. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.2527] [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]
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Hong G, Rahimian J, Qian Y. Monitoring Neutron Exposure of Radiation Therapists on 15 MV Linear Accelerators. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1793] [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: 10/24/2022]
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White E, Wang R, Rahimian J. Comparison of Whole-Brain Integral Dose Between Whole-Brain Radiation Therapy and Stereotactic Radiosurgery of Multiple Brain Metastases. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.2580] [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: 10/24/2022]
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31
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Brumer E, Dubrovskaya Y, Scipione MR, Aberle C, Rahimian J, Papadopoulos J. Evaluation of Treatment Courses When Vancomycin Is Given Every 8 Hours in Adult Patients. J Pharm Pract 2014; 28:511-7. [PMID: 25112304 DOI: 10.1177/0897190014544817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Several nomograms include recommendations to give intravenous (IV) vancomycin at 8-hour dosing intervals (Q8H). However, there is a lack of detailed data regarding this dosing recommendation. METHODS A retrospective chart review of 100 patients who received 107 treatment courses of vancomycin Q8H for at least 5 days was performed. Distribution of vancomycin trough levels and rate of nephrotoxicity were evaluated. RESULTS Median patient age was 38 years (interquartile range [IQR] 27-50 years), median weight was 67 kg (IQR 55-79 kg), and median creatinine clearance was 124 mL/min (IQR 101-147 mL/min). Median duration of Q8H dosing was 9 days (IQR 7-12 days). Within the initial 96 hours, only 7% (7 of 104) of maximum trough concentrations were >20 mg/L (median dose 15 mg/kg [IQR 15-18 mg/kg]). After 96 hours of Q8H dosing, 34% (30 of 89) of maximum troughs were >20 mg/L (median dose 17 mg/kg [IQR 15-20 mg/kg]), P = .0005. The rate of nephrotoxicity was 4%. CONCLUSION We observed an increase in the percentage of trough levels >20 mg/L later during treatment courses of vancomycin IV Q8H with a relatively small corresponding increase in vancomycin dose. Close monitoring of trough levels (eg, every 3 days) with prolonged courses of vancomycin IV Q8H is warranted.
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Affiliation(s)
- Erica Brumer
- Department of Pharmacy, NYU Langone Medical Center, New York, NY, USA
| | | | - Marco R Scipione
- Department of Pharmacy, NYU Langone Medical Center, New York, NY, USA
| | - Caitlin Aberle
- Department of Pharmacy, NYU Langone Medical Center, New York, NY, USA
| | - Joseph Rahimian
- Division of Infectious Diseases, Department of Medicine, NYU Langone Medical Center, New York, NY, USA
| | - John Papadopoulos
- Department of Pharmacy, NYU Langone Medical Center, New York, NY, USA
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Liu X, Rahimian J, Cosmatos H, Goy B, Heywood C, Qian Y. SU-E-T-55: Biological Equivalent Dose (BED) Comparison Between Permanent Interstitial Brachytherapy and Conventional External Beam Radiotherapy for Prostate Cancer. Med Phys 2014. [DOI: 10.1118/1.4888385] [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: 11/07/2022] Open
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33
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Farol H, Rahimian J, Alfaro A, Nall J, Wang R. A Dosimetric Feasibility Study Using Forward Planning Segmental Field Technique for Stationary Craniospinal and Spinal–Sacral Junctions in Craniospinal Axis Irradiation. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.2006] [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: 10/26/2022]
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34
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Mariscal L, Rahimian J, Girvigian M. Hypofractionated Stereotactic Body Radiation Therapy (SBRT) for Pelvic or Sacral Recurrence. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1504] [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: 10/26/2022]
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35
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Rahman S, Rahimian J. Comparative Study of Internal Target Volume (ITV) Based on PET-CT and 4DCT for Stereotactic Body Radiation Therapy of Non-small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.2183] [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: 11/26/2022]
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36
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Han J, Girvigian M, Chen J, Rahimian J, Miller M, Lodin K, Kaptein J. The Significance of Optic Nerve Involvement by Skull Base Meningioma and its Impact on Radiographic Control After Treatment With Stereotactic Radiosurgery or Fractionated Stereotactic Radiation Therapy. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.752] [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: 10/27/2022]
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37
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Rahman S, Rahimian J. 4DCT Planning Dose Reduction for Stereotactic Body Radiotherapy. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.1515] [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: 10/16/2022]
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38
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Rahimian J, Girvigian M, Feng L, Chen J, Miller M, Arellano A, Lodin K. Frameless Stereotactic Radiosurgery of Arteriovenous Malformations using High Resolution 3D Rotational Angiograms, and Novalis ExacTrac Systems. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1792] [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: 10/19/2022]
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39
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Girvigian M, Han J, Cahan B, Chen J, Arellano A, Miller M, Lodin K, Rahimian J. Early Outcomes of Basal Meningiomas Treated with Image-guided Hypofractionated Stereotactic Radiotherapy. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.676] [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: 10/19/2022]
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40
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Miller M, Girvigian M, Chen J, Rahimian J. Improvement in Presenting Visual Deficits and Diplopia in Patients with Orbital Nerve Sheath and Orbital Apex Meningiomas Treated with Fractionated Stereotactic Radiotherapy. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.594] [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: 10/20/2022]
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41
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Rahimian J, Girvigian M, Chen J, Rahimian R, Miller M. Geometric Accuracy of Frameless Based Image Guided Stereotactic Radiosurgery of Trigeminal Neuralgia using Brainlab's Exactrac 6-D Robotic System. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.1544] [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: 10/20/2022]
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Elemam A, Rahimian J, Mandell W. Infection with panresistant Klebsiella pneumoniae: a report of 2 cases and a brief review of the literature. Clin Infect Dis 2009; 49:271-4. [PMID: 19527172 DOI: 10.1086/600042] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Infections caused by carbapenemase-producing Klebsiella pneumoniae have been reported with increasing frequency, thereby limiting the choice of effective antimicrobial agents available to clinicians. This has prompted the increased use of polymyxins and tigecycline, but resistance to these agents is already emerging. We report 2 cases of infection with panresistant K. pneumoniae.
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Affiliation(s)
- Azza Elemam
- Section of Infectious Diseases, Saint Vincent's Hospital, New York, New York, USA.
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Girvigian M, Ling T, Chen J, Miller M, Rahimian J, Tome M. An Updated Comparison of Early Complications for Patients with Convexity and Parasagittal Meningioma Treated with either Stereotactic Radiosurgery or Fractionated Stereotactic Radiotherapy. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.1540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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44
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Kemmis T, Chen J, Girvigian M, Miller M, Rahimian J, Tome M. Validating the Radiosurgery-based Grading System for Large Arteriovenous Malformations Treated with Fractionated Stereotactic Radiotherapy. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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45
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Rahimian J. Reply to Graber and Schwartz. Infect Control Hosp Epidemiol 2008. [DOI: 10.1086/527452] [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: 11/03/2022]
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Shastry L, Rahimian J, Lascher S. Community-Associated Methicillin-Resistant Staphylococcus aureus Skin and Soft Tissue Infections in Men Who Have Sex With Men in New York City. ACTA ACUST UNITED AC 2007; 167:854-7. [PMID: 17452552 DOI: 10.1001/archinte.167.8.854] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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48
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Martiniuk F, Tambini M, Rahimian J, Moreira A, Yee H, Tchou-Wong KM, Hanna BA, Rom WN, Levis WR. Identification of novel hsp65 RFLPs for Mycobacterium leprae. J Drugs Dermatol 2007; 6:268-74. [PMID: 17373188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Leprosy or Hansen's disease is a chronic infectious disease caused by an acid-fast bacillus, Mycobacterium leprae (M. leprae). The bacilli proliferate in macrophages infiltrating the skin and gain entry to the dermal nerves via the laminar surface of Schwann cells where they replicate. After entry, the Schwann cells proliferate and then die. Conclusive identification of M. leprae DNA in a sample can be obtained by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) for the heat shock 65 gene (hsp65). Molecular epidemiology will make it possible to study the global distributions of M. leprae, explore the relationship between genotypes-incidence rates, mode of transmission, and the type of disease (tuberculoid vs. lepromatous). We amplified DNA using PCR for the hsp65 gene from 24 skin lesions from patients diagnosed with various types of leprosy. Fifteen out of 24 were positive for the hsp65 gene. Digestion with HaeIII-PAGE for the RFLP confirmation of the presence of M. leprae DNA showed the typical pattern in 5 out of 24 and 2 novel patterns in 10 out of 24 patients. We confirmed the presence of M. leprae DNA by sequencing the genes for gyraseA or B and folP, which contained only M. leprae specific single nucleotide polymorphisms (SNPs). Thus, we describe novel hsp65 RFLPs for M. leprae found in a high frequency making them ideal for future epidemiology and transmission studies.
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Affiliation(s)
- Frank Martiniuk
- Department of Medicine-Pulmonary Division, New York University School of Medicine, New York, NY 10016, USA.
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Girvigian M, Chen J, Rahimian J, Miller M, Tome M. 1109. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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50
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Rahimian J, Raoult D, Tang YW, Hanna BA. Bartonella quintana endocarditis with positive serology for Coxiella burnetii. J Infect 2006; 53:e151-3. [PMID: 16386308 DOI: 10.1016/j.jinf.2005.11.014] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 12/11/2004] [Accepted: 11/15/2005] [Indexed: 10/25/2022]
Abstract
Both Bartonella quintana and Coxiella burnetii are known to cause of blood culture negative endocarditis. In such case, the diagnosis is usually established by serology. A case of Bartonella quintana endocarditis is described where the serology was falsely positive for Coxiella burnetii. This case demonstrates the difficulty in distinguishing these two etiologic agents by routine serologic testing.
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