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Chong HH, See A, Kulkarni K. National trends in the initial diagnosis and management of carpal tunnel syndrome: results from the ELECTS (ELEctrophysiology in Carpal Tunnel Syndrome) study. Ann R Coll Surg Engl 2024; 106:64-69. [PMID: 36448937 PMCID: PMC10757874 DOI: 10.1308/rcsann.2022.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2022] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION The optimal role of nerve conduction studies (NCS) in management of carpal tunnel syndrome (CTS) is unclear, with no standardised guidance. This study aimed to identify variation in practice in the initial diagnosis of patients with suspected CTS, alongside evaluating how NCS findings influence clinical decision making. METHODS A national multicentre collaborative survey was conducted in 2021. All centres providing surgery for CTS were invited to participate, primarily via social media. All middle-senior grade orthopaedic/plastic surgeons and advanced care practitioners that regularly manage new referrals for suspected CTS were eligible to respond. Local representatives at each participating site submitted their responses to a central team who collated and analysed the results. RESULTS A total of 137 healthcare professionals responded from 18 UK NHS Trusts. Of these 137, 124 (91%) reported not employing any validated clinical questionnaires in their routine practice, preferring to rely on clinical diagnosis and/or NCS if available, whereas 84 (61%) utilised NCS to aid diagnosis, with significant differences among professionals with differing experience (p < 0.01). The most common methods for determining the severity of CTS were history, examination and NCS. In symptomatic CTS with confirmatory NCS, over 50% of clinicians would choose surgical decompression as their first-line intervention. In cases of either negative NCS or atypical presentation, 37% and 51%, respectively, would consider conservative management (e.g. splintage) or steroid injection first line. CONCLUSIONS With growing waiting lists for NCS and surgery, national consensus guidelines should be developed to support decision making, while maximising efficient utilisation of increasingly constrained resources.
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Affiliation(s)
- HH Chong
- University Hospital of Leicester NHS Trust, UK
| | - A See
- Kettering General Hospital NHS Foundation Trust, UK
| | - K Kulkarni
- Pulvertaft Hand Centre, University Hospitals of Derby and Burton NHS Foundation Trust, UK
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Scotcher M, Chong HH, Asif A, Kulkarni K. Radiological Criteria for Acceptable Alignment in Paediatric Mid-Shaft Forearm Fractures: A Systematic Review. Malays Orthop J 2023; 17:26-32. [PMID: 38107363 PMCID: PMC10722999 DOI: 10.5704/moj.2311.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/16/2022] [Indexed: 12/19/2023] Open
Abstract
Introduction Forearm fractures are common in children. The remodelling capacity of growing long bones in children makes these potentially forgiving injuries, recovering with good outcomes despite minimal intervention. Clinicians rely on radiological characteristics that vary with age to guide treatment decisions and minimise adverse sequelae. The purpose of this review was to consolidate the evidence base of radiological indications for intervention in paediatric mid-shaft forearm fractures. Materials and methods The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed for this review. Citable research output reporting radiological criteria for mid-shaft forearm fractures in paediatric patients (age ≤16 years) was screened and analysed to ascertain acceptable radiological criteria for non-operative management. Results A total of 2,059 papers were initially identified; 14 were selected following screening. Sagittal angulation >15°, coronal angulation >10°, and/or >50% (or >1cm) translation were the most common radiological indications for intervention in children aged 0 to 10 years. For children over 10 years of age, the most common radiological indication for intervention was sagittal angulation >10°, coronal angulation >10°, and/or >50% (or >1cm) translation. Conclusion This study revealed a scarcity of high-quality evidence to guide management and significant variation in outcome reporting throughout the published literature. Since Noonan and Price's 1998 recommendations, there has been no significant evolution in the evidence-base guided threshold for intervention in paediatric mid-shaft forearm fractures. There remains a pressing need for a robust multicentre observational study using the patient-reported outcome measurement information system (PROMIS) to address this complex and controversial area of uncertainty in paediatric trauma management.
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Affiliation(s)
- M Scotcher
- Department of Plastic Surgery, Addenbrooke's Hospital Cambridge University, Cambridge, United Kingdom
| | - H H Chong
- Department of Orthopaedic and Trauma, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - A Asif
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - K Kulkarni
- Department of Plastic Surgery, Addenbrooke's Hospital Cambridge University, Cambridge, United Kingdom
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Attlassy Y, Ahmed H, Slutsky R, Kulkarni K, Rajpurohit V, Taslakian B, Mabud T. Abstract No. 522 The Impact of Virtual Residency Interviews on the Geographic Distribution of Integrated Interventional and Diagnostic Radiology Residency Matches. J Vasc Interv Radiol 2023. [PMCID: PMC9950328 DOI: 10.1016/j.jvir.2022.12.380] [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: 02/27/2023] Open
Affiliation(s)
- Y. Attlassy
- New York University Grossman School of Medicine
| | - H. Ahmed
- New York University Grossman School of Medicine
| | - R. Slutsky
- New York University Grossman School of Medicine
| | - K. Kulkarni
- Department of Radiology at New York University Grossman School of Medicine
| | | | | | - T. Mabud
- New York University Grossman School of Medicine
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Manduca S, Mabud T, Liu S, Taslakian B, Morris E, Kulkarni K. Abstract No. 146 Effect of Embolic Particle Size on Outcomes of Uterine Artery Embolization for Mixed Adenomyosis/Fibroids: Are Smaller Particles Needed? J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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Tria N, Kulkarni K. Abstract No. 507 Safety and feasibility of adjuvant liposomal bupivacaine in superior hypogastric nerve block performed during uterine fibroid embolization. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.489] [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: 10/18/2022] Open
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Peterknecht E, Agerbak E, Mohamedahmed AYY, Stonelake S, Kulkarni K, Peravali R, Zaman S. Aggressive angiomyxoma of the ischioanal fossa in a post-menopausal woman. Ann R Coll Surg Engl 2021; 103:e59-e64. [PMID: 33559550 PMCID: PMC9773864 DOI: 10.1308/rcsann.2020.7008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Aggressive angiomyxoma is a rare mesenchymal tumour, primarily arising in the soft tissue of the pelvis and perineum in women of reproductive age. There is a paucity of evidence on optimal management because of the rarity of these tumours, but the consensus has been for surgical excision. We present the case of a 65-year-old woman who was admitted with left-sided buttock pain and initially diagnosed with a perianal abscess. She underwent examination under anaesthesia rectum with surgical excision of the lesion, subsequent histopathological and immunochemical analysis was suggestive of aggressive angiomyxoma. To complement our case report, we also present a literature review focusing on aggressive angiomyxoma in the ischioanal fossa (also known as the ischiorectal fossa) with only eight cases of primary aggressive angiomyxoma involving the ischioanal fossa documented to date. The primary aims of this case report and literature review are to familiarise clinicians with the clinical, histopathological and immunochemical features of these tumours, and to increase appreciation that despite the rarity of aggressive angiomyxoma, it might be considered in the differential diagnosis of ischioanal lesions.
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Affiliation(s)
- E Peterknecht
- Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, UK
| | - E Agerbak
- Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, UK
| | - AYY Mohamedahmed
- Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, UK
| | - S Stonelake
- Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, UK
| | - K Kulkarni
- Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, UK
| | - R Peravali
- Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, UK
| | - S Zaman
- Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, UK
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Scotcher M, Asif A, Kulkarni K. Are UK and Ireland trauma and orthopaedic surgeons maintaining their research output? Ann R Coll Surg Engl 2020; 102:625-631. [PMID: 32777931 DOI: 10.1308/rcsann.2020.0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Healthcare faces growing challenges. With reports of diminishing research output from the UK and Ireland in the leading surgical journals, this study aimed to ascertain whether this trend had been echoed in the trauma and orthopaedic literature. MATERIALS AND METHODS Citable research output from the 10 globally leading trauma and orthopaedic journals was analysed from five individual years, over a 20-year period, to ascertain trends in absolute output, geographical mix, and level of evidence. RESULTS The overall number of published articles fell by 14.5%. North America saw the greatest decline (-8.0%), followed by Japan (-5.6%) and Europe (-3.3%). The UK and Ireland (+2.9%) and the rest of the world (+13.9%) saw rising output. A decline in lower (levels IV and V) and a rise in higher (levels I, II and III) quality evidence was observed. The UK and Ireland had a greater proportion of higher-quality studies than North America and Japan, but lower than Europe and the rest of the world. The impact factor of the leading journal rose from 4.47 to 7.01. DISCUSSION The research landscape has evolved, with leading journals placing greater emphasis on higher-quality evidence. UK and Irish research output remains stable, contributing 14% of the most highly cited publications in 2018, and challenging North America's dominance with a greater proportion of level I and II evidence in the leading journals. CONCLUSION With the growing emergence of Europe and the rest of the world, UK and Irish authors must build upon the region's output despite political challenges such as Brexit. Increasing international collaboration will continue to play an important role.
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Affiliation(s)
| | - A Asif
- University of Leicester, Leicester, UK
| | - K Kulkarni
- University Hospitals of Leicester NHS Trust, Leicester, UK
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Mann J, Wernham A, Kulkarni K, Varma S. An unexpected lesion on the scalp. Clin Exp Dermatol 2020; 45:922-924. [PMID: 32449175 DOI: 10.1111/ced.14268] [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] [Accepted: 03/04/2020] [Indexed: 11/29/2022]
Affiliation(s)
- J Mann
- Departments of Dermatology, Nottingham Treatment Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - A Wernham
- Departments of Dermatology, Nottingham Treatment Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - K Kulkarni
- Department of Histopathology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Varma
- Departments of Dermatology, Nottingham Treatment Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Luttmann-Gibson H, Mora S, Camargo CA, Cook NR, Demler OV, Ghoshal A, Wohlgemuth J, Kulkarni K, Larsen J, Prentice J, Cobble M, Bubes V, Li C, Friedenberg G, Lee IM, Buring JE, Manson JE. Serum 25-hydroxyvitamin D in the VITamin D and OmegA-3 TriaL (VITAL): Clinical and demographic characteristics associated with baseline and change with randomized vitamin D treatment. Contemp Clin Trials 2019; 87:105854. [PMID: 31669447 PMCID: PMC6875603 DOI: 10.1016/j.cct.2019.105854] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/19/2019] [Accepted: 09/25/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The VITamin D and OmegA-3 TriaL (VITAL) is a completed randomized, placebo-controlled trial of vitamin D3 (2000 IU/day) and marine omega-3 (1 g/day) supplements in the primary prevention of cancer and cardiovascular disease. Here we examine baseline and change in 25-hydroxyvitamin D (25(OH)D) and related biomarkers with randomized treatment and by clinical factors. METHODS Baseline 25(OH)D was measured in 15,804 participants (mean age 68 years.; 50.8% women; 15.7% African Americans) and in 1660 1-year follow-up samples using liquid chromatography-tandem mass spectrometry and chemiluminescence. Calcium and parathyroid hormone (iPTH) were measured by chemiluminescence and spectrophotometry respectively. RESULTS Mean baseline total 25(OH)D (ng/mL ± SD) was 30.8 ± 10.0 ng/mL, and correlated inversely with iPTH (r = -0.28), p < .001. After adjusting for clinical factors, 25(OH)D (ng/mL ± SE) was lower in men vs women (29.7 ± 0.30 vs 31.4 ± 0.30, p < .0001) and in African Americans vs whites (27.9 ± 0.29 vs 32.5 ± 0.22, p < .0001). It was also lower with increasing BMI, smoking, and latitude, and varied by season. Mean 1-year 25(OH)D increased by 11.9 ng/mL in the active group and decreased by 0.7 ng/mL in placebo. The largest increases were noted among individuals with low baseline and African Americans. Results were similar for chemiluminescent immunoassay. Mean calcium was unchanged, and iPTH decreased with treatment. CONCLUSION In VITAL, baseline 25(OH)D varied by clinical subgroups, was lower in men and African Americans. Concentrations increased with vitamin D supplementation, with the greatest increases in those with lower baseline 25(OH)D. The seasonal trends in 25(OH)D, iPTH, and calcium may be relevant when interpreting 25(OH)D levels for clinical treatment decisions. CLINICAL TRIAL REGISTRATION VITAL ClinicalTrials.gov number NCT01169259.
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Affiliation(s)
- Heike Luttmann-Gibson
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue, Boston, MA 02215, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Landmark Center West, 401 Park Drive, Boston, MA 02215, USA
| | - Samia Mora
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue, Boston, MA 02215, USA; Division of Cardiovascular Medicine and Center for Lipid Metabolomics, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue, Boston, MA 02215, USA.
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA; Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Nancy R Cook
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue, Boston, MA 02215, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Olga V Demler
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue, Boston, MA 02215, USA
| | - Amit Ghoshal
- Quest Diagnostics, 27027 Tourney Road, Valencia, CA 91355, USA
| | - Jay Wohlgemuth
- Quest Diagnostics, 27027 Tourney Road, Valencia, CA 91355, USA
| | - Kris Kulkarni
- Atherotech Diagnostics, 201 London Pkwy #400, Birmingham, AL 35211, USA; VAP Diagnostics R&D Laboratory, 201 London Pkwy, Birmingham, AL 3521, USA
| | - Julia Larsen
- Quest Diagnostics, 27027 Tourney Road, Valencia, CA 91355, USA
| | - James Prentice
- Quest Diagnostics, 27027 Tourney Road, Valencia, CA 91355, USA
| | - Michael Cobble
- Atherotech Diagnostics, 201 London Pkwy #400, Birmingham, AL 35211, USA
| | - Vadim Bubes
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue, Boston, MA 02215, USA
| | - Chunying Li
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue, Boston, MA 02215, USA
| | - Georgina Friedenberg
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue, Boston, MA 02215, USA
| | - I-Min Lee
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue, Boston, MA 02215, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Julie E Buring
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue, Boston, MA 02215, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue, Boston, MA 02215, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
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Sathiaraj E, Chakraborthy S, Priya K, Kulkarni K. SUN-PO091: Nutritionist Delivered Quality Improvement Program Results in Significant Reduction in Unplanned Hospital Admissions Among Cancer Patients Undergoing Chemotherapy and/or Radiotherapy. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32725-6] [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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Delatour V, Clouet-Foraison N, Gaie-Levrel N, Marcovina S, Hoofnagle A, Kuklenyik Z, Caulfield M, Otvos J, Contois J, Krauss R, Kulkarni K, Remaley A, Vesper H, Cobbaert C, Gillery P. Standardization of advanced lipoprotein testing: The BioSITrace project. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.1479] [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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Kushchayeva YS, Tella SH, Kushchayev SV, Van Nostrand D, Kulkarni K. Comparison of hyperparathyroidism types and utility of dual radiopharmaceutical acquisition with Tc99m sestamibi and 123I for localization of rapid washout parathyroid adenomas. Osteoporos Int 2019; 30:1051-1057. [PMID: 30706095 DOI: 10.1007/s00198-019-04846-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 01/06/2019] [Indexed: 11/29/2022]
Abstract
UNLABELLED Tc99m-sestamibi dual-time imaging is a standard tool for localization of adenomas/hyperplasia in hyperparathyroidism. We investigated the degree and causes of localization failure among different types of hyperparathyroidism. Pre-operative parathyroid hormone levels and size of the gland were major determinants of Tc99m-sestamibi positivity; 123I scan may be helpful in localization failures. INTRODUCTION Tc99m-sestamibi dual-time imaging is a standard tool for localization of adenomas/hyperplasia in hyperparathyroidism. However, parathyroid adenomas/hyperplasia has been reported to washout as fast as normal thyroid tissue ("rapid washout") which may lead to diagnostic failure. We aimed to evaluate the determinants of rapid washout and to determine the role of subtraction imaging for detection of parathyroid adenomas/hyperplasia with rapid washout. METHODS Retrospective analysis of patients with hyperparathyroidism who have undergone Tc99m-sestamibi dual-time imaging and parathyroid surgery. Rapid washout was correlated to the type of hyperparathyroidism in surgically confirmed cases. Biochemical and pathological data were reviewed. RESULTS A total of 135 hyperparathyroidism patients met the inclusion criteria. Ninety-six (72%), 29 (21%), and 10 (7%) had primary, secondary, and tertiary hyperparathyroidisms, respectively. Rapid washout was identified in 28/87 glands (32%), 14/53 glands (26%), and 1/16 glands (6%) with primary, secondary, and tertiary hyperparathyroidisms, respectively. Glands that were positive on late-phase Tc99m-sestamibi scans were significantly large being 1.7 (IQR 1.4-2.3) vs. 1.45 (IQR 1-2) cm (p = 0.003). High parathyroid hormone levels (PTH) were associated with early-phase Tc99m-sestamibi positivity in both primary (p = 0.01) and secondary hyperparathyroidism (p = 0.03) but not with last phase (p = 0.11, p = 0.37, respectively). Correlative imaging with subtraction scintigraphy was positive in 14/16 (87.5%) parathyroid adenomas. CONCLUSION Pre-operative PTH levels and size of the gland were major determinants of Tc99m-sestamibi positivity on early-phase Tc99m-sestamibi scans, whereas size is an independent predictor of late-phase Tc99m-sestamibi positivity. Subtraction scintigraphy might be a useful tool in suspected cases of rapid washout adenomas/hyperplasia.
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Affiliation(s)
- Y S Kushchayeva
- Diabetes, Endocrinology, and Obesity Branch, NIDDK, NIH, Bethesda, MD, USA
| | - S H Tella
- University of South Carolina School of Medicine, Columbia, SC, USA
| | - S V Kushchayev
- Department of Radiology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - D Van Nostrand
- Division of Nuclear Medicine, MedStar Washington Hospital Center, 110 Irving Street, NW, Suite GB1, Washington, DC, 20010, USA
| | - K Kulkarni
- Division of Nuclear Medicine, MedStar Washington Hospital Center, 110 Irving Street, NW, Suite GB1, Washington, DC, 20010, USA.
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Keller S, Gorantla V, Aaltonen E, Kulkarni K, McDermott M. 03:27 PM Abstract No. 134 Superior hypogastric nerve block for post-procedure pain control after uterine artery embolization. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.183] [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] Open
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McDermott M, Kulkarni K. 03:00 PM Abstract No. 421 Treatment of enhanced myometrial vascularity with transarterial embolization. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.500] [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] Open
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Tolkacheva EG, Kluck R, Kulkarni K. P883Heart rhythm control using novel anti-arrhythmic pacing protocol. Europace 2018. [DOI: 10.1093/europace/euy015.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- E G Tolkacheva
- University of Minnesota, Biomedical Engineering, Minneapolis, United States of America
| | - R Kluck
- University of Minnesota, Biomedical Engineering, Minneapolis, United States of America
| | - K Kulkarni
- University of Minnesota, Biomedical Engineering, Minneapolis, United States of America
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Amico AL, Fang R, Raoul A, Wroblewski K, Nielsen S, Weipert C, Abe H, Sheth D, Romero I, Kulkarni K, Schacht D, Patrick-Miller L, Verp M, Bradbury AR, Hlubocky F, Olopade OI. Abstract P5-19-04: Psychosocial impact of a multi-modality surveillance program for women at high-risk for breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-19-04] [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: 11/16/2022]
Abstract
Abstract
Purpose: To evaluate the psychosocial impact of semi-annual dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) screening in women at high-risk for breast cancer.
Background: For women with BRCA1 and BRCA2 mutations and/or a personal or family history of breast cancer, annual breast MRI has shown improved sensitivity and cancer detection compared to mammography. However, MRI's heightened sensitivity may lead to increased: false positives requiring additional follow-up biopsy/imaging; iatrogenic risk; and psychosocial distress, which all may negatively impact women's overall health-related quality of life.
Methods: Between 2004 and 2016, we assembled a prospective cohort of high-risk women undergoing semi-annual DCE-MRI and annual mammography. We reviewed a subset of this group. Participants completed psychosocial assessments at baseline and 6-month visits using the following measures: coping (MBSS); state/trait anxiety (STAI-S/T); depression (BDI-II); risk perception; and mental health (SF-36). Participants were classified according to Monitor or Blunter coping style. Mixed-effects logistic regressions models examined effects of demographics on psychosocial changes over time.
Results: 295 women were recruited to the study; 44% of the study participants had pathogenic mutations in BRCA1 or BRCA2 genes. 232 of 295 enrolled participants (78.6%) completed psychosocial assessments. For the total population: median age 44y (range: 21-73), 71% ≥college/post-graduate education; 84% Caucasian; 8% African American; 2% Latino; 99% with health insurance; 72% annual income of >$60,000. One third of women had a personal cancer history. Participants were evenly split between baseline Monitoring and Blunting coping style (49% and 51%, respectively). No significant differences were found between demographics (age, race, income, mutation, cancer type, cancer history) or psychosocial factors (baseline trait anxiety (p =0.64), depression (p =0.65), SF36 global health (p=0.66). After adjusting for education, race, cancer history and coping, women with ≥$60,000 income had lower trait anxiety (p<0.000) and greater mental health (p<0.001) than those with <$60,000 income. Over time, change in trait anxiety varied by coping (p=0.0006): Blunters did not experience significant changes in trait anxiety (p=0.072) while Monitors had significant diminished trait anxiety over time (p<0.001). For depression, women with ≥$60,000 income and college educated had lower BDI-II depression (p<0.000). Yet, women with a cancer history had significantly greater BDH-II depression (p= 0.048). Mental health over time varied by race as non-whites had greater gains in mental health (p=0.001) over time than whites (p=0.03).
Conclusion: Semi-annual DCE-MRI did not cause a significantly elevated state anxiety or depression, nor was there a significant decline in mental health over time for groups regardless of cancer history and genetic mutation status. Coping style may have an impact on psychosocial outcomes for those undergoing heightened surveillance over time.
Citation Format: Amico AL, Fang R, Raoul A, Wroblewski K, Nielsen S, Weipert C, Abe H, Sheth D, Romero I, Kulkarni K, Schacht D, Patrick-Miller L, Verp M, Bradbury AR, Hlubocky F, Olopade OI. Psychosocial impact of a multi-modality surveillance program for women at high-risk for breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-19-04.
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Affiliation(s)
- AL Amico
- The University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; Independent Contractor
| | - R Fang
- The University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; Independent Contractor
| | - A Raoul
- The University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; Independent Contractor
| | - K Wroblewski
- The University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; Independent Contractor
| | - S Nielsen
- The University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; Independent Contractor
| | - C Weipert
- The University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; Independent Contractor
| | - H Abe
- The University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; Independent Contractor
| | - D Sheth
- The University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; Independent Contractor
| | - I Romero
- The University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; Independent Contractor
| | - K Kulkarni
- The University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; Independent Contractor
| | - D Schacht
- The University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; Independent Contractor
| | - L Patrick-Miller
- The University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; Independent Contractor
| | - M Verp
- The University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; Independent Contractor
| | - AR Bradbury
- The University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; Independent Contractor
| | - F Hlubocky
- The University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; Independent Contractor
| | - OI Olopade
- The University of Chicago, Chicago, IL; University of Pennsylvania, Philadelphia, PA; Independent Contractor
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Parker S, Nagra NS, Kulkarni K, Pegrum J, Barry S, Hughes R, Ghani Y. Inadequate pelvic radiographs: implications of not getting it right the first time. Ann R Coll Surg Engl 2017; 99:534-539. [PMID: 28682132 DOI: 10.1308/rcsann.2017.0095] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction Pelvic radiography is a frequent investigation. European guidelines aim to ensure appropriate use and adequate quality. When initial images are inadequate, repeat radiographs are often required, which may have significant patient safety and economic implications. Objectives The study aimed to assess the adequacy of pelvic imaging across three orthopaedic centres, to identify causes for inadequate imaging and to establish the cost of inadequate imaging from financial and patient safety perspectives. Methods Pelvic radiographs were identified on Picture Archiving and Communication System software at three UK hospitals. Radiographs were assessed against European guidelines and indications for repeat imaging were analysed. Results A total of 1,531 sequential pelvic radiographs were reviewed. The mean age of patients was 60 years (range 5 months to 101 years). Of this total, 51.9% of images were suboptimal, with no significant difference across the three hospitals (P > 0.05). Hospital 3 repeated radiographs in 6.3% of cases, compare with 18.1% and 19.7% at hospitals 1 and 2, respectively (P > 0.05). Hospital 3 identified pathology missed on the initial radiograph in 1% of cases, compared with 5.4% and 5.5% at hospitals 1 and 2, respectively (P > 0.05). Out-of-hours imaging is associated with a higher rate of suboptimal quality (69.1%) compared with normal working hours (51.3%; P = 0.006). Adequacy rates vary with age (χ 2 = 43.62, P < 0.001). Risk of having a suboptimal radiograph increases above the age of 60-years (χ 2 = 4.45, P < 0.05). The annual cost of repeat radiographs was £56,200 per hospital. Discussion and conclusion High rates of pelvic radiograph inadequacy can lead to missed pathology and the requirement for repeat imaging, which has significant patient safety and financial implications. Risk factors for inadequate radiographs include older patients and those having out-of-hours imaging.
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Affiliation(s)
- S Parker
- Department of Trauma and Orthopaedics, Royal Berkshire Hospital , Reading , UK
| | - N S Nagra
- Oxford University Clinical Academic Graduate School, John Radcliffe Hospital , Oxford , UK
| | - K Kulkarni
- Department of Trauma and Orthopaedics, East and North Herts NHS Trust, Lister Hospital , Stevenage , UK
| | - J Pegrum
- Department of Orthopaedics, Nuffield Orthopaedic Centre, Headington , Oxford , UK
| | - S Barry
- Department of Radiology, John Radcliffe Hospital , Oxford , UK
| | - R Hughes
- Department of Radiology, Stoke Mandeville Hospital , Aylesbury , UK
| | - Y Ghani
- Department of Trauma and Orthopaedic Surgery, Stoke Mandeville Hospital , Aylesbury , UK
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Kulkarni K, Arasappa R, Prasad K, Zutshi A, Chand P, Murthy P, Kesavan M. Comorbid depressive symptoms in persistent delusional disorder: A retrospective study from India. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.02.210] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BackgroundPrevious studies have reported depressive symptoms in patients with persistent delusional disorder (PDD). Patients with PDD and depression may need antidepressants for treatment.AimThe aim of the study was to compare the sociodemographic profile, clinical presentation and treatment response in patients with PDD with and without comorbid depressive symptoms.MethodsWe conducted a retrospective chart review of patients diagnosed with PDD (ICD-10) from 2000 to 2014 (n = 455). We divided the patients into PDD + depression (n = 187) and PDD only (n = 268) for analysis.ResultsOf the 187 patients with PDD + D, only eighteen (3.9%) were diagnosed with syndromal depression. There were no significant differences in sociodemographic profile including sex, marital and socioeconomic status (all P > 0.05). PDD + D group had a significantly younger age at onset ([PDD + D: 30.6 9.2 years vs. PDD: 33.5 11.1 years]; t = 2.9, P < 0.05). There was no significant difference between the clinical presentation including mode of onset, the main theme of their delusion and secondary delusions (all P > 0.3). However, comorbid substance dependence was significantly higher in patients with PDD only. (χ2 = 5.3, P = 0.02). In terms of treatment, response to antipsychotics was also comparable ([> 75% response: PDD + D = 77/142 vs. PDD = 106/179); χ2 = 1.9, P = 0.3). There was a significant difference between the two groups in terms of antidepressant treatment ([PDD + D = 32/187; 17% vs PDD: 17/268; 6%), χ2 = 12.9, P = 0.001).DiscussionPatients with PDD + D had significantly earlier onset of illness. These patients may require antidepressants for treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Shukla T, Jabeen Taj R, Kulkarni K, Shetty P, Viswanath B, Purushottam M, Reddy Y, Jain S. Pharmacogenetic Association Between Glutamatergic Genes and Sri Treatment Response in Obsessive Compulsive Disorder. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.1886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
IntroductionPharmacogenetic studies in obsessive-compulsive disorder (OCD) primarily focussing on serotonergic and dopaminergic polymorphisms, provided inconsistent findings. There is recent evidence for glutamatergic abnormalities in OCD.AimsExamine the association glutamatergic genes with serotonin reuptake inhibitor (SRI) response in OCD.ObjectivesTo study pharmacogenetic association between SLC1A1 and GRIN2B polymorphisms with SRI response in OCD.MethodsDSM-IV OCD patients were recruited from a specialty OCD clinic and evaluated using the Yale-Brown obsessive compulsive scale (YBOCS), Mini International Neuropsychiatric Interview (MINI) plus, Clinical Global Impression scale (CGI). They were subsequently reassessed with YBOCS and CGI. To study extreme phenotypes, we included only full responders (> 35% YBOCS improvement and CGI-I score of 1 or 2) to any SRI (n = 191) and non-responders (< 25% YBOCS improvement and CGI-I score ≥ 4) to adequate trial of at least two SRIs (n = 84). Partial responders were excluded. Genotyping was performed using an ABI9700 PCR machine.ResultsGenotype frequencies did not deviate significantly from the values predicted by the Hardy-Weinberg equation. Case-control association analyses revealed no significant association between genotype/allele frequencies with SRI response.ConclusionOur data does not show any association between polymorphisms in glutamatergic genes and SRI response in OCD though such associations have been found in other studies. More SNP's in the same gene could be responsible for the pharmacogenetic associations. More homogenous sample considering symptom dimensions and other phenotypic variables may be needed. It may be critical to go beyond “usual suspect” candidate gene research. In this regard, a novel approach to identify SRI response biomarkers is the use of cellular models.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Kulkarni K. Much more than just another guidance document. J Thromb Haemost 2016; 14:2093-2094. [PMID: 27627728 DOI: 10.1111/jth.13509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Indexed: 11/28/2022]
Abstract
As a pediatric hematologist oncologist with clinical and research interests in thrombosis in high-risk pediatric populations, and also as a member of the ISTH Early Career Task Force, I had the opportunity to develop a guidance document on 'Thromboprophylaxis for central venous catheters in the pediatric population' for the 'Guidelines and Guidance Documents' committee. In this communication, I share my experiences to date; I discuss my excitement and initial success, the steep learning curve required to build research acumen, the lessons learnt, and the opportunities and challenges faced. My experience with preparing the guidance document was much more than writing 'just another guidance document'.
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Affiliation(s)
- K Kulkarni
- Department of Pediatrics, Division of Hematology/Oncology, IWK Health Centre, Halifax, Nova Scotia, Canada
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21
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L'Italien GJ, Nelson JR, Mathur VS, Mason RP, Chowdhury PR, Philip S, Kulkarni K, Murthy V, Vemuri D, Shah U, Valencia R, Nanda N, Deedwania PC, Chowdhury S. Abstract 410: Link Between Hypertension and Insulin Resistance in South Asians: Implications for Prevention of Cardiovascular Complications. Arterioscler Thromb Vasc Biol 2016. [DOI: 10.1161/atvb.36.suppl_1.410] [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: 11/16/2022]
Abstract
Background:
The coexistence of hypertension (HTN) and insulin resistance (IR) substantially increases cardiovascular risk (CVR) and diabetes (DM) perhaps by endothelial dysfunction from low-grade chronic inflammation and oxidative stress. South Asian immigrants in United States (SA-USA) have a high salt consumption, IR, and salt sensitivity. The triglyceride (TG)/ HDL ratio is a known correlate of IR with ratios ≥3.5 associated with high risk. It is unknown whether SA-USA have a coexistence of HTN, IR, and DM resulting in high CVR.
Methods:
We reviewed the clinical history and Vertical Auto Profile technology (VAP) + lipid panel utilizing ultracentrifugation to directly measure lipid sub-fractions, for 348 participants (42% women) of the South Asian Cardiovascular Registry. Prevalent DM and Pre-DM were defined as HbA1c ≥ 6.5 and 5.7-6.4, respectively.
Results:
Of the 348 participants, mean age 55.3 years, 128 had HTN and were stratified into clinical risk groups based on fasting TG (mg/dL) levels: TG<150 (n=69), TG 150-199 (n=24), TG 200-499 (n=32), TG>500 (n=3). The corresponding TG/HDL ratios were: 1.7, 3.5, 6.2, and 20.4, respectively; the median TG (mg/dL) levels were: 100, 182, 268, and 572, respectively; the median LDL (mg/dL) levels were: 113, 144, 133, 102, respectively; the rates of DM were: 13%, 17%, 38%, and 67%; and the rates of Pre-DM/DM were: 62%, 63%, 78%, and 67%, respectively. Relative Risk for DM with TG/HDL≥ 3.5 was 3.6 (46 % had TG/HDL ≥ 3.5).
Conclusions:
South Asian immigrants participating in a community registry have: 1) A high rate of coexistence of HTN and IR portending a very high relative risk of diabetes. 2) A discordance of LDL levels and IR in patients with HTN. As IR gets higher, the relative risk of diabetes goes up but LDL levels decline.
Clinical Implications:
South Asian immigrants in the United States have a diet that is very high in salt, simple carbohydrates, and saturated fat. Many are vegetarian with no consumption of fish. Public health efforts to help reduce risk of CVD in South Asian immigrants should focus on low salt diet, with consumption of multigrain complex carbohydrates, poly-unsaturated fatty acids, omega-3 fatty acids, and lifestyle changes to reduce metabolic syndrome, diabetes, and hypertension.
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Affiliation(s)
- Gilbert J L'Italien
- South Asian Healthcare Foundation, South Asian Healthcare Foundation, Sugar Land, TX
| | - John R Nelson
- South Asian Healthcare Foundation, South Asian Healthcare Foundation, Sugar Land, TX
| | - Virendra S Mathur
- South Asian Healthcare Foundation, South Asian Healthcare Foundation, Sugar Land, TX
| | - R. Preston Mason
- South Asian Healthcare Foundation, South Asian Healthcare Foundation, Sugar Land, TX
| | - Palash R Chowdhury
- South Asian Healthcare Foundation, South Asian Healthcare Foundation, Sugar Land, TX
| | - Sephy Philip
- South Asian Healthcare Foundation, South Asian Healthcare Foundation, Sugar Land, TX
| | - Kris Kulkarni
- South Asian Healthcare Foundation, South Asian Healthcare Foundation, Sugar Land, TX
| | - Vemuri Murthy
- South Asian Healthcare Foundation, South Asian Healthcare Foundation, Sugar Land, TX
| | - Dwarka Vemuri
- South Asian Healthcare Foundation, South Asian Healthcare Foundation, Sugar Land, TX
| | - Uday Shah
- South Asian Healthcare Foundation, South Asian Healthcare Foundation, Sugar Land, TX
| | - Robert Valencia
- South Asian Healthcare Foundation, South Asian Healthcare Foundation, Sugar Land, TX
| | - Navin Nanda
- South Asian Healthcare Foundation, South Asian Healthcare Foundation, Sugar Land, TX
| | - Prakash C Deedwania
- South Asian Healthcare Foundation, South Asian Healthcare Foundation, Sugar Land, TX
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Kulkarni K, Arasappa R, Prasad K, Zutshi A, Chand P, Muralidharan K, Murthy P. A comparison of risperidone and olanzapine in the acute treatment of persistent delusional disorder: Data from a retrospective chart review. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.2011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IntroductionThere is a lack of pharmacological trials studying drug response in Persistent Delusional Disorder (PDD) to guide clinical practice. Available reviews of retrospective data indicate good response to second-generation antipsychotics, but even such data from India is sparse.Objectives and aimsWe aimed to compare the response of acute PDD to risperidone and olanzapine in our retrospective review.MethodsWe conducted a retrospective chart review of patients diagnosed with PDD (ICD-10) from 2000 to 2014 (n = 455) at our Center. We selected the data of patients prescribed either olanzapine or risperidone for the purpose of this analysis. We extracted data about dose, drug compliance and response, adverse effects, number of follow-up visits and hospitalizations. The study was approved by the Institute Ethics Committee.ResultsA total of 280/455 (61%) were prescribed risperidone and 86/455 (19%) olanzapine. The remaining (n = 89; 20%) had received other antipsychotics. The two groups were comparable in socio-demographic and clinical characteristics of PDD. Compliance was good and comparable in both groups (> 80%, P = 0.2). Response to treatment was comparable in both groups (85% partial response and > 52% good response, all P > 0.3). Olanzapine was effective at lower mean chlorpromazine equivalents than risperidone (240 vs. 391, P < 0.05).ConclusionOur study indicates a good response to both risperidone and olanzapine, if compliance to treatment can be ensured. In the absence of specific treatment guidelines for PDD, second-generation antipsychotics like risperidone and olanzapine offer good treatment options for this infrequently encountered and difficult to treat psychiatric disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Kulkarni K, Holly B. Evaluation and management for interventionalists: how to appropriately document and capture billing for clinical services. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Motamed S, Del Borgo MP, Kulkarni K, Habila N, Zhou K, Perlmutter P, Forsythe JS, Aguilar MI. A self-assembling β-peptide hydrogel for neural tissue engineering. Soft Matter 2016; 12:2243-2246. [PMID: 26853859 DOI: 10.1039/c5sm02902c] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We report a new class of β-peptide based hydrogel for neural tissue engineering. Our β-peptide forms a network of nanofibres in aqueous solution, resulting in a stable hydrogel at physiological conditions. The hydrogel shows excellent compatibility with neural cells and provides a suitable environment for cells to adhere and proliferate.
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Affiliation(s)
- S Motamed
- Department of Materials Science and Engineering, Monash Institute of Medical Engineering, Monash University, Clayton, Vic 3800, Australia.
| | - M P Del Borgo
- Monash Biomedicine Discovery Institute and Department of Biochemistry & Molecular Biology, Monash University, Clayton, Vic 3800, Australia.
| | - K Kulkarni
- School of Chemistry, Monash University, Clayton, Vic 3800, Australia
| | - N Habila
- Monash Biomedicine Discovery Institute and Department of Biochemistry & Molecular Biology, Monash University, Clayton, Vic 3800, Australia.
| | - K Zhou
- Department of Materials Science and Engineering, Monash Institute of Medical Engineering, Monash University, Clayton, Vic 3800, Australia.
| | - P Perlmutter
- School of Chemistry, Monash University, Clayton, Vic 3800, Australia
| | - J S Forsythe
- Department of Materials Science and Engineering, Monash Institute of Medical Engineering, Monash University, Clayton, Vic 3800, Australia.
| | - M I Aguilar
- Monash Biomedicine Discovery Institute and Department of Biochemistry & Molecular Biology, Monash University, Clayton, Vic 3800, Australia.
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Affiliation(s)
- S. E. Hamer
- Department of Dermatology; Queen's Medical Centre; Nottingham UK
| | - K. Kulkarni
- Department of Histopathology; Queen's Medical Centre; Nottingham UK
| | - S. N. Cohen
- Department of Dermatology; Queen's Medical Centre; Nottingham UK
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Affiliation(s)
- A N Patel
- Department of Dermatology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
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Toth P, Hamon S, Jones S, Martin S, Joshi P, Kulkarni K, Banerjee P, Hanotin C. Proprotein convertase subtilisin/kexin 9 monoclonal antibody therapy significantly reduced apoprotein cii and ciii levels in serum in phase 2 studies. Atherosclerosis 2014. [DOI: 10.1016/j.atherosclerosis.2014.05.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kulkarni K, Namazi IJ, Deshpande S, Goel R. Cervical epidural anaesthesia with ropivacaine for modified radical mastectomy. Kathmandu Univ Med J (KUMJ) 2014; 11:126-31. [PMID: 24096219 DOI: 10.3126/kumj.v11i2.12487] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cervical epidural anaesthesia (CEA) using local anesthetics (LA) is a well established technique for the surgeries in the neck, chest and upper arms. Recently ropivacaine is introduced with better safety profile. OBJECTIVES The aim was to observe the safety of Cervical epidural anaesthesia as an anaesthetic technique and to compare the efficacy of epidural 0.25% bupivacaine with 0.375% ropivacaine for radical mastectomies. METHODS A double blind study was conducted on 40 ASA grade I / II females who received CEA with 10 ml of 0.25% of bupivacaine +25μg of fentanyl in group B (n=20) and 10 ml of 0.375% of ropivacaine +25μg of fentanyl in group R (n=20) epidurally. Assessment of the block, vital monitoring and complications noted. RESULTS No significant differences observed in the onset of sensory block (5.05 min and 5.4 min in group B and R respectively, P>0.05).The mean motor blockade score, time to achieve complete blockade and time to grade I motor recovery was significantly longer in group B (2.3, 22.5 and 79.5 minutes respectively) as compared to group R (1.5, 18.3 and 66.3 minutes respectively, P<0.05). Respiratory distress developed in two patients of group B that required general anaesthesia (GA) with intubation. CONCLUSION Use of 0.37% ropivacaine is safer than 0.25% bupivacaine for CEA for radical mastectomy. It provides good surgical anaesthesia with lesser degree of motor blockade and the respiratory effects.
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Affiliation(s)
- K Kulkarni
- Department of Anaesthesia, D.Y. Patil Medical College, Kolhapur, Maharashtra, India
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Laxminarayan R, Kulkarni K, Kolhe N. AB1010 Comparing Digital Tomogram and Ultrasound in Established Rheumatoid Arhritis: Table 1. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1314] [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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Foo S, Cheng S, Varma S, Kulkarni K. Sequestrated meningocoele within a naevus sebaceous of Jadassohn on the scalp of a child. Clin Exp Dermatol 2014; 39:304-6. [PMID: 24635065 DOI: 10.1111/ced.12279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2013] [Indexed: 11/28/2022]
Abstract
Sequestrated meningocoele is an uncommon developmental anomaly in which meningothelial elements are found in the skin or subcutaneous tissue without underlying bony defect. By contrast, naevus sebaceous of Jadassohn (NSJ) is a circumscribed hamartomatous lesion occurring in about 0.3% of newborns. We report a child with a histologically confirmed sequestrated meningocoele within an NSJ on his scalp vertex. Such an occurrence has not been reported previously.
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Affiliation(s)
- S Foo
- Department of Dermatology, Nottingham University Hospitals, Queens Medical Centre, Nottingham, UK
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Affiliation(s)
- A Yaakub
- Department of Dermatology, Queen's Medical Centre, Nottingham, UK.
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Ramya P, Chaubal A, Kulkarni K, Gupta L, Kadoo N, Dhaliwal HS, Chhuneja P, Lagu M, Gupta V. QTL mapping of 1000-kernel weight, kernel length, and kernel width in bread wheat (Triticum aestivum L.). J Appl Genet 2011; 51:421-9. [PMID: 21063060 DOI: 10.1007/bf03208872] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Kernel size and morphology influence the market value and milling yield of bread wheat (Triticum aestivum L.). The objective of this study was to identify quantitative trait loci (QTLs) controlling kernel traits in hexaploid wheat. We recorded 1000-kernel weight, kernel length, and kernel width for 185 recombinant inbred lines from the cross Rye Selection 111 × Chinese Spring grown in 2 agro-climatic regions in India for many years. Composite interval mapping (CIM) was employed for QTL detection using a linkage map with 169 simple sequence repeat (SSR) markers. For 1000-kernel weight, 10 QTLs were identified on wheat chromosomes 1A, 1D, 2B, 2D, 4B, 5B, and 6B, whereas 6 QTLs for kernel length were detected on 1A, 2B, 2D, 5A, 5B and 5D. Chromosomes 1D, 2B, 2D, 4B, 5B and 5D had 9 QTLs for kernel width. Chromosomal regions with QTLs detected consistently for multiple year-location combinations were identified for each trait. Pleiotropic QTLs were found on chromosomes 2B, 2D, 4B, and 5B. The identified genomic regions controlling wheat kernel size and shape can be targeted during further studies for their genetic dissection.
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Affiliation(s)
- P Ramya
- Plant Molecular Biology Group, Division of Biochemical Sciences, National Chemical Laboratory, Maharashtra, India
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Foo SH, Kulkarni K, Varma S. A rare case of misplaced turban. Cylindroma. Clin Exp Dermatol 2010; 35:797-8. [PMID: 20831606 DOI: 10.1111/j.1365-2230.2010.03804.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- S H Foo
- Department of Dermatology, Queens Medical Centre, Nottingham University Hospitals, Nottingham, UK
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Kaur S, Kulkarni K. Joubert syndrome type I: neuroimaging findings in addition to the 'molar tooth' sign. Case Reports 2010; 2010:2010/apr29_1/bcr1120092464. [DOI: 10.1136/bcr.11.2009.2464] [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] Open
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Kulkarni K, Singh M, Kumar R. Is drug-resistant Salmonella typhi an emerging threat? Case Reports 2009; 2009:bcr04.2009.1783. [DOI: 10.1136/bcr.04.2009.1783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Panigrahi I, Kulkarni K, Dayal D. Acquired syndactyly in epidermolysis bullosa dystrophica. Case Reports 2009; 2009:bcr04.2009.1785. [DOI: 10.1136/bcr.04.2009.1785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Al-Daraji WI, Prescott RJ, Abdellaoui A, Khan MM, Kulkarni K, Youssef MM, Zelger BG, Zelger B. Cutaneous epithelioid angiomatous nodule: different views or interpretations in the analysis of ten new cases. Dermatol Online J 2009; 15:2. [PMID: 19379646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Classification schemes proposed for vascular lesions are the subjects of significant controversy. Cutaneous epithelioid angiomatous nodule (CEAN) was described in 2004, but there is no agreement as to whether this is a distinct entity or a type of either epithelioid hemangioma or angiolymphoid hyperplasia with eosinophilia. We present a typical case of CEAN and discuss nine other cases from our institution. We then provide two opposing viewpoints concerning its classification.
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Affiliation(s)
- W I Al-Daraji
- Department of Histopathology, Nottingham, United Kingdom.
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Al-Daraji WI, Prescott RJ, Abdellaoui A, Khan MM, Kulkarni K, Youssef MM, Zelger BG, Zelger B. Cutaneous Epithelioid Angiomatous Nodule: Different views or interpretations in the analysis of ten new cases. Dermatol Online J 2009. [DOI: 10.5070/d322q709vb] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Angus J, Roberts C, Kulkarni K, Leach I, Murphy R. Usefulness of the QuantiFERON®test in the confirmation of latent tuberculosis in association with erythema induratum. Br J Dermatol 2007; 157:1293-4. [DOI: 10.1111/j.1365-2133.2007.08227.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [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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Chua S, Affleck A, Kulkarni K. Florid hyperplastic folliculitis on the chin in a male renal transplant patient. Clin Exp Dermatol 2007; 33:98-9. [PMID: 18039343 DOI: 10.1111/j.1365-2230.2007.02593.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affleck AG, Gore A, Millard LG, Perks AGD, Kulkarni K, Chan S. Giant primary basal cell carcinoma with fatal hepatic metastases. J Eur Acad Dermatol Venereol 2007; 21:262-3. [PMID: 17243972 DOI: 10.1111/j.1468-3083.2006.01834.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Affiliation(s)
- K Kulkarni
- Division of Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, USA
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Kulkarni K, Van Nostrand D, Atkins F, Aiken M, Burman K, Wartofsky L. The relative frequency in which empiric dosages of radioiodine would potentially overtreat or undertreat patients who have metastatic well-differentiated thyroid cancer. Thyroid 2006; 16:1019-23. [PMID: 17042688 DOI: 10.1089/thy.2006.16.1019] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [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] [Indexed: 12/22/2022]
Abstract
The dosage of (131)I for the treatment of metastatic well-differentiated thyroid cancer is typically selected empirically. Benua and Leeper implemented a method to estimate the maximum dosages of (131)I that could be administered to a patient so as not to exceed a maximum tolerated radiation absorbed dose (MTD), which was defined as 200 rads (cGy) to the blood. The objective of this study was to determine the frequency of (131)I treatments in which the patient (1) would have exceeded the MTD (i.e., overtreatment) or (2) would have been able to receive higher dosages of (131)I thereby delivering a potentially higher radiation absorbed dose to their metastases (i.e., undertreatment) had the patient been administered various assumed empiric dosages of (131)I. The dosimetrically-determined maximum tolerated radioactivities (MTA) to deliver 200 rads to the blood (MTD) were tabulated at our facility. Data were then grouped to determine the percentage of patients who would have received less than or more than the MTD for various assumed empiric dosages of (131)I. A total of 127 dosimetries were performed. For assumed empiric dosages of (131)I (100 mCi, 150 mCi, 200 mCi, 250 mCi, and 300 mCi), the percentage of treatments for which patients would have exceeded the MTD were less than 1%, 5%, 11%, 17%, and 22%, respectively, and could have received a higher dosage of (131)I were more than 99%, 95%, 89%, 83%, and 78%, respectively. A significant number of patients receiving various empiric dosages of (131)I may exceed 200 rads (cGy) to the blood (potential overtreating). Likewise, the majority of patients may be able to receive much higher dosages of (131)I relative to empiric dosages thereby delivering potentially higher radiation absorbed doses to the metastases without exceeding 200 rads (cGy) to the blood (potential undertreating).
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Affiliation(s)
- K Kulkarni
- Division of Nuclear Medicine, Department of Medicine, Washington Hospital Center, Washington, DC 20010, USA
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Garcia CA, Van Nostrand D, Atkins F, Acio E, Butler C, Esposito G, Kulkarni K, Majd M. Reduction of Brown Fat 2-Deoxy-2-[F-18]fluoro-d-glucose Uptake by Controlling Environmental Temperature Prior to Positron Emission Tomography Scan. Mol Imaging Biol 2005; 8:24-9. [PMID: 16333529 DOI: 10.1007/s11307-005-0030-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
UNLABELLED Brown fat uptake of 2-deoxy-2-[F-18]fluoro-D: -glucose (FDG) on a positron emission tomography (PET) scan limits the ability to assess for cancer. Drugs such as benzodiazepine, propranolol, and reserpine have been proposed to reduce this uptake, but the studies have been either small clinical or preclinical trials. As an alternative, we evaluated the effect of controlling the patient's environmental temperature on brown fat uptake of FDG. METHOD From January 1, 2002 to November 30, 2004, patients were identified who had (1) a pattern of FDG uptake in the neck/paravertebral areas suggestive of brown fat, (2) a repeat FDG-PET scan after control of the patient's environmental temperature, and (3) no evidence of cancer in the neck/paravertebral areas by other diagnostic methods. For the follow-up PET scan, all patients wore warm clothing and avoided exposure to cold air during their transit to our facility. After arrival, patients were kept in a separate temperature-controlled room (at least 75 degrees F) for 15 minutes to two hours before FDG injection as well as during the uptake phase. Four physicians blindly and retrospectively assessed the FDG uptake in the neck and paravertebral regions on all initial and temperature-controlled PET scans by visually grading the radioactivity on a semiquantitative scale (0 = background, 1+ = background but <liver, 2+ = equal to liver, 3+ >liver). The changes in maximal SUVs were determined in the left and right neck region. Data were evaluated using a two-tail t-test. RESULTS Ten patients met the above criteria. The median age was 32 years with a range of 11-58 years. In comparing the semiquantitative uptake and the SUVs of FDG in the neck and paravertebral areas on the initial PET scan to the temperature-controlled PET scan, the mean decrease and the standard deviation of the decrease demonstrated a statistically significant decrease in with P values range from <0.02 to <0.001. CONCLUSION Controlling the patient's environmental temperature prior to the dosing and during the uptake phase can significantly reduce FDG uptake in brown fat in the neck and paravertebral areas. Further studies are warranted to determine the most effective protocol to control the patient's environmental temperature in order to minimize brown fat uptake.
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Affiliation(s)
- Carlos A Garcia
- Division of Nuclear Medicine, Department of Medicine, Washington Hospital Center, 110 Irving Street, NW, Washington, DC 20010, USA.
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Abstract
This case report describes a patient with Sjögren syndrome (SS) whose sole presenting feature was bilateral and painful submandibular gland enlargement. Extensive workup for alternate etiologies was negative and while serologies specific for SS were unremarkable, the diagnosis was eventually suggested by excisional biopsy. This case highlights the difficulty in making an early diagnosis of SS and demonstrates the important role of excisional biopsy in that diagnosis.
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Affiliation(s)
- K Kulkarni
- Department of Internal Medicine, Columbia University Medical Center, New York, NY, USA.
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Abstract
Dyke-Davidoff-Masson syndrome is clinically characterized by hemiparesis, hemiplegia, seizures, mental retardation, and facial asymmetry secondary to congenital or early childhood vascular insult. A 21-year-old man with Dyke-Davidoff-Masson syndrome presented with uncontrolled seizures. The authors present the magnetic resonance (MR) and positron emission tomography (PET) findings of this syndrome.
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Affiliation(s)
- K Kulkarni
- Nuclear Medicine Staff, Washington Hospital Center, Washington, DC 20010, USA.
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Abstract
AIMS To assess if the rising incidence of hepatocellular carcinoma in the United States can be accounted for by immigration and an ageing population, or is a true increase among the USA-born residents. METHODS Design--A retrospective chart review. Setting--Urban, multiethnic hospital and specialty clinics in a large indigent health system in Houston, Texas. Subjects--Approximately 23,000 admissions and 143,000 out-patient clinic visits each year from 1992 through 2001 were assessed. A total of 494 patient records were selected and reviewed because of suspicion of hepatocellular carcinoma. Analysis- Hepatocellular carcinoma was confirmed by histopathology, alpha-fetoprotein level >400 ng/mL, and suggestive imaging studies. The age-adjusted incidence was determined and causative factors were identified. RESULTS About 111 cases of confirmed hepatocellular carcinoma were found. The age-adjusted incidence rose from 3.44 per 100,000 hospital admissions during 1992-1996 (95% confidence interval: 2.86-4.02) to 5.19 during 1997-2001 (95% confidence interval: 4.41-5.97). The proportion of patients of non-USA place of birth decreased between 1992-1996 and 1997-2001 (46-24%, respectively, P = 0.03). Fifty-two per cent and 68% were hepatitis C virus-positive respectively; 37% and 34% were hepatitis B surface antigen-positive respectively; 46% and 59% had a history of alcohol abuse; and 22% and 11% had no identifiable risk factors. CONCLUSIONS The incidence of hepatocellular carcinoma within the greater Houston area has increased during the past decade, rising by 51% from 1992-1996 to 1997-2001. This increase is not from immigration or population ageing but represents a true rise among the native born population. Hepatitis C and alcoholic cirrhosis are associated with a majority of cases, particularly in the latter half of the decade.
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Affiliation(s)
- K Kulkarni
- Department of Medicine, Divisions of Gastroenterology, Houston, TX 77030, USA
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Kulkarni K, Lewis DA, Ison CA. Expression of the cytolethal distending toxin in a geographically diverse collection of Haemophilus ducreyi clinical isolates. Sex Transm Infect 2003; 79:294-7. [PMID: 12902578 PMCID: PMC1744705 DOI: 10.1136/sti.79.4.294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To screen a collection of isolates of Haemophilus ducreyi for expression of the cytolethal distending toxin (CDT). METHODS 45 clinical isolates of H ducreyi were screened for cytotoxic activity by examining the effect of culture supernatants on Hela cells. Expression was confirmed using immunoblotting with CDT specific monoclonal antibodies and the presence of the cdt genes determined by amplification of the cdt genes in a multiplex polymerase chain assay. RESULTS Of the 45 clinical isolates, six isolates from differing geographical origins did not demonstrate cytotoxic activity. Expression of CDT was also not detected in these six isolates using immunoblotting and the genes cdtA, cdtB, and cdtC were not amplified using PCR. The remaining isolates demonstrated cytotoxic activity, expressed the CDT proteins, and the presence of the cdt genes was confirmed. CONCLUSIONS CDT is considered a virulence factor of H ducreyi but was found to be absent in 13% of isolates from different geographical origins.
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Affiliation(s)
- K Kulkarni
- Department of Infectious Diseases and Microbiology, Faculty of Medicine, Imperial College, London W2 1PG, UK
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