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Morris MF, Chandrasekhar M, Gudi H, Schumann C, Benson B, Ng N, Mullen S, Huey W, O'Neal W. A Study to Measure the Ability of AI-CSQ to suppoRt The busy CCTA reader: SMART-CT. J Cardiovasc Comput Tomogr 2024; 18:213-214. [PMID: 37821353 DOI: 10.1016/j.jcct.2023.09.006] [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: 09/15/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023]
Affiliation(s)
| | | | - Harish Gudi
- Banner University Medical Center-Tucson, Tucson, AZ, USA
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Livraghi-Butrico A, Grubb B, Carpenter J, Danielsen S, Markovetz M, Chen G, Radicioni G, Saldana-Montavon A, Sun L, Gutay M, Vilar J, Ehre C, Thornton D, Cowley D, O'Neal W, Hill D, Button B, Kesimer M, Rubinstein M, Boucher R. 404 Why are mucins so gigantic, and is it rational to sever them to aid mucus clearance? J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01094-3] [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: 11/07/2022]
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3
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Vaccarino V, Shah AJ, Moncayo V, Nye J, Piccinelli M, Ko YA, Ma X, Murrah N, Shallenberger L, Driggers E, Levantsevych OM, Hammadah M, Lima BB, Young A, O'Neal W, Alkhalaf M, Haffar A, Raggi P, Goldberg J, Smith NL, Garcia EV, Quyyumi AA, Bremner JD. Posttraumatic Stress Disorder, Myocardial Perfusion, and Myocardial Blood Flow: A Longitudinal Twin Study. Biol Psychiatry 2022; 91:615-625. [PMID: 34865854 PMCID: PMC8918004 DOI: 10.1016/j.biopsych.2021.09.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/31/2021] [Accepted: 09/17/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND The link between posttraumatic stress disorder (PTSD) and ischemic heart disease remains elusive owing to a shortage of longitudinal studies with a clinical diagnosis of PTSD and objective measures of cardiac compromise. METHODS We performed positron emission tomography in 275 twins who participated in two examinations approximately 12 years apart. At both visits, we obtained a clinical diagnosis of PTSD, which was classified as long-standing (both visit 1 and visit 2), late onset (only visit 2), and no PTSD (no PTSD at both visits). With positron emission tomography, we assessed myocardial flow reserve (MFR), which, in absence of significant coronary stenoses, indexes coronary microvascular function. We compared positron emission tomography data at visit 2 across the three categories of longitudinally assessed PTSD and examined changes between the two visits. RESULTS Overall, 80% of the twins had no or minimal obstructive coronary disease. Yet, MFR was depressed in twins with PTSD and was progressively lower across groups with no PTSD (2.13), late-onset PTSD (1.97), and long-standing PTSD (1.93) (p = .01). A low MFR (a ratio <2.0) was present in 40% of the twins without PTSD, in 56% of those with late-onset PTSD, and in 72% of those with long-standing PTSD (p < .001). Associations persisted in multivariable analysis, when examining changes in MFR between visit 1 and visit 2, and within twin pairs. Results were similar by zygosity. CONCLUSIONS Longitudinally, PTSD is associated with reduced coronary microcirculatory function and greater deterioration over time. The association is especially noted among twins with chronic, long-standing PTSD and is not confounded by shared environmental or genetic factors.
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Affiliation(s)
- Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
| | - Amit J Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Atlanta Veterans Affairs Health Care System, Decatur, Georgia
| | - Valeria Moncayo
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Jonathon Nye
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Xin Ma
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Nancy Murrah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lucy Shallenberger
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Emily Driggers
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Oleksiy M Levantsevych
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Muhammad Hammadah
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Bruno B Lima
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - An Young
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Wesley O'Neal
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Mhmtjamil Alkhalaf
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ammer Haffar
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Paolo Raggi
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Jack Goldberg
- Seattle Epidemiologic Research and Information Center, United States Department of Veterans Affairs Office of Research and Development, Seattle, Washington
| | - Nicholas L Smith
- Seattle Epidemiologic Research and Information Center, United States Department of Veterans Affairs Office of Research and Development, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Arshed A Quyyumi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - J Douglas Bremner
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia; Atlanta Veterans Affairs Health Care System, Decatur, Georgia
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Garg PK, Guan W, Karger AB, Steffen BT, O'Neal W, Heckbert SR, Michos ED, Tsai MY. Lp(a) (Lipoprotein [a]) and Risk for Incident Atrial Fibrillation: Multi-Ethnic Study of Atherosclerosis. Circ Arrhythm Electrophysiol 2020; 13:e008401. [PMID: 32302223 DOI: 10.1161/circep.120.008401] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Parveen K Garg
- Division of Cardiology, University of Southern California, Los Angeles (P.K.G.)
| | - Weihua Guan
- Division of Biostatistics, School of Public Health (W.G.), University of Minnesota, Minneapolis
| | - Amy B Karger
- Department of Laboratory Medicine and Pathology (A.B.K., B.T.S., M.Y.T.), University of Minnesota, Minneapolis
| | - Brian T Steffen
- Department of Laboratory Medicine and Pathology (A.B.K., B.T.S., M.Y.T.), University of Minnesota, Minneapolis
| | - Wesley O'Neal
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA (W.O.)
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle (S.R.H.)
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (E.D.M.)
| | - Michael Y Tsai
- Department of Laboratory Medicine and Pathology (A.B.K., B.T.S., M.Y.T.), University of Minnesota, Minneapolis
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Effoe VS, O'Neal W, Santos R, Rubinsztain L, Zafari AM. Pseudo-Wellens syndrome, acute pancreatitis, and an anomalous coronary artery: a case report. J Med Case Rep 2019; 13:387. [PMID: 31884973 PMCID: PMC6936050 DOI: 10.1186/s13256-019-2315-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 05/24/2019] [Accepted: 11/18/2019] [Indexed: 11/20/2022] Open
Abstract
Background Chest pain associated with transient electrocardiogram changes mimicking an acute myocardial infarction have been described in acute pancreatitis. These ischemic electrocardiogram changes can present a diagnostic dilemma, especially when patients present with concurrent angina pectoris and epigastric pain warranting noninvasive or invasive imaging studies. Case presentation A 45-year-old African-American man with a history of alcohol use disorder presented to the emergency department of our institution with 36 hours of concurrent epigastric pain and left-sided chest pain radiating to his left arm and associated with nausea and dyspnea. On physical examination, he was afebrile; his blood pressure was elevated; and he had epigastric tenderness. His laboratory test results were significant for hypokalemia, normal troponin, and elevated serum lipase and amylase levels. Serial electrocardiograms for persistent chest pain showed ST-segment elevations with dynamic T-wave changes in the right precordial electrocardiogram leads, consistent with Wellens syndrome. He was immediately taken to the cardiac catheterization laboratory, where selective coronary angiography showed normal coronary arteries with an anomalous origin of the right coronary artery from the opposite sinus. Given his elevated lipase and amylase levels, the patient was treated for acute alcohol-induced pancreatitis with intravenous fluids and pain control. His chest pain and ischemic electrocardiogram changes resolved within 24 hours of admission, and coronary computed tomography angiography showed an interarterial course of the right coronary artery without high-risk features. Conclusions Clinicians may consider deferring immediate cardiac catheterization and attribute electrocardiogram changes to acute pancreatitis in patients presenting with angina pectoris and acute pancreatitis if confirmed by normal cardiac enzymes and elevated levels of lipase and amylase. However, when clinical signs and electrocardiogram findings are highly suggestive of myocardial ischemia/injury, immediate noninvasive coronary computed tomography angiography may be the best approach to make an early diagnosis.
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Affiliation(s)
- V S Effoe
- Atlanta Veterans Health Care System, Decatur, GA, USA.,Department of Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - W O'Neal
- Atlanta Veterans Health Care System, Decatur, GA, USA.,Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - R Santos
- Atlanta Veterans Health Care System, Decatur, GA, USA.,Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - L Rubinsztain
- Atlanta Veterans Health Care System, Decatur, GA, USA.,Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
| | - A M Zafari
- Atlanta Veterans Health Care System, Decatur, GA, USA. .,Department of Medicine, Morehouse School of Medicine, Atlanta, GA, USA. .,Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
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Garg PK, Jorgensen N, Diez-Roux AV, O'Neal W, Mujahid M, Moore K, Soliman EZ, Heckbert SR. Neighborhood environments and risk of incident atrial fibrillation: The Multi-Ethnic Study of Atherosclerosis. Eur J Prev Cardiol 2019; 27:2116-2118. [PMID: 31349772 DOI: 10.1177/2047487319866020] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Parveen K Garg
- Division of Cardiology, University of Southern California Keck School of Medicine, Los Angeles, USA
| | - Neal Jorgensen
- Department of Biostatistics, University of Washington, Seattle, USA
| | - Ana V Diez-Roux
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, USA
| | - Wesley O'Neal
- Division of Cardiology, Emory University School of Medicine, Atlanta, USA
| | - Mahasin Mujahid
- Department of Epidemiology, School of Public Health, University of California, Berkeley, USA
| | - Kari Moore
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, USA
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, and Department of Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, USA
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, USA
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Dhindsa D, Sandesara P, Mehta A, Topel M, Allard-Ratick M, O'Neal W, Khambhati J, Bakthadze B, Tahhan AS, Hayek S, Sperling LS, Quyyumi A. ASSOCIATION OF HIGH HDL IN PATIENTS WITH CORONARY ARTERY DISEASE: IMPACT OF RACE AND SEX. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)30731-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Almuwaqqat Z, Alkhoder A, Tahhan AS, Amin M, Kaseer B, Choudhary M, Bahjat G, Dhindsa D, Jafri M, O'Neal W, Siddiqui S, Abdulbaki R, Qadir S, Sidoti A, Khan A, Dhanani M, Soliman E, Vaccarino V, Quyyumi A, Shah A. T-WAVE AXIS DEVIATION PREDICTS INCIDENT HEART FAILURE AND FATAL OUTCOMES IN HIGH RISK SUBJECTS UNDERGOING CORONARY ANGIOGRAPHY. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31165-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Venkatesh S, Sandesara P, Arora S, O'Neal W. MARKERS OF KIDNEY FUNCTION AND THE RISK FOR ADVERSE EVENTS IN PATIENTS WITH HEART FAILURE WITH PRESERVED EJECTION FRACTION. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31317-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Khambhati J, Allard-Ratick M, Dhindsa D, Lee S, Chen J, Sandesara PB, O'Neal W, Quyyumi AA, Wong ND, Blumenthal RS, Sperling LS. Re: The art of cardiovascular risk assessment. Clinical Cardiology
2018;41(5):677-684. Clin Cardiol 2018; 41:1111. [DOI: 10.1002/clc.22998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 06/13/2018] [Indexed: 11/05/2022] Open
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Khambhati J, Allard-Ratick M, Dhindsa D, Lee S, Chen J, Sandesara PB, O'Neal W, Quyyumi AA, Wong ND, Blumenthal RS, Sperling LS. The art of cardiovascular risk assessment. Clin Cardiol 2018; 41:677-684. [PMID: 29746005 DOI: 10.1002/clc.22930] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/12/2018] [Accepted: 02/17/2018] [Indexed: 12/16/2022] Open
Abstract
Cardiovascular disease (CVD) remains the leading cause of death in the United States. Healthcare expenditures have been principally allocated toward treatment of CVD at the end of the health/disease continuum, rather than toward health promotion and disease prevention. A focused effort on both primordial and primary prevention can promote cardiovascular health and reduce the burden of CVD. Risk-factor assessment for predicting atherosclerotic CVD events serves as the foundation of preventive cardiology and has been driven by population-based scoring algorithms based on traditional risk factors. Incorporating individual nontraditional risk factors, biomarkers, and selective use of noninvasive measures may help identify more at-risk patients as well as truly low-risk individuals, allowing for better targeting of treatment intensity. Using a combination of validated population-based atherosclerotic CVD risk-assessment tools, nontraditional risk factors, social health determinants, and novel markers of atherosclerotic disease, we should be able to improve our ability to assess CVD risk. Through scientific evidence, clinical judgment, and discussion between the patient and clinician, we can implement an effective evidence-based strategy to assess and reduce CVD risk.
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Affiliation(s)
- Jay Khambhati
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Marc Allard-Ratick
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Devinder Dhindsa
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Suegene Lee
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - John Chen
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Pratik B Sandesara
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Wesley O'Neal
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Arshed A Quyyumi
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Nathan D Wong
- Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, California
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Heart Disease, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Laurence S Sperling
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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O'Neal W, Bennet A, Singleton MJ, Judd S, Howard G, Howard V, Hooker S, Soliman E. OBJECTIVELY MEASURED PHYSICAL ACTIVITY AND THE RISK OF ATRIAL FIBRILLATION: THE REASONS FOR GEOGRAPHIC AND RACIAL DIFFERENCES IN STROKE (REGARDS) STUDY. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)33213-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Lee S, Khambhati J, Sandesara P, O'Neal W, Samman Tahhan A, Hayek S, Hammadah M, Mohammad-Kelli M, Topel M, Alkhodar A, Aida H, Chivukula K, Sperling L, Quyyumi A. 956High-sensitivity troponin I predicts the risk of adverse outcomes in patients with chronic kidney disease. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Broughton S, O'Neal W, Al-Mallah M, Bluemke D, Heckbert S, Lima J, Soliman E. NORMAL FINDINGS ON NONINVASIVE CARDIAC ASSESSMENT AND THE PREDICTION OF HEART FAILURE: THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS (MESA). J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34865-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hammadah M, Pearce B, Abdelhadi N, Ghafeer M, Alkhoder A, Obideen M, Levantsevych O, Weng L, Mheid IA, Wilmot K, Ramadan R, Kelli HM, O'Neal W, Tahhan AS, Pimple P, Sulivan S, Sandesara P, Shah A, Sun Y, Bremner D, Paolo R, Vaccarino V, Quyyumi A. INFLAMMATORY RESPONSE TO MENTAL STRESS AND MENTAL STRESS INDUCED MYOCARDIAL ISCHEMIA. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)33474-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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O'Neal W, Efird J, Ferguson T. IMPACT OF PREOPERATIVE ATRIAL FIBRILLATION ON LONG-TERM SURVIVAL AFTER OPEN HEART SURGERY. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61215-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Waters JM, O'Neal W, White KL, Wakeford C, Lansdon EB, Harris J, Svarovskaia ES, Miller MD, Borroto-Esoda K. Mutations in the thumb–connection and RNase H domain of HIV type-1 reverse transcriptase of antiretroviral treatment-experienced patients. Antivir Ther 2009. [DOI: 10.1177/135965350901400215] [Citation(s) in RCA: 4] [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: 11/16/2022]
Abstract
Background Antiretroviral therapy that targets HIV type-1 (HIV-1) reverse transcriptase (RT) can be linked to mutations in the thumb–connection (amino acids [AA] 241–426) and RNase H (AA 427–560) domains, which could affect drug resistance. Methods Genotypical and statistical analyses were performed on HIV-1 RT from 100 antiretroviral treatment-naive and 248 antiretroviral treatment-experienced patients, the majority of whom were infected with HIV-1 subtype B. The RT region was analysed in three parts: the polymerase (AA 1–240), thumb–connection (AA 241–426) and RNase H (AA 427–560) domains. Results The polymerase domain had statistically significant changes between the two groups at 24 AA positions that are known resistance sites. Within the thumb–connection domain, R284 and N348 had statistically significant changes between the groups ( P=0.007 and P≤0.001, respectively). In treatment-experienced patients, 17.3% had R284K, whereas 24.5% had N348I substitutions. Both R284 and N348 were 100% conserved in treatment-naive patients. Within the RNase H domain, only K451 showed a statistically significant change ( P≤0.001), with K451R present in 11% of treatment-experienced patients but remaining 100% conserved among treatment-naive patients. Conclusions RT mutations at three positions outside of the polymerase region were associated with antiretroviral therapy: R284K, N348I and K451R. Both R284K and K451R interact with the phosphate backbone of the template or primer in HIV-1 RT crystal structures and could potentially influence the positioning of the primer strand, thus affecting polymerization, the efficiency of nucleoside reverse transcriptase inhibitor excision and/or RNase H activity.
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Waters JM, O'Neal W, White KL, Wakeford C, Lansdon EB, Harris J, Svarovskaia ES, Miller MD, Borroto-Esoda K. Mutations in the thumb-connection and RNase H domain of HIV type-1 reverse transcriptase of antiretroviral treatment-experienced patients. Antivir Ther 2009; 14:231-239. [PMID: 19430098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Antiretroviral therapy that targets HIV type-1 (HIV-1) reverse transcriptase (RT) can be linked to mutations in the thumb-connection (amino acids [AA] 241-426) and RNase H (AA 427-560) domains, which could affect drug resistance. METHODS Genotypical and statistical analyses were performed on HIV-1 RT from 100 antiretroviral treatment-naive and 248 antiretroviral treatment-experienced patients, the majority of whom were infected with HIV-1 subtype B. The RT region was analysed in three parts: the polymerase (AA 1-240), thumb-connection (AA 241-426) and RNase H (AA 427-560) domains. RESULTS The polymerase domain had statistically significant changes between the two groups at 24 AA positions that are known resistance sites. Within the thumb-connection domain, R284 and N348 had statistically significant changes between the groups (P=0.007 and P< or =0.001, respectively). In treatment-experienced patients, 17.3% had R284K, whereas 24.5% had N348I substitutions. Both R284 and N348 were 100% conserved in treatment-naive patients. Within the RNase H domain, only K451 showed a statistically significant change (P</=0.001), with K451R present in 11% of treatment-experienced patients but remaining 100% conserved among treatment-naive patients. CONCLUSIONS RT mutations at three positions outside of the polymerase region were associated with antiretroviral therapy: R284K, N348I and K451R. Both R284K and K451R interact with the phosphate backbone of the template or primer in HIV-1 RT crystal structures and could potentially influence the positioning of the primer strand, thus affecting polymerization, the efficiency of nucleoside reverse transcriptase inhibitor excision and/or RNase H activity.
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Mehta J, Singhal S, Gee AP, Chiang KY, Godder K, Rhee Fv FV, DeRienzo S, O'Neal W, Lamb L, Henslee-Downey PJ. Bone marrow transplantation from partially HLA-mismatched family donors for acute leukemia: single-center experience of 201 patients. Bone Marrow Transplant 2004; 33:389-96. [PMID: 14716338 DOI: 10.1038/sj.bmt.1704391] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Between February 1993 and December 1999, 201 patients (1-59 years old, median 23) with acute leukemia (67% not in remission) underwent ex vivo T-cell-depleted (TCD) bone marrow transplants (BMT) from partially mismatched related donors (PMRD; 92% mismatched for 2-3 HLA A, B, DR antigens). Conditioning comprised total body irradiation, cyclophosphamide, cytarabine, etoposide, anti-thymocyte globulin (ATG), and methylprednisolone. Graft-versus-host disease (GVHD) prophylaxis comprised partial TCD with OKT3 (n=143) or T10B9 (n=58), steroids, ATG, and cyclosporine. The engraftment rate was 98%. The cumulative incidences of grades II-IV acute GVHD and chronic GVHD were 13 and 15%, respectively. The 5-year cumulative incidences of relapse and transplant-related mortality (TRM) were 31 and 51%, respectively. The actuarial 5-year overall survival (OS) and disease-free survival (DFS) probabilities were 19 and 18%, respectively. Patient age >15 years, active disease at transplant, donor age >25 years, and 3-antigen donor mismatch (host-versus-graft) affected the outcome adversely. The actuarial 5-year OS of four groups of patients identified based upon these risk factors was 39, 20, 13, and 0%, respectively (P<0.0001). We conclude that PMRD BMT is a potential treatment option for patients with high-risk acute leukemia who require an alternative donor transplant and fall into a group with a reasonable expected outcome.
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Affiliation(s)
- J Mehta
- Division of Transplantation Medicine, South Carolina Cancer Center, University of South Carolina, Columbia, SC, USA.
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Godder KT, Mehta J, Chiang KY, Adams S, van Rhee F, Singhal S, Higgins-Smith K, O'Neal W, DeRienzo S, Henslee-Downey JP, Metha J. Partially mismatched related donor bone marrow transplantation as salvage for patients with AML who failed autologous stem cell transplant. Bone Marrow Transplant 2001; 28:1031-6. [PMID: 11781612 DOI: 10.1038/sj.bmt.1703279] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2000] [Accepted: 09/13/2001] [Indexed: 11/08/2022]
Abstract
Treatment options for patients who relapse are limited and the outcome is dismal. Between August 1993 and January 1999, 17 patients, median age 26 (4-44) years, underwent T cell depleted bone marrow transplant from partially mismatched related donors (PMRD), as a salvage for AML relapsing after an autograft. The median time from auto-transplant to relapse was 7 months (1.5-24) and the interval between transplants was 10 months (3-30). All patients had active leukemia at time of transplant. Donors were siblings (n = 8), parents (n = 2), daughters (n = 4) and others (n = 3), and 82% were > or = 2 major HLA antigen mismatched with the recipient. The conditioning therapy included total body irradiation in 14 patients and was busulfan-based in three. Graft-versus-host disease (GVHD) prophylaxis consisted of partial T cell depletion along with post-transplant immunosuppression. Median day to engraftment was 16 days (12-20). Acute GVHD was seen in six patients, and chronic GVHD in four of 13 surviving beyond 100 days. Ten patients died of non-relapse causes, at 1-588 (median 77) days. Two patients relapsed at 3 and 4 months. Five patients (29%) are surviving leukemia-free 42-84 months post transplant (median 68 months). A short interval between transplants was predictive of early relapse but not mortality. Age <18 and <2 organ toxicities were marginally predictive of better survival. We conclude that BMT from PMRD is a reasonable option for patients with refractory AML post autograft.
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Affiliation(s)
- K T Godder
- Division of Transplantation Medicine, South Carolina Cancer Center Columbia, SC, USA
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Morral N, O'Neal W, Rice K, Leland M, Kaplan J, Piedra PA, Zhou H, Parks RJ, Velji R, Aguilar-Córdova E, Wadsworth S, Graham FL, Kochanek S, Carey KD, Beaudet AL. Administration of helper-dependent adenoviral vectors and sequential delivery of different vector serotype for long-term liver-directed gene transfer in baboons. Proc Natl Acad Sci U S A 1999; 96:12816-21. [PMID: 10536005 PMCID: PMC23112 DOI: 10.1073/pnas.96.22.12816] [Citation(s) in RCA: 346] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The efficiency of first-generation adenoviral vectors as gene delivery tools is often limited by the short duration of transgene expression, which can be related to immune responses and to toxic effects of viral proteins. In addition, readministration is usually ineffective unless the animals are immunocompromised or a different adenovirus serotype is used. Recently, adenoviral vectors devoid of all viral coding sequences (helper-dependent or gutless vectors) have been developed to avoid expression of viral proteins. In mice, liver-directed gene transfer with AdSTK109, a helper-dependent adenoviral (Ad) vector containing the human alpha(1)-antitrypsin (hAAT) gene, resulted in sustained expression for longer than 10 months with negligible toxicity to the liver. In the present report, we have examined the duration of expression of AdSTK109 in the liver of baboons and compared it to first-generation vectors expressing hAAT. Transgene expression was limited to approximately 3-5 months with the first-generation vectors. In contrast, administration of AdSTK109 resulted in transgene expression for longer than a year in two of three baboons. We have also investigated the feasibility of circumventing the humoral response to the virus by sequential administration of vectors of different serotypes. We found that the ineffectiveness of readministration due to the humoral response to an Ad5 first-generation vector was overcome by use of an Ad2-based vector expressing hAAT. These data suggest that long-term expression of transgenes should be possible by combining the reduced immunogenicity and toxicity of helper-dependent vectors with sequential delivery of vectors of different serotypes.
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Affiliation(s)
- N Morral
- Department of Molecular Genetics, Baylor College of Medicine, Houston, TX 77030, USA
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22
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Lamb LS, Abhyankar SA, Hazlett L, O'Neal W, Folk RS, Vogt S, Parrish RS, Bridges K, Henslee-Downey PJ, Gee AP. Expression of CD134 (0X-40) on T cells during the first 100 days following allogeneic bone marrow transplantation as a marker for lymphocyte activation and therapy-resistant graft-versus-host disease. Cytometry 1999; 38:238-43. [PMID: 10516610 DOI: 10.1002/(sici)1097-0320(19991015)38:5<238::aid-cyto6>3.0.co;2-o] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
CD134 (OX-40) is an activation-associated antigen which functions as a costimulatory receptor for CD4+ T cells. In order to determine the expression of CD134 during immune recovery following allogeneic bone marrow transplantation (BMT), we measured its expression on T cells and T cell subsets during the first 100 days following BMT in 26 patients. CD4+CD134+ T could be seen approximately 14 days following BMT cells in patients who did not develop GvHD which required therapy (n = 20). The percentage of CD4+CD134+ cells continued to increase up to the fourth week following BMT to a maximum of 40-50% of CD4+ T cells (normal = 1-8%). Two patients who developed Grade I-II GvHD and who responded to treatment with pulsed high-dose methylprednisolone (MPD) showed a decline of approximately 40% in CD4+CD134+ T cells was seen within 48 hours of treatment. Four patients who developed GvHD that was not responsive to MPD and who later developed high IV GvHD showed increasing CD4+CD134+ T cells up to 85% of the CD4+ T cells. Additionally, rapid increases in CD134+ T cells following antibody-based T cell therapy were associated with GvHD recurrence. In no cases was the percentage of CD134+ CD4+ T cells predictive of clinical GvHD. In this exploratory study, we have shown that CD134, although not predictive of the initial onset of GvHD, may be a useful tool for monitoring the response to early GvHD therapy and identification of patients at risk for reemergence of GvHD who may benefit from anti-T cell therapy. Cytometry (Comm. Clin. Cytometry) 38: 238-243, 1999.
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Affiliation(s)
- L S Lamb
- Division of Transplantation Medicine, Palmetto Richland Memorial Hospital, Center for Cancer Treatment and Research, University of South Carolina School of Medicine, Columbia, South Carolina.
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O'Neal W. Clinical trials--a golden opportunity for laboratories? MLO Med Lab Obs 1999; 31:20-2. [PMID: 11184275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Morral N, O'Neal W, Zhou H, Langston C, Beaudet A. Immune responses to reporter proteins and high viral dose limit duration of expression with adenoviral vectors: comparison of E2a wild type and E2a deleted vectors. Hum Gene Ther 1997; 8:1275-86. [PMID: 9215744 DOI: 10.1089/hum.1997.8.10-1275] [Citation(s) in RCA: 145] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Experiments designed to evaluate the effect of deletion of E2a on duration of expression using adenoviral vectors led to a series of observations regarding host responses to adenoviral vectors and reporter proteins. In studies using human alpha1-antitrypsin (hAAT) as a reporter gene, we found that the duration of expression is very brief for C3H/J and CBA/J mice but is prolonged for C57BL/6J mice, that disappearance of hAAT from the blood is correlated with the appearance of antibodies, and that immunization against hAAT can prevent appearance of the protein in the blood after administration of an adenoviral vector. Deletion of E2a in hAAT vectors did not prolong expession in C3H/J or CBA/J mice and did not shorten duration of expression in C57BL/6J mice. Using similar vectors expressing Escherichia coli beta-galactosidase (beta-Gal) in immunocompetent mice, short duration of expression with a beta-Gal reporter was remarkably different from the long expression with an identical vector expressing hAAT in C57BL/6J. In the case of vectors expressing hAAT, adenoviral sequences persisted in the liver, and inflammatory responses were minimal compared to vectors expressing beta-Gal, where adenoviral sequences disappeared from the liver concomitant with a prominent inflammatory response. The duration of expression of beta-Gal in hepatocytes was increased in transgenic mice expressing the reporter in keratinocytes, indicating that host immune responses to the reporter can limit duration of expression. Dosage studies indicated that persistence of expression of hAAT can be markedly decreased by administration of high doses of vector in a manner consistent with a nonimmune-mediated toxicity following injection. These experiments indicate that host responses to reporter genes rather than host responses to adenoviral proteins can be the primary determinant of duration of expression under many experimental conditions.
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Affiliation(s)
- N Morral
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
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Abstract
Although adenovirus vectors offer many advantages, it would be desirable to develop vectors with improved expression and decreased toxicity. Toward this objective, an adenovirus vector system with deletion of both the El and E2a regions was developed. A 5.9-kb fragment of the adenovirus type 5 (Ad5) genome containing the E2a gene and its early and late promoters was transfected into 293 cells. A complementing cell line, designated 293-C2, expressed the E2a mRNA and protein and was found to complement the defect in Ad5 viruses with temperature-sensitive or deletion mutations in E2a. A deletion of 1.3 kb removing codons 40 to 471 of the 529 amino acids of E2a was introduced into plasmids for preparation of viruses and vectors. An Ad5 virus with disruption of the El gene and deletion of E2a grew on 293-C2 cells but not on 293 cells. Vectors with E1 and E2a deleted expressing Escherichia coli beta-galactosidase or human alpha1-antitrypsin were prepared and expressed the reporter genes after intravenous injection into mice. This vector system retains sequences in common between the complementing cell line and the vectors, including 3.4 kb upstream and 1.1 kb downstream of the deletion. These vectors have potential advantages of increased capacity for insertion of transgene sequences, elimination of expression of E2a, and possibly reduction in expression of other viral proteins. Although the titers of the vectors with deleted are about 10- to 30-fold below those of vectors with E2a wild-type regions, the former vectors are suitable for detailed studies with animals to evaluate the effects on host immune responses, on duration of expression, and on safety.
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Affiliation(s)
- H Zhou
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030, USA
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26
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O'Neal W. Professional Clinical Chemists. Clin Chem 1992. [DOI: 10.1093/clinchem/38.3.436] [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: 11/12/2022]
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O'Neal W. Professional clinical chemists. Clin Chem 1992; 38:436. [PMID: 1547568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Abstract
The pharmacokinetics and pharmacodynamics of intravenous atenolol were studied in 10 children during cardiac electrophysiologic studies. The intravenous pharmacokinetic data were best described by a two-compartment model and revealed the following (mean +/- SD): total body clearance, 0.15 +/- 0.06 L/hr/kg; volume of the central compartment 0.33 +/- 0.06 L/kg; volume of distribution at steady state, 0.83 +/- 0.15 L/kg; distributive elimination half-life, 0.29 +/- 0.08 hour; and terminal elimination half-life, 4.56 +/- 1.05 hours. The data suggest that children have a slightly shorter terminal elimination half-life than that of adults. Pharmacodynamic data showed a significantly (p less than 0.01) increased sinus cycle length and an increase in His to ventricle conduction time (p less than 0.05). Further studies are necessary to determine the optimal oral dose and dosing frequency of atenolol and to access the response of children to long-term treatment.
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Affiliation(s)
- M L Buck
- Department of Clinical Pharmacy, Medical University of South Carolina, Charleston
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Flanigan RC, Butler KM, O'Neal W, Rapp RP, Casale AJ, Allen DC, McRoberts JW. Comparison of epsilon aminocaproic acid and normal saline for postoperative bladder irrigation following transurethral resection of prostate. Urology 1985; 26:227-8. [PMID: 3898514 DOI: 10.1016/0090-4295(85)90114-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A prospective, randomized, double-blind trial of bladder irrigation with a 0.5% solution of epsilon aminocaproic acid (EACA) versus normal saline plus placebo was undertaken in 75 patients undergoing transurethral resection of the prostate for benign or malignant disease. Systemic absorption after irrigation with EACA was not detectable. No significant advantage, however, was demonstrated for the EACA solution over normal saline irrigation in measured postoperative blood loss, irrigant volume, hours of catheterization, or length of hospital stay.
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O'Neal W, Whitten KM, Baumann RJ, Blouin RA, Piecoro JJ. Lack of serious toxicity following carbamazepine overdosage. Clin Pharm 1984; 3:545-7. [PMID: 6488737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Rapp RP, Young B, Foster TS, Tibbs PA, O'Neal W. Ceftazidime versus tobramycin/ticarcillin in treating hospital acquired pneumonia and bacteremia. Pharmacotherapy 1984; 4:211-5. [PMID: 6384945 DOI: 10.1002/j.1875-9114.1984.tb03360.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Thirty-five patients in a neurosurgical intensive care unit who had nosocomial pneumonia and bacteremia were randomly assigned to receive either ceftazidime (Cef) or the combination of ticarcillin and pharmacokinetically adjusted doses of tobramycin (T/T). Fifteen of 17 patients (88%) who received Cef were cured or improved compared to 15 of 18 (83%) who received T/T. The original pathogen was eradicated from the respiratory secretion in 10 of 15 patients receiving Cef compared to only 6 of 18 patients receiving T/T (p = 0.12). All patients in both treatment groups who had positive blood cultures cleared the organism from the bloodstream. No cases of drug toxicity, including renal toxicity, were seen in either group. Cef used as a single agent in nosocomial pneumonias and bacteremias performed at least as well as T/T.
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