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Shouval R, Goldman A, Flynn JR, El-Moghraby A, Rehman M, Devlin SM, Corona M, Landego I, Lin RJ, Scordo M, Raj SS, Giralt SA, Palomba ML, Dahi PB, Walji M, Salles G, Nath K, Geyer MB, Park JH, Fein JA, Kosmidou I, Shah GL, Liu JE, Perales MA, Mahmood SS. Atrial arrhythmias following CAR-chimeric antigen receptor T-cell therapy: Incidence, risk factors and biomarker profile. Br J Haematol 2024. [PMID: 38735683 DOI: 10.1111/bjh.19497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 04/18/2024] [Indexed: 05/14/2024]
Abstract
Recent reports have raised concerns about the association of chimeric antigen receptor T cell (CAR-T) with non-negligible cardiotoxicity, particularly atrial arrhythmias. First, we conducted a pharmacovigilance study to assess the reporting of atrial arrhythmias following CD19-directed CAR-T. Subsequently, to determine the incidence, risk factors and outcomes of atrial arrhythmias post-CAR-T, we compiled a retrospective single-centre cohort of non-Hodgkin lymphoma patients. Only commercial CAR-T products were considered. Atrial arrhythmias were nearly fourfold more likely to be reported after CAR-T therapy compared to all other cancer patients in the FAERS (adjusted ROR = 3.76 [95% CI 2.67-5.29]). Of the 236 patients in our institutional cohort, 23 (10%) developed atrial arrhythmias post-CAR-T, including 12 de novo arrhythmias, with most (83%) requiring medical intervention. Atrial arrhythmias frequently co-occurred with cytokine release syndrome and were associated with higher post-CAR-T infusion peak levels of IL-10, TNF-alpha and LDH, and lower trough levels of fibrinogen. In a multivariable analysis, risk factors for atrial arrhythmia were history of atrial arrhythmia (OR = 6.80 [2.39-19.6]) and using CAR-T product with a CD28-costimulatory domain (OR = 5.17 [1.72-18.6]). Atrial arrhythmias following CD19-CAR-T therapy are prevalent and associated with elevated inflammatory biomarkers, a history of atrial arrhythmia and the use of a CAR-T product with a CD28 costimulatory domain.
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Affiliation(s)
- Roni Shouval
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Adam Goldman
- Department of Internal Medicine, Sheba Medical Center, Ramat-Gan, Israel
| | - Jessica R Flynn
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ahmed El-Moghraby
- Department of Medicine, Cardiology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mahin Rehman
- Department of Medicine, Cardiology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sean M Devlin
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Magdalena Corona
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ivan Landego
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Internal Medicine, Max Rady Faculty of Health Sciences, Section of Medical Oncology and Hematology, University of Manitoba, Manitoba, Canada
| | - Richard J Lin
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Michael Scordo
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sandeep S Raj
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sergio A Giralt
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - M Lia Palomba
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Parastoo B Dahi
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Moneeza Walji
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Gilles Salles
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Karthik Nath
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mark B Geyer
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jae H Park
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Joshua A Fein
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Ioanna Kosmidou
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Cardiology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Gunjan L Shah
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jennifer E Liu
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Cardiology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Miguel-Angel Perales
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Syed S Mahmood
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Cardiology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Cardio-Oncology Service, St. Francis Hospital & Heart Center, Catholic Health Services in Long Island, Roslyn, New York, USA
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Mahmood SS, Riedell PA, Feldman S, George G, Sansoterra SA, Althaus T, Rehman M, Mead E, Liu JE, Devereux RB, Weinsaft JW, Kim J, Balkan L, Barbar T, Lee Chuy K, Harchandani B, Perales MA, Geyer MB, Park JH, Palomba ML, Shouval R, Tomas AA, Shah GL, Yang EH, Gaut DL, Rothberg MV, Horn EM, Leonard JP, Van Besien K, Frigault MJ, Chen Z, Mehrotra B, Neilan TG, Steingart RM. Biomarkers and cardiovascular outcomes in chimeric antigen receptor T-cell therapy recipients. Eur Heart J 2023; 44:2029-2042. [PMID: 36939851 PMCID: PMC10256191 DOI: 10.1093/eurheartj/ehad117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 03/21/2023] Open
Abstract
AIMS Chimeric antigen receptor T-cell therapy (CAR-T) harnesses a patient's immune system to target cancer. There are sparse existing data characterizing death outcomes after CAR-T-related cardiotoxicity. This study examines the association between CAR-T-related severe cardiovascular events (SCE) and mortality. METHODS AND RESULTS From a multi-centre registry of 202 patients receiving anti-CD19 CAR-T, covariates including standard baseline cardiovascular and cancer parameters and biomarkers were collected. Severe cardiovascular events were defined as a composite of heart failure, cardiogenic shock, or myocardial infarction. Thirty-three patients experienced SCE, and 108 patients died during a median follow-up of 297 (interquartile range 104-647) days. Those that did and did not die after CAR-T were similar in age, sex, and prior anthracycline use. Those who died had higher peak interleukin (IL)-6 and ferritin levels after CAR-T infusion, and those who experienced SCE had higher peak IL-6, C-reactive protein (CRP), ferritin, and troponin levels. The day-100 and 1-year Kaplan-Meier overall mortality estimates were 18% and 43%, respectively, while the non-relapse mortality (NRM) cumulative incidence rates were 3.5% and 6.7%, respectively. In a Cox model, SCE occurrence following CAR-T was independently associated with increased overall mortality risk [hazard ratio (HR) 2.8, 95% confidence interval (CI) 1.6-4.7] after adjusting for age, cancer type and burden, anthracycline use, cytokine release syndrome grade ≥ 2, pre-existing heart failure, hypertension, and African American ancestry; SCEs were independently associated with increased NRM (HR 3.5, 95% CI 1.4-8.8) after adjusting for cancer burden. CONCLUSION Chimeric antigen receptor T-cell therapy recipients who experience SCE have higher overall mortality and NRM and higher peak levels of IL-6, CRP, ferritin, and troponin.
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Affiliation(s)
- Syed S Mahmood
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Weill Cornell Medicine, 520 East 70th Street. ST 443, New York, NY 10021, USA
- Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Peter A Riedell
- The David and Etta Jonas Center for Cellular Therapy, University of Chicago, Chicago, IL 60637, USA
| | - Stephanie Feldman
- Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Gina George
- Cornell MPH Program, Cornell University, Ithaca, NY 14853, USA
| | | | - Thomas Althaus
- The David and Etta Jonas Center for Cellular Therapy, University of Chicago, Chicago, IL 60637, USA
| | - Mahin Rehman
- Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Elena Mead
- Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jennifer E Liu
- Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Richard B Devereux
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Weill Cornell Medicine, 520 East 70th Street. ST 443, New York, NY 10021, USA
| | - Jonathan W Weinsaft
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Weill Cornell Medicine, 520 East 70th Street. ST 443, New York, NY 10021, USA
| | - Jiwon Kim
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Weill Cornell Medicine, 520 East 70th Street. ST 443, New York, NY 10021, USA
| | - Lauren Balkan
- Department of Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - Tarek Barbar
- Department of Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - Katherine Lee Chuy
- Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Bhisham Harchandani
- Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Miguel-Angel Perales
- Adult BMT Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - Mark B Geyer
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - Jae H Park
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - M Lia Palomba
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - Roni Shouval
- Adult BMT Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - Ana A Tomas
- Adult BMT Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Gunjan L Shah
- Adult BMT Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - Eric H Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Daria L Gaut
- Division of Hematology/Oncology, Department of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Michael V Rothberg
- David Geffen School of Medicine, University of California at Los Angeles, CA 90095, USA
| | - Evelyn M Horn
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Weill Cornell Medicine, 520 East 70th Street. ST 443, New York, NY 10021, USA
| | - John P Leonard
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - Koen Van Besien
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - Matthew J Frigault
- Cellular Immunotherapy Program, Division of Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Division of Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Zhengming Chen
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY 10021, USA
| | - Bhoomi Mehrotra
- The Cancer Center, St Francis Hospital, Roslyn, NY 11576, USA
| | - Tomas G Neilan
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Richard M Steingart
- Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Milling TJ, Middeldorp S, Xu L, Koch B, Demchuk A, Eikelboom JW, Verhamme P, Cohen AT, Beyer-Westendorf J, Michael Gibson C, Lopez-Sendon J, Crowther M, Shoamanesh A, Coppens M, Schmidt J, Albaladejo P, Connolly SJ, Bastani A, Clark C, Concha M, Cornell J, Dombrowski K, Fermann G, Fulmer J, Goldstein J, Kereiakes D, Milling T, Pallin D, Patel N, Refaai M, Rehman M, Schmaier A, Schwarz E, Shillinglaw W, Spohn M, Takata T, Venkat A, Welker J, Welsby I, Wilson J, Van Keer L, Verschuren F, Blostein M, Eikelboom J, Althaus K, Berrouschot J, Braun G, Doeppner T, Dziewas R, Genth-Zotz S, Greinacher P, Hamann F, Hanses F, Heide W, Kallmuenzer B, Kermer P, Poli S, Royl G, Schellong S, Schnupp S, Schwarze J, Spies C, Thomalla G, von Mering M, Weissenborn K, Wollenweber F, Gumbinger C, Jaschinski U, Maschke M, Mochmann HC, Pfeilschifter W, Pohlmann C, Zahn R, Bouzat P, Schmidt J, Vallejo C, Floccard B, Coppens M, van Wissen S, Arellano-Rodrigo E, Valles E, Alikhan R, Breen K, Hall R, Crowther M, Albaladejo P, Cohen A, Demchuk A, Schmidt J, Wyse D, Garcia D, Prins M, Nakamya J, Büller H, Mahaffey KW, Alexander JH, Cairns J, Hart R, Joyner C, Raskob G, Schulman S, Veltkamp R, Meeks B, Zotova E, Ahmad S, Pinto T, Baker K, Dykstra A, Holadyk-Gris I, Malvaso A, Demchuk A. Final Study Report of Andexanet Alfa for Major Bleeding With Factor Xa Inhibitors. Circulation 2023; 147:1026-1038. [PMID: 36802876 DOI: 10.1161/circulationaha.121.057844] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND Andexanet alfa is a modified recombinant inactive factor Xa (FXa) designed to reverse FXa inhibitors. ANNEXA-4 (Andexanet Alfa, a Novel Antidote to the Anticoagulation Effects of Factor Xa Inhibitors) was a multicenter, prospective, phase-3b/4, single-group cohort study that evaluated andexanet alfa in patients with acute major bleeding. The results of the final analyses are presented. METHODS Patients with acute major bleeding within 18 hours of FXa inhibitor administration were enrolled. Co-primary end points were anti-FXa activity change from baseline during andexanet alfa treatment and excellent or good hemostatic efficacy, defined by a scale used in previous reversal studies, at 12 hours. The efficacy population included patients with baseline anti-FXa activity levels above predefined thresholds (≥75 ng/mL for apixaban and rivaroxaban, ≥40 ng/mL for edoxaban, and ≥0.25 IU/mL for enoxaparin; reported in the same units used for calibrators) who were adjudicated as meeting major bleeding criteria (modified International Society of Thrombosis and Haemostasis definition). The safety population included all patients. Major bleeding criteria, hemostatic efficacy, thrombotic events (stratified by occurring before or after restart of either prophylactic [ie, a lower dose, for prevention rather than treatment] or full-dose oral anticoagulation), and deaths were assessed by an independent adjudication committee. Median endogenous thrombin potential at baseline and across the follow-up period was a secondary outcome. RESULTS There were 479 patients enrolled (mean age, 78 years; 54% male, 86% White; 81% anticoagulated for atrial fibrillation at a median time of 11.4 hours since last dose, with 245 (51%) on apixaban, 176 (37%) on rivaroxaban, 36 (8%) on edoxaban, and 22 (5%) on enoxaparin. Bleeding was predominantly intracranial (n=331 [69%]) or gastrointestinal (n=109 [23%]). In evaluable apixaban patients (n=172), median anti-FXa activity decreased from 146.9 ng/mL to 10.0 ng/mL (reduction, 93% [95% CI, 94-93]); in rivaroxaban patients (n=132), it decreased from 214.6 ng/mL to 10.8 ng/mL (94% [95% CI, 95-93]); in edoxaban patients (n=28), it decreased from 121.1 ng/mL to 24.4 ng/mL (71% [95% CI, 82-65); and in enoxaparin patients (n=17), it decreased from 0.48 IU/mL to 0.11 IU/mL (75% [95% CI, 79-67]). Excellent or good hemostasis occurred in 274 of 342 evaluable patients (80% [95% CI, 75-84]). In the safety population, thrombotic events occurred in 50 patients (10%); in 16 patients, this occurred during treatment with prophylactic anticoagulation that began after the bleeding event. No thrombotic episodes occurred after oral anticoagulation restart. Specific to certain populations, reduction of anti-FXa activity from baseline to nadir significantly predicted hemostatic efficacy in patients with intracranial hemorrhage (area under the receiver operating characteristic curve, 0.62 [95% CI, 0.54-0.70]) and correlated with lower mortality in patients <75 years of age (adjusted P=0.022; unadjusted P=0.003). Median endogenous thrombin potential was within the normal range by the end of andexanet alfa bolus through 24 hours for all FXa inhibitors. CONCLUSIONS In patients with major bleeding associated with the use of FXa inhibitors, treatment with andexanet alfa reduced anti-FXa activity and was associated with good or excellent hemostatic efficacy in 80% of patients. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02329327.
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Affiliation(s)
- Truman J Milling
- Seton Dell Medical School Stroke Institute, Dell Medical School, University of Texas at Austin (T.J.M.)
| | - Saskia Middeldorp
- Department of Internal Medicine and Radboud Institute of Health Sciences, Nijmegenthe Netherlands (S.M.)
| | - Lizhen Xu
- Population Health Research Institute, McMaster University, HamiltonOntario Canada. (L.X., A.S., S.J.C.)
| | - Bruce Koch
- Alexion, AstraZeneca Rare Disease, BostonMA (B.K.)
| | - Andrew Demchuk
- Departments of Clinical Neurosciences and Radiology, Cumming School of Medicine, University of Calgary, AlbertaCanada (A.D.)
| | - John W Eikelboom
- Department of Medicine, McMaster University, HamiltonOntario Canada. (J.W.E., M. Crowther)
| | - Peter Verhamme
- Center for Molecular and Vascular Biology, University of Leuven, Belgium (P.V.)
| | | | - Jan Beyer-Westendorf
- Department of Medicine I, Division of Hematology and Hemostasis, University Hospital Dresden, Germany (J.B-W.)
| | | | - Jose Lopez-Sendon
- Instituto de Investigación Hospital Universitario, La PazMadridSpain (J. L-S.)
| | - Mark Crowther
- Department of Medicine, McMaster University, HamiltonOntario Canada. (J.W.E., M. Crowther)
| | - Ashkan Shoamanesh
- Population Health Research Institute, McMaster University, HamiltonOntario Canada. (L.X., A.S., S.J.C.)
| | - Michiel Coppens
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands (M. Coppens)
| | - Jeannot Schmidt
- Centre Hospitalier Universitaire de Clermont-Ferrand, France (J.S.)
| | | | - Stuart J Connolly
- Population Health Research Institute, McMaster University, HamiltonOntario Canada. (L.X., A.S., S.J.C.)
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Gendia A, Rehman M, Cota A, Gilbert J, Clark J. Can virtual reality technology be considered as a part of the surgical care pathway? Ann R Coll Surg Engl 2023; 105:2-6. [PMID: 36374265 PMCID: PMC9773243 DOI: 10.1308/rcsann.2022.0125] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Virtual reality (VR) is emerging as a new technology in the healthcare sector. It has been shown to enhance the patient's experience and satisfaction in various settings. This review aims to give a brief description of the use of VR and establish validity of its applications to improve the patient's pathway through surgery. METHODS A literature search was conducted using the PubMed and Embase™ databases to identify fields in which VR technology has been trialled in relation to surgery. The search terms 'virtual reality' and 'surgery' were employed. RESULTS Although benefits relating to VR use have been identified in mental health, obesity management, and physical and cognitive rehabilitation, those in surgery have been less well documented. There are, however, some important but limited benefits reported in managing surgery related stress and improving preoperative patient education as well as VR being an adjunct to some level of postoperative analgesia. CONCLUSIONS The current applications of VR in relation to surgical care fall into four main categories: preoperative education, supporting mental health, postoperative pain management, and pre and postoperative patient optimisation. Future studies and validation of VR applications should be carried out so the technology can be utilised throughout the entire patient pathway as VR surgical care bundles.
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Affiliation(s)
- A Gendia
- Royal Cornwall Hospitals NHS Trust, UK
| | - M Rehman
- Northampton General Hospital NHS Trust, UK
| | - A Cota
- Royal Cornwall Hospitals NHS Trust, UK
| | - J Gilbert
- Royal Cornwall Hospitals NHS Trust, UK
| | - J Clark
- Royal Cornwall Hospitals NHS Trust, UK
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Rehman M, Adiyaman A, Smit JJJ, Manfai B, Elvan A. Comparison of safety and efficacy between POLARx and Arctic Front cryoballoon ablation. Europace 2022. [DOI: 10.1093/europace/euac053.110] [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: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Pulmonary vein isolation (PVI) remains the cornerstone of atrial fibrillation (AF) ablation. The POLARx cryoballoon, which maintains a constant balloon pressure during ablation, was recently introduced for the treatment of AF. We present a comparison of acute and follow-up efficacy and safety outcomes between POLARx and Arctic Front, a frequently used second-generation used cryoballoon.
Methods
251 consecutive patients who underwent first-time cryoballoon AF ablation with POLARx (n=118) or Arctic Front (n=133) with a follow-up of at least 6 months, were retrospectively included.
Results
Of the total 251 patients who were included, mean age was 63 ± 9 years and 161 (64%) participants were male. The majority of the patients suffered from paroxysmal atrial fibrillation (95%). Follow-up success rates did not significantly differ between the POLARx (79%) and Artic Front (75%) groups at 6 months. Antiarrhythmic drug-use after the blanking period of 3 months was 9% for the POLARx group. Complication rates, excluding groin complications, were low in both study groups and were not significantly different (4% in POLARx vs 3% in Arctic Front). Procedure times (71 ± 23 minutes vs. 120 ± 36 minutes) and fluoroscopy times (20 ± 10 minutes vs. 33 ± 18 minutes) were both more favourable in the POLARx group. Lastly, nadir balloon temperatures were significantly lower (-57 ± 7 ºC vs -51 ± 7 ºC) for the POLARx group for all pulmonary veins (p<0.001).
Conclusion
Cryoballoon AF ablation with the POLARx cryoballoon results in similar success and complication rates at 6 months, in comparison with Arctic Front. Procedure and fluoroscopy times are shorter and balloon nadir temperatures are significantly lower for the POLARx cryoballoon. This can lead to optimal logistics and thus cost-effective use of lab and personnel.
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Affiliation(s)
- M Rehman
- Isala Clinics, Zwolle, Netherlands (The)
| | - A Adiyaman
- Isala Clinics, Zwolle, Netherlands (The)
| | - JJJ Smit
- Isala Clinics, Zwolle, Netherlands (The)
| | - B Manfai
- Isala Clinics, Zwolle, Netherlands (The)
| | - A Elvan
- Isala Clinics, Zwolle, Netherlands (The)
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Rehman M, El-Dabh A, Mandal S, Sattur S. A case report of a massive cardiac intimal sarcoma manifesting as syncope during a stress test. Eur Heart J Case Rep 2021; 5:ytab258. [PMID: 34377908 PMCID: PMC8343455 DOI: 10.1093/ehjcr/ytab258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/24/2020] [Accepted: 06/07/2021] [Indexed: 11/21/2022]
Abstract
Background Syncope has many aetiologies but from a cardiac standpoint, if arrhythmogenic and ischaemic causes are not present, obstructive lesions should be considered. Cardiac spindle cell sarcomas are incredibly rare and difficult to cure. Case summary A 62-year-old man presented for exercise stress test and had a syncopal episode on the treadmill. He was found to have a massive mass obstructing the transmitral flow. Patient was taken to the operating room and the mass was resected successfully. Histopathological confirmation revealed the mass to be a cardiac intimal sarcoma. Patient was initiated on a trial regimen of doxorubin, ifosfamide, and mesna. Discussion Cardiac intimal sarcomas are aggressive cancers and are difficult to treat; there are no established treatment guidelines. They can lead to obstruction of blood flow through the cardiac chambers. From a cardiac perspective, without arrhythmogenic and ischaemic causes of syncope, obstructive lesions should be considered.
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Affiliation(s)
- Mahin Rehman
- Department of Internal Medicine & Department of Cardiology, Heart and Vascular Center, Guthrie/Robert Packer Hospital, 1 Guthrie Square, Sayre, PA 18840, USA
| | - Ashraf El-Dabh
- Department of Internal Medicine & Department of Cardiology, Heart and Vascular Center, Guthrie/Robert Packer Hospital, 1 Guthrie Square, Sayre, PA 18840, USA
| | - Shobha Mandal
- Department of Internal Medicine & Department of Cardiology, Heart and Vascular Center, Guthrie/Robert Packer Hospital, 1 Guthrie Square, Sayre, PA 18840, USA
| | - Sudhakar Sattur
- Department of Internal Medicine & Department of Cardiology, Heart and Vascular Center, Guthrie/Robert Packer Hospital, 1 Guthrie Square, Sayre, PA 18840, USA
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Xing R, Mustapha O, Ali T, Rehman M, Zaidi SS, Baseer A, Batool S, Mukhtiar M, Shafique S, Malik M, Sohail S, Ali Z, Zahid F, Zeb A, Shah F, Yousaf A, Din F. Development, Characterization, and Evaluation of SLN-Loaded Thermoresponsive Hydrogel System of Topotecan as Biological Macromolecule for Colorectal Delivery. Biomed Res Int 2021; 2021:9968602. [PMID: 34285920 PMCID: PMC8275402 DOI: 10.1155/2021/9968602] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/21/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chemotherapeutic drugs cause severe toxicities if administered unprotected, without proper targeting, and controlled release. In this study, we developed topotecan- (TPT-) loaded solid lipid nanoparticles (SLNs) for their chemotherapeutic effect against colorectal cancer. The TPT-SLNs were further incorporated into a thermoresponsive hydrogel system (TRHS) (TPT-SLNs-TRHS) to ensure control release and reduce toxicity of the drug. Microemulsion technique and cold method were, respectively, used to develop TPT-SLNs and TPT-SLNs-TRHS. Particle size, polydispersive index (PDI), and incorporation efficiency (IE) of the TPT-SLNs were determined. Similarly, gelation time, gel strength, and bioadhesive force studies of the TPT-SLNs-TRHS were performed. Additionally, in vitro release and pharmacokinetic and antitumour evaluations of the formulation were done. RESULTS TPT-SLNs have uniformly distributed particles with mean size in nanorange (174 nm) and IE of ~90%. TPT-SLNs-TRHS demonstrated suitable gelation properties upon administration into the rat's rectum. Moreover, drug release was exhibited in a control manner over an extended period of time for the incorporated TPT. Pharmacokinetic studies showed enhanced bioavailability of the TPT with improved plasma concentration and AUC. Further, it showed significantly enhanced antitumour effect in tumour-bearing mice as compared to the test formulations. CONCLUSION It can be concluded that SLNs incorporated in TRHS could be a potential source of the antitumour drug delivery with better control of the drug release and no toxicity.
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Affiliation(s)
- R. Xing
- Department of Pharmacy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
- Beijing Key Laboratory of Bio-characteristic Profiling for Evaluation of Rational Drug Use, Beijing 100038, China
| | - O. Mustapha
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, DOW University of Health Sciences, 74200 Karachi, Pakistan
| | - T. Ali
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, DOW University of Health Sciences, 74200 Karachi, Pakistan
| | - M. Rehman
- HE.J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences, University of Karachi, Karachi 75270, Pakistan
| | - S. S. Zaidi
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, DOW University of Health Sciences, 74200 Karachi, Pakistan
| | - A. Baseer
- Department of Pharmacy, Abasyn University Peshawar, KPK, Pakistan
| | - S. Batool
- Nanomedicine Research Group, Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - M. Mukhtiar
- Department of Pharmacy, Faculty of Medical and Health Sciences, University of Poonch Rawalakot, AJK, Pakistan
| | - S. Shafique
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, DOW University of Health Sciences, 74200 Karachi, Pakistan
| | - M. Malik
- Nanomedicine Research Group, Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - S. Sohail
- Nanomedicine Research Group, Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Z. Ali
- Nanomedicine Research Group, Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - F. Zahid
- Nanomedicine Research Group, Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - A. Zeb
- Riphah Institute of Pharmaceutical Sciences, Riphah International University, Sector G-7/4, Islamabad 44000, Pakistan
| | - F. Shah
- Riphah Institute of Pharmaceutical Sciences, Riphah International University, Sector G-7/4, Islamabad 44000, Pakistan
| | - A. Yousaf
- Department of Pharmacy, COMSATS University Islamabad, Lahore Campus, Lahore 54000, Pakistan
| | - F. Din
- Nanomedicine Research Group, Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
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Rehman M, Lucero D, Khan S, Molina J. A RARE CASE OF AN ENDOBRONCHIAL PLASMACYTOMA. Chest 2020. [DOI: 10.1016/j.chest.2020.09.141] [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: 11/15/2022] Open
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9
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Khan S, Rehman M, McElhaney N, Siddiqui F, Karki A. THAT NAGGING COUGH: INTRATHORACIC SCHWANNOMA WITH HORNERS SYNDROME. Chest 2020. [DOI: 10.1016/j.chest.2020.08.1430] [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] Open
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10
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Rehman M, Gondal A, Khan S, Rehman NU, Molina J. Neutropenic Enterocolitis and Rapid Spontaneous Resolution of Portal Venous Gas: A Non-Respiratory Manifestation of COVID-19. Cureus 2020; 12:e9445. [PMID: 32742892 PMCID: PMC7389872 DOI: 10.7759/cureus.9445] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic is affecting millions across the globe. The population of immunosuppressed individuals are at greatest risk of morbidity and mortality. Data on COVID-19 induced illness in the immunocompromised host are sparse. We aim to highlight the possibility of atypical and non-respiratory presentations of COVID-19 (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) in immunosuppressed individuals as our case reveals a rare COVID-19 associated GI presentation of neutropenic enterocolitis with bloody diarrhea.
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Affiliation(s)
- Mahin Rehman
- Internal Medicine, Guthrie Robert Packer Hospital, Sayre, USA
| | - Amlish Gondal
- Internal Medicine, Guthrie Robert Packer Hospital, Sayre, USA
| | - Salman Khan
- Pulmonary and Critical Care Medicine, Geisinger Medical Center, Danville, USA
| | | | - Jaime Molina
- Critical Care Medicine, Guthrie Robert Packer Hospital, Sayre, USA
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Rehman M, Rehman NU. Precordial ECG Lead Mispositioning: Its Incidence and Estimated Cost to Healthcare. Cureus 2020; 12:e9040. [PMID: 32656045 PMCID: PMC7343296 DOI: 10.7759/cureus.9040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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12
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Mohamud AY, Griffith B, Rehman M, Miller D, Chebl A, Patel SC, Howell B, Kole M, Marin H. Intraluminal Carotid Artery Thrombus in COVID-19: Another Danger of Cytokine Storm? AJNR Am J Neuroradiol 2020; 41:1677-1682. [PMID: 32616585 DOI: 10.3174/ajnr.a6674] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 06/01/2020] [Indexed: 12/11/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is associated with a severe inflammatory response. Inflammation affects atherosclerotic plaque vulnerability and promotes a thrombogenic environment. We report a series of 6 patients with COVID-19 with acute ischemic stroke due to intraluminal carotid artery thrombus presenting during an 8-day period. Six patients were included (5 men) with a mean age of 65.8 years (range, 55-78 years). COVID-19 was diagnosed by detection of Severe Acute Respiratory Syndrome coronavirus 2 in 5 patients and was presumed due to typical clinical and imaging findings in 1 patient. All patients had vascular risk factors including diabetes (83%), hyperlipidemia (100%), and smoking (17%). Four patients presented with large infarcts with initial NIHSS scores of 24-30. During their hospitalization, all patients had elevated D-dimer and C-reactive protein levels, 5 patients had elevated lactate dehydrogenase and ferritin levels, 3 had elevated interleukin-6 levels, and 2 had elevated troponin levels. Inflammation related to COVID-19 may result in rupture of vulnerable atherosclerotic plaques, resulting in thrombosis and acute ischemic stroke.
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Affiliation(s)
- A Y Mohamud
- From the Departments of Neurology (A.Y.M., M.R., D.M., A.C., B.H.)
| | | | - M Rehman
- From the Departments of Neurology (A.Y.M., M.R., D.M., A.C., B.H.)
| | - D Miller
- From the Departments of Neurology (A.Y.M., M.R., D.M., A.C., B.H.)
| | - A Chebl
- From the Departments of Neurology (A.Y.M., M.R., D.M., A.C., B.H.)
| | | | - B Howell
- From the Departments of Neurology (A.Y.M., M.R., D.M., A.C., B.H.)
| | - M Kole
- Neurosurgery (M.K.), Henry Ford Health System, Detroit, Michigan
| | - H Marin
- Radiology (B.G., S.C.P., H.M.)
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13
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Khan S, Rehman M, Achakzai B, Khan A, Khan I, McElhaney N, Siddiqui F, Karki A. Incidental intrathorcic schwannoma post upper respiratory tract infection associated with Horner's syndrome: A case report. Respir Med Case Rep 2020; 30:101126. [PMID: 32577367 PMCID: PMC7303989 DOI: 10.1016/j.rmcr.2020.101126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/09/2020] [Indexed: 11/09/2022] Open
Abstract
Background Schwannomas may remain asymptomatic, and may be discovered incidentally. Case presentation Here we describe a case of a young female complaining of upper respiratory tract symptoms who was incidentally found to have an intrathoracic neurogenic tumor consistent with schwannoma associated with Horner's syndrome. Biopsy of the tumor revealed S100, BCL-2 and CD 99+ compatible with schwannoma. Patient had brachial plexus exploration and dissection of thoracic inlet tumor resected through video assisted thoracoscopic surgery (VATS). Patient did exceptionally well afterwards with no documented Horner's symptoms. Conclusion Characterized as a rare case, this patient presented post viral infection and found to have a rare tumor. Successful surgical treatment alleviated her symptoms.
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Affiliation(s)
- Salman Khan
- Guthrie Clinic, Sayre, Pennsylvania 18840, USA
| | | | | | - Amber Khan
- Guthrie Clinic, Sayre, Pennsylvania 18840, USA
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14
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Abstract
We present a case of a 39-year-old male who presented with chest pain without fever or respiratory symptoms. Troponins were elevated and electrocardiogram (ECG) was inconclusive for ST-elevation myocardial infarction (STEMI). Angiography revealed normal coronaries and the patient was found to be coronavirus disease 2019 (COVID-19) positive; he was diagnosed with COVID-19 myocarditis. With the global pandemic, more cases are emerging regarding myocardial injury induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Although COVID-19 manifests primarily as respiratory disease, few cases of cardiac injury without respiratory involvement or febrile illness have been reported. This case illustrates that COVID-19 can present atypically and affect an isolated non-respiratory organ system.
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Affiliation(s)
- Mahin Rehman
- Internal Medicine, Guthrie Clinic, Robert Packer Hospital, Sayre, USA
| | - Amlish Gondal
- Internal Medicine, Guthrie Clinic, Robert Packer Hospital, Sayre, USA
| | - Najeeb U Rehman
- Cardiology, Guthrie Clinic, Robert Packer Hospital, Sayre, USA
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15
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Rehman M, Sharma S. RISK CONSIDERATIONS OF LARGE PAPILLARY FIBROELASTOMAS: A CASE OF RISK VS. BENEFIT IN AN OCTOGENARIAN. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)33584-1] [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: 11/26/2022]
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16
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Rehman M, Sharma S, Ronsivalle J, Rehman N, McClintic B. A UNIQUE RCA: AN ANOMALOUS ORIGIN WITH A COURSE BETWEEN THE GREAT VESSELS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)33767-0] [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: 10/24/2022]
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17
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Rehman M, Sharma S, Ronsivalle J, Rehman N, Aitsebaomo J. THE IMPLICATIONS OF AN ANATOMICAL ANOMALY: A CASE OF AN INTRACAMERAL RIGHT CORONARY ARTERY (RCA). J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)33766-9] [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: 10/24/2022]
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18
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Rehman M, Roden A, Mansfield A. P1.06-22 Pathologic and Imaging Response Correlations in Patients Treated with Neoadjuvant Chemotherapy for Mesothelioma. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1009] [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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Mishra NK, Mishra JK, Srivastava GN, Shah D, Rehman M, Latheef NA, Maurya A, Rajak BK. Should vitamin D be routinely checked for all chronic obstructive pulmonary disease patients? Lung India 2019; 36:492-498. [PMID: 31670296 PMCID: PMC6852226 DOI: 10.4103/lungindia.lungindia_141_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Aims and Objectives: This study aimed to compare the vitamin D levels between chronic obstructive pulmonary disease (COPD) patients and healthy controls and to describe the correlation between vitamin D levels and lung functions. Methods: Fifty COPD patients (cases) and 30 healthy volunteers (controls) were recruited and their serum vitamin D level was measured together with lung function (forced vital capacity and forced expiratory volume in 1 s [FEV1]) by spirometry. vitamin D was categorized as ≤20 nmol/l: deficient, 21–50 nmol/l: inadequate, and ≥51 nmol/l as sufficient. Results: In this case–control cross-sectional study, lower vitamin D levels were associated with lower lung function in both cases as well as controls, the effect being more pronounced in cases. Mean FEV1 at vitamin D ≤20 nmol/l (0.98 ± 0.40 vs. controls 1.93 ± 0.24 with P = 0.006), mean FEV1 at vitamin D 21–50 nmol/l (1.55 ± 0.54 vs. 2.20 ± 0.31 with P = 0.000), and mean FEV1 at vitamin D ≥51 nmol/l (2.06 ± 0.54 vs. 2.20 ± 0.31 with P = 0.002). Moreover, the severity of predicted postbronchodilator FEV1% was also much lower among COPD cohort versus healthy volunteers (mean FEV1%: cases 47.88 ± 14.22 vs. controls 58.76 ± 15.05 with P = 0.002). Conclusions: Importantly, lung function in both the groups was affected by decreased vitamin D level; decrease in FEV1 was more pronounced among COPD patients compared to controls showing more expiratory airflow limitation. Vitamin D levels are associated with changes in lung function in cases of COPD as well as healthy controls. Larger studies to confirm the association in Indian context are required and routine assessment of vitamin D may be undertaken to obviate the effects of low vitmain D level on lung function.
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Affiliation(s)
- Navin Kumar Mishra
- Department of TB and Respiratory Diseases, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Jai Kishan Mishra
- Department of TB and Respiratory Diseases, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - G N Srivastava
- Department of TB and Respiratory Diseases, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - D Shah
- Department of TB and Respiratory Diseases, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - M Rehman
- Department of TB and Respiratory Diseases, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - N A Latheef
- Department of TB and Respiratory Diseases, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - A Maurya
- Department of TB and Respiratory Diseases, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Bhupendar K Rajak
- Department of TB and Respiratory Diseases, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Garcia R, Guenancia C, Le Gal F, Rehman M, Tao Kong Man V, Christiaens L, Ingrand P, Degand B. Contractibility sensor signal evolution predicts cardiovascular events in patients with cardiac resynchronization therapy. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2018.10.201] [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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21
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Krishnamachari B, Rehman M, Cohn JE, Chan V, Modi N, Leitner O, Tangney K, O'Connor A, Blazey W, Koehler S, Tegay D. Video Education on Hereditary Breast and Ovarian Cancer (HBOC) for Physicians: an Interventional Study. J Cancer Educ 2018; 33:1213-1221. [PMID: 28573517 DOI: 10.1007/s13187-017-1233-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The National Comprehensive Cancer Network (NCCN) guidelines are the gold standard in hereditary cancer risk assessment, screening, and treatment. A minority of physicians follow NCCN guidelines for BRCA1 or BRCA2 mutations. This study assesses the impact of an interventional educational program on HBOC in terms of knowledge. Physicians were sent an invite to join either an intervention survey (web-training offered prior to the knowledge survey) or control survey (web-training offered after the knowledge survey). Sixty-nine physicians in the intervention arm and 67 physicians in the control arm completed the survey. The interventional group regularly answered items correctly at a higher frequency than the control group. For example, 64.71% (n = 44) of physicians in the intervention group knew that multi-gene testing does not have to include only highly penetrant genes compared to 32.84% (n = 22) of the control group (p < 0.01). Similar results were seen with other specific survey items. The current study is important in that it shows web-based education to be a feasible and effective modality for training on hereditary breast cancer. This type of education may be incorporated into CME programs and can be used as a foundation for further studies as well.
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Affiliation(s)
- Bhuma Krishnamachari
- Department of Clinical Specialties, New York Institute of Technology College of Osteopathic Medicine, 20 Riland PO Box 8000, Northern Boulevard, Old Westbury, NY, 11568, USA.
| | - Mahin Rehman
- Academic Medicine Scholars Program, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Jason E Cohn
- Department of Otolaryngology-Facial Plastic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Vivian Chan
- Academic Medicine Scholars Program, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Neil Modi
- Division of Research, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
| | | | | | | | - William Blazey
- Department of Family Medicine, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Sharon Koehler
- Department of Clinical Specialties, New York Institute of Technology College of Osteopathic Medicine, 20 Riland PO Box 8000, Northern Boulevard, Old Westbury, NY, 11568, USA
| | - David Tegay
- Department of Clinical Specialties, New York Institute of Technology College of Osteopathic Medicine, 20 Riland PO Box 8000, Northern Boulevard, Old Westbury, NY, 11568, USA
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Hummaira Qudsia Y, Rehman M. Explore the Factors Affecting Behavioral and Psychological Changes on Obstetricians/Gynecologists in Maternal Health Care Center. cswhi 2018. [DOI: 10.22359/cswhi_9_3_03] [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: 11/23/2022]
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Kocijan T, Cappelletto A, Rehman M, Tang Y, Vodret S, Zentilin L, Giacca M, Zacchigna S. Understanding the poor angiogenic capacity of the mammalian heart. Vascul Pharmacol 2018. [DOI: 10.1016/j.vph.2017.12.032] [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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Schaerer F, Kerforne T, Lacroix C, Chauvet S, Rayed-Pelardy F, Biedermann C, Lequeux B, Corbi P, Christiaens L, Rehman M, Larrieu-Ardilouze E. Predictors for myocardial recovery of patients implanted with an ECMO device following myocardial infarction. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2017.11.125] [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]
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Khatoon SS, Rehman M, Rahman A. The Role of Natural Products in Alzheimer's and Parkinson's Disease. Studies in Natural Products Chemistry 2018. [DOI: 10.1016/b978-0-444-64058-1.00003-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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26
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Rehman M, Madni A, Shi D, Ihsan A, Tahir N, Chang KR, Javed I, Webster TJ. Enhanced blood brain barrier permeability and glioblastoma cell targeting via thermoresponsive lipid nanoparticles. Nanoscale 2017; 9:15434-15440. [PMID: 28976512 DOI: 10.1039/c7nr05216b] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Thermoresponsive targeting is used to deliver therapeutic agents at hyperthermic conditions (39-45 °C). However, available thermoresponsive drug delivery systems (TDDS), including liposomes, have a complex method of preparation involving toxic solvents and reagents. The objective of this in vitro study was to prepare and characterize thermoresponsive lipid nanoparticles (TLN) for treating glioblastoma, the most aggressive brain tumor whose treatment is limited by a low blood brain barrier (BBB) permeability of drugs. Thermoresponsive lipids were prepared by mixing liquid and solid fatty acids (0.1 : 1 to 2 : 1 ratio) and lipid mixtures exhibiting a solid-liquid phase transition at 39 °C were identified by plotting melting point against liquid contents. TLN were prepared by a hot melt encapsulation method using mono- or double-surfactant systems. TLN showed desirable size (<270 nm), zeta potential (-35 to -50 mV), spherical morphology and stability by FTIR studies. In the drug release studies, paclitaxel release was slow at 37 °C, however, it was released abruptly at 39 °C due to the faster diffusion rate from liquid state nanoparticles. During cytotoxicity studies, the unloaded TLN were non-toxic whereas paclitaxel loaded TLN showed higher cytotoxicity to glioblastoma cells at 39 °C (69% cell viability after one hour) compared to 37 °C (82% cell viability). The TLN showed higher permeability across an in vitro model of BBB at 39 °C due to a deformable liquid state which can squeeze through the tight junctions of the BBB. In conclusion, this study demonstrated that the TLN can be used as a safe and effective alternative to traditional TDDS with higher potential to target glioblastoma cells across the BBB.
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Affiliation(s)
- M Rehman
- Department of Chemical Engineering, Northeastern University, Boston, MA 02115, USA.
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Garcia R, Rehman M, Goujeau C, Degand B, Le Gal F, Labarre Q, Bidegain N, Christiaens L, Bouleti C. P6120Left ventricular longitudinal strain impairment predicts cardiovascular events in asymptomatic type 1 myotonic dystrophy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6120] [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: 11/13/2022] Open
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Ringlé A, Dornhorst A, Dawson D, Rehman M, Ruisanchez C, Nihoyannopoulos P. 31 Changes in myocardial deformation assessed by 2D and 3D speckle tracking echocardiography in asymptomatic type 1 diabetic patients. Archives of Cardiovascular Diseases Supplements 2015. [DOI: 10.1016/s1878-6480(15)30269-x] [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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Javed I, Ranjha N, Mahmood K, Kashif S, Rehman M, Usman F. Drug release optimization from microparticles of poly(E-caprolactone) and hydroxypropyl methylcellulose polymeric blends: formulation and characterization. J Drug Deliv Sci Technol 2014. [DOI: 10.1016/s1773-2247(14)50126-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bashir S, Quadri M, Rehman M, Ganai A. Effect of herbal extract supplementations in feed on serum and eggyolk lipid profile in Jabalpur colour layer birds. Appl Biol Rese 2014. [DOI: 10.5958/0974-4517.2014.00047.0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Walsh KP, Fowler JR, Chen O, Gaughan JP, Ali S, Rehman M, Rehman S. The validity and reliability of preoperative radiographic canal diameter measurements of the femur. HSS J 2013; 9:150-6. [PMID: 24426861 PMCID: PMC3757481 DOI: 10.1007/s11420-013-9334-z] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 03/28/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND The femoral canal is frequently measured preoperatively in cases where an intramedullary device is planned for operative fixation of a fracture. To our knowledge, a formal assessment of validity and reliability of preoperative canal measurements has not been previously performed. QUESTIONS/PURPOSES This study aims to determine the validity and reliability of preoperative canal measurements of the femur made on plain radiographs using comparison with curved planar reformation software as the gold standard. METHODS Fifty-six patients were identified based on availability of anterior-posterior (AP) and lateral radiographs of the femur and computed tomography (CT) of the lower extremity. Four "raters" measured the canal diameter at its narrowest point and the distance from the lesser trochanter to the isthmus on the AP, lateral radiograph, and CT. The width of the femoral nail on AP radiographs was also measured to determine magnification error. Curved planar reformation (CPR) was used to provide the most accurate calculation of the canal diameter. RESULTS Compared to the isthmus position determined by CPR, the measurement was most accurate on an AP and the diameter of the canal was most accurate using coronal CT, followed by AP radiographs. The measured canal diameter of the fractured femur on APs was compared to that of the used implant and varied by 1 mm. DISCUSSION/CONCLUSION The AP plain radiographic measurement was found to be more accurate for determination of the canal diameter compared to the lateral radiograph. These findings confirm the utility of preoperative canal measurements in predicting the feasibility of placing a specific size intramedullary implant.
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Affiliation(s)
- Kenneth P. Walsh
- />Temple University School of Medicine, 3401 N Broad St, Philadelphia, PA 19140 USA
| | - John R. Fowler
- />Department of Orthopaedics, Temple University Hospital, 3401 N Broad St, Philadelphia, PA 19140 USA
| | - Oliver Chen
- />Department of Radiology, Temple University Hospital, 3401 N Broad St, Philadelphia, PA 19140 USA
| | - John P. Gaughan
- />Biostatistics Consulting Center, Temple University School of Medicine, 3401 N Broad St, Philadelphia, PA 19140 USA
| | - Sayed Ali
- />Department of Radiology, Temple University Hospital, 3401 N Broad St, Philadelphia, PA 19140 USA
| | - Mahin Rehman
- />Department of Orthopaedics, Temple University Hospital, 3401 N Broad St, Philadelphia, PA 19140 USA
| | - Saqib Rehman
- />Department of Orthopaedics, Temple University Hospital, 3401 N Broad St, Philadelphia, PA 19140 USA
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Abstract
OBJECTIVE To retrospectively investigate the experience at one urban level one trauma center with gunshot femoral fractures with vascular injury and to examine the implication of surgical sequence with regards to short-term complications and ischaemia time. METHODS We performed a retrospective study of 24 patients treated at an urban level one trauma center over a 10-year period with low velocity gunshot wounds resulting in femur fractures and major vascular injury. Data were stratified according to sequence of surgical intervention. RESULTS The mean age was 31.3 years. Mean time to revascularization was highest in patients undergoing definitive orthopaedic fixation first (660 min) and lowest in patient undergoing shunting first (210 min). Most complications in patients undergoing vascular repair first, included two disrupted repairs requiring immediate revision after subsequent orthopaedic fixation. Other complications included compartment syndrome and one amputation. CONCLUSION Surgical sequence did not appear to impact the outcome with regard to limb loss, compartment syndrome, or mortality. Orthopaedic repair following vascular repair, however, is a risk for disruption of the vascular repair. We suggest that close and early direct communication between the orthopaedic and vascular surgeons take place in order to facilitate a satisfactory outcome.
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Affiliation(s)
- Saqib Rehman
- Department of Orthopaedic Surgery, Temple University Hospital, Philadelphia, PA 19140, USA.
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Sreeramareddy C, Suri S, Menezes RG, Kumar HNH, Rehman M, Islam R, Shah M, Sathian B, Pereira XV, Shetty U, Vaswani VR. SP4-24 Self-reported tobacco smoking practices among medical students and their perceptions towards training about tobacco smoking in medical curricula: a cross-sectional, questionnaire survey in Malaysia, India, Pakistan, Nepal, and Bangladesh. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976p.18] [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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Shuhaiber J, Rehman M, Jenkins K, Fynn-Thompson F, Bacha E. The role of surgical therapy for pulmonary vein atresia in childhood. Pediatr Cardiol 2011; 32:639-45. [PMID: 21359946 DOI: 10.1007/s00246-011-9942-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 09/19/2010] [Indexed: 10/18/2022]
Abstract
UNLABELLED The outcome for children with pulmonary vein atresia has been historically poor. This report describes clinical outcomes after surgical treatment of primary and secondary pulmonary vein atresia. All patients undergoing surgery for pulmonary vein atresia at Children's Hospital Boston from 1 January 2005 to 1 January 2009 were identified. The data available for analysis included demographic characteristics, findings based on cardiac catheterization and other imaging, clinical information, operative surgical intervention, and pulmonary vein histology. The study-specific information included the calculated number of atretic pulmonary veins as well as surgical interventions performed during the study period. The study end points included successful relief of pulmonary vein atresia, recurrence of pulmonary atresia or stenosis, overall pulmonary vein disease progression, and patient survival. A total of 16 patients with one or more pulmonary vein atresias were identified in the cardiac surgery registry database. Of these 16 patients, 5 had primary pulmonary atresia, and 11 had secondary atresia after repair of anomalous pulmonary venous drainage. Surgical recanalization of atretic pulmonary veins was achieved for more than 80% of the patients. At the most recent follow-up assessment, 7 (44%) of the 16 patients had recurrence of atresia. Five of the patients had development of new atresia in other previously healthy pulmonary veins. The median follow-up period was 4 months for primary and 17 months for secondary pulmonary vein atresia. The three main predictors of pulmonary vein disease progression after surgery were the presence of underlying lung disease (P = 0.036), prematurity (P = 0.035), and a history of recurrent pulmonary vein atresia. The overall mortality rate for the patients with primary or secondary pulmonary vein atresia was 56% at the most recent follow-up assessment (100% for the patients with primary vein atresia and 36% for the patients with secondary vein atresia). CONCLUSIONS Surgical recanalization of pulmonary vein atresia is possible, but prognosis remains poor. Recurrence of atresia can take place as early as a few months in the presence of underlying lung disease, prematurity, or history of recurrent pulmonary vein atresia. Further research is needed to identify mechanisms for attaining and sustaining pulmonary vein patency after surgery.
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Affiliation(s)
- J Shuhaiber
- Department of Cardiac Surgery, Cincinnati Childrens Hospital, Cincinnati, OH, USA.
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Ambardekar AP, Sestokas AK, Schwartz DM, Flynn JM, Rehman M. Concomitant hypertension, bradycardia, and loss of transcranial electric motor evoked potentials during pedicle hook removal: report of a case. J Clin Monit Comput 2011; 24:437-40. [PMID: 21210192 DOI: 10.1007/s10877-010-9268-7] [Citation(s) in RCA: 2] [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] [Received: 09/18/2009] [Accepted: 12/10/2010] [Indexed: 11/30/2022]
Abstract
Neurophysiologic monitors in the form of transcranial electric motor evoked potentials (tceMEPs) and somatosensory evoked potentials (SSEPs) have become widely used modalities to monitor spinal cord function during major orthopedic spine procedures. In combination with invasive and non-invasive clinical monitoring and an anesthesia information management system (AIMS), we promptly recognized an acute change in hemodynamic and neurophysiologic parameters, managed intraoperative spinal cord contusion, and successfully minimized iatrogenic injury to the spinal cord during corrective spine surgery.
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Affiliation(s)
- A P Ambardekar
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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Rehman M, Melgar JC, Rivera C JM, Idris AM, Brown JK. First Report of "Candidatus Liberibacter psyllaurous" or "Ca. Liberibacter solanacearum" Associated with Severe Foliar Chlorosis, Curling, and Necrosis and Tuber Discoloration of Potato Plants in Honduras. Plant Dis 2010; 94:376. [PMID: 30754216 DOI: 10.1094/pdis-94-3-0376c] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
From 2006 to 2009, all commercial potato fields in Azacualpa F.M. Honduras were heavily infested with the potato psyllid Bactericera cockerelli (Sulc.). Plants exhibited interveinal chlorosis, vein-greening, downward curling, stunting, above ground tuber formation, and brownish flecks in some tubers. Disease incidence ranged from 50 to 95%. Leaf samples and psyllids were collected from seven fields in two potato-growing regions of Honduras. Total DNA was purified from the leaves of 30 symptomatic and three asymptomatic plants. DNA was extracted from 20 adult and 10 immature (4th to 5th instar) psyllids according to Frohlich et al (1). PCR primers, PSY680F 5'-GTTCGGAATAACTGGGCGTA-3' and PSY1R 5'-CCCATAAGGGCCATGAGGACT-3', were used to amplify a 680-bp fragment of the 16S rDNA for the recently described "Candidatus Liberibacter physallaurous" (2) and "Ca. L. solanacearum" (3). PSY1R/PSY680F primer design was based on the association of a previously undescribed liberibacter with vein-greening symptoms in greenhouse tomato plants in Arizona from 2006 to 2007 (GenBank Accession No. GQ926918) that lead to the hypothesis that a similar bacterium could be associated with symptomatic potato plants in Honduras. PCR amplification, cloning, and sequencing of the resultant 16S rDNA amplicons indicated that 17 of 30 potato plants, 8 of 20 adult and 7 of 10 third to fourth instar psyllids, respectively, were positive for liberibacter based on 99 to 100% shared nucleotide sequence (nt) identity with the analogous sequence from liberibacter (EU812558 [2]). To substantiate these results, a second molecular marker was targeted using the 1611F and 480R primers (~980 bp) that amplify the 16S-23S-ITSrDNA of liberibacter (2) for selected liberibacter-positive samples (above). Amplicons of the expected size were obtained from 12 of 17 potato and 7 of 10 immature psyllids. No PCR product of the expected size was obtained from asymptomatic potato samples or the PCR negative (water) control. The resultant PCR amplicons were cloned and 12 to 15 clones per amplicon were sequenced. The sequences were aligned and the percentage pair wise nt identity was calculated by Clustal W revealing that the 16S rDNA and 16S-23S-ITS sequences, respectively, shared 99 to 100% nt identity with each other. BLAST analysis against the NCBI database indicated that the 16S rRNA sequences from potato plants (GQ926922) and immature psyllids (GQ926923), and the 16S-ITS-23S sequence from potato plants (GQ926924) and immature psyllids (GQ926925), shared 98.5 to 100% nt identity with 'Ca. Liberibacter' reported from potato (EU812556; [2,4]) and tomato (EU812558, EU812559, EU935005; [2,3]). Evidence for the widespread presence of liberibacter and the potato psyllid in potato fields in Honduras, together with foliar and tuber symptoms that are reminiscent of those recently described in potato plants in the United States affected with 'zebra chip' disease (4), suggest that a similar or identical disease of the potato also occurs in Honduras. This emergent disease poses a serious threat to potato production in Honduras and elsewhere in Central America. References: (1) D. R. Frohlich et al., Mol. Ecol. 8:1683, 1999. (2) A. K. Hansen et al. Appl. Environ. Microbiol. 78:5862, 2008. (3) L. W. Liefting et al. Plant Dis. 93:208, 2009. (4) J. E. Munyaneza et al. J. Econ. Entomol. 100:656, 2007.
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Affiliation(s)
- M Rehman
- Department of Microbiology, Hazara University, Mansehra, Pakistan
| | - J C Melgar
- Department of Plant Protection, FHIA, San Pedro Sula, Honduras
| | - J M Rivera C
- Department of Plant Protection, FHIA, San Pedro Sula, Honduras
| | - A M Idris
- School of Plant Sciences, The University of Arizona, Tucson
| | - J K Brown
- School of Plant Sciences, The University of Arizona, Tucson
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Brown JK, Rehman M, Rogan D, Martin RR, Idris AM. First Report of "Candidatus Liberibacter psyllaurous" (synonym "Ca. L. solanacearum") Associated with 'Tomato Vein-Greening' and 'Tomato Psyllid Yellows' Diseases in Commercial Greenhouses in Arizona. Plant Dis 2010; 94:376. [PMID: 30754215 DOI: 10.1094/pdis-94-3-0376b] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
During the winter of 2006-2007, plants in commercial tomato greenhouses (GH-1 and GH-2; total 320 acres [129.5 ha]) in Arizona were infested with the potato psyllid Bactericera cockerelli (Sulc) and more than 60% and ~20% of the plants, respectively, exhibited leaf curling, chlorosis, and shortened internodes. In addition, some plants in GH-1 developed an unusual 'vein-greening' phenotype. Nucleic acids were isolated from 10 symptomatic and three asymptomatic plants from each greenhouse. PCR primers designed to amplify a phytoplasma-like 16S rDNA (850 bp) yielded the expected size product from GH-1 samples, whereas samples from GH-2 and the asymptomatic samples from both greenhouses did not. Several 16S rDNA PCR products (3 of 60) when cloned and sequenced, surprisingly shared 97% homology with 'Candidatus Liberibacter asiaticus' (GenBank No. GQ926917). PCR primers PSY680F 5'-GTTCGGAATAACTGGGCGTA-3' and PSY1R 5'-CCCATAAGGGCCATGAGGACT-3', based on the resultant 16S rDNA sequences, were used to amplify a 680-bp fragment from plant DNA extracts and psyllid lysates (1). A robust PCR product (~680 bp) was obtained from 10 of 10 GH-1 plant extracts (GQ926918) and from a GH-1-derived psyllid colony (28 of 35 adults) (GQ926919) and the tomato plants on which they were reared. In contrast, no 680-bp product was obtained from GH-1 asymptomatic plants (0 of 3), GH-2 plants (0 of 10 symptomatic; 0 of 3 asymptomatic), GH-2-derived psyllid colonies (0 of 35 adults), or psyllid colony tomato plants (data not shown). At least three 680-bp amplicons for each sample type were cloned and 8 to 10 inserts were sequenced for each. BLAST analysis revealed that all 680-bp sequences shared 99 to 100% nt identity with the analogous 16SrDNA from "Ca. Liberibacter psyllaurous" (2) and synonym "Ca. L. solanacearum" (3). A second molecular marker was obtained with the 1611F and 480R primers (2) to amplify the 16SrDNA-23S-ITS (980 bp) from >3 plant extracts and psyllid lysates that tested positive for liberibacter. Clustal W alignment of the 16S-23S-ITS sequences from GH-1 original tomato plants and psyllid colony plants (GQ926920) and psyllids (GQ926921) indicated they were 100% identical to each other and BLAST analysis indicated 99 to 100% shared identity with "Ca. L. psyllaurous" (EU812558) (synonym "Ca. L. solanacearum"). Transmission electron microscopy examination of GH-1 and GH-2 psyllids revealed rod and pleomorphic-shaped bacteria (0.5 to 2.0+ μm) at the brain-salivary gland interface in psyllids from the GH-1 liberibacter-positive colony. No such bacteria were observed in GH-2 liberibacter-negative psyllids. These results support an etiological role of a new liberibacter spp. in the development of the 'vein-greening' symptom phenotype. In contrast, the GH-2 'yellows' phenotype is reminiscent of 'psyllid toxicity' in tomato colonized by B. cockerelli (4). To our knowledge, this is the first report of distinct psyllid-associated diseases in greenhouse tomato in Arizona, one associated with a new 'Ca. Liberibacter' spp., manifest as 'vein-greening' disease, and the other associated with psyllid feeding, in which liberibacter is undetectable in plants and psyllids, and is manifest as the 'tomato psyllid yellows' disease. References: (1) D. R. Frohlich et al. Mol. Ecol. 8:1683, 1999. (2) A. K. Hansen et al. Appl. Environ. Microbiol. 74:5862, 2008. (3) L. W. Liefting et al. Plant Dis. 93:208, 2009. (4) H. J. Pack. Utah Agric. Exp. Stn. Bull. 209, 1929.
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Affiliation(s)
- J K Brown
- School of Plant Sciences, The University of Arizona, Tucson
| | - M Rehman
- Department of Microbiology, Hazara University, Mansehra, Pakistan
| | - D Rogan
- School of Plant Sciences, The University of Arizona, Tucson
| | - R R Martin
- USDA-ARS Horticultural Crops Research Laboratory, Corvallis, OR
| | - A M Idris
- School of Plant Sciences, The University of Arizona, Tucson
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Srivastava S, Ramdass B, Nagarajan S, Rehman M, Mukherjee G, Krishna S. Notch1 regulates the functional contribution of RhoC to cervical carcinoma progression. Br J Cancer 2009; 102:196-205. [PMID: 19953094 PMCID: PMC2813755 DOI: 10.1038/sj.bjc.6605451] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The role of Notch signalling in human epithelial cancers is of immense interest. In this study, we examine the interplay between Notch signalling and RhoC, a well-established molecular factor in metastasis. By linking the function of Notch and RhoC, we further strengthen the notion that there is a pro-oncogenic role of Notch signalling in human cervical cancers. METHODS RhoC protein expression in cervical carcinoma cell lines was assessed by western blotting. Using CaSki and SiHa cells (cervical carcinoma cells lines), we show that RhoC contributes to wound healing, invasion and migration, anoikis resistance, colony formation, in vitro tube formation and tumour formation. Immunohistochemical studies were carried out to assess the co-expression of RhoC, pAkt and Notch1 in clinical sections. RESULTS An assessment of the changes associated with epithelial-to-mesenchymal transition (EMT) shows that both Notch1 and RhoC have similar phenotypic contribution to EMT. Rho activity assessment on Notch1 inhibition with DAPT shows decreased RhoC activity. We further show that constitutively active RhoC rescues the phenotypic effect of Notch1 inactivation, and a comparison of Notch1 with RhoC expression shows an overlap between the two proteins in the same areas of the tissue. CONCLUSION This study has provided evidence to suggest that RhoC is an effector of Notch1 in cervical carcinoma.
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Affiliation(s)
- S Srivastava
- National Centre for Biological Sciences, TIFR, Bangalore, Karnataka, India.
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Sahibzada P, Ali N, Zahidullah M, Rehman M. Ventricular free wall rupture. J Ayub Med Coll Abbottabad 2009; 21:22-26. [PMID: 20524461] [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: 05/29/2023]
Abstract
BACKGROUND Left ventricular free wall rupture (FWR) is reported to occur in 2-6% of cases presenting with acute myocardial infarction. Mortality of this complication is very high, accounting for 20-30% of all infarct related deaths. The objective of our study was to present our surgical experience of free wall rupture over a period of five years from 2004-2009. METHODOLOGY A review of our records over this period of time was undertaken. RESULTS In our series of six patients collected over this time period, 3 (50%) presented with hypotension and 3 (50%) with persistent chest pain ECG evidence of myocardial infarction was present in 4 (67%) cases, LVH in 2 (33.3%) cases and 2 (33.3%) showed diffuse ST and T changes. Echocardiogram was useful in the diagnosis of rupture but was not confirmatory. Coronary angiography and left ventriculography was performed in all the patients. Surgery was performed in all cases confirming the FWR. CONCLUSION In this sma I s,ries there was no surgical mortality which may reflect the favourable prognosis in sub acute rupture where haemodynamic stability is achieved with medical therapy prior to surgery.
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Williams J, Kona B, Kothari R, Rehman M, Krishnan P. THE USEFULNESS OF HEAD COMPUTED TOMOGRAPHY SCANS IN PATIENTS ADMITTED FOR DELIRIUM TREMENS AT A TEACHING COMMUNITY HOSPITAL. Chest 2007. [DOI: 10.1378/chest.132.4_meetingabstracts.562a] [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: 11/01/2022] Open
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Williams J, Kona B, Shah R, Rehman M, Krishnan P. CYSTIC LUNG DISEASE DUE TO LYMPHOCYTIC INTERSTITIAL PNEUMONIA IN A PATIENT WITH HUMAN IMMUNODEFICIENCY VIRUS INFECTION. Chest 2007. [DOI: 10.1378/chest.132.4_meetingabstracts.734] [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: 11/01/2022] Open
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Ntukidem NI, Nguyen AT, Stearns V, Rehman M, Schott A, Skaar T, Jin Y, Blanche P, Li L, Lemler S, Hayden J, Krauss RM, Desta Z, Flockhart DA, Hayes DF. Estrogen receptor genotypes, menopausal status, and the lipid effects of tamoxifen. Clin Pharmacol Ther 2007; 83:702-10. [PMID: 17713466 PMCID: PMC2782693 DOI: 10.1038/sj.clpt.6100343] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Tamoxifen induces important changes in serum lipid profiles in some women; however, little information is available to predict which women will experience improved lipid profiles during tamoxifen therapy. As part of a multicenter prospective observational trial in 176 breast cancer patients, we tested the hypothesis that tamoxifen-induced lipid changes were associated with genetic variants in candidate target genes (CYP2D6, ESR1, and ESR2). Tamoxifen lowered low-density lipoprotein cholesterol (P<0.0001) by 23.5 mg/dl (13.5-33.5 mg/dl) and increased triglycerides (P=0.006). In postmenopausal women, the ESR1-XbaI and ESR2-02 genotypes were associated with tamoxifen-induced changes in total cholesterol (P=0.03; GG vs GA/AA) and triglycerides (P=0.01; gene-dose effect), respectively. In premenopausal women, the ESR1-XbaI genotypes were associated with tamoxifen-induced changes in triglycerides (P=0.002; gene-dose effect) and high-density lipoprotein (P=0.004; gene-dose effect). Our results suggest that estrogen receptor genotyping may be useful in predicting which women would benefit more from tamoxifen.
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Affiliation(s)
- NI Ntukidem
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - AT Nguyen
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - V Stearns
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - M Rehman
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - A Schott
- Department of Internal Medicine and Breast Oncology Program, Comprehensive Cancer Center, University of Michigan Health and Hospitals System, Ann Arbor, Michigan, USA
| | - T Skaar
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Y Jin
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - P Blanche
- Children's Hospital Oak land Research Institute, Oakland, California, USA
| | - L Li
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - S Lemler
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - J Hayden
- Department of Internal Medicine and Breast Oncology Program, Comprehensive Cancer Center, University of Michigan Health and Hospitals System, Ann Arbor, Michigan, USA
| | - RM Krauss
- Children's Hospital Oak land Research Institute, Oakland, California, USA
| | - Z Desta
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - DA Flockhart
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - DF Hayes
- Department of Internal Medicine and Breast Oncology Program, Comprehensive Cancer Center, University of Michigan Health and Hospitals System, Ann Arbor, Michigan, USA
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Hussain A, Malik A, Jalal A, Rehman M. Abnormalities of conduction after total correction of Fallot's tetralogy: a prospective study. J PAK MED ASSOC 2002; 52:77-82. [PMID: 12073716] [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: 02/25/2023]
Abstract
OBJECTIVE To determine the frequency of post-operative conduction abnormalities in Pakistani patients undergoing total correction for Fallot's Tetralogy. PATIENTS AND METHODS One hundred and fifteen patients of Fallot's Tetralogy underwent definitive repair between January, 1999 and April, 2000. Their mean age was 12.89 years (range 3-30 years). One hundred nine patients (94.78%) had severe cyanosis and 6 patients (5.21%) were moderately cyanotic due to mild right ventricular outflow tract (RVOT) obstruction. Thirty percent patients required frequent hospital admissions within 6 months before the time of operation due to -hyper-cyanotic spells. The mean haematocrit was 50.83 (range 28-71). The majority of patients were in NYHA class-III (57%) and 45% had previous palliative shunt procedures done. Surgical access was through the RVOT in 90% cases and trans-atrial in 10%. RVOT patch was used in 55.9%, Pulmonary artery patch in 13.5% and trans-annular patch in 17.1% of cases. RESULTS The mean bypass time was 79.15 min and the mean cross clamp time 51.23 min. Average stay in the intensive care unit was 4.48 days. Twenty-three patients required re-exploration for bleeding. Sixty-nine patients required inotropic support. Fifteen patients had transient heart blocks and two had complete heart block requiring permanent pace-maker. Nineteen patients had various transient arrhythmias which were managed medically. Univariate analysis showed that higher age at operation, low preoperative heart rate, prolonged bypass time, prolonged cross clamp time and presence of patch on pulmonary artery were more common in patients who developed various heart blocks. However, none of these factors had statistical significance or definitive cause-effect relationship with heart blocks. CONCLUSION With careful surgical technique, total correction of Fallot's tetralogy can be conducted in children and young adults, with a very low risk of conduction abnormalities.
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Affiliation(s)
- A Hussain
- Department of Cardiac Surgery, National Institute of Cardiovascular Diseases, Karachi
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Abstract
Solubilities of a model compound (nicotinic acid) in pure supercritical carbon dioxide (SC-CO(2)) and SC-CO(2) modified with methanol have been measured in the pressure range of 80-200 bar and between temperatures of 35 and 90 degrees C. On-line ultraviolet detection enabled a simple and relatively fast measurement of very low levels of solubility (10(-7) mol fraction) with good accuracy in pure and modified SC-CO(2). The solute solubility in both pure SC-CO(2) and SC-CO(2) modified with methanol increased with pressure at all investigated temperatures. A retrograde solubility behavior was observed in that, at pressures below 120 bar, a solubility decrease on temperature increase occurred. Solubility data were used to calculate supersaturation values and to define optimum operating conditions to obtain crystalline particles 1-5 microm in diameter using the solution-enhanced dispersion by supercritical fluids (SEDS) process, thereby demonstrating the feasibility of a one-step production process for particulate pharmaceuticals suitable for respiratory drug delivery.
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Affiliation(s)
- M Rehman
- Drug Delivery Group, School of Pharmacy, University of Bradford, Bradford, BD7 1DP, United Kingdom
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Rehman M, Sherlekar S, Schwartz R, Choudhry D. One lung anaesthesia for video assisted thoracoscopic lung biopsy in a paediatric patient. Paediatr Anaesth 2000; 9:85-7. [PMID: 10712722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- M Rehman
- Department of Anesthesia and Critical Care, St. Christopher's Hospital for Children, Philadelphia, PA, USA
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Bhutto E, Naim M, Ehtesham M, Rehman M, Siddique MA, Jehan I. Prognostic indicators of childhood acute viral encephalitis. J PAK MED ASSOC 1999; 49:311-6. [PMID: 10695286] [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: 02/15/2023]
Abstract
OBJECTIVE To devise a set of clinical signs and laboratory parameters that would help clinicians assess prognosis in patients and plan appropriate management. METHODS Medical records of 147 paediatric cases (with a discharge diagnosis of acute viral encephalitis) admitted over a ten year period from 1987 to 1997 were reviewed and relevant information collected on a data extraction form. RESULTS Of 147 patients, 24 (16.3%) died and 48 (32.7%) were left with severe neurological deficits. A GCS (Glasgow Coma Scale) score between 6-10 had an association with poor outcome (OR = 2.62, Chi-square = 5.57, p-value = 0.018) and that a GCS score of > or = 5 was even more strongly suggestive of poor outcome (OR = 5.49, Chi-square = 12.08, p-value = 0.0005). A history of having seizures, for more than 3 days, also showed a strong association with poor outcome (OR = 3.66, Chi-square = 5.46, p-value = 0.019). CONCLUSION Patients with an increased risk of death and severe disability can be identified using a few guidelines. Of these, a history of seizures of > 3 days and/or impaired consciousness (GCS < or = 10), at the time of presentation to the hospital, constitute high risk. These cases must be identified promptly and aggressive therapy initiated in order to improve long term outcome.
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Affiliation(s)
- E Bhutto
- Department of Community Health Sciences, Aga Khan University, Karachi
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Abstract
PURPOSE Living organ donation is being performed with increasing frequency to overcome the shortage of organs for transplantation. Our experience in the anesthetic management of donors with relevant issues is discussed and complications encountered are recorded. METHODS Data were collected retrospectively and analyzed on all 22 left lateral hepatectomies performed at our institution between 1993 to 1997 for transplantation. RESULTS Major ethical concern was the risk to the donors and anesthetic issues were those of a major abdominal procedure. All except four donors were parents (mother/father). Average blood loss was 805 +/- 479 ml and only two donors required blood transfusion. Mean operative time was 8.2 +/- 1.5 hr. Thoracic epidural analgesia was the most commonly adopted mode of pain relief. Average time to return of bowel sound postoperatively was 3.1 +/- 1.0 days and was not influenced by the postoperative analgesic technique used. Total duration of hospital stay was 8.4 +/- 1.1 days. Three donors developed minor postoperative complications atrial fibrillation and retained JP drain; left lower lobe pneumonia; and incisional hernia. All patients recovered uneventfully. CONCLUSION Living organ donors contribute towards decreasing the shortage of organs for transplantation. Minimizing the discomfort associated with the surgical intervention and providing a complication-free perioperative course will positively influence the continued availability of such donations. On review of the first 22 left lateral hapatectomies performed, we observed only minor complications. Postoperative pain was a serious problem and thoracic epidural provided satisfactory analgesia.
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Affiliation(s)
- D K Choudhry
- Department of Anesthesia and Critical Care, St. Christopher's Hospital for Children, Philadelphia, PA 19134-1095, USA.
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Abstract
Morning Glory syndrome is an uncommon congenital optic disc anomaly with occasional systemic associations. A case of unsuspected difficult intubation in a three-year old patient is described in this case report.
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Affiliation(s)
- Y Shevchenko
- Department of Anaesthesia and Critical Care, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania 19134, USA
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Taurog JD, Maika SD, Satumtira N, Dorris ML, McLean IL, Yanagisawa H, Sayad A, Stagg AJ, Fox GM, Lê O'Brien A, Rehman M, Zhou M, Weiner AL, Splawski JB, Richardson JA, Hammer RE. Inflammatory disease in HLA-B27 transgenic rats. Immunol Rev 1999; 169:209-23. [PMID: 10450519 DOI: 10.1111/j.1600-065x.1999.tb01317.x] [Citation(s) in RCA: 173] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED A spontaneous inflammatory disease in rats transgenic for HLA-B27 resembles the B27-associated human spondyloarthropathies. Colitis and arthritis, the two most important features, require T cells, gut bacteria, and high expression of B27 in bone marrow-derived cells. Control rats with HLA-B7 remain healthy. Most rats with HLA-Cw6 (associated with psoriasis vulgaris) remain healthy; a minority develop mild and transient disease. Rats with a mutant B27 with a Cys67-->Ser substitution resemble wild-type B27 transgenics, but with a lower prevalence of arthritis. A similar phenotype is seen in B27 rats co-expressing a viral peptide that binds B27. Disease-prone LEW but not F344 B27 rats develop high serum IgA levels concurrent with disease progression. Colitis is associated with high interferon-gamma, arthritis with high interleukin-6. Disease is similar in B27 LEW, F344, and PVG rats, but the DA background is protective. CONCLUSIONS The spondyloarthropathy-like disease in rats is specific for HLA-B27 but does not require Cys67. Arthritis but not colitis is particularly sensitive to B27 peptide-binding specificity. Genetic background exerts a strong influence, but some phenotypic differences exist between permissive strains that do not influence disease susceptibility. The data favor a role for B27 peptide presentation in arthritis, but other mechanisms to explain the role of B27 have not been excluded.
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Affiliation(s)
- J D Taurog
- Harold C. Simmons Arthritis Research Center, University of Texas Southwestern Medical Center, Dallas 75235-8884, USA.
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