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Wong W, Dickerson JC, Valtis YK, Habet M, Bernard M, Kelly L, Lattin J, Garrity P, Sood R, Ohanian A, Chege MW, Bhatt AS, Huang FW, Yacab R. Cancer Demographics and Time-to-Care in Belize. Oncologist 2023:7079006. [PMID: 36928719 DOI: 10.1093/oncolo/oyad030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/12/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Belize is a middle-income Caribbean country with poorly described cancer epidemiology and no comprehensive cancer care capacity. In 2018, GO, Inc., a US-based NGO, partnered with the Ministry of Health and the national hospital in Belize City to create the first public oncology clinic in the country. Here, we report demographics from the clinic and describe time intervals to care milestones to allow for public health targeting of gaps. PATIENTS AND METHODS Using paper charts and a mobile health platform, we performed a retrospective chart review at the Karl Heusner Memorial Hospital (KHMH) clinic from 2018 to 2022. RESULTS During this time period, 465 patients with cancer presented to the clinic. Breast cancer (28%) and cervical cancer (12%) were most common. Most patients (68%) presented with stage 3 or 4 disease and were uninsured (78%) and unemployed (79%). Only 21% of patients ever started curative intent treatment. Median time from patient-reported symptoms to a biopsy or treatment was 130 and 189 days. For the most common cancer, breast, similar times were seen at 140 and 178 days. Time intervals at the clinic: <30 days from initial visit to biopsy (if not previously performed) and <30 days to starting chemotherapy. CONCLUSION This study reports the first clinic-based cancer statistics for Belize. Many patients have months between symptom onset and treatment. In this setting, the clinic has built infrastructure allowing for minimal delays in care despite an underserved population. This further affirms the need for infrastructure investment and early detection programs to improve outcomes in Belize.
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Affiliation(s)
- Wayne Wong
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - James C Dickerson
- Department of Medicine (Hematology and Oncology), Stanford University, Stanford, CA, USA
| | - Yannis K Valtis
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Marta Habet
- Medical Oncology, Karl Heusner Memorial Hospital, Belize City, Belize
| | - Margaret Bernard
- Nursing Department, Karl Heusner Memorial Hospital, Belize City, Belize
| | - Lorna Kelly
- Nursing Department, Karl Heusner Memorial Hospital, Belize City, Belize
| | - John Lattin
- Department of Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | | | - Rupali Sood
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Alec Ohanian
- Department of Medicine, UCSF School of Medicine, San Francisco, CA, USA
| | - Maryanne W Chege
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Ami S Bhatt
- Global Oncology, Inc., Oakland, CA, USA.,Department of Medicine (Hematology, Blood and Marrow Transplantation) and of Genetics, Director of Global Oncology for the Stanford Center for Innovation in Global Health, Stanford University, Stanford, CA, USA
| | - Franklin W Huang
- Global Oncology, Inc., Oakland, CA, USA.,Division of Hematology and Oncology, Department of Medicine, San Francisco Veterans Affairs Medical Center, University of California San Francisco, San Francisco, CA, USA.,Department of Urology, University of California San Francisco, San Francisco, CA, USA.,Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Ramon Yacab
- Medical Oncology, Karl Heusner Memorial Hospital, Belize City, Belize
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Sood R, Ryan L, Niemierko A, Spring LM, Juric D, Isakoff SJ, Wander SA, Shin J, Ko N, Ellisen L, Moy B, Bardia A, Vidula N. Abstract PD1-10: Impact of Race on Clinical, Socioeconomic, and Genomic Characteristics, Clinical Trial Participation, and Receipt of Genotype-matched Therapy Among Patients with Metastatic Breast Cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-pd1-10] [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: 03/06/2023]
Abstract
Abstract
Background: Clinical outcomes in breast cancer differ across racial and ethnic populations. We have previously demonstrated that receipt of genotype-matched therapy targeted to an actionable mutation may potentially improve patient outcomes (Vidula, CCR, 2021). We evaluated the impact of race on clinical, socioeconomic, and genomic characteristics, clinical trial participation, and receipt of genotype-matched therapy among patients with metastatic breast cancer (MBC). Methods: We conducted a retrospective study of patients with MBC at an academic institution who underwent cell-free DNA testing (cfDNA, Guardant360, 74 gene panel) as part of routine clinical care from 11/29/2016-11/2/2020. Patient demographics (including self-reported race and ethnicity) and clinical trial enrollment (at same institution) were determined by retrospective data collection. Mutations identified in cfDNA were characterized as actionable based on the variant interpretation performed by Guardant360 using vetted genomic databases, and receipt of genotype-matched therapy targeted to an actionable mutation was determined as previously described (Vidula, CCR, 2021). Pearson’s chi-squared and Wilcoxon rank-sum tests were used to compare categorical and continuous variables between groups, with p< 0.05 indicating statistical significance. Results: Four hundred and twenty-five patients with MBC and cfDNA results were identified, of which 369 were White (87%), 27 Black (6.4%), 15 Hispanic (3.5%), and 14 Asian (3.3%). There were no significant differences in median age at MBC diagnosis (p=0.064), disease subtype distribution (p=0.74), proportions of de-novo/recurrent MBC (p=0.95), presence of visceral metastases (p=0.84), Charleston comorbidity index (p=0.93), menopausal status (p=0.3), and level of education (p=0.44) across racial groups. Higher proportions of non-primary English speakers were seen in Hispanic (80%) and Asian (29%) races (p< 0.001). Median distance traveled to the institution also varied based on race, with White patients traveling further (White: 39.1 miles, Black: 21.8 miles, Hispanic 9.4 miles, Asian 9.1 miles, p< 0.001). In addition, type of insurance varied based on race, with White patients having the highest rates of commercial insurance and Medicare, Black patients having the highest rate of state-supported insurance, and Asian patients having the highest uninsured rates (p< 0.001). Clinical trial enrollment rates did not significantly differ by race (White: 44%, Black: 37%, Hispanic: 47%, and Asian 21%, p=0.34), but patients without insurance were significantly less likely to be enrolled on a trial than those with commercial insurance (p=0.03). The proportion of patients with ≥1 actionable mutation in cfDNA did not vary significantly by race (White: 78%, Black: 56%, Hispanic: 73%, Asian 86%, p=0.18) and the median number of actionable mutations found in cfDNA was similar across races (p=0.31). However, receipt of genotype-matched therapy targeted to an actionable mutation varied by race, with the highest rates of matched therapy in White patients (White: 28%, Black: 11%, Hispanic 13%, Asian 14%, p< 0.001). After multivariable logistic regression adjusting for subtype, commercial insurance versus other insurance types, and proximity to the center, White patients remained significantly more likely to receive matched therapy (p=0.029). Conclusions: We observed significant race-based differences in non-English speaking status, insurance type, and median distance traveled to the institution. Racial/ethnic minority patients were less likely to receive genotype-matched therapy than White patients. Further research is needed to identify barriers and reduce disparities in access to precision medicine.
Citation Format: Rupali Sood, Lianne Ryan, Andrzej Niemierko, Laura M. Spring, Dejan Juric, Steven J. Isakoff, Seth A. Wander, Jennifer Shin, Naomi Ko, Leif Ellisen, Beverly Moy, Aditya Bardia, Neelima Vidula. Impact of Race on Clinical, Socioeconomic, and Genomic Characteristics, Clinical Trial Participation, and Receipt of Genotype-matched Therapy Among Patients with Metastatic Breast Cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD1-10.
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Affiliation(s)
- Rupali Sood
- 1Massachusetts General Hospital, Massachusetts
| | - Lianne Ryan
- 2Cancer Center, Massachusetts General Hospital
| | | | - Laura M. Spring
- 4Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Dejan Juric
- 5Massachusetts General Hospital Cancer Center, Department of Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Seth A. Wander
- 7Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | | | - Leif Ellisen
- 10Massachusetts General Hospital, Boston, Massachusetts
| | | | - Aditya Bardia
- 12Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Neelima Vidula
- 13Harvard Medical School, Massachusetts General, Boston, Massachusetts
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Guleria K, Sood R, Goel H, Sharma U, Singla A. 138MO A randomized study to compare outcomes of intravesical chemohyperthermia with mitomycin C vs intravesical BCG for intermediate and high risk non-muscle invasive bladder cancer (NMIBC). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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Samanta J, Naidu GSRSNK, Sood R, Nada R, Sharma A, Jain S. Calcinosis cutis with amyopathic dermatomyositis. QJM 2022; 115:613-614. [PMID: 35731215 DOI: 10.1093/qjmed/hcac148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Samanta
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - G S R S N K Naidu
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - R Sood
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - R Nada
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - A Sharma
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - S Jain
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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Wong W, Dickerson J, Sood R, Valtis Y, Yacab RA, Lattin J, Garrity P, Bhatt AS, Huang FW. Updated demographics at the only public oncology clinic in Belize. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18787] [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: 11/20/2022] Open
Abstract
e18787 Background: Belize is a middle-income Caribbean country without comprehensive cancer care capacity and poorly described cancer epidemiology. In 2020, we reported some of the first cancer demographics from the country. This was made possible by a capacity building partnership with the only public oncology clinic in the country at Karl Heusner Memorial Hospital (KHMH). Here we provide an update on demographic trends at this clinic. Methods: We performed a retrospective chart review of all available patient data at the KHMH clinic from December 2020 to December 2021. This was compared to data from the clinic’s founding in 2018 through its first 12 months. Results: From December 2020 through December 2021, the clinic saw 332 patients, an increase of 141% from the 236 patients seen over the first 12-month period of the clinic. In 2021, 250 (75%) patients had a confirmed pathologic diagnosis of cancer, with 78 (23%) remaining under clinical suspicion. This is in comparison to 63% of patients with a pathologic diagnosis in 2018. H&E staining alone remained the only publicly available pathologic service. Patients were predominantly female (67%) with a median age of 54 (Range: 2-95). The most common histologies (n = 332) were breast (29%), cervical (11%), colorectal (8%), prostate (4%), gastric (4%), and lung (3%). Of patients with histologically confirmed cancer, 221 (66%) were able to be fully staged. Patients predominantly presented with later stage disease (25% Stage III, 34% Stage IV). At the end of 2021, out of all patients tracked longitudinally over the year (n = 332), 24% remained in need of full diagnostic assessment, 34% were on curative treatment (predominantly cytotoxic chemotherapy), 22% were under surveillance, and 18% were receiving palliative chemotherapy or best supportive care due to advanced disease. This is in comparison to 2018, when there was no capacity to administer chemotherapy at KHMH and patients were referred to either private clinics or out of the country. Conclusions: The burden of cancer in Belize is significant and diverse. Compared to 2018, in 2021, the number of patients seen at KHMH increased 141%, as did the percentage of patients with histologically confirmed cancer (120% increase). Chemotherapy treatment was made possible through procurement of a chemotherapeutic stock at KHMH due to key partnerships with the Belizean government, hospital administration, and crucially, the only medical oncologist in the nation. This has led to chemotherapy being available at a public clinic in the country for the first time. Despite this progress, patients continue to present at late stages and many cannot access cancer care due to limited resources, cost, and low public awareness. This further affirms the need for infrastructure investment and early detection programs to improve cancer outcomes in Belize.
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Affiliation(s)
- Wayne Wong
- University of Rochester School of Medicine & Dentistry, Rochester, NY
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Wong W, Dickerson J, Sood R, Yacab RA, Valtis Y, Lattin J, Garrity P, Bhatt AS, Huang FW. Breast cancer characteristics and time to chemotherapy initiation in Belize. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18643] [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: 11/20/2022] Open
Abstract
e18643 Background: Breast cancer is the most common cancer in low and middle-income countries. Belize, a middle-income country in the Caribbean with significant inequality, lacks a national screening program and has limited treatment capacity. There are no studies describing breast cancer characteristics in Belize in the available literature. We collected data from the sole public oncology clinic in the country, established in 2018 at Karl Heusner Memorial Hospital (KHMH), to describe the characteristics of breast cancer patients and establish baseline measurements of time to chemotherapy initiation for the curative intent treatment population; the aim being to identify potential areas for quality improvement. Methods: We performed a retrospective chart review of available patient data from December 2020 to December 2021. We examined the time from a patient’s initial visit at KHMH until chemotherapy initiation (TCI) in the neoadjuvant setting with patients stratified by stage. Significant outliers (predominantly patients with misclassified data or those with private access to physicians and therapeutics) were excluded. Results: The clinic provided care for 80 patients with biopsy-proven breast cancer between December 2020 to December 2021. Patients were 97% female with a median age of 55 (Range: 34-81). For stageable patients (n=75), 33% presented with clinically localized disease, 49% with locally advanced, and 17% with recurrent or metastatic disease. Of the 51 patients on chemotherapy, 57% were receiving preoperative treatment, 31% were on adjuvant therapy, and 12% on palliative therapy. Patients not on therapy (n=29) at KHMH were either in surveillance, referred to a private cancer center, or deceased. Neoadjuvant TCI was calculated for 21 patients after the removal of outliers (n=5). The majority of these patients arrived at their initial clinic visit with a biopsy-proven diagnosis. Mean TCI for early stage disease was 49 days (n=7, 95% CI [9, 89]) and locally advanced disease was 36 days (n=14, 95% CI [12, 61]). Aggregate mean TCI was 40 days (n=21, 95% CI [19, 62]). Conclusions: In Belize, breast cancer affects younger women and patients present with later stages of disease than in high-income countries; however, time to chemotherapy initiation in a small sample of neoadjuvant patients at the Belizean clinic was comparable. Given the inherent limitations of small samples of data, additional investigation is needed to support these findings, as well as to delineate patient barriers to access and potential for improvements in clinic follow-up. Nevertheless, indications of a robust TCI call for further characterization of this newly established cancer clinic and its practices.
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Affiliation(s)
- Wayne Wong
- University of Rochester School of Medicine & Dentistry, Rochester, NY
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Atallah NJ, Warren HM, Roberts MB, Elshaboury RH, Bidell MR, Gandhi RG, Adamsick M, Ibrahim MK, Sood R, Bou Zein Eddine S, Cobler-Lichter MJ, Alexander NJ, Timmer KD, Atallah CJ, Viens AL, Panossian VS, Scherer AK, Proctor T, Smartt S, Letourneau AR, Paras ML, Johannes S, Wiemer J, Mansour MK. Baseline procalcitonin as a predictor of bacterial infection and clinical outcomes in COVID-19: A case-control study. PLoS One 2022; 17:e0262342. [PMID: 35025929 PMCID: PMC8758006 DOI: 10.1371/journal.pone.0262342] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 12/22/2021] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Coronavirus disease-2019 (COVID-19) is associated with a wide spectrum of clinical symptoms including acute respiratory failure. Biomarkers that can predict outcomes in patients with COVID-19 can assist with patient management. The aim of this study is to evaluate whether procalcitonin (PCT) can predict clinical outcome and bacterial superinfection in patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). METHODS Adult patients diagnosed with SARS-CoV-2 by nasopharyngeal PCR who were admitted to a tertiary care center in Boston, MA with SARS-CoV-2 infection between March 17 and April 30, 2020 with a baseline PCT value were studied. Patients who were presumed positive for SARS-CoV-2, who lacked PCT levels, or who had a positive urinalysis with negative cultures were excluded. Demographics, clinical and laboratory data were extracted from the electronic medical records. RESULTS 324 patient charts were reviewed and grouped by clinical and microbiologic outcomes by day 28. Baseline PCT levels were significantly higher for patients who were treated for true bacteremia (p = 0.0005) and bacterial pneumonia (p = 0.00077) compared with the non-bacterial infection group. Baseline PCT positively correlated with the NIAID ordinal scale and survival over time. When compared to other inflammatory biomarkers, PCT showed superiority in predicting bacteremia. CONCLUSIONS Baseline PCT levels are associated with outcome and bacterial superinfection in patients hospitalized with SARS-CoV-2.
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Affiliation(s)
- Natalie J. Atallah
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- * E-mail: (MM); (NA)
| | - Hailey M. Warren
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
| | - Matthew B. Roberts
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Ramy H. Elshaboury
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, United States of America
| | - Monique R. Bidell
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, United States of America
| | - Ronak G. Gandhi
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, United States of America
| | - Meagan Adamsick
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, United States of America
| | - Maryam K. Ibrahim
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Rupali Sood
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Savo Bou Zein Eddine
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Surgery, Massachusetts General Hospital, Boston, MA, United States of America
| | | | - Natalie J. Alexander
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
| | - Kyle D. Timmer
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
| | | | - Adam L. Viens
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
| | - Vahe S. Panossian
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Allison K. Scherer
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Teddie Proctor
- Fisher Diagnostics, Part of Thermo Fisher Scientific, Middletown, VA, United States of America
| | - Sherrie Smartt
- Fisher Diagnostics, Part of Thermo Fisher Scientific, Middletown, VA, United States of America
| | - Alyssa R. Letourneau
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Molly L. Paras
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Sascha Johannes
- B·R·A·H·M·S GmbH, Part of Thermo Fisher Scientific, Hennigsdorf, Germany
| | - Jan Wiemer
- B·R·A·H·M·S GmbH, Part of Thermo Fisher Scientific, Hennigsdorf, Germany
| | - Michael K. Mansour
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- * E-mail: (MM); (NA)
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Sharma V, Sood R, Sharma U, Goel H. Predicting stone composition by dual energy computed tomography before extra corporeal shock wave lithotripsy and comparing it with stone analysis. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00642-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sood R, Masalu N, Connolly RM, Chao CA, Faustine L, Mbulwa C, Anderson BO, Rositch AF. Invasive breast Cancer treatment in Tanzania: landscape assessment to prepare for implementation of standardized treatment guidelines. BMC Cancer 2021; 21:527. [PMID: 33971839 PMCID: PMC8108449 DOI: 10.1186/s12885-021-08252-2] [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] [Received: 12/16/2020] [Accepted: 04/21/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Incidence of breast cancer continues to rise in low- and middle-income countries, with data from the East African country of Tanzania predicting an 82% increase in breast cancer from 2017 to 2030. We aimed to characterize treatment pathways, receipt of therapies, and identify high-value interventions to increase concordance with international guidelines and avert unnecessary breast cancer deaths. METHODS Primary data were extracted from medical charts of patients presenting to Bugando Medical Center, Tanzania, with breast concerns and suspected to have breast cancer. Clinicopathologic features were summarized with descriptive statistics. A Poisson model was utilized to estimate prevalence ratios for variables predicted to affect receipt of life-saving adjuvant therapies and completion of therapies. International and Tanzanian guidelines were compared to current care patterns in the domains of lymph node evaluation, metastases evaluation, histopathological diagnosis, and receptor testing to yield concordance scores and suggest future areas of focus. RESULTS We identified 164 patients treated for suspected breast cancer from April 2015-January 2019. Women were predominantly post-menopausal (43%) and without documented insurance (70%). Those with a confirmed histopathology diagnosis (69%) were 3 times more likely to receive adjuvant therapy (PrR [95% CI]: 3.0 [1.7-5.4]) and those documented to have insurance were 1.8 times more likely to complete adjuvant therapy (1.8 [1.0-3.2]). Out of 164 patients, 4% (n = 7) received concordant care based on the four evaluated management domains. The first most common reason for non-concordance was lack of hormone receptor testing as 91% (n = 144) of cases did not undergo this testing. The next reason was lack of lymph node evaluation (44% without axillary staging) followed by absence of abdominopelvic imaging in those with symptoms (35%) and lack of histopathological confirmation (31%). CONCLUSIONS Patient-specific clinical data from Tanzania show limitations of current breast cancer management including axillary staging, receipt of formal diagnosis, lack of predictive biomarker testing, and low rates of adjuvant therapy completion. These findings highlight the need to adapt and adopt interventions to increase concordance with guidelines including improving capacity for pathology, developing complete staging pathways, and ensuring completion of prescribed adjuvant therapies.
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Affiliation(s)
- Rupali Sood
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Office E6150, Baltimore, MD, 21205, USA
| | | | - Roisin M Connolly
- Cancer Research @ UCC, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Christina A Chao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Office E6150, Baltimore, MD, 21205, USA
| | | | | | - Benjamin O Anderson
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Office E6150, Baltimore, MD, 21205, USA.
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Kumar R, Gupta RP, Bera BC, Anand T, Bhatia S, Kumar N, Sood R, Pavulraj S, Mathew MK, Balena V, Karthik S, Sansanwal R, Tripathi BN, Virmani N. Pathological and immunological protection induced by inactivated reverse genetics-based H3N8 equine influenza vaccine candidate in murine model. Acta Virol 2021; 64:359-374. [PMID: 32985215 DOI: 10.4149/av_2020_314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Equine influenza (EI) is an important viral respiratory disease of equines caused by influenza A virus (IAV). The antigenic drift in IAVs necessitates regular updating and harmonization of vaccine strain with the circulating virus. The reverse genetics-based recombinant viruses could be easy instrument in generating vaccine against circulating virus in a quick and effective manner. Present study has been envisaged to evaluate the immunogenicity and protective efficacy of inactivated recombinant equine influenza virus (rgEIV) vaccine candidate having six segments from H1N1 virus (A/WSN/33/H1N1) and HA (hemaglutinin) and NA (neuraminidase) segments from H3N8 equine influenza virus [(A/eq/Jammu-Katra/06/08) of clade 2 of Florida sublineage] generated through reverse genetic engineering. BALB/c mice were immunized with inactivated rgEIV adjuvanted with aluminium hydroxide gel and challenged with H3N8 virus (A/eq/Jammu-Katra/06/08). The protective efficacy was evaluated through serology, cytokine profiling, clinical signs, gross and histopathological changes, immunohistochemistry and residual virus quantification. Immunizations induced robust humoral immune response as estimated through hemagglutination inhibition assay (HAI). The antibodies were isotyped and the predominant subclass was IgG1. The vaccine candidate produced mixed Th1 and Th2 responses through stimulation of IFN-γ, IL-2, IL-4 and IL-6 expression. Immunization protected mice against challenge as reflected through reduction in clinical signs and body weight loss, early recovery, mild pathological changes (gross and histopathological lesions) as evident through scoring of lesions, low residual virus in nasopharynx and lungs quantified through egg titration and quantitative reverse transcriptase PCR (qRT-PCR). The study demonstrates that inactivated recombinant EIV generated through reverse genetic approach provides equivalent protection to that observed with inactivated whole H3N8 EIV vaccine. Keywords: equine influenza; reverse genetics; vaccine; pathology; murine model.
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Singh AK, Zameer A, Sood R, Verma S, Samanta J, Bal A, Sinha SK, Kochhar R. Chronic diarrhea with white colon: primary intestinal lymphangiectasia. QJM 2020; 113:886-887. [PMID: 32330275 DOI: 10.1093/qjmed/hcaa139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Indexed: 12/29/2022] Open
Affiliation(s)
| | | | - R Sood
- Department of Pathology, Post-Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India
| | - S Verma
- Department of Gastroenterology
| | | | - A Bal
- Department of Pathology, Post-Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India
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Varlotto JM, Voland R, DeCamp MM, Rava P, Fitzgerald TJ, Maxfield M, Lou F, Oliveira P, Sood R, Baima J, Zhang J, McIntosh L, Rassaei N, Flickinger JC, Walsh W, Maddox D, Uy K. The rates of second lung cancers and the survival of surgically-resected second primary lung cancers in patients undergoing resection of an initial primary lung cancer. Lung Cancer 2020; 147:115-122. [PMID: 32688194 DOI: 10.1016/j.lungcan.2020.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The Lung Cancer Screening Trial demonstrated improved overall survival (OS) and lung cancer specific survival (LCSS), likely due to finding early-stage NSCLC. The purpose of our investigation is to evaluate whether long-term surveillance strategies (4+ years after surgical resection of the initial lung cancer(1LC)) would be beneficial in NSCLC patients by assessing the rates of second lung cancers(2LC) and the OS/LCSS in patients undergoing definitive surgery in 1LC as compared to 2LC (>48 months after 1LC) populations. METHODS SEER13/18 database was reviewed for patients during 1998-2013. Log-rank tests were used to determine the OS/LCSS differences between the 1LC and 2LC in the entire surgical group(EG) and in those having an early-stage resectable tumors (ESR, tumors <4 cm, node negative). Joinpoint analysis was used to determine rates of second cancers 4-10 year after 1LC using SEER-9 during years 1985-2014. RESULTS The rate of 2LCs was significantly less than all other second cancers until 2001 when the incidence of 2LCs increased sharply and became significantly greater than all other second cancers in females starting in year 2005 and in men starting in year 2010. OS/LCSS, adjusted for propensity score by using inverse probability weighting, demonstrated similar OS, but worse LCSS for 2LCs in the EG, but similar OS/LCSSs in the ESR group. CONCLUSION Because the rate of 2LCs are increasing and because the OS/LCSS of the 1LC and 2LC are similar in early-stage lesions, we feel that continued surveillance of patients in order to find early-stage disease may be beneficial.
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Affiliation(s)
- J M Varlotto
- Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, MA, United States; University of Massachusetts Medical School, Worcester, MA, United States.
| | - R Voland
- School of Nursing, University of Wisconsin, Madison, WI, United States
| | - M M DeCamp
- Division of Thoracic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Paul Rava
- Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, MA, United States; University of Massachusetts Medical School, Worcester, MA, United States
| | - T J Fitzgerald
- Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, MA, United States; University of Massachusetts Medical School, Worcester, MA, United States
| | - M Maxfield
- University of Massachusetts Medical School, Worcester, MA, United States; Division of Thoracic Surgery, University of Massachusetts Medical Center, Worcester, MA, United States
| | - F Lou
- University of Massachusetts Medical School, Worcester, MA, United States; Division of Thoracic Surgery, University of Massachusetts Medical Center, Worcester, MA, United States
| | - P Oliveira
- University of Massachusetts Medical School, Worcester, MA, United States; Division of Pulmonary, Allergy and Critical Care Medicine, Worcester, MA, United States
| | - R Sood
- University of Massachusetts Medical School, Worcester, MA, United States; Division of Pulmonary, Allergy and Critical Care Medicine, Worcester, MA, United States
| | - J Baima
- University of Massachusetts Medical School, Worcester, MA, United States; Department of Orthopedics and Rehabilitation, University of Massachusetts Medical Center, Worcester, MA, United States
| | - J Zhang
- University of Massachusetts Medical School, Worcester, MA, United States; Department of Quantitative Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Lacey McIntosh
- University of Massachusetts Medical School, Worcester, MA, United States; Department of Radiology, University of Massachusetts, Worcester, MA, United States
| | - Negar Rassaei
- Department of Pathology, Penn State Hershey Medical Center, Hershey, PA, United States
| | - J C Flickinger
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - W Walsh
- University of Massachusetts Medical School, Worcester, MA, United States; Division of Medical Oncology, University of Massachusetts Medical Center, Worcester, MA, United States
| | - D Maddox
- Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, MA, United States; University of Massachusetts Medical School, Worcester, MA, United States
| | - K Uy
- University of Massachusetts Medical School, Worcester, MA, United States; Division of Thoracic Surgery, University of Massachusetts Medical Center, Worcester, MA, United States
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13
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Sood R, Rositch AF, Shakoor D, Ambinder E, Pool KL, Pollack E, Mollura DJ, Mullen LA, Harvey SC. Ultrasound for Breast Cancer Detection Globally: A Systematic Review and Meta-Analysis. J Glob Oncol 2020; 5:1-17. [PMID: 31454282 PMCID: PMC6733207 DOI: 10.1200/jgo.19.00127] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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: 12/24/2022] Open
Abstract
PURPOSE Mammography is not always available or feasible. The purpose of this systematic review and meta-analysis is to assess the diagnostic performance of ultrasound as a primary tool for early detection of breast cancer. MATERIALS AND METHODS For this systematic review and meta-analysis, we comprehensively searched PubMed and SCOPUS to identify articles from January 2000 to December 2018 that included data on the performance of ultrasound for detection of breast cancer. Studies evaluating portable, handheld ultrasound as an independent detection modality for breast cancer were included. Quality assessment and bias analysis were performed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Sensitivity analyses and meta-regression were used to explore heterogeneity. The study protocol has been registered with the international prospective register of systematic reviews (PROSPERO identifier: CRD42019127752). RESULTS Of the 526 identified studies, 26 were eligible for inclusion. Ultrasound had an overall pooled sensitivity and specificity of 80.1% (95% CI, 72.2% to 86.3%) and 88.4% (95% CI, 79.8% to 93.6%), respectively. When only low- and middle-income country data were considered, ultrasound maintained a diagnostic sensitivity of 89.2% and specificity of 99.1%. Meta-analysis of the included studies revealed heterogeneity. The high sensitivity of ultrasound for the detection of breast cancer was not statistically significantly different in subgroup analyses on the basis of mean age, risk, symptoms, study design, bias level, and study setting. CONCLUSION Given the increasing burden of breast cancer and infeasibility of mammography in certain settings, we believe these results support the potential use of ultrasound as an effective primary detection tool for breast cancer, which may be beneficial in low-resource settings where mammography is unavailable.
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Affiliation(s)
- Rupali Sood
- Johns Hopkins Medicine, Baltimore, MD.,RAD-AID International, Chevy Chase, MD
| | - Anne F Rositch
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | - Kara-Lee Pool
- RAD-AID International, Chevy Chase, MD.,University of California, Los Angeles, CA
| | - Erica Pollack
- RAD-AID International, Chevy Chase, MD.,Denver Health Medical Center, Denver, CO
| | | | | | - Susan C Harvey
- Johns Hopkins Medicine, Baltimore, MD.,RAD-AID International, Chevy Chase, MD
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14
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Sood R, Mancinetti M, Betticher D, Cantin B, Ebneter A. Management of bleeding in palliative care patients in the general internal medicine ward: a systematic review. Ann Med Surg (Lond) 2020; 50:14-23. [PMID: 31908774 PMCID: PMC6940657 DOI: 10.1016/j.amsu.2019.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 11/21/2019] [Accepted: 12/10/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Palliative care patients, those suffering from at least one chronic lifelong medical condition and hospice care patients, those with a life expectancy less than 6 months, are regularly hospitalised in general internal medicine wards. By means of a clinical case, this review aims to equip the internist with an approach to bleeding in this population. Firstly, practical advice on platelet transfusions will be provided. Secondly, the management of bleeding in site-specific situations will be addressed (from the ENT/pulmonary sphere, gastrointestinal - urogenital tract and cutaneous ulcers). Finally, an algorithm pertaining to the management of catastrophic bleeding is proposed. METHODS Electronic databases, including EMBASE, Pubmed, Google Scholar and the Cochrane Library were studied as primary resources, in association with local guidelines, to identify papers exploring platelet transfusions and alternative management of site-specific bleeding in palliative care patients. RESULTS Haemorrhagic complications are frequent in palliative care patients in the internal medicine ward. Current guidelines propose a therapeutic-only platelet transfusion policy. Nonetheless, prophylactic and/or therapeutic transfusion remains a physician-dependent decision. Site-specific therapeutic options are based on expert opinion and case reports. While invasive measures may be pertinent in certain situations, their application must be compatible with patient goals. Catastrophic bleeding requires caregivers' comforting presence; pharmacological management is secondary. CONCLUSION Literature is lacking regarding management of bleeding in the palliative care population hospitalised in an acute medical setting. Recommendations are of limited quality, the majority based on case reports or expert opinion. Further studies, exploring for example the impact on patient quality of life, are desirable to improve the management of this frequently encountered complication.
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Affiliation(s)
- R. Sood
- Internal Medicine Department, Fribourg Hospital, Chemin des Pensionnats 2-6, 1752, Villars-sur-Glâne, Switzerland
| | - M. Mancinetti
- Internal Medicine Department, Fribourg Hospital, Chemin des Pensionnats 2-6, 1752, Villars-sur-Glâne, Switzerland
- Medical Education Unit, University of Fribourg, Avenue de l'Europe 20, 1700, Fribourg, Switzerland
| | - D. Betticher
- Internal Medicine Department, Fribourg Hospital, Chemin des Pensionnats 2-6, 1752, Villars-sur-Glâne, Switzerland
| | - B. Cantin
- Internal Medicine Department, Fribourg Hospital, Chemin des Pensionnats 2-6, 1752, Villars-sur-Glâne, Switzerland
- Palliative Care Department, Fribourg Hospital, Avenue Jean-Paul II 12, 1752, Villars-sur-Glâne, Switzerland
| | - A. Ebneter
- Internal Medicine Department, Fribourg Hospital, Chemin des Pensionnats 2-6, 1752, Villars-sur-Glâne, Switzerland
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15
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Sood R, Surapaneni A, Luo S, Appel LJ, Winkler C, Grams ME, Naik RP. Sickle cell trait, estimated glomerular filtration rate, and risk of adverse outcomes in chronic kidney disease. Am J Hematol 2019; 94:E275-E278. [PMID: 31342549 DOI: 10.1002/ajh.25588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 07/20/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Rupali Sood
- Division of Hematology, Department of MedicineJohns Hopkins University Baltimore Maryland
| | - Aditya Surapaneni
- Welch Center for Prevention, Epidemiology, and Clinical ResearchJohns Hopkins University Baltimore Maryland
| | - Shengyuan Luo
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public Health Baltimore Maryland
| | - Lawrence J. Appel
- Welch Center for Prevention, Epidemiology, and Clinical ResearchJohns Hopkins University Baltimore Maryland
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public Health Baltimore Maryland
| | | | - Morgan E. Grams
- Welch Center for Prevention, Epidemiology, and Clinical ResearchJohns Hopkins University Baltimore Maryland
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public Health Baltimore Maryland
- Division of Nephrology, Department of MedicineJohns Hopkins University Baltimore Maryland
| | - Rakhi P. Naik
- Division of Hematology, Department of MedicineJohns Hopkins University Baltimore Maryland
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16
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Downs BM, Mercado-Rodriguez C, Cimino-Mathews A, Chen C, Yuan JP, Van Den Berg E, Cope LM, Schmitt F, Tse GM, Ali SZ, Meir-Levi D, Sood R, Li J, Richardson AL, Mosunjac MB, Rizzo M, Tulac S, Kocmond KJ, de Guzman T, Lai EW, Rhees B, Bates M, Wolff AC, Gabrielson E, Harvey SC, Umbricht CB, Visvanathan K, Fackler MJ, Sukumar S. DNA Methylation Markers for Breast Cancer Detection in the Developing World. Clin Cancer Res 2019; 25:6357-6367. [PMID: 31300453 DOI: 10.1158/1078-0432.ccr-18-3277] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/04/2019] [Accepted: 07/02/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE An unmet need in low-resource countries is an automated breast cancer detection assay to prioritize women who should undergo core breast biopsy and pathologic review. Therefore, we sought to identify and validate a panel of methylated DNA markers to discriminate between cancer and benign breast lesions using cells obtained by fine-needle aspiration (FNA).Experimental Design: Two case-control studies were conducted comparing cancer and benign breast tissue identified from clinical repositories in the United States, China, and South Africa for marker selection/training (N = 226) and testing (N = 246). Twenty-five methylated markers were assayed by Quantitative Multiplex-Methylation-Specific PCR (QM-MSP) to select and test a cancer-specific panel. Next, a pilot study was conducted on archival FNAs (49 benign, 24 invasive) from women with mammographically suspicious lesions using a newly developed, 5-hour, quantitative, automated cartridge system. We calculated sensitivity, specificity, and area under the receiver-operating characteristic curve (AUC) compared with histopathology for the marker panel. RESULTS In the discovery cohort, 10 of 25 markers were selected that were highly methylated in breast cancer compared with benign tissues by QM-MSP. In the independent test cohort, this panel yielded an AUC of 0.937 (95% CI = 0.900-0.970). In the FNA pilot, we achieved an AUC of 0.960 (95% CI = 0.883-1.0) using the automated cartridge system. CONCLUSIONS We developed and piloted a fast and accurate methylation marker-based automated cartridge system to detect breast cancer in FNA samples. This quick ancillary test has the potential to prioritize cancer over benign tissues for expedited pathologic evaluation in poorly resourced countries.
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Affiliation(s)
- Bradley M Downs
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Ashley Cimino-Mathews
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chuang Chen
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, P.R. China
| | - Jing-Ping Yuan
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, P.R. China
| | - Eunice Van Den Berg
- Department of Anatomical Pathology, University of Witwaterstrand and National Health Laboratory Service, Johannesburg, South Africa
| | - Leslie M Cope
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fernando Schmitt
- Medical Faculty of Porto University, Institute of Molecular Pathology and Immunology of Porto University, Porto, Portugal
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Syed Z Ali
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Danielle Meir-Levi
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rupali Sood
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Juanjuan Li
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, P.R. China
| | - Andrea L Richardson
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marina B Mosunjac
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Monica Rizzo
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | | | | | | | - Antonio C Wolff
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Edward Gabrielson
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Susan C Harvey
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher B Umbricht
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kala Visvanathan
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Bloomberg School of Public Health, Baltimore, Maryland
| | - Mary Jo Fackler
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Saraswati Sukumar
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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17
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Boyd AN, Hartman BC, Sood R, Walroth TA. A voltage-based analysis of fluid delivery and outcomes in burn patients with electrical injuries over a 6-year period. Burns 2019; 45:869-875. [PMID: 30935702 DOI: 10.1016/j.burns.2018.08.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/02/2018] [Accepted: 08/10/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Electrical injuries are associated with significant morbidity for affected patients. While cardiac and surgical interventions have been extensively reported, no practice guidelines or studies have specifically addressed fluid delivery and associated outcomes of patients with electrical injuries. The study objective was to evaluate the differences in fluid delivery in patients with high (≥1000V) and low (<1000V) voltage electrical injuries. METHODS This retrospective, observational study included adult electrical injury patients admitted for acute care. Patients with reported voltages were classified into high and low voltage subgroups. Primary outcomes of fluid administration and urine output over the first 24h after injury were assessed between subgroups. Secondary outcomes included renal, cardiac, surgical, and additional complications such as mortality, cost, and length of stay. RESULTS Data were analyzed in 36 patients with reported voltages, including 26 patients in the high and 10 patients in the low voltage subgroups. Patients in the high voltage subgroup had a statistically significant higher median (IQR) total IV fluid given [46.6 (22.4-61.9) vs. 22.5 (8.3-31.4) mL/kg, p=0.033] in the first 24h to achieve a similar urine output to the low voltage subgroup. The high voltage patients had higher rates of myoglobinuria, rhabdomyolysis, and creatinine kinase elevation. Patients in the high voltage vs. low voltage group had significantly longer median (IQR) length of stay (days) [11 (2-19) vs. 1 (1-6); p=0.015] and higher cost of hospital stay [$124,608 (19,486-296,991) vs. $16,165 (12,409-69,659); p=0.033]. CONCLUSIONS These results reinforce the importance of assessing electrical injuries and obtaining a voltage to provide patient-specific care, as high voltage electrical injuries receive more fluid than estimated maintenance rates. This study is the first of its kind to characterize fluid given for high and low voltage electrical injuries and effects on patient outcomes.
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Affiliation(s)
- A N Boyd
- Eskenazi Health, Department of Pharmacy, 720 Eskenazi Avenue, Indianapolis, IN, 46202, United States.
| | - B C Hartman
- Eskenazi Health, Richard M. Fairbanks Burn Center, 720 Eskenazi Avenue, Indianapolis, IN, 46202, United States.
| | - R Sood
- Eskenazi Health, Richard M. Fairbanks Burn Center, 720 Eskenazi Avenue, Indianapolis, IN, 46202, United States.
| | - T A Walroth
- Eskenazi Health, Department of Pharmacy, 720 Eskenazi Avenue, Indianapolis, IN, 46202, United States.
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18
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Boyd AN, Gervasio JM, Blair ME, Foster DR, Harris SA, Whitten JA, Hartman BC, Sood R, Walroth TA. 116 Redefining Refeeding Syndrome in Burn Patients. J Burn Care Res 2019. [DOI: 10.1093/jbcr/irz013.117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- A N Boyd
- Rhode Island Hospital, Providence, RI; Butler University, Indianapolis, IN; Eskenazi Health, Indianapolis, IN; Purdue University, West Lafayette, IN
| | - J M Gervasio
- Rhode Island Hospital, Providence, RI; Butler University, Indianapolis, IN; Eskenazi Health, Indianapolis, IN; Purdue University, West Lafayette, IN
| | - M E Blair
- Rhode Island Hospital, Providence, RI; Butler University, Indianapolis, IN; Eskenazi Health, Indianapolis, IN; Purdue University, West Lafayette, IN
| | - D R Foster
- Rhode Island Hospital, Providence, RI; Butler University, Indianapolis, IN; Eskenazi Health, Indianapolis, IN; Purdue University, West Lafayette, IN
| | - S A Harris
- Rhode Island Hospital, Providence, RI; Butler University, Indianapolis, IN; Eskenazi Health, Indianapolis, IN; Purdue University, West Lafayette, IN
| | - J A Whitten
- Rhode Island Hospital, Providence, RI; Butler University, Indianapolis, IN; Eskenazi Health, Indianapolis, IN; Purdue University, West Lafayette, IN
| | - B C Hartman
- Rhode Island Hospital, Providence, RI; Butler University, Indianapolis, IN; Eskenazi Health, Indianapolis, IN; Purdue University, West Lafayette, IN
| | - R Sood
- Rhode Island Hospital, Providence, RI; Butler University, Indianapolis, IN; Eskenazi Health, Indianapolis, IN; Purdue University, West Lafayette, IN
| | - T A Walroth
- Rhode Island Hospital, Providence, RI; Butler University, Indianapolis, IN; Eskenazi Health, Indianapolis, IN; Purdue University, West Lafayette, IN
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19
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Walroth TA, Switzer AR, Spera LJ, Whitten JA, Harris SA, Fritschle AC, Foster DR, Hartman BC, Sood R. 27 Prescribing Patterns of Pharmacologic Sleep Agents Following the Implementation of a Sleep Protocol in Adult Burn Patients. J Burn Care Res 2019. [DOI: 10.1093/jbcr/irz013.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- T A Walroth
- Eskenazi Health, Indianapolis, IN; Orlando Health, Orlando, FL; Indiana University School of Medicine, Indianapolis, IN; Purdue University, West Lafayette, IN
| | - A R Switzer
- Eskenazi Health, Indianapolis, IN; Orlando Health, Orlando, FL; Indiana University School of Medicine, Indianapolis, IN; Purdue University, West Lafayette, IN
| | - L J Spera
- Eskenazi Health, Indianapolis, IN; Orlando Health, Orlando, FL; Indiana University School of Medicine, Indianapolis, IN; Purdue University, West Lafayette, IN
| | - J A Whitten
- Eskenazi Health, Indianapolis, IN; Orlando Health, Orlando, FL; Indiana University School of Medicine, Indianapolis, IN; Purdue University, West Lafayette, IN
| | - S A Harris
- Eskenazi Health, Indianapolis, IN; Orlando Health, Orlando, FL; Indiana University School of Medicine, Indianapolis, IN; Purdue University, West Lafayette, IN
| | - A C Fritschle
- Eskenazi Health, Indianapolis, IN; Orlando Health, Orlando, FL; Indiana University School of Medicine, Indianapolis, IN; Purdue University, West Lafayette, IN
| | - D R Foster
- Eskenazi Health, Indianapolis, IN; Orlando Health, Orlando, FL; Indiana University School of Medicine, Indianapolis, IN; Purdue University, West Lafayette, IN
| | - B C Hartman
- Eskenazi Health, Indianapolis, IN; Orlando Health, Orlando, FL; Indiana University School of Medicine, Indianapolis, IN; Purdue University, West Lafayette, IN
| | - R Sood
- Eskenazi Health, Indianapolis, IN; Orlando Health, Orlando, FL; Indiana University School of Medicine, Indianapolis, IN; Purdue University, West Lafayette, IN
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20
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Affiliation(s)
- K Gabehart
- Richard M. Fairbanks Burn Center at Eskenazi Health, Indianapolis, IN
| | - D Roggy
- Richard M. Fairbanks Burn Center at Eskenazi Health, Indianapolis, IN
| | - R Sood
- Richard M. Fairbanks Burn Center at Eskenazi Health, Indianapolis, IN
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21
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Sood R, Rathod PV, Dokhe Y, Jani KK, Sivakumar V, Balasubramanian D, Iyer S, Thankappan K, Sadasivan S. PO-074 Pharyngoesophageal stricture following laryngeal-hypopharyngeal cancer treatment-management outcome. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30240-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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22
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Sood R, Paul J, Rajan S, Subramanian S, Balasubramanian D, Iyer S. PO-076 Predictors of postoperative pneumonia in patient undergoing oral cancer resection and its management. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30242-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Hu W, Agrawal M, Thadani S, Mukul SK, Sood R, Patel A, Dhanak R, Tailor S. Comparative evaluation of a single 2.0-mm AO locking reconstruction plate with conventional miniplate osteosynthesis for treatment of linear non-comminuted fractures of symphysis and parasymphsis region of the mandible. J Stomatol Oral Maxillofac Surg 2019; 120:11-15. [PMID: 30739640 DOI: 10.1016/j.jormas.2018.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/30/2018] [Accepted: 10/14/2018] [Indexed: 11/27/2022]
Abstract
The objective of the study was to evaluate and compare the relative efficacy of treating linear non-comminuted mandibular fracture of symphysis and parasymphysis region using single 2.0-mm AO locking reconstruction plate or using two conventional miniplates. In this study, 80 patients of symphysis or parasymphysis fracture were divided randomly in two equal groups and treated with open reduction and internal fixation using two 2.5-mm miniplates or with a single 2.0-mm AO locking reconstruction plate. Operating time in case of open reduction and fixation using a single 2.0-mm locking reconstruction plate was significantly less when compared to open reduction and fixation using two conventional miniplates. Both groups showed satisfactory fracture reduction and healing. No postoperative malocclusion was noted, and both groups showed comparable improvement in masticatory efficiency. In conclusion, fracture fixation using a single 2.0-mm AO locking reconstruction plate without use of a second plate at the superior border for treatment of linear non comminuted mandibular fracture in symphysis and parasymphysis region gives comparable results as with treatment by conventional miniplate system and provides significant savings in operating time, ease of use and decrease in amount of hardware incorporated in the body.
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Affiliation(s)
- W Hu
- Department of oral and maxillofacial surgery, Ahmedabad municipal dental college and hospital, Khokhra, Ahmedabad, India.
| | - M Agrawal
- Department of oral and maxillofacial surgery, government dental college and hospital, Ahmedabad, India
| | - S Thadani
- Smile train cleft lip and palate project, Indus hospital, Sabarmati, Ahmedabad, India
| | - S K Mukul
- Department of oral and maxillofacial surgery, All India institute of medical sciences, Patna, India
| | - R Sood
- Department of oral and maxillofacial surgery, Ahmedabad municipal dental college and hospital, Khokhra, Ahmedabad, India
| | - A Patel
- Department of oral and maxillofacial surgery, government dental college and hospital, Ahmedabad, India
| | - R Dhanak
- Department of oral and maxillofacial surgery, Karnawati school of dentistry, Ahmedabad, India
| | - S Tailor
- Department of oral and maxillofacial surgery, government dental college and hospital, Ahmedabad, India
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24
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Sood R, Kuhle CL, Kapoor E, Thielen JM, Frohmader KS, Mara KC, Faubion SS. Association of mindfulness and stress with menopausal symptoms in midlife women. Climacteric 2019; 22:377-382. [DOI: 10.1080/13697137.2018.1551344] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- R. Sood
- Division of General Internal Medicine, Menopause & Women's Sexual Health Clinic, Mayo Clinic, Rochester, MN, USA
| | - C. L. Kuhle
- Division of General Internal Medicine, Menopause & Women's Sexual Health Clinic, Mayo Clinic, Rochester, MN, USA
| | - E. Kapoor
- Division of General Internal Medicine, Menopause & Women's Sexual Health Clinic, Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - J. M. Thielen
- Division of General Internal Medicine, Menopause & Women's Sexual Health Clinic, Mayo Clinic, Rochester, MN, USA
| | | | - K. C. Mara
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - S. S. Faubion
- Division of General Internal Medicine, Menopause & Women's Sexual Health Clinic, Mayo Clinic, Rochester, MN, USA
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Sood R, Rositch AF, Ambinder E, Pool KL, Shakoor D, Pollack E, Mullen L, Harvey S. Ultrasound for Breast Cancer Detection in Low-Resource Settings: Systematic Review and Meta-Analysis. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.10510] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Of breast cancer–related deaths worldwide, 62.1% occur in low- and middle-income countries (LMICs). Mammography, the gold standard for screening, is largely infeasible in limited-resource settings, predominantly because of unavailability. Recent data show a dismal 0 to 12 mammography units per one million women age 50 to 69 years in most of sub-Saharan Africa. Breast ultrasound, which is used in high-resource settings to supplement mammography in certain clinical scenarios, offers a potentially viable alternative for early breast cancer detection in resource-limited areas because it is portable, economical, and a versatile technology. Methods We conducted a review of the literature to assess the potential for ultrasound alone in the detection of breast cancer. PubMed and Scopus queries with terms “breast neoplasms” and “diagnostic imaging” were systematically filtered to n = 33. Inclusion criteria were peer-reviewed studies in human participants, retrospective or prospective reviews, and a reference standard of biopsy/histopathology. Each paper was required to have extractable data with which to calculate true positives, false positives, true negatives, and false negatives. Breast imagers reviewed each paper using QUADAS and reached consensus for inclusion. Results Heterogeneity analyses confirmed a high diversity of all included studies. Pooled weighted analyses of all included studies demonstrated that the sensitivity of ultrasound for the detection of breast cancer ranged from 17% to 100%, with a 69% mean. This is higher than the known reported sensitivity of mammography for breast cancer detection of 67.8%. The specificity of ultrasound ranged from 28% to 100%, with a pooled total specificity of 97%, which is higher than the known specificity of mammography of 75%. In addition, ultrasound performed with superior sensitivity to mammography in the studies performed in LMICs that directly compared ultrasound with mammography (six of 11 studies). In the remaining five studies in LMICs, the sensitivity of ultrasound for breast cancer detection was high and ranged from 62% to 100%. Stratified analyses by age, breast density, presenting symptoms, and high-risk factors maintained the high sensitivities and specificities of ultrasound. Conclusion Sensitivities and specificities of ultrasound are comparable to mammography for the detection of invasive breast cancer. Handheld ultrasound may offer a viable alternative where mammography is not widely available as a primary detection modality for breast cancer. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Susan Harvey Honoraria: Hologic Inc, IBM Watson Imaging Consulting or Advisory Role: IBM Watson, Hologic Inc Research Funding: IBM Watson
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Affiliation(s)
- Rupali Sood
- Rupali Sood, Emily Ambinder, Delaram Shakoor, Lisa Mullen, and Susan Harvey, Johns Hopkins University School of Medicine; Anne F. Rositch, Bloomberg School of Public Health, Baltimore, MD; Kara-Lee Pool, University of California, Los Angeles, Los Angeles, CA; and Erica Pollack, Denver Health, Denver, CO
| | - Anne F. Rositch
- Rupali Sood, Emily Ambinder, Delaram Shakoor, Lisa Mullen, and Susan Harvey, Johns Hopkins University School of Medicine; Anne F. Rositch, Bloomberg School of Public Health, Baltimore, MD; Kara-Lee Pool, University of California, Los Angeles, Los Angeles, CA; and Erica Pollack, Denver Health, Denver, CO
| | - Emily Ambinder
- Rupali Sood, Emily Ambinder, Delaram Shakoor, Lisa Mullen, and Susan Harvey, Johns Hopkins University School of Medicine; Anne F. Rositch, Bloomberg School of Public Health, Baltimore, MD; Kara-Lee Pool, University of California, Los Angeles, Los Angeles, CA; and Erica Pollack, Denver Health, Denver, CO
| | - Kara-Lee Pool
- Rupali Sood, Emily Ambinder, Delaram Shakoor, Lisa Mullen, and Susan Harvey, Johns Hopkins University School of Medicine; Anne F. Rositch, Bloomberg School of Public Health, Baltimore, MD; Kara-Lee Pool, University of California, Los Angeles, Los Angeles, CA; and Erica Pollack, Denver Health, Denver, CO
| | - Delaram Shakoor
- Rupali Sood, Emily Ambinder, Delaram Shakoor, Lisa Mullen, and Susan Harvey, Johns Hopkins University School of Medicine; Anne F. Rositch, Bloomberg School of Public Health, Baltimore, MD; Kara-Lee Pool, University of California, Los Angeles, Los Angeles, CA; and Erica Pollack, Denver Health, Denver, CO
| | - Erica Pollack
- Rupali Sood, Emily Ambinder, Delaram Shakoor, Lisa Mullen, and Susan Harvey, Johns Hopkins University School of Medicine; Anne F. Rositch, Bloomberg School of Public Health, Baltimore, MD; Kara-Lee Pool, University of California, Los Angeles, Los Angeles, CA; and Erica Pollack, Denver Health, Denver, CO
| | - Lisa Mullen
- Rupali Sood, Emily Ambinder, Delaram Shakoor, Lisa Mullen, and Susan Harvey, Johns Hopkins University School of Medicine; Anne F. Rositch, Bloomberg School of Public Health, Baltimore, MD; Kara-Lee Pool, University of California, Los Angeles, Los Angeles, CA; and Erica Pollack, Denver Health, Denver, CO
| | - Susan Harvey
- Rupali Sood, Emily Ambinder, Delaram Shakoor, Lisa Mullen, and Susan Harvey, Johns Hopkins University School of Medicine; Anne F. Rositch, Bloomberg School of Public Health, Baltimore, MD; Kara-Lee Pool, University of California, Los Angeles, Los Angeles, CA; and Erica Pollack, Denver Health, Denver, CO
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Ghoke SS, Sood R, Kumar N, Pateriya AK, Bhatia S, Mishra A, Dixit R, Singh VK, Desai DN, Kulkarni DD, Dimri U, Singh VP. Evaluation of antiviral activity of Ocimum sanctum and Acacia arabica leaves extracts against H9N2 virus using embryonated chicken egg model. Altern Ther Health Med 2018; 18:174. [PMID: 29866088 PMCID: PMC5987647 DOI: 10.1186/s12906-018-2238-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 05/23/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND In the view of endemic avian influenza H9N2 infection in poultry, its zoonotic potential and emergence of antiviral resistance, two herbal plants, Ocimum sanctum and Acacia arabica, which are easily available throughout various geographical locations in India were taken up to study their antiviral activity against H9N2 virus. We evaluated antiviral efficacy of three different extracts each from leaves of O. sanctum (crude extract, terpenoid and polyphenol) and A. arabica (crude extract, flavonoid and polyphenol) against H9N2 virus using in ovo model. METHODS The antiviral efficacy of different leaves extracts was systematically studied in three experimental protocols viz. virucidal (dose-dependent), therapeutic (time-dependent) and prophylactic (dose-dependent) activity employing in ovo model. The maximum non-toxic concentration of each herbal extracts of O. sanctum and A. arabica in the specific pathogen free embryonated chicken eggs was estimated and their antiviral efficacy was determined in terms of reduction in viral titres, measured by Haemagglutination (HA) and real time quantitative reverse transcription polymerase chain reaction (RT-qPCR) assays. RESULTS All the extracts of O. sanctum (crude extract, terpenoid and polyphenol) and A. arabica (crude extract, flavonoid and polyphenol) showed significant virucidal activity, however, crude extract ocimum and terpenoid ocimum showed highly significant to significant (p < 0.001-0.01) decrease in virus genome copy numbers with lowest dose tested. Similarly, therapeutic effect was observed in all three extracts of O. sanctum in comparison to the virus control, nevertheless, crude extract ocimum and terpenoid ocimum maintained this effect for longer period of time (up to 72 h post-incubation). None of the leaves extracts of A. arabica had therapeutic effect at 24 and 48 h post-incubation, however, only the crude extract acacia and polyphenol acacia showed delayed therapeutic effect (72 h post-inoculation). Prophylactic potential was observed in polyphenol acacia with highly significant antiviral activity compared to virus control (p < 0.001). CONCLUSIONS The crude extract and terpenoid isolated from the leaves of O. sanctum and polyphenol from A. arabica has shown promising antiviral properties against H9N2 virus. Future investigations are necessary to formulate combinations of these compounds for the broader antiviral activity against H9N2 viruses and evaluate them in chickens.
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Affiliation(s)
- D Roggy
- Richard M Fairbanks Burn Center, Indianapolis, IN
| | - R Sood
- Richard M Fairbanks Burn Center, Indianapolis, IN
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28
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Kothiwala AK, S Rai HI, Garg K, Singh M, Singh P, Sharma BS, Sood R. Giant anterior interhemispheric fissure amoebic abscess: A rare case. Neurol India 2018; 66:548-551. [PMID: 29547192 DOI: 10.4103/0028-3886.227320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - H I S Rai
- Department of Neurosurgery, AIIMS, New Delhi, India
| | | | | | - Pankaj Singh
- Department of Neurosurgery, AIIMS, New Delhi, India
| | - B S Sharma
- Department of Neurosurgery, AIIMS, New Delhi, India
| | - R Sood
- Department of Internal Medicine, AIIMS, New Delhi, India
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Sagar RC, Sood R, Gracie DJ, Gold MJ, To N, Law GR, Ford AC. Cyclic vomiting syndrome is a prevalent and under-recognized condition in the gastroenterology outpatient clinic. Neurogastroenterol Motil 2018; 30. [PMID: 28745840 DOI: 10.1111/nmo.13174] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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: 05/15/2017] [Accepted: 06/30/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder (FGID) characterized by intermittent episodes of nausea and vomiting. Our aim was to report its prevalence and associated features. METHODS Data concerning demographics, symptoms, and psychiatric comorbidity were collected. Symptoms compatible with CVS were classified as per Rome III criteria. We recorded whether a diagnosis of CVS was considered in patients after negative investigation. We compared demographics and association with other FGIDs in patients with and without CVS. KEY RESULTS 920 of 1002 patients provided data. Of the 920 patients, 112 (12.2%) had symptoms compatible with CVS. Thirteen (11.6%) of these had an organic cause for their symptoms, but 99 patients (88.4%) were deemed to have CVS (prevalence=10.8%). Organic causes for symptoms compatible with CVS included gastroparesis, large hiatus hernia, achalasia, and small bowel obstruction. Only 39.4% of patients with CVS were asked about vomiting symptoms at their initial consultation, and a diagnosis of CVS was considered in only four (4.0%) of the 99 patients. CVS was associated with younger age, tobacco smoking, never having married, psychiatric comorbidity, and presence of symptoms compatible with other FGIDs (P≤.01). CONCLUSIONS AND INFERENCES Prevalence of CVS in this outpatient gastroenterology adult population was 10.8%. Identified associations included younger age, tobacco smoking, psychiatric comorbidity, and symptoms compatible with other FGIDs. The condition was considered as a possible diagnosis in <5% of patients who met the diagnostic criteria.
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Affiliation(s)
- R C Sagar
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - R Sood
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - D J Gracie
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - M J Gold
- School of Medicine, University of Leeds, Leeds, UK
| | - N To
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - G R Law
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - A C Ford
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
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30
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Pathak AP, Murugkar HV, Nagarajan S, Sood R, Tosh C, Kumar M, Athira CK, Praveen A. Survivability of low pathogenic (H9N2) avian influenza virus in water in the presence of Atyopsis moluccensis (Bamboo shrimp). Zoonoses Public Health 2017; 65:e124-e129. [PMID: 29115743 DOI: 10.1111/zph.12420] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Indexed: 11/30/2022]
Abstract
Low pathogenic avian influenza virus (LPAIV) exhibits an ecological climax with the aquatic ecosystem. The most widely prevalent subtype of LPAIV is H9N2. Wild aquatic birds being the natural reservoirs and ducks, the "Trojan horses" for Avian Influenza Virus (AIV), can contaminate the natural water bodies inhabited by them. The virus can persist in the contaminated water from days to years depending upon the environmental conditions. Various aquatic species other than ducks can promote the persistence and transmission of AIV; however, studies on the role of aquatic fauna in persistence and transmission of avian influenza virus are scarce. This experiment was designed to evaluate the survivability of H9N2 LPAIV in water with and without Atyopsis moluccensis (bamboo shrimp) for a period of 12 days. The infectivity and amount of virus in water were calculated and were found to be significantly higher in water with A. moluccensis than in water without A. moluccensis. The study also showed that A. moluccensis can accumulate the virus mechanically which can infect chicken eggs up to 11 days. The virus transmission potential of A. moluccensis requires further studies.
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Affiliation(s)
- A P Pathak
- Department of Veterinary Public Health and Epidemiology, G. B. Pant University of Agriculture and Technology, Pantnagar, Uttarakhand, India
| | - H V Murugkar
- Indian Council of Agricultural Research- National Institute of High Security Animal Diseases (ICAR-NIHSAD), Bhopal, Madhya Pradesh, India
| | - S Nagarajan
- Indian Council of Agricultural Research- National Institute of High Security Animal Diseases (ICAR-NIHSAD), Bhopal, Madhya Pradesh, India
| | - R Sood
- Indian Council of Agricultural Research- National Institute of High Security Animal Diseases (ICAR-NIHSAD), Bhopal, Madhya Pradesh, India
| | - C Tosh
- Indian Council of Agricultural Research- National Institute of High Security Animal Diseases (ICAR-NIHSAD), Bhopal, Madhya Pradesh, India
| | - M Kumar
- Indian Council of Agricultural Research- National Institute of High Security Animal Diseases (ICAR-NIHSAD), Bhopal, Madhya Pradesh, India
| | - C K Athira
- Division of Veterinary Public Health, Indian Veterinary Research Institute, Bareilly, Uttar Pradesh, India
| | - A Praveen
- Veterinary Dispensary, Korukollu, Krishna District, Andhra Pradesh, India
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Vasudevan G, Vanamayya PR, Nagarajan S, Rajukumar K, Suba S, Venketash G, Tosh C, Sood R, Nissly RH, Kuchipudi SV. Infectious dose-dependent accumulation of live highly pathogenic avian influenza H5N1 virus in chicken skeletal muscle-implications for public health. Zoonoses Public Health 2017; 65:e243-e247. [PMID: 28941132 DOI: 10.1111/zph.12406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Indexed: 11/27/2022]
Abstract
Highly pathogenic avian influenza viruses (HPAIV) of H5N1 subtype are a major global threat to poultry and public health. Export of poultry products, such as chicken and duck meat, is a known source for the cross-boundary spread of HPAI H5N1 viruses. Humans get infected with HPAI H5N1 viruses either by close contact with infected poultry or through consumption of fresh/undercooked poultry meat. Skeletal muscle is the largest soft tissue in chicken that has been shown to contain virus during systemic HPAIV infection and supports productive virus infection. However, the time between infection of a chicken with H5N1 virus and presence of virus in muscle tissue is not yet known. Further, it is also not clear whether chicken infected with low doses of H5N1 virus that cause non-fatal subclinical infections continue to accumulate virus in skeletal muscle. We investigated the amount and duration of virus detection in skeletal muscle of chicken experimentally infected with different doses (102 , 103 and 104 EID50 ) of a HPAI H5N1 virus. Influenza viral antigen could be detected as early as 6 hr after infection and live virus was recovered from 48 hr after infection. Notably, chicken infected with lower levels of HPAI H5N1 virus (i.e., 102 EID50 ) did not die acutely, but continued to accumulate high levels of H5N1 virus in skeletal muscle until 6 days post-infection. Our data suggest that there is a potential risk of human exposure to H5N1 virus through meat from clinically healthy chicken infected with a low dose of virus. Our results highlight the need to implement rigorous monitoring systems to screen poultry meat from H5N1 endemic countries to limit the global spread of H5N1 viruses.
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Affiliation(s)
- G Vasudevan
- National Institute of High Security Animal Diseases, Bhopal, Madhya Pradesh, India.,Poultry Disease Diagnosis and Surveillance Laboratory, Veterinary College and Research Institute Campus, Tamil Nadu Veterinary and Animal Sciences University, Namakkal, Tamil Nadu, India
| | - P R Vanamayya
- National Institute of High Security Animal Diseases, Bhopal, Madhya Pradesh, India
| | - S Nagarajan
- National Institute of High Security Animal Diseases, Bhopal, Madhya Pradesh, India
| | - K Rajukumar
- National Institute of High Security Animal Diseases, Bhopal, Madhya Pradesh, India
| | - S Suba
- National Institute of High Security Animal Diseases, Bhopal, Madhya Pradesh, India
| | - G Venketash
- National Institute of High Security Animal Diseases, Bhopal, Madhya Pradesh, India
| | - C Tosh
- National Institute of High Security Animal Diseases, Bhopal, Madhya Pradesh, India
| | - R Sood
- National Institute of High Security Animal Diseases, Bhopal, Madhya Pradesh, India
| | - R H Nissly
- Animal Diagnostic Laboratory, Department of Veterinary and Biomedical Sciences, The Pennsylvania State University, University Park, PA, USA
| | - S V Kuchipudi
- Animal Diagnostic Laboratory, Department of Veterinary and Biomedical Sciences, The Pennsylvania State University, University Park, PA, USA
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Sood R, Jiramongkolchai K, Streiff M, Gonzalez C, Shanbhag S, Lanzkron S, Arevalo JF, Naik R. Look into my eyes: An unusual first presentation of sickle cell disease. Am J Hematol 2017; 92:968-971. [PMID: 28494508 DOI: 10.1002/ajh.24787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/02/2017] [Accepted: 05/05/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Rupali Sood
- Division of Hematology, Department of Medicine; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Kim Jiramongkolchai
- Division of Hematology, Department of Medicine; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Michael Streiff
- Department of Ophthalmology; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Christopher Gonzalez
- Division of Transfusion Medicine, Department of Pathology; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Satish Shanbhag
- Department of Ophthalmology; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Sophie Lanzkron
- Department of Ophthalmology; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - J. Fernando Arevalo
- Division of Hematology, Department of Medicine; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Rakhi Naik
- Department of Ophthalmology; Johns Hopkins University School of Medicine; Baltimore Maryland
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33
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Sood R, Gracie DJ, Gold MJ, To N, Pinto-Sanchez MI, Bercik P, Moayyedi P, Ford AC, Law GR. Editorial: latent class analysis to improve confidence in the diagnosis of IBS - authors' reply. Aliment Pharmacol Ther 2017; 45:1268-1269. [PMID: 28370047 DOI: 10.1111/apt.14012] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- R Sood
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - D J Gracie
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - M J Gold
- School of Medicine, University of Leeds, Leeds, UK
| | - N To
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - M I Pinto-Sanchez
- Gastroenterology Division, Health Sciences Center, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - P Bercik
- Gastroenterology Division, Health Sciences Center, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - P Moayyedi
- Gastroenterology Division, Health Sciences Center, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - A C Ford
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - G R Law
- Division of Epidemiology & Biostatistics, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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Sood R, Gracie DJ, Gold MJ, To N, Pinto-Sanchez MI, Bercik P, Moayyedi P, Ford AC, Law GR. Derivation and validation of a diagnostic test for irritable bowel syndrome using latent class analysis. Aliment Pharmacol Ther 2017; 45:824-832. [PMID: 28105700 DOI: 10.1111/apt.13949] [Citation(s) in RCA: 6] [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: 11/21/2016] [Revised: 12/06/2016] [Accepted: 12/28/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND The accuracy of symptom-based diagnostic criteria for irritable bowel syndrome (IBS) is modest. AIMS To derive and validate a new test that utilises latent class analysis. METHODS Symptom, colonoscopy, and histology data were collected from 1981 patients and 360 patients in two cohorts referred to secondary care for investigation of their gastrointestinal symptoms in Canada and the UK, respectively. Latent class analysis was used to identify naturally occurring clusters in patient-reported symptoms in the Canadian dataset, and the latent class model derived from this was then applied to the UK dataset in order to validate it. Sensitivity, specificity, and positive and negative likelihood ratios (LRs) were calculated for the latent class models. RESULTS In the Canadian cohort, the model had a sensitivity of 44.7% (95% CI 40.0-50.0) and a specificity of 85.3% (95% CI 83.4-87.0). Positive and negative LRs were 3.03 (95% CI 2.57-3.56) and 0.65 (95% CI 0.59-0.71) respectively. A maximum positive LR of 3.93 was achieved following construction of a receiver operating characteristic curve. The performance in the UK cohort was similar, with a sensitivity and specificity of 52.5% (95% CI 42.2-62.7) and 84.3% (95% CI 79.3-88.6), respectively. Positive and negative LRs were 3.35 (95% CI 2.38-4.70) and 0.56 (95% CI 0.45-0.68), respectively, with a maximum positive LR of 4.15. CONCLUSIONS A diagnostic test for IBS, utilising patient-reported symptoms incorporated into a latent class model, performs as accurately as symptom-based criteria. It has potential for improvement via addition of clinical markers, such as coeliac serology and faecal calprotectin.
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Affiliation(s)
- R Sood
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - D J Gracie
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - M J Gold
- School of Medicine, University of Leeds, Leeds, UK
| | - N To
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - M I Pinto-Sanchez
- Farncombe Family Digestive Health Research Institute, Gastroenterology Division, McMaster University, Health Sciences Center, Hamilton, ON, Canada
| | - P Bercik
- Farncombe Family Digestive Health Research Institute, Gastroenterology Division, McMaster University, Health Sciences Center, Hamilton, ON, Canada
| | - P Moayyedi
- Farncombe Family Digestive Health Research Institute, Gastroenterology Division, McMaster University, Health Sciences Center, Hamilton, ON, Canada
| | - A C Ford
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - G R Law
- Division of Epidemiology & Biostatistics, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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35
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Sood R, Ford AC. Editorial: volatile organic compounds in irritable bowel syndrome - technology for an accurate and reliable point-of-care test? Aliment Pharmacol Ther 2017; 45:563-564. [PMID: 28074509 DOI: 10.1111/apt.13896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- R Sood
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - A C Ford
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
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36
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Selinger CP, Carbery I, Warren V, Rehman AF, Williams CJ, Mumtaz S, Bholah H, Sood R, Gracie DJ, Hamlin PJ, Ford AC. The relationship between different information sources and disease-related patient knowledge and anxiety in patients with inflammatory bowel disease. Aliment Pharmacol Ther 2017; 45:63-74. [PMID: 27778366 DOI: 10.1111/apt.13831] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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: 08/08/2016] [Revised: 08/26/2016] [Accepted: 09/26/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patient education forms a cornerstone of management of inflammatory bowel disease (IBD). The Internet has opened new avenues for information gathering. AIM To determine the relationship between different information sources and patient knowledge and anxiety in patients with IBD. METHODS The use of information sources in patients with IBD was examined via questionnaire. Anxiety was assessed with the hospital anxiety and depression scale and disease-related patient knowledge with the Crohn's and colitis knowledge score questionnaires. Associations between these outcomes and demographics, disease-related factors, and use of different information sources were analysed using linear regression analysis. RESULTS Of 307 patients (165 Crohn's disease, 142 ulcerative colitis) 60.6% were female. Participants used the hospital IBD team (82.3%), official leaflets (59.5%), and official websites (53.5%) most frequently in contrast to alternative health websites (9%). University education (P < 0.001), use of immunosuppressants (P = 0.025), Crohn's and Colitis UK membership (P = 0.001), frequent use of the hospital IBD team (P = 0.032), and frequent use of official information websites (P = 0.005) were associated with higher disease-related patient knowledge. Female sex (P = 0.004), clinically active disease (P < 0.001), frequent use of general practitioners (P = 0.014), alternative health websites (homoeopathy, nutritionists, etc.) (P = 0.004) and random links (P = 0.016) were independently associated with higher anxiety. CONCLUSIONS Different patient information sources are associated with better knowledge or worse anxiety levels. Face-to-face education and written information materials remain the first line of patient education. Patients should be guided towards official information websites and warned about the association between the use of alternative health websites or random links and anxiety.
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Affiliation(s)
- C P Selinger
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Biomedical and Clinical sciences, University of Leeds, Leeds, UK
| | - I Carbery
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - V Warren
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A F Rehman
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - C J Williams
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S Mumtaz
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - H Bholah
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - R Sood
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Biomedical and Clinical sciences, University of Leeds, Leeds, UK
| | - D J Gracie
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Biomedical and Clinical sciences, University of Leeds, Leeds, UK
| | - P J Hamlin
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Biomedical and Clinical sciences, University of Leeds, Leeds, UK
| | - A C Ford
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Biomedical and Clinical sciences, University of Leeds, Leeds, UK
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Sood R, Kuhle C, Kapoor E, Rullo J, Thielen J, Frohmader K, Mara K, Schroeder D, Faubion S. A negative view of menopause: does the type of symptom matter? Climacteric 2016; 19:581-587. [DOI: 10.1080/13697137.2016.1241227] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- R. Sood
- Women’s Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - C. Kuhle
- Women’s Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - E. Kapoor
- Women’s Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - J. Rullo
- Women’s Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - J. Thielen
- Women’s Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - K. Frohmader
- Women’s Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - K. Mara
- Biomedical Statistics and Informatics, Division of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - D. Schroeder
- Biomedical Statistics and Informatics, Division of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - S. Faubion
- Women’s Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Batra U, Parikh PM, Prabhash K, Tongaonkar HB, Chibber P, Dabkara D, Deshmukh C, Ghadyalpatil N, Hingmire S, Joshi A, Raghunath SK, Rajappa S, Rajendranath R, Rawal SK, Singh M, Singh R, Somashekhar SP, Sood R. Oncology Gold Standard™ practical consensus recommendations 2016 for treatment of advanced clear cell renal cell carcinoma. South Asian J Cancer 2016; 5:167-175. [PMID: 28032079 PMCID: PMC5184749 DOI: 10.4103/2278-330x.189933] [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] [Indexed: 11/28/2022] Open
Abstract
The Oncology Gold Standard (OGS) Expert Group on renal cell carcinoma (RCC) developed the consensus statement to provide community oncologists practical guidelines on the management of advanced clear cell (cc) RCC using published evidence, practical experience of experts in real life management, and results of a nationwide survey involving 144 health-care professionals. Six broad question categories containing 33 unique questions cover major situations in the routine management of RCC. This document serves as a ready guide for the standard of care to optimize outcome. The table of "Take Home Messages" at the end is a convenient tool for busy practitioners.
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Affiliation(s)
| | | | - PM Parikh
- Correspondence to: Dr Purvish M. Parikh, Department of Precision Oncology, Asian Cancer Institute, Somaiya Hospital, Sion East, Mumbai. E-mail:
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39
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Bhatia S, Khandia R, Sood R, Bhat S, Siddiqui A, Jahagirdhar G, Mishra S, Mishra A, Pateriya A, Kulkarni D. Reverse genetics based rgH5N2 vaccine provides protection against high dose challenge of H5N1 avian influenza virus in chicken. Microb Pathog 2016; 97:172-7. [DOI: 10.1016/j.micpath.2016.06.011] [Citation(s) in RCA: 6] [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] [Received: 04/14/2016] [Revised: 06/05/2016] [Accepted: 06/06/2016] [Indexed: 11/25/2022]
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40
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Pandya M, Rao M, Barmana T, Sood R, Dube S, Venkataramanan R. Activity of a novel ketolide A against haemophilus influenzae using in vitro and in vivo pharmacodynamic models. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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41
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Carlson DA, Gluskin AB, Mogni B, Koo J, Sood R, Lin Z, Pandolfino JE. Esophageal diverticula are associated with propagating peristalsis: a study utilizing high-resolution manometry. Neurogastroenterol Motil 2016; 28:392-8. [PMID: 26646704 PMCID: PMC4760883 DOI: 10.1111/nmo.12739] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 09/07/2015] [Accepted: 10/30/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Esophageal diverticula have been associated with esophageal motility disorders, most commonly achalasia. We aimed to evaluate high-resolution manometry (HRM) motility diagnoses and pressurization patterns in patients with esophageal diverticula. METHODS Patients were retrospectively identified for distal esophageal diverticula and previously completed HRM. High-resolution manometries were analyzed according to the Chicago Classification, and the pressure slope of the compartmentalization phase (time between upper esophageal sphincter closure and the transition zone) of esophageal bolus transit was measured. Pressure slopes were also measured in 10 asymptomatic volunteers (controls) for comparison. KEY RESULTS Nineteen patients (ages 31-83) were included. Eight (42%) patients had normal motility, five (26%) had esophagogastric junction outflow obstruction, and two (11%) had jackhammer esophagus; four patients had other motility diagnoses including only one patient with achalasia. A total of six patients (32%) had at least one hypercontractile swallow. Greater compartmentalization phase pressure slopes were observed in patients at the mid-esophageal body in both supine (median [interquartile range]: 1.9 mmHg/s [0.9, 3.6]) and upright (1.1 [0.1, 3.1]) positions than in controls (supine: -1.3 [-2.4, -0.11], p = 0.001; upright; -0.71 [-2.1, -0.02], p = 0.005). CONCLUSIONS & INFERENCES Propagating peristalsis, often with hypercontractility, was commonly seen in our cohort of patients with esophageal diverticula. Abnormal compartmentalization phase pressurization may indicate a relationship of abnormal esophageal wall mechanics and/or compliance with diverticula; however whether these findings are causal or reactionary remains unclear.
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Affiliation(s)
- D. A. Carlson
- Division of Gastroenterology and Hepatology; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - A. B. Gluskin
- Division of Gastroenterology and Hepatology; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - B. Mogni
- Division of Gastroenterology and Hepatology; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - J. Koo
- Division of Gastroenterology and Hepatology; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - R. Sood
- Division of Gastroenterology and Hepatology; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Z. Lin
- Division of Gastroenterology and Hepatology; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - J. E. Pandolfino
- Division of Gastroenterology and Hepatology; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
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42
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Warwick A, Gibson J, Sood R, Lotery A. A rare penetrant TIMP3 mutation confers relatively late onset choroidal neovascularisation which can mimic age-related macular degeneration. Eye (Lond) 2015; 30:488-91. [PMID: 26493035 DOI: 10.1038/eye.2015.204] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 09/03/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To perform a genotype-phenotype correlation for three patients heterozygous for a missense mutation in the tissue inhibitor of metalloproteinase 3 (TIMP3) gene. METHODS Retrospective, observational case series. The medical records and photographs were reviewed for three patients diagnosed at the time with neovascular age-related macular degeneration (AMD). All were later found to carry a predicted C113G mutation in the TIMP3 gene, other known mutations in which are associated with Sorsby's fundus dystrophy. RESULTS All three patients developed drusen and bilateral choroidal neovascularisation with subsequent disciform scarring and atrophy. Visual acuity rapidly deteriorated to <6/60 in both eyes. The age of onset varied from 56 to 64 years and the interval to contralateral eye involvement varied from 4 to 6 years. Two of the three patients had a family history of AMD. All three patients were heterozygous for the C113G nucleotide change, resulting in a Ser38Cys change at the N terminus of the TIMP3 protein. CONCLUSION This case series suggests the C113G TIMP3 variant may represent a novel highly penetrant mutation causing choroidal neovascularisation of relatively late onset for Sorsby's fundus dystrophy, mimicking early onset AMD.
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Affiliation(s)
- A Warwick
- Clinical Neurosciences Research Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Eye Unit, University Southampton NHS Trust, Southampton, UK
| | - J Gibson
- Centre for Biological Science, Faculty of Natural and Environmental Sciences, University of Southampton, Southampton, UK
| | - R Sood
- Centre for Biological Science, Faculty of Natural and Environmental Sciences, University of Southampton, Southampton, UK
| | - A Lotery
- Clinical Neurosciences Research Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Eye Unit, University Southampton NHS Trust, Southampton, UK
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43
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Premkrishnan GN, Sood R, Hemadri D, Chanu KV, Khandia R, Bhat S, Dimri U, Bhatia S. Cross-sectional study indicates nearly a quarter of sheep population in Karnataka state of India is infected with ovine herpesvirus 2. Virusdisease 2015; 26:180-8. [PMID: 26396985 PMCID: PMC4571589 DOI: 10.1007/s13337-015-0274-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 08/13/2015] [Indexed: 10/23/2022] Open
Abstract
In a cross-sectional study, prevalence of ovine herpesvirus 2 (family: Herpesviridae, subfamily: Gammaherpesvirinae, genus Macavirus and species: Ovine herpesvirus 2) infection was estimated in sheep population of Karnataka state in India. Based on the three stage cluster sampling method, whole blood samples (356) of sheep were collected from 11 sheep-dense districts of the state. The samples were tested for presence of OvHV-2 genome by recommended hemi-nested polymerase chain reaction (PCR) test. The true prevalence of OvHV-2 infection in sheep population of Karnataka was 24.44 %. Of the 11 district surveyed, highest true prevalence of 42.42 % (CI 25.56-59.29) was found in Raichur followed by Tumkur (39.02 %, CI 24.09-53.96). Inverse distance weighted interpolation of prevalence indicated that OvHV-2 prevalence within a given district is not uniform and there are areas of varied prevalence. The nucleotide sequence of the 422 bp DNA fragment, amplified in PCR, matched 99 % with OvHV-2 reference sequence and other sequences reported from India. Grouping of OvHV-2 sequences obtained from Karnataka with those from Andhra Pradesh, Tamil Nadu and Jammu and Kashmir in the neighbour joining tree indicated a close relationship among the OvHV-2s circulating in India. This is the first study in the country where systematic screening of sheep population of a state for the presence of OvHV-2 infection has been carried out, which indicated a widespread prevalence calling for an urgent need for policy measures to prevent economic losses due to the disease in susceptible cattle and buffalo species.
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Affiliation(s)
- G. N. Premkrishnan
- />ICAR-National Institute of High Security Animal Diseases (NIHSAD), Anand Nagar, Bhopal, Madhya Pradesh 462021 India
| | - R. Sood
- />ICAR-National Institute of High Security Animal Diseases (NIHSAD), Anand Nagar, Bhopal, Madhya Pradesh 462021 India
| | - D. Hemadri
- />ICAR-National Institute of Veterinary Epidemiology and Disease Informatics (NIVEDI), Ramagondanahalli, Yelahanka, Bengaluru, Karnataka 560064 India
| | - Kh Victoria Chanu
- />ICAR-National Institute of High Security Animal Diseases (NIHSAD), Anand Nagar, Bhopal, Madhya Pradesh 462021 India
| | - R. Khandia
- />ICAR-National Institute of High Security Animal Diseases (NIHSAD), Anand Nagar, Bhopal, Madhya Pradesh 462021 India
| | - S. Bhat
- />ICAR-National Institute of High Security Animal Diseases (NIHSAD), Anand Nagar, Bhopal, Madhya Pradesh 462021 India
| | - U. Dimri
- />Division of Veterinary Medicine, ICAR-Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh 243122 India
| | - S. Bhatia
- />ICAR-National Institute of High Security Animal Diseases (NIHSAD), Anand Nagar, Bhopal, Madhya Pradesh 462021 India
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44
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Sood R, Gracie DJ, Law GR, Ford AC. Systematic review with meta-analysis: the accuracy of diagnosing irritable bowel syndrome with symptoms, biomarkers and/or psychological markers. Aliment Pharmacol Ther 2015; 42:491-503. [PMID: 26076071 DOI: 10.1111/apt.13283] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [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: 04/20/2015] [Revised: 05/14/2015] [Accepted: 05/30/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a complex, heterogeneous disease which can be challenging to diagnose. No study has identified and assessed the accuracy of all available methods of diagnosing IBS. AIM To conduct a systematic review of the literature to identify and assess accuracy of symptom-based diagnostic criteria, biomarkers, psychological markers or combinations thereof. METHODS MEDLINE, EMBASE and EMBASE Classic were searched (until April 2015) to identify studies reporting accuracy of available methods to diagnose IBS in adult populations. Eligible studies assessed accuracy of these diagnostic tests against an accepted reference standard. Data were extracted to calculate positive and negative likelihood ratios, with 95% confidence intervals (CIs), of the diagnostic test utilised. Where more than one study used the same test, data were pooled in a meta-analysis. RESULTS Twenty-two studies (7106 patients) were eligible. Positive and negative likelihood ratios of the current gold standard, the Rome III criteria, were 3.35 (95% CI: 2.97-3.79) and 0.39 (95% CI: 0.34-0.46), similar to other symptom-based criteria. Eleven biomarkers performed no better than symptom-based criteria. Psychological markers performed well in one study. Five different combinations were assessed. The best in terms of positive likelihood ratio was faecal calprotectin, intestinal permeability and Rome I criteria (26.4; 95% CI: 11.4-61.9), and in terms of negative likelihood ratio serum-based biomarkers and psychological markers (0.18; 95% CI: 0.12-0.25). CONCLUSIONS Symptom-based diagnostic criteria, biomarkers and psychological markers performed modestly in predicting IBS. Combining symptoms with markers appears more effective, and may represent the way forward in the diagnosis of IBS.
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Affiliation(s)
- R Sood
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - D J Gracie
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - G R Law
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - A C Ford
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
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45
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Sood R, Hansen NF, Donovan FX, Carrington B, Bucci D, Maskeri B, Young A, Trivedi NS, Kohlschmidt J, Stone RM, Caligiuri MA, Chandrasekharappa SC, Marcucci G, Mullikin JC, Bloomfield CD, Liu P. Somatic mutational landscape of AML with inv(16) or t(8;21) identifies patterns of clonal evolution in relapse leukemia. Leukemia 2015; 30:501-4. [PMID: 26139325 PMCID: PMC4679720 DOI: 10.1038/leu.2015.141] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- R Sood
- Oncogenesis and Development Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.,Zebrafish Core, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - N F Hansen
- Comparative Genomics Analysis Unit, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - F X Donovan
- Genomics Core, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - B Carrington
- Zebrafish Core, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - D Bucci
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - B Maskeri
- NIH Intramural Sequencing Center, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - A Young
- NIH Intramural Sequencing Center, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - N S Trivedi
- Bioinformatics and Scientific Programming Core, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - J Kohlschmidt
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA.,Alliance for Clinical Trials in Oncology Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - R M Stone
- Medical Oncology/Hematologic Malignancies, Dana-Farber Cancer Institute, Harvard University, Boston, MA, USA
| | - M A Caligiuri
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - S C Chandrasekharappa
- Genomics Core, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.,Cancer Genomics Unit, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - G Marcucci
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA.,Department of Hematology and Hematopoietic Cell Transplantation, Hematologic Malignancies and Stem Cell Transplantation Institute, City of Hope, Duarte, CA, USA
| | - J C Mullikin
- Comparative Genomics Analysis Unit, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.,NIH Intramural Sequencing Center, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - C D Bloomfield
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - P Liu
- Oncogenesis and Development Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
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Sood R, Zhang B, Serghei A, Bernard J, Drockenmuller E. Triethylene glycol-based poly(1,2,3-triazolium acrylate)s with enhanced ionic conductivity. Polym Chem 2015. [DOI: 10.1039/c5py00273g] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A well-defined triethylene glycol-based poly(1,2,3-triazolium acrylate) having a bis(trifluoromethane)sulfonimide anion and an anhydrous ionic conductivity of 10−5 S cm−1 at 30 °C is reported.
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Affiliation(s)
- R. Sood
- Université Claude Bernard Lyon 1
- INSA de Lyon
- Ingénierie des Matériaux Polymères (IMP – UMR CNRS 5223)
- 69622 Villeurbanne Cedex
- France
| | - B. Zhang
- Université Claude Bernard Lyon 1
- INSA de Lyon
- Ingénierie des Matériaux Polymères (IMP – UMR CNRS 5223)
- 69622 Villeurbanne Cedex
- France
| | - A. Serghei
- Université Claude Bernard Lyon 1
- INSA de Lyon
- Ingénierie des Matériaux Polymères (IMP – UMR CNRS 5223)
- 69622 Villeurbanne Cedex
- France
| | - J. Bernard
- Université Claude Bernard Lyon 1
- INSA de Lyon
- Ingénierie des Matériaux Polymères (IMP – UMR CNRS 5223)
- 69622 Villeurbanne Cedex
- France
| | - E. Drockenmuller
- Université Claude Bernard Lyon 1
- INSA de Lyon
- Ingénierie des Matériaux Polymères (IMP – UMR CNRS 5223)
- 69622 Villeurbanne Cedex
- France
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Sengupta D, Shaikh A, Bhatia S, Pateriya A, Khandia R, Sood R, Prakash A, Pattnaik B, Pradhan H. Development of single-chain Fv against the nucleoprotein of type A influenza virus and its use in ELISA. J Virol Methods 2014; 208:129-37. [DOI: 10.1016/j.jviromet.2014.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 07/31/2014] [Accepted: 08/12/2014] [Indexed: 10/24/2022]
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Pitroda S, Widau R, Parekh A, Golden D, Ranck M, Sood R, Huang X, Darga T, Roizman B, Khodarev N, Weichselbaum R. RIG-1-Like Receptor LGP2 Protects Tumor Cells From Ionizing Radiation. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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49
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Bhatia S, Kunal A, Khandia R, Siddiqui A, Pateriya AK, Sood R. Genetic and antigenic analysis of H5N1 viruses for selection of HA-donor virus for vaccine strains. Indian J Virol 2014; 24:357-64. [PMID: 24426298 DOI: 10.1007/s13337-013-0151-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 07/24/2013] [Indexed: 10/26/2022]
Abstract
Genetic and antigenic analysis of H5N1 viruses, isolated in India during a period from year 2006 to 2010, was carried out for selection of the potential H5-HA (haemagglutinin) gene donor virus for developing a reverse genetics based DIVA marker H5 vaccine for poultry in India. Out of the 47 H5N1 viruses (clade 2.2), 14 representative viruses were selected on the basis of amino acid sequence analysis of HA1 gene for further antigenic characterization. Using antigenic cartography, an antigenic map was constructed based on the data of cross-HI (haemagglutinin inhibition) titration of 14 sera versus 14 viruses to visualize the relatedness among the antigens and antigenic coverage of the sera. Sera against five H5N1 viruses (A/crow/Assam/142119/2008, A/chicken/West Bengal/100879/2008, A/chicken/West Bengal/155505/2009, A/chicken/West Bengal/80995/2008 and A/chicken/West Bengal/81760/2008) exhibited maximum (100 %) antigenic coverage, hence, were selected as the potential HA donor viruses. However, the virus strain A/chicken/West Bengal/80995/2008 matched completely with the consensus amino acid sequence of the 47 viruses, therefore, was considered the best HA donor candidate out of the five showing 100 % antigenic coverage. The present study demonstrates a stepwise methodology for logical selection of vaccine strain or HA gene donor strain for developing H5 vaccines using genetic and antigenic data.
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Affiliation(s)
- S Bhatia
- High Security Animal Disease Laboratory, Indian Veterinary Research Institute, Anand Nagar, Bhopal, 462021 Madhya Pradesh India
| | - A Kunal
- High Security Animal Disease Laboratory, Indian Veterinary Research Institute, Anand Nagar, Bhopal, 462021 Madhya Pradesh India
| | - R Khandia
- High Security Animal Disease Laboratory, Indian Veterinary Research Institute, Anand Nagar, Bhopal, 462021 Madhya Pradesh India
| | - A Siddiqui
- High Security Animal Disease Laboratory, Indian Veterinary Research Institute, Anand Nagar, Bhopal, 462021 Madhya Pradesh India
| | - A K Pateriya
- High Security Animal Disease Laboratory, Indian Veterinary Research Institute, Anand Nagar, Bhopal, 462021 Madhya Pradesh India
| | - R Sood
- High Security Animal Disease Laboratory, Indian Veterinary Research Institute, Anand Nagar, Bhopal, 462021 Madhya Pradesh India
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Lopresti ML, Edmiston KL, Oconnor A, Gates E, Vijayaraghavan G, Sood R, Khanna S. Abstract P2-04-04: Breast cancer risk reduction in high risk women identified at the time of screening mammography. Integrating data from an established high risk clinic. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p2-04-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: At the time of screening mammography, patient data can be collected and entered into a Modified Gail Model Risk Assessment Tool to identify patients at increased risk of invasive breast cancer. In turn, these patients can be referred to high risk centers where risk reduction strategies and chemoprophylaxis can be considered. The objective of this study is to establish how many women are at high risk of invasive breast cancer in a screening population who should be referred to a high risk center for counseling.
Methods: This is an observational prospective study evaluating 1,000 women at a single institution presenting for mammographic screening or diagnostic evaluation. At the time of mammography, these women routinely complete a standard intake questionnaire addressing breast cancer risk factors put forward by the institutional clinic. Modified Gail model risk scores were calculated from these data sheets. Women with a 5 year risk of invasive breast cancer of 1.7% or greater were identified as well as women at particularly high risk (≥3.4% or double the 5-year risk). At the time of analysis patients with a history of breast cancer or who underwent diagnostic mammography were excluded. Retrospective data from our institutional high risk clinic from January 2007 to December 2009 was analyzed in respect to patient age at referral, Gail Model Score, personal history of breast cancer, history of benign breast biopsies, and recommendation for and acceptance of chemoprophylaxis.
Results: Of 1,000 women screened in the prospective analysis, 366 had ≥1.7% 5-year risk of invasive breast cancer. 26% (96) of these women were under 60 years old while 74% (270) were ≥60 years old. Among the latter group, 19.6% (53) were found to have ≥ 3.4% of developing invasive cancer. In these women with double the 5-year risk, 96.2% had a family history of breast cancer and 69.8% had a prior biopsy. Similarly, in women under 60, greater than half were high risk secondary to a prior biopsy or family history. In the retrospective analysis of 600 patients evaluated in the high risk clinic, 38.8% were eligible for chemoprevention based on age >35, Gail model risk score, and no contraindications to treatment. 45.7% accepted recommendation for chemoprophylaxis as opposed 54.3% who had declined. Age was not found to be a predictor of acceptance of treatment.
Conclusions: 1/3 of patients who receive annual screening are at high risk for breast cancer. These patients can be identified from data routinely obtained at the time of screening mammography. These women should be referred for high-risk counseling and consideration of chemoprevention at the time of screening mammography. Further prospective studies may be warranted to determine if this is an effective way to provide risk reduction strategies for high risk women.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-04-04.
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Affiliation(s)
- ML Lopresti
- Umass Memorial Medical Center, Worcester, MA
| | - KL Edmiston
- Umass Memorial Medical Center, Worcester, MA
| | - A Oconnor
- Umass Memorial Medical Center, Worcester, MA
| | - E Gates
- Umass Memorial Medical Center, Worcester, MA
| | | | - R Sood
- Umass Memorial Medical Center, Worcester, MA
| | - S Khanna
- Umass Memorial Medical Center, Worcester, MA
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