1
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Dada A, Macki M, Tawil M, Chryssikos T, Tan LA. Surgical Untethering of S1 Nerve Root Herniation Into L4 Perineural Cyst: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024; 26:103. [PMID: 37707423 DOI: 10.1227/ons.0000000000000898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/06/2023] [Indexed: 09/15/2023] Open
Affiliation(s)
- Abraham Dada
- Department of Neurological Surgery, University of California, San Francisco, School of Medicine, San Francisco , California , USA
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2
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Tawil M, Maldonado TS, Xia Y, Berland T, Cayne N, Jacobowitz G, Lugo J, Lamparello P, Sadek M, Rockman C, Berger JS. Response to clopidogrel in patients undergoing lower extremity revascularization. Vascular 2023; 31:1110-1116. [PMID: 35590464 DOI: 10.1177/17085381221103417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Clopidogrel is effective at decreasing cardiovascular events in patients with peripheral artery disease (PAD); however, its effect on limb outcomes are less known. This study investigated the variability in response to clopidogrel and its relationship with clinical limb outcomes. METHODS Three hundred subjects were enrolled in the Platelet Activity and Cardiovascular Events (PACE) study prior to lower extremity revascularization, of whom 104 were on clopidogrel. Light transmission platelet aggregation was measured in response to ADP 2 μ m immediately prior to revascularization. Patients were followed longitudinally for a median follow-up of 18 months. The primary endpoint was major adverse limb events (MALE) defined by major amputation or reoperation of the affected limb. Patients were stratified into groups according to percent ADP-induced aggregation. Poor response to clopidogrel was defined by >50% aggregation. RESULTS Overall, the median age was 70 (63, 76) and 35.6% were female. Twenty-nine (27.9%) patients experienced MALE during their follow-up. Median aggregation to ADP 2 μ m was 22.5% (Q1-Q3: 10%, 50%) and 27 subjects (26%) were clopidogrel poor responders. Baseline aggregation was higher in subjects who went on to develop a MALE than those without MALE (43% vs 20%, p = .017). Subjects with aggregation > median (22.5%) were more likely to experience MALE than aggregation < median (38.5% vs 17.3%, p = .029). After multivariable adjustment for age, sex, race/ethnicity, BMI, diabetes, coronary artery disease, and aspirin use, aggregation > median was associated with MALE (adjusted HR [aHR] 2.67, 95% CI 1.18-6.01, p = .018). When stratified by established cut-offs for responsiveness to clopidogrel (50% aggregation), poor responders were more likely to experience MALE than normal responders (44.4% vs 22.1%, aHR 2.18, 95% CI 1.00-4.78, p = .051). CONCLUSIONS Among patients undergoing lower extremity revascularization on clopidogrel, higher baseline percent aggregation is associated with increased risk for major adverse limb events.
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Affiliation(s)
- Michael Tawil
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Thomas S Maldonado
- Division of Vascular Surgery, Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Yuhe Xia
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Todd Berland
- Division of Vascular Surgery, Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Neal Cayne
- Division of Vascular Surgery, Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Glenn Jacobowitz
- Division of Vascular Surgery, Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Joanelle Lugo
- Division of Vascular Surgery, Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Patrick Lamparello
- Division of Vascular Surgery, Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Mikel Sadek
- Division of Vascular Surgery, Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Caron Rockman
- Division of Vascular Surgery, Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Jeffrey S Berger
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
- Division of Vascular Surgery, Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
- Center for the Prevention of Cardiovascular Disease, New York University Grossman School of Medicine, New York, NY, USA
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3
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Macki M, Ambati VS, Park C, Tawil M, Dada A, Jamieson A, Wilkinson S, Chryssikos T, Mummaneni PV. Surgical resection of lumbar intradural metastatic renal cell carcinoma. Neurosurg Focus Video 2023; 9:V22. [PMID: 37859942 PMCID: PMC10583818 DOI: 10.3171/2023.7.focvid2379] [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] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/14/2023] [Indexed: 10/21/2023]
Abstract
A 60-year-old male with renal cell carcinoma (RCC) presented with back pain, weakness, and bowel and bladder urgency. MRI demonstrated a cauda equina tumor at L2. Following L1-3 laminectomies, intraoperative ultrasound localized the tumor. After dural opening, a vascular tumor was adherent to the cauda equina. Intraoperative nerve stimulation helped to identify the nerve rootlets. Tumor was removed in a piecemeal fashion. Tumor dissection caused periodic spasms in L1-3 distributions. A neuromonitoring checklist was used to recover motor evoked potential signals with elevated mean arterial pressures. Hemostasis was challenging with the vascular tumor. Intraoperative ultrasound confirmed tumor debulking. Pathology confirmed metastatic RCC.
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Affiliation(s)
- Mohamed Macki
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Vardhaan S Ambati
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Christine Park
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Michael Tawil
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Abraham Dada
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Alysha Jamieson
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Sean Wilkinson
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Timothy Chryssikos
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, California
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4
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Tawil M, Sorour O, Morshed R, Huang J, Agarwal N, Shabani S, Theodosopoulos P, Mummaneni P. Use of Intraoperative Ultrasound to Achieve Gross Total Resection of a Large Cervicomedullary Ependymoma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 24:e298. [PMID: 36715969 DOI: 10.1227/ons.0000000000000571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/06/2022] [Indexed: 01/31/2023] Open
Affiliation(s)
- Michael Tawil
- Department of Neurological Surgery, University of California, San Francisco, School of Medicine, San Francisco, California USA
| | - Omar Sorour
- UMass Chan School of Medicine, University of Massachusetts, Worcester, Massachusetts, USA
| | - Ramin Morshed
- Department of Neurological Surgery, University of California, San Francisco, School of Medicine, San Francisco, California USA
| | - Jeremy Huang
- Department of Neurological Surgery, University of California, San Francisco, School of Medicine, San Francisco, California USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of California, San Francisco, School of Medicine, San Francisco, California USA
| | - Saman Shabani
- Department of Neurological Surgery, University of California, San Francisco, School of Medicine, San Francisco, California USA
| | - Philip Theodosopoulos
- Department of Neurological Surgery, University of California, San Francisco, School of Medicine, San Francisco, California USA
| | - Praveen Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, School of Medicine, San Francisco, California USA
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5
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Fogh S, Hernandez Y, Ambati V, Collis S, Tawil M, Zhang L, Greenstein A, Frederic R, Destri M, Hoffer N, Mishra K, Marshall N, Chang SM, Taylor J. QOL-17. UNDERSTANDING MULTIDISCIPLINARY PROVIDER PERSPECTIVES AND PREFERENCES FOR INCORPORATING EXERCISE INTO PRIMARY BRAIN TUMOR MANAGEMENT. Neuro Oncol 2022. [PMCID: PMC9660893 DOI: 10.1093/neuonc/noac209.944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
Exercise has proven benefit in patients with cancer with most studies focused on patients with high functional and neurocognitive status. Patients with brain tumors, however, frequently have deficits in cognition, motor, balance, or other symptoms that are further exacerbated by surgery and adjuvant treatment. We sought to determine providers’ knowledge, attitudes, motivating factors and preferences for integrating exercise into the treatment of patients with brain tumors.
METHODS
We surveyed multidisciplinary providers in Neurosurgery, Radiation Oncology and Neuro-Oncology from a single, quaternary medical center. Questions assessed demographics, current practices, attitudes, knowledge, motivating factors and barriers for integrating exercise into treatment. Questions were extrapolated from existing published questionnaires and sent electronically.
RESULTS
Most providers (92%) reported that exercise was important for patients' lifestyle and 80% felt it should be integrated into the treatment of patients with primary brain tumors. Nighty-six percent felt that exercise improved quality of life, decreased fatigue (100%) and reduced treatment related side effects (92%) yet only 57% of providers initiated a conversation about exercise with patients. Top motivating factors for promoting exercise were perceived benefit to patients’ quality of life and disease outcomes. Barriers to provider/patient discussions about exercise included, lack of time or appropriate expertise to discuss exercise with patients, and concern that patients have competing priorities. Some providers (23%) were concerned about potential limitations/complications with patients exercising including inability to participate from side effects of treatment (38%), physical deficits (61%) and fatigue (42%).
CONCLUSION
Understanding barriers for providers to incorporate exercise into their patients’ treatment regimens is critical to strategizing best practices. Findings from this study help to expand our understanding of barriers and facilitators to incorporating exercise interventions into brain cancer treatment and will assist with the implementation of a structured exercise program to enhance physical health for our patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Susan M Chang
- University of California, San Francisco , San Francisco, CA , USA
| | - Jennie Taylor
- University of California San Francisco , San Francisco , USA
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6
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Garshick MS, Block R, Drenkova K, Tawil M, James G, Brenna JT. Statin therapy upregulates arachidonic acid status via enhanced endogenous synthesis in patients with plaque psoriasis. Prostaglandins Leukot Essent Fatty Acids 2022; 180:102428. [PMID: 35490599 PMCID: PMC9870621 DOI: 10.1016/j.plefa.2022.102428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/27/2021] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 01/26/2023]
Abstract
Circulating fatty acids (FA) may be important in the psoriatic pro-inflammatory phenotype. FADS1 converts linoleic acid (LA) to arachidonic acid (AA), a precursor to potent signaling molecules. HMG-CoA reductase inhibitors (statins) increase FADS1/2 expression in vitro. Psoriasis patients (42 ± 14 years/age, 47% male) were randomized to 40 mg of atorvastatin (n = 20) or nothing (n = 10) for two weeks and plasma FA measured pre and post treatment. After treatment, LDL-C was 44% lower in the statin compared to the no-treatment group. Statins increased FADS1/2 expression, and lowered LA 12% (33% - > 29%, p<0.001) and raised AA 14% (7.7% - > 9.0%, p<0.01) with no change in the no-treatment group. In psoriasis, statins enhance AA and decrease LA, consistent with the action of enhanced FADS expression in vivo. Therapies intended to blunt the effects of AA on platelet aggregation, such as aspirin or omega-3 fatty acids, may require dose adjustment when co-administered with atorvastatin. NCT: NCT03228017.
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Affiliation(s)
- Michael S Garshick
- Center for the Prevention of Cardiovascular Disease, Department of Medicine, NYU Langone Health, United States; Leon H. Charney Division of Cardiology, Department of Medicine, NYU Langone Health, United States; Cardiovascular Research Center, NYU Langone Health, United States.
| | - Robert Block
- Department of Public Health Sciences and Cardiology Division, Department of Medicine, University of Rochester, United States
| | - Kamelia Drenkova
- Cardiovascular Research Center, NYU Langone Health, United States
| | - Michael Tawil
- Cardiovascular Research Center, NYU Langone Health, United States
| | - Genevieve James
- Dell Pediatric Research Institute and Dept of Nutrition, University of Texas at Austin, United States
| | - J Thomas Brenna
- Dell Pediatric Research Institute and Dept of Nutrition, University of Texas at Austin, United States
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7
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Tawil M, DiGiorgio AM. Competition in California’s Medi-Cal Managed Care Market Assessed by Herfindahl-Hirschman Index. INQUIRY 2022; 59:469580221127063. [PMID: 36168304 PMCID: PMC9520176 DOI: 10.1177/00469580221127063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Evaluating market competition is an important practice to assess how the forces and components at play in a select market interact. Healthcare markets are similar to any other market present in the world, where competition can be present or absent in the exchange of goods and services. Applying a standard measure of assessing market competition, the Herfindahl-Hirschman Index, to California’s Medi-Cal managed care marketplace, it is found that there is no competition present in all of California’s counties as defined by the common interpretation of the Herfindahl-Hirschman Index. A distinctive trend in markets is that when less competition is present, the cost of goods and services increases to reflect the principles of supply and demand. California Medi-Cal markets follow this trend of less competitive markets being associated with increased adult midpoint costs. These findings help further to elucidate California’s Medi-Cal marketplace on a county-by county level.
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Affiliation(s)
- Michael Tawil
- School of Medicine, University of California, San Francisco, CA, USA
| | - Anthony M. DiGiorgio
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
- Institute for Health Policy Studies, University of California, San Francisco, CA, USA
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8
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Barrett TJ, Cornwell M, Myndzar K, Rolling CC, Xia Y, Drenkova K, Biebuyck A, Fields AT, Tawil M, Luttrell-Williams E, Yuriditsky E, Smith G, Cotzia P, Neal MD, Kornblith LZ, Pittaluga S, Rapkiewicz AV, Burgess HM, Mohr I, Stapleford KA, Voora D, Ruggles K, Hochman J, Berger JS. Platelets amplify endotheliopathy in COVID-19. Sci Adv 2021; 7:eabh2434. [PMID: 34516880 PMCID: PMC8442885 DOI: 10.1126/sciadv.abh2434] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/19/2021] [Indexed: 05/08/2023]
Abstract
Given the evidence for a hyperactive platelet phenotype in COVID-19, we investigated effector cell properties of COVID-19 platelets on endothelial cells (ECs). Integration of EC and platelet RNA sequencing revealed that platelet-released factors in COVID-19 promote an inflammatory hypercoagulable endotheliopathy. We identified S100A8 and S100A9 as transcripts enriched in COVID-19 platelets and were induced by megakaryocyte infection with SARS-CoV-2. Consistent with increased gene expression, the heterodimer protein product of S100A8/A9, myeloid-related protein (MRP) 8/14, was released to a greater extent by platelets from COVID-19 patients relative to controls. We demonstrate that platelet-derived MRP8/14 activates ECs, promotes an inflammatory hypercoagulable phenotype, and is a significant contributor to poor clinical outcomes in COVID-19 patients. Last, we present evidence that targeting platelet P2Y12 represents a promising candidate to reduce proinflammatory platelet-endothelial interactions. Together, these findings demonstrate a previously unappreciated role for platelets and their activation-induced endotheliopathy in COVID-19.
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Affiliation(s)
- Tessa J. Barrett
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - MacIntosh Cornwell
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
- Institute for Systems Genetics, New York University Grossman School of Medicine, New York, NY, USA
| | - Khrystyna Myndzar
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Christina C. Rolling
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Yuhe Xia
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Kamelia Drenkova
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Antoine Biebuyck
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Alexander T. Fields
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Michael Tawil
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Eugene Yuriditsky
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Grace Smith
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Paolo Cotzia
- Department of Pathology, New York University Grossman School of Medicine, New York, NY, USA
- Center for Biospecimen Research, New York University Grossman School of Medicine, New York, NY, USA
| | - Matthew D. Neal
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lucy Z. Kornblith
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Stefania Pittaluga
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Amy V. Rapkiewicz
- Department of Pathology, NYU Langone Long Island Hospital, New York University Langone Health, Mineola, NY, USA
| | - Hannah M. Burgess
- Department of Microbiology, New York University Langone Health, New York, NY, USA
| | - Ian Mohr
- Department of Microbiology, New York University Langone Health, New York, NY, USA
| | | | - Deepak Voora
- Department of Medicine, Duke Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Kelly Ruggles
- Institute for Systems Genetics, New York University Grossman School of Medicine, New York, NY, USA
| | - Judith Hochman
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Jeffrey S. Berger
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
- Department of Surgery, New York University Langone Health, New York, NY, USA
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9
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Barrett TJ, Cornwell M, Myndzar K, Rolling C, Xia Y, Drenkova K, Biebuyck A, Fields A, Tawil M, Luttrell-Williams E, Yuriditsky E, Smith G, Cotzia P, Neal MD, Kornblith L, Pittaluga S, Rapkiewicz A, Burgess H, Mohr I, Stapleford K, Voora D, Ruggles K, Hochman J, Berger JS. Abstract 109: Platelets Amplify Endotheliopathy In Covid-19. Arterioscler Thromb Vasc Biol 2021. [DOI: 10.1161/atvb.41.suppl_1.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In addition to their pivotal role in thrombosis and hemostasis, platelets participate in inflammatory responses and endothelial cell activation - hallmarks in the pathogenesis of coronavirus disease 2019 (COVID-19). Given the evidence for a hyperactive platelet phenotype in COVID-19, we investigated effector cell properties of COVID-19 platelets on endothelial cells (ECs). To explore this interaction, ECs were treated with platelet releasate from patients with and without COVID-19, and EC mRNA sequencing performed. We demonstrate that platelet released factors in COVID-19 promote an inflammatory hypercoagulable endotheliopathy. Investigation of the COVID-19 platelet transcriptome identified pathways related to organelle/granule release, metabolism, and immune effector function in addition to upregulation of
S100A8
and
S100A9
mRNA. Incubation of primary megakaryocytes with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) also induced upregulation of
S100A8
and
S100A9
mRNA. Consistent with increased gene expression, the heterodimer protein product of
S100A8
/
A9
, myeloid-related protein (MRP)8/14, was released to a greater extent by platelets from COVID-19 patients relative to controls. We demonstrate that platelet-derived MRP8/14 activates microvascular endothelial cells, promotes an inflammatory hypercoagulable phenotype, and is a significant contributor to thromboinflammation and poor clinical outcomes in COVID-19 patients. Finally, we present evidence that therapeutic targeting of platelet P2Y
12
represents a promising candidate to reduce proinflammatory and prothrombotic platelet-endothelial interactions. Altogether, these findings demonstrate a previously unappreciated role for platelets and their activation-induced endotheliopathy in COVID-19.
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Affiliation(s)
| | | | | | | | - Yuhe Xia
- NYU Langone Health, New York, NY
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10
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Garshick M, Tawil M, LoSicco K, Brenna J, Block R, Berger J, James G. Statin therapy upregulated arachidonic acid status via enhanced endogenous synthesis in patients with plaque psoriasis. J Clin Lipidol 2021. [DOI: 10.1016/j.jacl.2021.08.021] [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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11
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Garshick MS, Nikain C, Tawil M, Pena S, Barrett TJ, Wu BG, Gao Z, Blaser MJ, Fisher EA. Reshaping of the gastrointestinal microbiome alters atherosclerotic plaque inflammation resolution in mice. Sci Rep 2021; 11:8966. [PMID: 33903700 PMCID: PMC8076321 DOI: 10.1038/s41598-021-88479-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/13/2021] [Indexed: 02/08/2023] Open
Abstract
Since alterations in the intestinal microbiota may induce systemic inflammation and polarization of macrophages to the M1 state, the microbiome role in atherosclerosis, an M1-driven disease, requires evaluation. We aimed to determine if antibiotic (Abx) induced alterations to the intestinal microbiota interferes with atherosclerotic plaque inflammation resolution after lipid-lowering in mice. Hyperlipidemic Apoe−/− mice were fed a western diet to develop aortic atherosclerosis with aortas then transplanted into normolipidemic wild-type (WT) mice to model clinically aggressive lipid management and promote atherosclerosis inflammation resolution. Gut microbial composition pre and post-transplant was altered via an enteral antibiotic or not. Post aortic transplant, after Abx treatment, while plaque size did not differ, compared to Apoe−/− mice, Abx– WT recipient mice had a 32% reduction in CD68-expressing cells (p = 0.02) vs. a non-significant 12% reduction in Abx+ WT mice. A trend toward an M1 plaque CD68-expresing cell phenotype was noted in Abx+ mice. By 16S rRNA sequence analysis, the Abx+ mice had reduced alpha diversity and increased Firmicutes/Bacteroidetes relative abundance ratio with a correlation between gut Firmicutes abundance and plaque CD68-expressing cell content (p < 0.05). These results indicate that in a murine atherosclerotic plaque inflammation resolution model, antibiotic-induced microbiome perturbation may blunt the effectiveness of lipid-lowering to reduce the content of plaque inflammatory CD68-expressing cells.
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Affiliation(s)
- Michael S Garshick
- Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University School of Medicine, New York, USA.,Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, USA
| | - Cyrus Nikain
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, USA
| | - Michael Tawil
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, USA
| | - Stephanie Pena
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, USA
| | - Tessa J Barrett
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, USA
| | - Benjamin G Wu
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York, USA.,Division of Pulmonary and Critical Care, Veterans Affairs New York Harbor Healthcare System, New York, NY, USA
| | - Zhan Gao
- Center for Advanced Biotechnology and Medicine, Rutgers University, 679 Hoes Lane West, Piscataway, NJ, 08854, USA
| | - Martin J Blaser
- Center for Advanced Biotechnology and Medicine, Rutgers University, 679 Hoes Lane West, Piscataway, NJ, 08854, USA.
| | - Edward A Fisher
- Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University School of Medicine, New York, USA. .,Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, USA. .,Marc and Ruti Bell Vascular Biology Program, Cardiovascular Research Center, New York University Langone Health, New York, USA.
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12
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Elnabawi YA, Garshick MS, Tawil M, Barrett TJ, Fisher EA, Lo Sicco K, Neimann AL, Scher JU, Krueger J, Berger JS. CCL20 in psoriasis: A potential biomarker of disease severity, inflammation, and impaired vascular health. J Am Acad Dermatol 2020; 84:913-920. [PMID: 33259876 DOI: 10.1016/j.jaad.2020.10.094] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/29/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Psoriasis is associated with increased cardiovascular risk that is not captured by traditional proinflammatory biomarkers. OBJECTIVE To investigate the relationship between Psoriasis Area and Severity Index, circulating proinflammatory biomarkers, and vascular health in psoriasis. METHODS In patients with psoriasis and in age and sex-matched controls, 273 proteins were analyzed with the Proseek Multiplex Cardiovascular disease reagents kit and Inflammatory reagents kit (Olink Bioscience), whereas vascular endothelial inflammation and health were measured via direct transcriptomic analysis of brachial vein endothelial cells. RESULTS In psoriasis, chemokine ligand 20 (CCL20), interleukin (IL) 6, and IL-17A were the top 3 circulating proinflammatory cytokines. Vascular endothelial inflammation correlated with CCL20 (r = 0.55; P < .001) and less so with IL-6 (r = 0.36; P = .04) and IL-17A (r = 0.29; P = .12). After adjustment for potential confounders, the association between CCL20 and vascular endothelial inflammation remained significant (β = 1.71; P = .02). In nested models, CCL20 added value (χ2 = 79.22; P < .001) to a model already incorporating the Psoriasis Area and Severity Index, Framingham risk, high-sensitivity C-reactive protein, Il-17A, and IL-6 (χ2 = 48.18; P < .001) in predicting vascular endothelial inflammation. LIMITATIONS Our study was observational and did not allow for causal inference in the relationship between CCL20 and cardiovascular risk. CONCLUSION We demonstrate that CCL20 expression has a strong association with vascular endothelial inflammation, reflects systemic inflammation, and may serve as a potential biomarker of impaired vascular health in psoriasis.
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Affiliation(s)
- Youssef A Elnabawi
- Department of Internal Medicine, New York University School of Medicine, New York, New York
| | - Michael S Garshick
- Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, New York, New York; Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York.
| | - Michael Tawil
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York
| | - Tessa J Barrett
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York
| | - Edward A Fisher
- Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, New York, New York; Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York
| | - Kristen Lo Sicco
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Andrea L Neimann
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Jose U Scher
- Psoriatic Arthritis Center, Division of Rheumatology, New York University School of Medicine, New York, New York
| | - James Krueger
- Laboratory for Investigative Dermatology, Rockefeller University, New York, New York
| | - Jeffrey S Berger
- Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, New York, New York; Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York; Division of Hematology, New York University School of Medicine, New York, New York; Division of Vascular Surgery, Department of Surgery, New York University School of Medicine, New York, New York
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Tawil M, Berger J, Lamparello P, Jacobowitz G, Cayne N, Sadek M, Berland T, Lugo J, Rockman C, Maldonado T. Increased Risk of Major Limb Events in Poor Clopidogrel Responders: Platelet Activity in Vascular Surgery and Cardiovascular Events (PACE) Study Subgroup Analysis. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.08.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Garshick MS, Baumer Y, Dey AK, Grattan R, Ng Q, Teague HL, Yu ZX, Chen MY, Tawil M, Barrett TJ, Underberg J, Fisher EA, Krueger J, Powell-Wiley TM, Playford MP, Berger JS, Mehta NN. Characterization of PCSK9 in the Blood and Skin of Psoriasis. J Invest Dermatol 2020; 141:308-315. [PMID: 32615123 DOI: 10.1016/j.jid.2020.05.115] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/11/2020] [Accepted: 05/18/2020] [Indexed: 12/30/2022]
Abstract
Mechanisms explaining the link between psoriasis, a proinflammatory condition, and cardiovascular disease are not fully known. PCSK9 is predominantly expressed in hepatocytes as a critical regulator of lipid metabolism, and clinical trials targeting PCSK9 reduce cardiovascular disease. Independent of its role in lipid metabolism, PCSK9 levels associate with endothelial dysfunction and predict cardiovascular events. We used two separate human psoriasis cohorts and the K14-Rac1V12-/+ murine model of psoriasis to investigate PCSK9 and cardiovascular risk in psoriasis. In both psoriasis cohorts (n = 88 and n = 20), PCSK9 levels were 20% and 13% higher than in age-, sex-, and cholesterol-matched controls, respectively (P < 0.05 for each comparison) and correlated with PASI (r = 0.43, P < 0.05). Despite no difference in hepatocyte expression, K14-Rac1V12-/+ mice demonstrated skin-specific PCSK9 staining, which was confirmed in human psoriatic lesional skin. In patients with psoriasis, PCSK9 levels correlated with impaired endothelial vascular health (e.g., early atherosclerosis, β = 4.5, P < 0.01) and log converted coronary artery calcium score (β = 0.30, P = 0.01), which remained significant after adjustment for Framingham risk, body mass index, and active biologic use. Taken together, these findings suggest, independent of cholesterol, an association between circulating PCSK9 and early as well as advanced stages of atherosclerosis in psoriasis.
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Affiliation(s)
- Michael S Garshick
- Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University School of Medicine, New York, New York, USA; Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Yvonne Baumer
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Amit K Dey
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ryan Grattan
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Qimin Ng
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Heather L Teague
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Zu-Xi Yu
- Pathology Core Facility, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Marcus Y Chen
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael Tawil
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Tessa J Barrett
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - James Underberg
- Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Edward A Fisher
- Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University School of Medicine, New York, New York, USA; Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - James Krueger
- Laboratory for Investigative Dermatology, Rockefeller University, New York, New York, USA
| | - Tiffany M Powell-Wiley
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Martin P Playford
- Pathology Core Facility, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jeffrey S Berger
- Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University School of Medicine, New York, New York, USA; Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, USA; Division of Hematology, Department of Medicine, New York University School of Medicine, New York, New York, USA; Division of Vascular Surgery, Department of Surgery, New York University School of Medicine, New York, New York, USA
| | - Nehal N Mehta
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
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15
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Garshick MS, Tawil M, Barrett TJ, Salud-Gnilo CM, Eppler M, Lee A, Scher JU, Neimann AL, Jelic S, Mehta NN, Fisher EA, Krueger JG, Berger JS. Activated Platelets Induce Endothelial Cell Inflammatory Response in Psoriasis via COX-1. Arterioscler Thromb Vasc Biol 2020; 40:1340-1351. [PMID: 32131611 PMCID: PMC7180109 DOI: 10.1161/atvbaha.119.314008] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Patients with psoriasis have impaired vascular health and increased cardiovascular disease (CVD). Platelets are key players in the pathogenesis of vascular dysfunction in cardiovascular disease and represent therapeutic targets in cardiovascular prevention. The object of this study was to define the platelet phenotype and effector cell properties on vascular health in psoriasis and evaluate whether aspirin modulates the platelet-induced phenotype. Approach and Results: Platelets from psoriasis patients (n=45) exhibited increased platelet activation (relative to age- and gender-matched controls, n=18), which correlated with psoriasis skin severity. Isolated platelets from psoriasis patients demonstrated a 2- to 3-fold (P<0.01) increased adhesion to human aortic endothelial cells and induced proinflammatory transcriptional changes, including upregulation of IL 8 (interleukin 8), IL1β, and Cox (cyclooxygenase)-2 Platelet RNA sequencing revealed an interferon signature and elevated expression of COX-1, which correlated with psoriasis disease severity (r=0.83, P=0.01). In a randomized trial of patients with psoriasis, 2 weeks of 81 mg low-dose aspirin, a COX-1 inhibitor, reduced serum thromboxane (Tx) B2 and reduced brachial vein endothelial proinflammatory transcript expression >70% compared with the no-treatment group (P<0.01). Improvement in brachial vein endothelial cell inflammation significantly correlated with change in serum TxB2 (r=0.48, P=0.02). CONCLUSIONS In patients with psoriasis, platelets are activated and induce endothelial cell inflammation. Low-dose aspirin improved endothelial cell health in psoriasis via platelet COX-1 inhibition. These data demonstrate a previously unappreciated role of platelets in psoriasis and endothelial cell inflammation and suggests that aspirin may be effective in improving vascular health in patients with psoriasis. Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT03228017.
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Affiliation(s)
- Michael S. Garshick
- Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University School of Medicine
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine
| | - Michael Tawil
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine
| | - Tessa J. Barrett
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine
| | | | - Michael Eppler
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine
| | - Angela Lee
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine
| | - Jose U. Scher
- Psoriatic Arthritis Center, Division of Rheumatology, Department of Medicine, New York University School of Medicine
| | - Andrea L. Neimann
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine
| | - Sanja Jelic
- Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, Columbia University Medical Center
| | - Nehal N. Mehta
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung and Blood Institute, National Institutes of Health
| | - Edward A. Fisher
- Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University School of Medicine
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine
| | - James G. Krueger
- Psoriatic Arthritis Center, Division of Rheumatology, Department of Medicine, New York University School of Medicine
| | - Jeffrey S. Berger
- Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University School of Medicine
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine
- Division of Hematology, Department of Medicine, New York University School of Medicine
- Division of Vascular Surgery, Department of Surgery, New York University School of Medicine
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Garshick MS, Grattan R, Barrett T, Tawil M, Fisher E, Krueger J, Berger J. BIOMARKER CORRELATES OF IMPAIRED VASCULAR HEALTH IN PATIENTS WITH PSORIASIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32876-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Garshick MS, Tawil M, Barrett T, Salud C, Eppler M, Lee A, Scher J, Neimann A, Jelic S, Mehta N, Fisher E, Krueger J, Berger J. ACTIVATED PLATELETS INDUCE ENDOTHELIAL CELL INFLAMMATORY RESPONSE IN PSORIASIS WHICH IS INHIBITED BY LOW-DOSE ASPIRIN. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32845-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Garshick MS, Nikain C, Tawil M, Wu B, Gao Z, Blaser M, Fisher E. THE CONTRIBUTION OF GASTROINTESTINAL MICROBIOME ALTERATIONS TO ATHEROSCLEROTIC PLAQUE REGRESSION. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32655-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Angarita F, Acuna S, Torregrosa L, Tawil M, Escallon J, Ruíz Á. Perioperative variables associated with surgical site infection in breast cancer surgery. J Hosp Infect 2011; 79:328-32. [DOI: 10.1016/j.jhin.2011.08.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 08/02/2011] [Indexed: 11/28/2022]
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20
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Somalanka S, Tawil M, Baikunje S. Oesophageal anomaly in a newborn after maternal exposure to mycofenolate mofetil. Case Reports 2009; 2009:bcr04.2009.1791. [DOI: 10.1136/bcr.04.2009.1791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Abstract
To determine the factors that allow early recognition of injuries to the intrathoracic and intra-abdominal organs in patients with penetrating wounds to the lower thorax and abdomen with site of entrance located in the back or flanks, we retrospectively analyzed the cases of 77 such patients. There were 65 stab wounds (85%) and 12 gunshot wounds (15%). The injuries were confined to the abdomen in 46 (60%); 39 were stab wounds and seven were gunshot wounds. The wounds were confined to the chest in 24 patients (31%) and involved both the chest and abdomen in seven cases (9%). Of the 53 abdominal wounds, 21 necessitated celiotomy; in 20 of them, an intra-abdominal organ was found injured, and one patient died (1.9%). Of the 24 injuries confined to the chest, only one patient required emergency thoracotomy due to massive hemorrhage; all 24 patients survived. All of the seven thoracoabdominal injuries, two produced by gunshot and five by stabbing, necessitated celiotomy. Most patients with gunshot wounds to the back and flanks require celiotomy, but a selective therapy can be safely used in patients with stab wounds. The rate of negative exploratory celiotomy was less than 5%; the mortality was 1.3%.
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23
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Zurayk H, Tawil M, Gangarosa E. Effect of urban versus rural residence and of maternal education on infant health in South Lebanon. J Epidemiol Community Health 1982; 36:192-6. [PMID: 7142884 PMCID: PMC1052209 DOI: 10.1136/jech.36.3.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A sample of 253 women from rural and urban areas of south Lebanon were visited for 18 months after delivery. Information was collected on patterns of reproduction, infant feeding, and use of the health services. The findings indicate that educated women and women living in urban areas were better off in terms of family formation patterns, immunisation, and well-baby care. The importance of educating women, particularly in rural areas, as a policy that can be varied to improve child health and growth is thus emphasised. The study also indicates, however, the special need for health education programmes directed to all mothers to emphasise proper breast-feeding patterns and the importance of preventive health care for infants. The findings also indicate the need for a more diversified system of delivering health care in which properly trained paramedical personnel take part, particularly in rural areas.
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