3,160 results on '"Dhawan A"'
Search Results
2. Nanotechnology-based Herbal Formulations: A Survey of Recent Patents, Advancements, and Transformative Headways
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Anureet Kaur, Lakhvir Kaur, Ayushi Mahajan, Ravi Dhawan, and Gurjeet Singh
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2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Drug Compounding ,Herbal Medicine ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,General Engineering ,food and beverages ,Nanotechnology ,Condensed Matter Physics ,complex mixtures ,COVID-19 Drug Treatment ,Patents as Topic ,Transformative learning ,Humans ,Medicine ,General Materials Science ,business - Abstract
Nanotechnology in association with herbal medicine can lead to enhanced therapeutic and diminished adverse effects of medication. In turn, it can lead to synergistic effects of administered compound overcoming its demerits. Nowadays, the trend of herbal compounds to treat even a small illness is gaining momentum. Gone are the days when the ineffectiveness of a compound was impossible to be dealt with. Nevertheless, in this competitive era of science and innovative technology, it has become possible to maximize the usefulness of ineffective yet potent herbal compounds. The demand for herbal compounds is getting amplified because of their ability to treat a myriad of diseases, including COVID-19, showing fewer side effects. The merger of nanotechnology with traditional medicine augments the potential of herbal drugs for devastating dangerous and chronic diseases like cancer. In this review article, we have tried to assimilate the complete information regarding the use of different nanocarriers to overcome the drawbacks of herbal compounds. In addition, all the recent advancements in the herbal field, as well as the future exploration to be emphasized, have been discussed.
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- 2022
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3. Understanding Corporate Social Responsibility beyond Corporate Responsibility
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Rao, R. Prabhakar and Dhawan, Nidhi
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- 2017
4. Chest wall tuberculosis in children: a mimicker of bone tumour
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Muthuvel Balasubramaniyan, Sanjay Verma, Akshay Kumar Saxena, and Sumeet R Dhawan
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musculoskeletal diseases ,medicine.medical_specialty ,Sternum ,Tuberculosis ,030231 tropical medicine ,Antitubercular Agents ,Bone Neoplasms ,Case Report ,Tuberculosis, Osteoarticular ,03 medical and health sciences ,0302 clinical medicine ,Scapula ,Bone tumours ,030225 pediatrics ,medicine ,Humans ,Child ,Thoracic Wall ,Paediatric oncology ,business.industry ,Osteoarticular tuberculosis ,General Medicine ,medicine.disease ,Radiology ,Presentation (obstetrics) ,business - Abstract
Osteoarticular tuberculosis of flat bones of the chest wall such as sternum, scapula and rib is extremely rare in children. Because of its atypical clinical presentation mimicking malignant bone tumours, diagnosis remains a challenge. Histological and microbiological diagnosis remains confirmatory. Antitubercular therapy is the cornerstone in management.
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- 2023
5. Low-dose radiation therapy (LDRT) for COVID-19 and its deadlier variants
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Edward J. Calabrese, Rachna Kapoor, Gaurav Dhawan, James S. Welsh, Vikas Dhawan, and Seyed Alireza Javadinia
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medicine.medical_specialty ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,business.industry ,NF-E2-Related Factor 2 ,Health, Toxicology and Mutagenesis ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Pharmacology toxicology ,Low dose ,COVID-19 ,Dose-Response Relationship, Radiation ,Radiotherapy Dosage ,General Medicine ,Toxicology ,Letter to the Editor, News and Views ,Clinical trial ,Treatment modality ,Low Dose Radiation Therapy ,Medicine ,Humans ,business ,Intensive care medicine - Abstract
Coronavirus variants are gaining strongholds throughout the globe. Despite early signals that SARS-CoV-2 coronavirus case numbers are easing up in the United States and during the middle of a (not so easy) vaccination roll out, the country has passed a grim landmark of 600,000 deaths. We contend that these numbers would have been much lower if the medical community undertook serious investigations into the potential of low doses of radiation (LDRT) as a mainstream treatment modality for COVID-19 pneumonia. LDRT has been posited to manifest anti-infectious and anti-inflammatory properties at doses of 0.3-1.0 Gy via the activation of the Nrf-2 pathway. Although some researchers are conducting well-designed clinical trials on the potential of LDRT, the deep-rooted, blind, and flawed acceptance of the Linear No-Threshold (LNT) model for ionizing radiation has led to sidelining of this promising therapy and thus unimaginable numbers of deaths in the United States.
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- 2021
6. Enhanced performance of triple‐junction tandem organic solar cells due to the presence of plasmonic nanoparticles
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Uttam K. Kumawat, Kamal Kumar, Anuj Dhawan, and Abhijit Das
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Plasmonic nanoparticles ,Technology ,Materials science ,Tandem ,Organic solar cell ,broadband absorption ,business.industry ,Triple junction ,Science ,scattering ,organic solar cells ,FDTD simulations ,General Energy ,Optoelectronics ,light trapping ,nanoparticles ,Safety, Risk, Reliability and Quality ,business - Abstract
A triple‐junction tandem organic solar cell (OSC) having polymer active materials, P3HT:PC70BM, Si‐PCPDTBT:PC70BM, and PMDPP3T:PC70BM is presented. These active layer materials cover a 300 nm to 1000 nm broad solar spectrum and have minimally overlapping narrow absorption bands. The performance of the triple‐junction tandem OSC was improved by introducing plasmonic nanospheres (NSs) over the top electrode of the OSC. The OSCs were modeled in finite‐difference time‐domain (FDTD) to optimize the performance of the NSs. Nanospheres of three plasmonic materials—gold (Au), silver (Ag), and aluminum (Al) were individually simulated over the top electrode of the OSCs. The NSs affect absorption in the active layer materials, around their respective plasmonic resonance peaks. The low‐cost Al NSs enhance light trapping in the top and middle subcells, leading to a 14% improvement in overall short circuit current density (JSC) of the triple‐junction tandem OSC in comparison with that of the reference OSC without any NSs. It is also observed that while the enhancement of the overall JSC of the triple‐junction tandem OSC due to the Al NSs is greater than that due to the Ag NSs, the presence of Au NSs leads to a decrease in the overall JSC in comparison with that of the reference OSC.
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- 2022
7. Mycoplasma hominis: An under recognized pathogen
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Jaweed Ahmed, Jyoti Rawre, Neha Dhawan, Neena Khanna, and Benu Dhawan
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0301 basic medicine ,Microbiology (medical) ,030106 microbiology ,Immunology ,Mycoplasma hominis ,Microbiology ,03 medical and health sciences ,0302 clinical medicine ,Immune system ,Antibiotic resistance ,Immunology and Microbiology (miscellaneous) ,Humans ,Immunology and Allergy ,Medicine ,Mycoplasma Infections ,030212 general & internal medicine ,Abscess ,Pathogen ,Virulence ,General Immunology and Microbiology ,biology ,business.industry ,Genitourinary system ,medicine.disease ,biology.organism_classification ,Anti-Bacterial Agents ,Infectious Diseases ,Infective endocarditis ,Septic arthritis ,business - Abstract
Mycoplasma hominis, a commensal of the genital tract, is a potential underestimated pathogen causing both genitourinary and extragenital infections including neonatal infections. Septic arthritis, prosthetic joint infection, central nervous system (CNS) infections, infective endocarditis and abscess formation are common extragenital infections associated mainly with immunocompromised patients. Mycoplasma hominis lipoproteins play an important role in pathogenicity and directly interact with the host immune system. Polymerase chain reaction (PCR) is the mainstay of diagnosis. Increasing resistance to tetracyclines and quinolones which are used for treatment, is a matter of global concern. We reviewed PubMed literature and Google search engine on the recent developments of association of Mycoplasma hominis with various diseases, pathogenesis, diagnosis and treatment.
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- 2021
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8. Global Health Education during the COVID-19 Pandemic: Challenges, Adaptations, and Lessons Learned
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Bobbi S. Pritt, Brett Hendel-Paterson, Stephen J. Dunlop, Hope M Pogemiller, Megan K. Shaughnessy, Alma Habib, William M. Stauffer, Adriana Dhawan, Beth Scudder, Kristina M. Krohn, Viviane Tchonang Leuche, Nasreen S. Quadri, Tsige H Gebreslasse, Michael A Sundberg, Sarah Sponsler, and Sarah Kesler
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Online model ,Universities ,media_common.quotation_subject ,Global Health ,Education, Distance ,Excellence ,Virology ,Global health ,Humans ,Uganda ,Environmental impact assessment ,Quality (business) ,Health Education ,Perspective Pieces ,media_common ,SARS-CoV-2 ,business.industry ,COVID-19 ,Public relations ,Thailand ,United States ,Synchronous learning ,Infectious Diseases ,Sustainability ,Carbon footprint ,Parasitology ,Curriculum ,business - Abstract
Global health education programs should strive continually to improve the quality of education, increase access, create communities that foster excellence in global health practices, and ensure sustainability. The COVID-19 pandemic forced the University of Minnesota’s extensive global health education programs, which includes a decade of hybrid online and in-person programing, to move completely online. We share our experience, a working framework for evaluating global health educational programming, and lessons learned. Over the decades we have moved from a predominantly passive, lecture-based, in-person course to a hybrid online (passive) course with an intensive hands-on 2-week requirement. The pandemic forced us to explore new active online learning models. We retained our on-demand, online passive didactics, which used experts’ time efficiently and was widely accessible and well received. In addition, we developed a highly effective synchronous online component that we felt replaced some of the hands-on activities effectively and led us to develop new and innovative “hands-on” experiences. This new, fully online model combining quality asynchronous and synchronous learning provided many unanticipated advantages, such as increasing access while decreasing our carbon footprint dramatically. By sharing our experience, lessons learned, and resources, we hope to inspire other programs likewise to innovate to improve quality, access, community, and sustainability in global health, especially if these innovations can help decrease negative aspects of global health education such as its environmental impact.
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- 2021
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9. Gastro-retentive drug delivery system: A better approach of drug delivery system
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Rita Dhawan, Rajiv Kumar, Rohit Kumar Chopra, Parminder Nain, and Harpreet Singh
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medicine.medical_specialty ,business.industry ,Drug delivery ,Medicine ,Gastro retentive ,business ,Intensive care medicine ,System a - Abstract
The oral route is the best and most popular route for the administration of drugs in the systemic circulation. There are number of drugs which are given through the oral route. Gastro-retentive drug delivery system is very important system for the drug delivery system. The gastro-retentive drugs prolonged the drug time in the git and also improve their their bioavailability. These are widely used for site specific for the treatment of git disorders and diseases. There are number of approaches for gastro retentive drug delivery system such as floating system, mucoadhesive system, swelling system, high density system etc. In this review we discussed about approaches and various perspectives of gastro retentive drug delivery system.
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- 2021
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10. Laboratory detection of bacterial pathogens and clinical and laboratory response of syndromic management in patients with cervical discharge: A retrospective study
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Sanjay Singh, Deepika Yadav, Seema Sood, Somesh Gupta, and Benu Dhawan
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medicine.medical_specialty ,Infectious Diseases ,Syndromic management ,business.industry ,Internal medicine ,Medicine ,Retrospective cohort study ,In patient ,Dermatology ,Cervical discharge ,business - Abstract
Background Cervical discharge as part of cervicitis and pelvic inflammatory disease is a cause of significant morbidity in sexually active women worldwide. Non-gonococcal and non- chlamydial bacterial pathogens are becoming more prevalent. Aims This study aims to determine bacterial pathogens causing cervical discharge using culture and/or polymerase chain reaction and assess the clinical and laboratory response to the conventional syndromic kit regimen established by the World Health Organisation. Methods A retrospective review of records of women with cervical discharge over one year period. Culture and/or polymerase chain reaction results of endocervical swabs of various bacterial pathogens at baseline and after four weeks of treatment with syndromic kit regimen were recorded. Results A total of 70 case records were reviewed for clinical details, out of which results of bacterial culture and polymerase chain reaction were available for 67 cases. Infectious aetiology was found in 30 (44.7%) patients with Ureaplasma species being the most common organism isolated on culture (18, 26.8%) and polymerase chain reaction (25, 37.3%), respectively. Polymerase chain reaction for Chlamydia trachomatis and Mycoplasma hominis was positive in ten (14.9%) and four (6%) cases, respectively. None of the patients showed positive culture for Neisseria gonorrhoeae. Coinfection was seen in eight (11.9%) patients with the majority showing Chlamydia trachomatis and Ureaplasma spp. coinfection (five patients). Forty one cases (58.5%) received tab. cefixime 400 mg and tab. azithromycin one gram stat (kit 1), while 29 cases (43.3%) received tab. cefixime 400 mg stat, tab. metronidazole 400 mg and cap. doxycycline 100 mg, both twice daily for 14 days (kit 6). Minimal to no clinical improvement with treatment was seen in 14 out of 32 cases (44%) at the end of four weeks with the conventional kit regimen. Post-treatment culture and/or polymerase chain reaction were positive in nine out of 28 cases (32.1%) with Ureaplasma spp. being the most common. Limitations Retrospective study design, small sample size and fewer cases with follow-up data were the main limitations. Conclusion Ureaplasma spp. was the most common infectious cause of cervical discharge in our patients. Treatment given as part of syndromic management led to a clinical and microbiological response in around half and two-third cases, respectively.
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- 2021
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11. Comparison of 4 weeks versus 12 weeks antiseizure medication for acute symptomatic seizures in children with Acute Encephalitis Syndrome: An open-label, randomized controlled trial
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Naveen Sankhyan, Muralidharan Jayashree, Sumeet R Dhawan, Jitendra Kumar Sahu, and Pratibha Singhi
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Pediatrics ,medicine.medical_specialty ,Time Factors ,Randomization ,Encephalopathy ,law.invention ,Epilepsy ,Randomized controlled trial ,Recurrence ,Seizures ,law ,medicine ,Acute Febrile Encephalopathy ,Humans ,Child ,Neuroradiology ,business.industry ,Electroencephalography ,Symptomatic seizures ,General Medicine ,medicine.disease ,Clinical trial ,Neurology ,Relative risk ,Anticonvulsants ,Neurology (clinical) ,business - Abstract
Objective To compare the proportion of children with seizure recurrence/s during 6-18 months of follow-up among children with acute symptomatic seizures underlying acute encephalitis syndrome (AES) treated with either 4 weeks or 12 weeks of antiseizure medication (ASM). Methods Eligible children aged 3 months to 12 years with acute symptomatic seizures underlying AES, receiving a single ASM at 4 weeks of illness, and without seizure recurrence from day 7–28 of illness were included in this comparative, parallel-group assignment, open-label, randomized control study (either 4 weeks or 12 weeks duration). The primary outcome was to compare proportions of children developing seizure recurrence over six months of follow-up. The secondary outcomes were to study seizure recurrence over 12–18 months follow-up and factor(s) associated with seizure recurrence. Results Of 232 children with AES screened, 60 eligible children were randomized in two groups. Baseline demographics were comparable (except the duration of illness) between the groups. Seizure recurrences at 6, 12 and 18 months were none, two (one in each group, relative risk 1.0, 95% CI 0.06–16.76; p-value >0.99), and six (one and five children in 4 and 12 weeks groups respectively, relative risk 0.17, 95% CI 0.01–1.62; p-value 0.19) respectively. There was no association of seizure recurrences with seizure characteristics, abnormal electroencephalography and neuroradiology. Children with disabilities at randomization had a higher risk of seizure recurrence at 18 months of follow-up (relative risk 7.16, 95% CI 1.1–43.9; p-value 0.049). Significance With limitations of the study design, this study provides Class I evidence that a shorter duration (4 weeks) of ASM is comparable with 12 weeks therapy for preventing seizure recurrences in children with AES. Trial registration Clinical Trials.gov identifier: NCT03181945; Clinical Trial Registry of India identifier: CTRI/2017/06/008783.
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- 2021
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12. Fluorine-containing pharmaceuticals approved by the FDA in 2020: Synthesis and biological activity
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Jianlin Han, Yingjie Yu, Vadim A. Soloshonok, Aiyao Liu, Haibo Mei, Kunisuke Izawa, Wei Zhang, and Gagan Dhawan
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Food and drug administration ,business.industry ,Hereditary angioedema ,Medicine ,Fluorine containing ,Biological activity ,General Chemistry ,Pharmacology ,business ,medicine.disease - Abstract
Thirteen new fluorine-containing drugs, which have been granted approval by the US Food and Drug Administration (FDA) in 2020, are profiled in this review. Therapeutic areas of these new fluorinated pharmaceuticals include medicines and diagnostic agents for Cushing's disease, neurofibromatosis, migraine, Alzheimer's disease, myelodysplastic syndromes, hereditary angioedema attacks, and various cancers. Molecules of these approved drugs feature aromatic fluorine (Ar-F) (11 compounds), aromatic Ar-CF3 (1), aliphatic CHF (1) and CF2 (1) groups. For each compound, we provide a spectrum of biological activity, medicinal chemistry discovery, and synthetic approaches.
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- 2021
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13. Multipotentiality of Luliconazole against Various Fungal Strains: Novel Topical Formulations and Patent Review
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Ayushi Mahajan, Ravi Dhawan, Lakhvir Kaur, Gurjeet Singh, and Lovepreet Singh
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Antifungal ,Antifungal Agents ,Traditional medicine ,medicine.drug_class ,business.industry ,Luliconazole ,Fungi ,Imidazoles ,chemistry.chemical_compound ,Topical cream ,Infectious Diseases ,Biopharmaceutical ,chemistry ,Skin penetration ,Drug Discovery ,Aqueous solubility ,medicine ,Pharmacology (medical) ,business ,Candida - Abstract
Abstract: Luliconazole is a broad-spectrum antifungal agent with impactful fungicidal and fungistatic activity. It has shown exceptional potency against miscellaneous fungal strains like Candida, Aspergillus, Malassezia, Fusarium species and various dermatophytes. Luliconazole belongs to class II of the Biopharmaceutical Classification System with low aqueous solubility. Although it is available conventionally as 1% w/v topical cream, it has limitations of lower skin permeation and shorter skin retention. Therefore, nanoformulations based on various polymers and nanostructure carriers can be employed to overcome the impediments regarding topical delivery and efficacy of luliconazole. In this review, we have tried to provide insight into the literature gathered from authentic web resources and research articles regarding recent research conducted on the subject of formulation development, patents, and future research requisites of luliconazole. Nanoformulations can play a fundamental role in improving topical delivery by escalating dermal localization and skin penetration. Fabricating luliconazole into nanoformulations can overcome the drawbacks and can efficiently enhance its antimycotic activity. It has been concluded that luliconazole has exceptional potential in the treatment of various fungal infections, and therefore, it should be exploited to its maximum for its innovative application in the field of mycology.
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- 2021
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14. Proceedings of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition Monothematic Conference, 2020: 'Acute Liver Failure in Children': Treatment and Directions for Future Research
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Girish Gupte, Henkjan J. Verkade, Dominique Debray, Jörg Jahnel, Sara Mancell, Nedim Hadzic, Estelle Alonso, Robert H. Squires, Ulrich Baumann, Giuseppe Indolfi, Françoise Smets, Marianne Samyn, Austen Worth, Piotr Czubkowski, Björn Fischler, Stéphan Clément de Cléty, Georg Auzinger, Aglaia Zellos, Christian Staufner, Anil Dhawan, Yael Mozer, Ton Lisman, Ryszard Grenda, UCL - SSS/IREC/PEDI - Pôle de Pédiatrie, UCL - (SLuc) Service de gastro-entérologie et hépatologie pédiatrique, UCL - (SLuc) Service de soins intensifs, Groningen Institute for Organ Transplantation (GIOT), and Center for Liver, Digestive and Metabolic Diseases (CLDM)
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medicine.medical_specialty ,business.industry ,Gastroenterology ,Liver failure ,Infant ,Nutritional Status ,Liver Failure, Acute ,Pediatrics, Perinatology and Child Health ,medicine ,Humans ,Child ,Child Nutritional Physiological Phenomena ,Intensive care medicine ,business ,Societies, Medical - Abstract
OBJECTIVES: The Hepatology Committee of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) aims to educate pediatric gastroenterologists, members of ESPGHAN and professionals from other specialties promoting an exchange of clinical expertise in the field of pediatric hepatology.METHODS: The 2020 single topic ESPGHAN monothematic 3-day conference on pediatric liver disease, was organized in Athens, Greece and was entitled " Acute Liver Failure" (ALF). ALF is a devastating disease with high mortality and in a considerable fraction of patients, the cause remains unresolved. As knowledge in diagnosis and treatment of ALF in infants and children has increased in the past decades, the objective was to update physicians in the field with developments in medical therapy and indications for liver transplantation (LT) and to identify areas for future research in clinical and neurocognitive outcomes in ALF.RESULTS: We recently reported the epidemiology, diagnosis, and initial intensive care management issues in separate manuscript. Herewith we report on the medical treatment, clinical lessons arising from pediatric studies, nutritional and renal replacement therapy (RRT), indications and contraindications for LT, neurocognitive outcomes, new techniques used as bridging to LT, and areas for future research. Oral presentations by experts in various fields are summarized highlighting key learning points.CONCLUSIONS: The current report summarizes the current insights in medical treatment of pediatric ALF and the directions for future research.
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- 2021
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15. Abnormal monocyte differentiation and function in chronic myelomonocytic leukemia
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Abhishek Dhawan and Eric Padron
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Myeloid ,business.industry ,Monocyte ,Disease progression ,Chronic myelomonocytic leukemia ,Cell Differentiation ,Leukemia, Myelomonocytic, Chronic ,Hematology ,Disease ,medicine.disease ,Monocytes ,Hematopoiesis ,Haematopoiesis ,medicine.anatomical_structure ,Monocyte differentiation ,medicine ,Cancer research ,Humans ,business ,Function (biology) ,Secretome - Abstract
PURPOSE OF REVIEW Monocytes serve as the phagocytic defense surveillance system of the human body. Although there is comprehensive evidence regarding monocyte development, characterization and function under steady state hematopoietic continuum, the deviations and complexities in the monocyte secretome during myeloid malignancies have not been comprehensively examined and delineated. RECENT FINDINGS This review summarizes the aspects of development, functions, transcriptional and cytokine-mediated regulation of monocytes during steady state hematopoiesis and also contrasts the aberrations observed in myelomonocytic leukemias like chronic myelomonocytic leukemia (CMML). It presents the findings from the major studies highlighting the novel markers for identifying CMML monocytes, altered signaling cascades, roles in disease progression and potential therapeutic interventions to reduce the monocyte mediated inflammatory milieu for disease amelioration. SUMMARY Recent findings provide rationale for the development of therapeutic strategies aimed at disrupting the leukemic initiating cells and malignant monocyte axis.
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- 2021
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16. Cutaneous ectopia of lung, located on back and neck: Hitherto undescribed presentation
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Rupali Sharma, Shashi Dhawan, and Osama
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Pathology ,medicine.medical_specialty ,Histology ,Lung ,Choristoma ,business.industry ,Rare entity ,Dermatology ,respiratory system ,medicine.disease ,respiratory tract diseases ,Pathology and Forensic Medicine ,medicine.anatomical_structure ,Heterotopia (medicine) ,medicine ,Presentation (obstetrics) ,Lung tissue ,business - Abstract
Ectopia is defined as the presence of a normal-appearing tissue in an abnormal location, where it is not normally found. In the literature, it is also referred to as heterotopia and is described as choristoma when it forms a mass. Lung tissue ectopia is a rare anomaly and is characterized by presence of mature lung tissue comprising of well-formed bronchi, bronchioles and alveoli at an abnormal location. Occurrence of ectopic lung tissue in the skin is an extremely rare entity and the diagnosis is mostly established by histopathologic examination. This report documents a rare occurrence of cutaneous ectopic lung tissue at two locations (neck and back). Cutaneous ectopia at multiple sites has not been described in the literature till date. This article is protected by copyright. All rights reserved.
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- 2021
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17. Liver transplantation for pediatric inherited metabolic liver diseases
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Anil Dhawan and Sunitha Vimalesvaran
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Inherited ,medicine.medical_specialty ,Pediatric metabolic liver disease ,Liver transplantation ,Hepatology ,Medical treatment ,business.industry ,medicine.medical_treatment ,Gold standard ,End stage liver disease ,Minireviews ,Long terms ,Cell therapy ,Transplantation ,Gene therapy ,Quality of life ,medicine ,Liver based metabolic disorders ,Intensive care medicine ,business ,Pediatric population - Abstract
Liver transplantation (LT) remains the gold standard treatment for end stage liver disease in the pediatric population. For liver based metabolic disorders (LBMDs), the decision for LT is predicated on a different set of paradigms. With improved outcomes post-transplantation, LT is no longer merely life saving, but has the potential to also significantly improve quality of life. This review summarizes the clinical presentation, medical treatment and indications for LT for some of the common LBMDs. We also provide a practical update on the dilemmas and controversies surrounding the indications for transplantation, surgical considerations and prognosis and long terms outcomes for pediatric LT in LBMDs. Important progress has been made in understanding these diseases in recent years and with that we outline some of the new therapies that have emerged.
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- 2021
18. Critically ill patients with severe immune checkpoint inhibitor related neurotoxicity: A multi-center case series
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Michael Hovden, Prabalini Rajendram, Abhijit Duggal, Stephen M. Pastores, Vikram Dhawan, Cristina Gutierrez, Jeannee Campbell, and Heather Torbic
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Pediatrics ,medicine.medical_specialty ,Critical Illness ,medicine.medical_treatment ,Encephalopathy ,Guillain-Barre Syndrome ,Critical Care and Intensive Care Medicine ,Article ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Myasthenia Gravis ,medicine ,Humans ,Renal replacement therapy ,Adverse effect ,Immune Checkpoint Inhibitors ,Retrospective Studies ,Mechanical ventilation ,business.industry ,030208 emergency & critical care medicine ,Retrospective cohort study ,medicine.disease ,Intensive care unit ,Intensive Care Units ,030228 respiratory system ,Concomitant ,business ,Polyneuropathy - Abstract
Purpose Serious immune checkpoint inhibitor (ICI)-related neurotoxicity is rare. There is limited data on the specifics of care and outcomes of patients with severe neurological immune related adverse events (NirAEs) admitted to the Intensive Care Unit (ICU). Materials and methods Retrospective study of patients with severe NirAEs admitted to the ICU at 3 academic centers between January 2016 and December 2018. Clinical data collected included ICI exposure, type of NirAE (central [CNS] or peripheral nervous system [PNS) disorders), and patient outcomes including neurological recovery and mortality. Results Seventeen patients developed severe NirAEs. Eight patients presented with PNS disorders; 6 with myasthenia gravis (MG), 1 had a combination of MG and polyneuropathy and 1 had Guillain-Barre syndrome. Nine patients had CNS disorders (6 seizures and 5 had concomitant encephalopathy. During ICU admission, 65% of patients required mechanical ventilation, 35% vasopressors, and 18% renal replacement therapy. The median ICU and hospital length of stay were 7 (2–36) and 18 (4–80) days, respectively. Hospital mortality was 29%. At hospital discharge, 18% of patients made a full neurologic recovery, 41% partial recovery, and 12% did not recover. Conclusion Severe NirAEs while uncommon, can be serious or even life-threatening if not diagnosed and treated early.
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- 2021
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19. Hypercholesterolemia Impairs Clearance of Neutrophil Extracellular Traps and Promotes Inflammation and Atherosclerotic Plaque Progression
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Purbasha Bhattacharya, Manikandan Subramanian, Sriram Narayanan, Umesh Kumar Dhawan, Ayush Aggarwal, and Vijayprakash Manickam
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Male ,Necrosis ,Mice, Knockout, ApoE ,Neutrophils ,THP-1 Cells ,Plaque progression ,Hypercholesterolemia ,Aortic Diseases ,HL-60 Cells ,Inflammation ,Extracellular Traps ,deoxyribonucleases ,necrosis ,Lesion ,chemistry.chemical_compound ,Translational Sciences ,medicine ,Animals ,Deoxyribonuclease I ,Humans ,plasma ,extracellular trap ,Endodeoxyribonucleases ,business.industry ,Endoplasmic reticulum ,Tauroursodeoxycholic acid ,Hep G2 Cells ,Neutrophil extracellular traps ,Atherosclerosis ,Endoplasmic Reticulum Stress ,Plaque, Atherosclerotic ,Mice, Inbred C57BL ,Disease Models, Animal ,chemistry ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,Disease Progression ,Cancer research ,Female ,Caco-2 Cells ,Inflammation Mediators ,medicine.symptom ,Chemical chaperone ,Cardiology and Cardiovascular Medicine ,business ,Signal Transduction - Abstract
Supplemental Digital Content is available in the text., Objective: Hypercholesterolemia-induced NETosis and accumulation of neutrophil extracellular traps (NETs) in the atherosclerotic lesion exacerbates inflammation and is causally implicated in plaque progression. We investigated whether hypercholesterolemia additionally impairs the clearance of NETs mediated by endonucleases such as DNase1 and DNase1L3 and its implication in advanced atherosclerotic plaque progression. Approach and Results: Using a mouse model, we demonstrate that an experimental increase in the systemic level of NETs leads to a rapid increase in serum DNase activity, which is critical for the prompt clearance of NETs and achieving inflammation resolution. Importantly, hypercholesterolemic mice demonstrate an impairment in this critical NET-induced DNase response with consequent delay in the clearance of NETs and defective inflammation resolution. Administration of tauroursodeoxycholic acid, a chemical chaperone that relieves endoplasmic reticulum stress, rescued the hypercholesterolemia-induced impairment in the NET-induced DNase response suggesting a causal role for endoplasmic reticulum stress in this phenomenon. Correction of the defective DNase response with exogenous supplementation of DNase1 in Apoe−/− mice with advanced atherosclerosis resulted in a decrease in plaque NET content and significant plaque remodeling with decreased area of plaque necrosis and increased collagen content. From a translational standpoint, we demonstrate that humans with hypercholesterolemia have elevated systemic extracellular DNA levels and decreased plasma DNase activity. Conclusions: These data suggest that hypercholesterolemia impairs the NET-induced DNase response resulting in defective clearance and accumulation of NETs in the atherosclerotic plaque. Therefore, strategies aimed at rescuing this defect could be of potential therapeutic benefit in promoting inflammation resolution and atherosclerotic plaque stabilization.
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- 2021
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20. Increased Load to Failure in Biceps Tenodesis With All-Suture Suture Anchor Compared With Interference Screw: A Cadaveric Biomechanical Study
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Aman Dhawan, Dallas M. Smuin, Emily Vannatta, Gregory S. Lewis, Christopher M. Stauch, and Brittany Ammerman
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Orthodontics ,030222 orthopedics ,Sutures ,business.industry ,Bone Screws ,Tenodesis ,030229 sport sciences ,Biceps ,Biomechanical Phenomena ,03 medical and health sciences ,Preload ,0302 clinical medicine ,medicine.anatomical_structure ,Suture (anatomy) ,Suture Anchors ,Load to failure ,Cadaver ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Displacement (orthopedic surgery) ,Cortical bone ,business ,Cadaveric spasm ,Fixation (histology) - Abstract
To compare the biomechanical characteristics of a single radially expanding all-suture anchor with an interference screw for open subpectoral long head of biceps tendon (LHBT) tenodesis.Eighteen fresh-frozen matched-pair human cadaveric humeri were used for this biomechanical study. The matched pair humeri were randomly assigned into 2 experimental biceps tenodesis groups: conventional interference screw (CIS) or all-suture suture anchor (ASSA). Open subpectoral LHBT tenodesis was then performed and biomechanical testing was performed using a servohydraulic test frame. A preload of 5 N was applied for 2 minutes before cyclic loading. Displacement was recorded at cycle 300 (D300) and cycle 500 (D500) and at ultimate failure. Data recorded included displacement, load to failure, displacement at failure. Paired t test was used for analysis.Decreased displacement was observed for the CIS group at D300 (1.67 ± 0.57 mm vs 3.35 ± 2.24 mm; P = .04), D500 (2.00 ± 0.76 mm vs 3.87 ± 2.20 mm; P = .04), and at failure (5.17 ± 3.05 mm vs 10.76 ± 2.66 mm; P.001). Load to failure was lower in CIS specimens (170 ± 24.5 N vs 217.8 ± 51.54 N; P = .02). Failure in each case was tendon pullout for all CIS specimens; in ASSA 6 specimens failed as the suture pulled through the tendon, 2 specimens failed by suture breakage. No difference in stiffness was observed between the 2 groups (CIS = 98.33 ± 22.98 N/m vs ASSA = 75.94 ± 44.83 N/m; P = .20).Our study found that open subpectoral biceps tenodesis performed with an ASSA construct results in increased load to failure as compared with CIS. However, the CIS did demonstrate decreased displacement as compared to ASSA in this cadaveric biomechanical study.ASSA and CIS at time zero provide fixation as indicated by the provider intraoperatively for LHBT tenodesis. ASSA, however, does remove less cortical bone than does CIS and therefore produces a smaller stress riser in the proximal humerus. Further testing as to the integrity of ASSA is warranted to determine the integrity of the tenodesis with cyclical loading.
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- 2021
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21. Nicotine Exposure Via Electronic Cigarettes Significantly Impedes Biomechanical Healing Properties of Tendon Healing in a Rat Model
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Gregory S. Lewis, Erin Barlow, Jesse E. Bible, Aman Dhawan, Patrick Kennedy, Matthew R. Garner, Kaitlin Saloky, Aditya Yadavalli, and Michael Aynardi
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Nicotine ,NICOTINE EXPOSURE ,Electronic Nicotine Delivery Systems ,010501 environmental sciences ,Achilles Tendon ,01 natural sciences ,law.invention ,Rats, Sprague-Dawley ,Masson's trichrome stain ,03 medical and health sciences ,0302 clinical medicine ,law ,Animals ,Medicine ,Orthopedics and Sports Medicine ,Clinical significance ,0105 earth and related environmental sciences ,Wound Healing ,030222 orthopedics ,Achilles tendon ,business.industry ,Rats ,Tendon ,medicine.anatomical_structure ,Anesthesia ,Cohort ,Analysis of variance ,business ,Electronic cigarette - Abstract
Purpose To evaluate the biomechanical and histologic effects on Achilles tendon repair of inhaled combusted tobacco versus nicotine exposure via electronic cigarette versus a control group in a small-animal model (Sprague-Dawley rat). Methods Fifty-four Sprague-Dawley rats were randomized into 3 groups: combusted tobacco, e-cigarettes, or control. Experimental rats were exposed to research cigarettes or e-cigarette vapor in a smoking chamber for 4 weeks. Surgical transection and repair of the Achilles tendon were then completed, followed by 2 additional weeks of exposure. Achilles tendons were harvested, and biomechanical tensile testing was performed. Histologic evaluation was completed, including hematoxylin-eosin staining, trichrome staining, and immunohistochemistry analysis for type I and type III collagen. Results The control group showed the highest mean tensile load to failure, at 41.0 ± 10.4 N (range, 18.3-55.1 N); the cigarette cohort had the second highest mean, at 37.3 ± 11.1 N (range, 14.0-54.7 N); and finally, the vaping group had the lowest mean, at 32.3 ± 8.4 N (range, 17.8-45.1 N). One-way analysis of variance showed a significant difference in load to failure when comparing the control group with the e-cigarette group (P = .026). No statistical difference was detected between the control group and cigarette group (P = .35) or between the e-cigarette group and cigarette group (P = .23). Stiffness and qualitative histologic analysis showed no difference among groups. Conclusions This investigation shows that in a rat model, nicotine exposure via e-cigarette significantly impedes the biomechanical healing properties of Achilles tendon surgical repair. Clinical Relevance The results indicate that although e-cigarettes are often used as a perceived “safer” alternative to smoking, their use may have a detrimental effect on tendon load to failure.
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- 2021
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22. To Study the Outcome of Cataract Surgery in a Rural Indian Population Which Primarily Depends on Camps and NGOs for a Free Cataract Surgery
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Bodhraj Dhawan and Vaishali B Dhawan
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medicine.medical_specialty ,business.industry ,General surgery ,medicine.medical_treatment ,Indian population ,Medicine ,Cataract surgery ,business ,Outcome (game theory) - Published
- 2020
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23. Doppler Evaluation of Vertebral Artery in Cervical Spondylosis - A Prospective Study in Rural Indian Set Up
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Bodhraj Dhawan and Vaishali B Dhawan
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medicine.medical_specialty ,symbols.namesake ,business.industry ,Vertebral artery ,medicine.artery ,symbols ,Cervical spondylosis ,Medicine ,Radiology ,business ,medicine.disease ,Prospective cohort study ,Doppler effect - Published
- 2020
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24. Low dose radiation therapy as a potential life saving treatment for COVID-19-induced acute respiratory distress syndrome (ARDS)
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Rachna Kapoor, Bharat Monga, James Giordano, Gaurav Dhawan, Edward J. Calabrese, Rajiv Dhawan, and Ravinder Singh
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RANTES, regulated on activation and normally T-cell expressed ,medicine.medical_specialty ,ARDS ,PDGF, platelet derived growth factor ,Pneumonia, Viral ,Disease ,IFN-γ, interferon γ ,Cytokine storm ,Article ,IP, induced protein ,030218 nuclear medicine & medical imaging ,Betacoronavirus ,03 medical and health sciences ,Hormesis ,0302 clinical medicine ,Pandemic ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Intensive care medicine ,Adverse effect ,Pandemics ,FGF, fibroblast growth factors ,TNF-α, tumor necrosis factor α ,Anti-inflammatory phenotype ,Respiratory Distress Syndrome ,VEGF, vascular endothelial growth factor ,SARS-CoV-2 ,business.industry ,Public health ,COVID-19 ,Hematology ,MCP, monocyte chemoattractant protein ,medicine.disease ,G-CSF, granulocyte colony-stimulating factor ,IL, interleukin ,Low dose radiotherapy ,Acute Respiratory Distress Syndrome (ARDS) ,Oncology ,Radiology Nuclear Medicine and imaging ,030220 oncology & carcinogenesis ,Low Dose Radiation Therapy ,GM-CSF, Granulocyte-macrophage colony-stimulating factor ,Coronavirus Infections ,business ,MIP, macrophage inflammatory protein - Abstract
Highlights • The clinical spectrum of COVID-19 ranges from an asymptomatic form to mild respiratory symptoms such as dry cough, fever, and moderate dyspnea, to more severe presentations, such as neurologic manifestations (e.g.- cerebrovascular accident consequential to cytokine-induced changes in blood clotting; direct encephalitic effects), viral pneumonia, acute respiratory distress syndrome (ARDS) and sequential organ failure (SOF) as result of cytokine storm. • The entry of pathogenic COVID-19 virus in humans leads to activation of inflammatory cells. Activated inflammatory cells enter the pulmonary circulation and induce a ubiquity of cytokines (i.e.- “cytokine storm”) that lead to rapid, wide-spread damage of the pulmonary epithelium and alveolar cells, as well as other vital organs. • Low-dose Radiotherapy (RT) induces a highly integrated, complex, and systemic response that involves polarization of macrophages to an M-2 anti-inflammatory phenotype. • Recommend administering a single dose of 0.3 - 0.5 Gy to patients experiencing pneumonia, ARDS (Cytokine storm), to attempt rapid amelioration of the systemic inflammatory cascade., The new coronavirus COVID-19 disease caused by SARS-CoV-2 was declared as global public health emergency by WHO on Jan 30, 2020. Despite massive efforts from various governmental, health and medical organizations, the disease continues to spread globally with increasing fatality rates. Several experimental drugs have been approved by FDA with unknown efficacy and potential adverse effects. The exponentially spreading pandemic of COVID-19 deserves prime public health attention to evaluate yet unexplored arenas of management. We opine that one of these treatment options is low dose radiation therapy for severe and most critical cases. There is evidence in literature that low dose radiation induces an anti-inflammatory phenotype that can potentially afford therapeutic benefit against COVID-19- related complications that are associated with significant morbidity and mortality. Herein, we review the effects and putative mechanisms of low dose radiation that may be viable, useful and of value in counter-acting the acute inflammatory state induced by critical stage COVID-19.
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- 2020
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25. Initial Invasive or Conservative Strategy for Stable Coronary Disease
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Maron D. J., Hochman J. S., Reynolds H. R., Bangalore S., O'Brien S. M., Boden W. E., Chaitman B. R., Senior R., Lopez-Sendon J., Alexander K. P., Lopes R. D., Shaw L. J., Berger J. S., Newman J. D., Sidhu M. S., Goodman S. G., Ruzyllo W., Gosselin G., Maggioni A. P., White H. D., Bhargava B., Min J. K., John Mancini G. B., Berman D. S., Picard M. H., Kwong R. Y., Ali Z. A., Mark D. B., Spertus J. A., Krishnan M. N., Elghamaz A., Moorthy N., Hueb W. A., Demkow M., Mavromatis K., Bockeria O., Peteiro J., Miller T. D., Szwed H., Doerr R., Keltai M., Selvanayagam J. B., Gabriel Steg P., Held C., Kohsaka S., Mavromichalis S., Kirby R., Jeffries N. O., Harrell F. E., Rockhold F. W., Broderick S., Bruce Ferguson T., Williams D. O., Harrington R. A., Stone G. W., Rosenberg Y, ISCHEMIA Research Group: Joseph Ricci, A Tello Montoliu, A I Robero Aniorte, Abbey Mulder, Abhay A Laddu, Abhinav Goyal, Abhishek Dubey, Abhishek Goyal, Abigail Knighton, Abraham Oomman, Adam J Jaskowiak, Adam Kolodziej, Adam Witkowski, Adnan Hameed, Adriana Anesini, Afshan Hussain, Agne Juceviciene, Agne Urboniene, Agnes Jakal, Agnieszka Szramowska, Ahmad Khairuddin, Ahmed Abdel-Latif, Ahmed Adel, Ahmed Aljzeeri, Ahmed Kamal, Ahmed Talaat, Aimee Mann, Aira Contreras, Ajit Kumar, V K Kumar, Akemi Furukawa, Akshay Bagai, Akvile Smigelskaite, Alain Furber, Alain Rheault, Alaine Melanie Loehr, Alan Rosen, Albert Varga, Albertina Qelaj, Alberto Barioli, Aldo Russo, Alec Moorman, Alejandro Gisbert, Aleksandra Fratczak, Aleksandras Laucevicius, Alena Kuleshova, Alessandro Sionis, Alexander A Sirker, Alexander M Chernyavskiy, Alexandra Craft, Alexandra Vazquez, Alexandre Ciappina Hueb, Alexandre S Colafranseschi, Alexandre Schaan de Quadros, Alexandre Tognon, Ali Alghamdi, Alice Manica Muller, Aline Nogueira Rabaça, Aline Peixoto Deiro, Alison Hallam, Allegra Stone, Allison Schley, Almudena Castro, Alvaro Rabelo Ales, Amanda Germann, Amanda O'Malley, Amar Uxa, Amarachi Ojajuni, Amarino C Oliveira Jr, Amber B Hull, Ambuj Roy, Amer Zarka, Amir Janmohamed, Ammani Brown, Ammy Malinay, Amparo Martinez Monzonis, Amy J Richards, Amy Iskandrian, Amy Ollinger, Ana D Djordjevic-Dikic, Ana Fernández Martínez, Ana Gomes Almeida, Ana Paula Batista, Ana Rita Francisco, Ana S Mladenovic, Ana Santana, Anam Siddiqui, Anastasia M Kuzmina-Krutetskaya, Andras Vertes, Andre S Sousa, Andre Gabriel, André Schmidt, Andrea M Lundeen, Andrea Bartykowszki, Andrea Lorimer, Andrea Mortara, Andrea Pascual, Andreia Coelho, Andreia Rocha, Andrés García-Rincón, Andrew G Howarth, Andrew J Moriarty, Andrew Docherty, Andrew Starovoytov, Andrew Zurick, Andrzej Łabyk, Andrzej Swiatkowski, Andy Lam, Anelise Kawakami, Angela Hoye, Angela Kim, Angelique Smit, Angelo Nobre, Anil V Shah, Anja Ljubez, Anjali Anand, Ankush Sachdeva, Ann Greenberg, Ann Luyten, Ann Ostrander, Anna Di Donato, Anna Cichocka-Radwan, Anna Fojt, Anna Plachcinska, Anna Proietti, Anna Teresinska, Anne Marie Webb, Anne Cartwright, Anne Heath, Anne Mackin, Anong Amaritakomol, Anong Chaiyasri, Anoop Chauhan, Anoop Mathew, Anthony Gemignani, Anto Luigi Andres, Antonia Vega, Antonietta Hansen, Antonino Ginel Iglesias, Antonio Carlos Carvalho, Antonio Di Chiara, Antonio Serra Peñaranda, Antonio Carvalho, Antonio Colombo, Antonio Fiarresga, Anupama Rao, Aquiles Valdespino-Estrada, Araceli Boan, Areef Ishani, Ariel Diaz, Arijit Ghosh, Arintaya Prommintikul, Arline Roberts, Arnold H Seto, Arnold P Good, Arshed Quyyumi, Arthur J Labovitz, Arthur Kerner, Arturo S Campos-Santaolalla, Arunima Misra, Ashok Mukherjee, Ashok Seth, Ashraf Seedhom, Asim N Cheema, Asker Ahmed, Atul Mathur, Atul Verma, Audrey W Leong, Axel Åkerblom, Axelle Fuentes, Aynun Naher, Badhma Valaiyapathi, Baljeet Kaur, Bandula Guruge, Barbara Brzezińska, Barbara Nardi, Bartosz Czarniak, Bebek Singh, Begoña Igual, Bela Merkely, Belen Cid Alvarez, Benjamin J Spooner, Benjamin J W Chow, Benjamin Cheong, Benoy N Shah, Bernard de Bruyne, Bernardas Valecka, Bernhard Jäger, Beth A Archer, Beth Abramson, Beth Jorgenson, Bethany Harvey, Betsy O'Neal, Bev Atkinson, Bev Bozek, Bevin Lang, Bijulal Sasidharan, Bin Yang, Bin Zhang, Binoy Mannekkattukudy Kurian, Bjoern Goebel, Bob Hu, Bogdan A Popescu, Bogdan Crnokrak, Bolin Zhu, Bonnie J Kirby, Brandi D Zimbelman, Brandy Starks, Branko D Beleslin, Brenda Hart, Brian P Shapiro, Brian McCandless, Brianna Wisniewski, Brigham R Smith, Brooks Mirrer, Bruce McManus, Bruce Rutkin, Bruna Edilena Paulino, Bruna Maria Ascoli, Bryn Smith, Byron J Allen, C Michael Gibson, C Noel Bairey Merz, Calin Pop, Cameron Hague, Camila Thais de Ormundo, Candace Gopaul, Candice P Edillo, Carísi A Polanczyk, Carita Krannila, Carla Vicente, Carl-Éric Gagné, Carlo Briguori, Carlos Peña Gil, Carlos Alvarez, Carly Ohmart, Carmen C Beladan, Carmen Ginghina, Carol M Kartje, Caroline Alsweiler, Caroline Brown, Caroline Callison, Caroline Pinheiro, Caroline Rodgers, Caroline Spindler, Carolyn Corbett, Carrie Drum, Casey Riedberger, Catherine Bone, Catherine Fleming, Catherine Gordon, Catherine Jahrsdorfer, Catherine Lemay, Catherine Weick, Cathrine Patten, Cecilia Goletto, Cezary Kepka, Chandini Suvarna, Chang Xu, Chantale Mercure, Charle A Viljoen, Charlene Wiyarand, Charles Jia-Yin Hou, Charles Y Lui, Charles Cannan, Charles Cornet, Charlotte Pirro, Chataroon Rimsukcharoenchai, Chen Wang, Cheng-Ting Tsai, Chen-Yen Chien, Cheryl A Allardyce, Chester M Hedgepeth, Chetan Patel, Chiara Attanasio, Chih-Hsuan Yen, Chi-Ming Chow, Ching Min Er, Ching-Ching Ong, Cholenahally Nanjappa Manjunath, Chris Beck, Chris Buller, Christel Vassaliere, Christian Hamm, Christiano Caldeira, Christie Ballantyne, Christina Björklund, Christine R Hinton, Christine Bergeron, Christine Masson, Christine Roraff, Christine Shelley, Christophe Laure, Christophe Thuaire, Christopher Kinsey, Christopher McFarren, Christopher Spizzieri, Christopher Travill, Chun-Chieh Liu, Chung-Lieh Hung, Chunguang Li, Chun-Ho Yun, Chunli Xia, Ciarra Heard, Cidney Schultz, Clare Venn-Edmonds, Claudia P Hochberg, Claudia Wegmayr, Claudia Cortés, Claudia Escobar, Cláudia Freixo, Claudio T Mesquita, Clemens T Kadalie, Colin Berry, Constance Philander, Corine Thobois, Costantino Costantini, Courtney Page, Craig Atkinson, Craig Barr, Craig Paterson, Cristina Bare, Cynthia Baumann, Cynthia Burman, Dalisa Espinosa, Damien Collison, Dan Deleanu, Dan Elian, Dan Gao, Dana Oliver, Daniel P Vezina, Daniel O'Rourke, Daniele Komar, Danielle Schade, Darrel P Francis, Dastan Malaev, David A Bull, David E Winchester, David P Faxon, David Booth, David Cohen, David DeMets, David Foo, David Schlichting, David Taggart, David Waters, David Wohns, Davis Vo, Dawid Teodorczyk, Dawn Shelstad, Dawn Turnbull, Dayuan Li, Dean Kereiakes, Deborah O'Neill, Deborah Yip, Debra K Johnson, Debra Dees, Deepak L Bhatt, Deepika Gopal, Deepti Kumar, Deirdre Mattina, Deirdre Murphy, Delano R Small, Delsa K Rose, Dengke Jiang, Denis Carl Phaneuf, Denise Braganza, Denise Fine, Derek Cyr, Desiree Tobin, Diana Cukali, Diana Parra, Diane Camara, Diane Minshall Liu, Diego Adrián Vences, Diego Franca de Cunha, Dimitrios Stournaras, Dipti Patel, Dongze Li, Donna Exley, Dorit Grahl, Dragana Stanojevic, Duarte Cacela, Dwayne S G Conway, E Pinar Bermudez, Eapen Punnoose, Edgar L Tay, Edgar Karanjah, Edoardo Verna, Eduardo Hernandez-Rangel, Edward D Nicol, Edward O McFalls, Edward T Martin, Edyta Kaczmarska, Ekaterina I Lubinskaya, Elena A Demchenko, Elena Refoyo Salicio, Eli Feen, Elihú Durán-Cortés, Elisabeth M Janzen, Elise L Hannemann, Elise van Dongen, Elissa Restelli Piloto, Eliza Kaplan, Elizabeta Srbinovska Kostovska, Elizabeth Capasso-Gulve, Elizabeth Congdon, Elizabeth Ferguson, Elizaveta V Zbyshevskaya, Ellen Magedanz, Ellie Fridell, Ellis W Lader, Elvin Kedhi, Emanuela Racca, Emilie Tachot, Emily DeRosa, Encarnación Alonso-Álvarez, Eric Nicollet, Eric Peterson, Erick Alexánderson Rosas, Erick Donato Morales, Erin Orvis, Ermina Moga, Estelle Montpetit, Estevao Figueiredo, Eugene Passamani, Eugenia Nikolsky, Eunice Yeoh, Evgeniy I Kretov, Ewa Szczerba, Ewelina Wojtala, Expedito Eustáquio Ribeiro Silva, F Marin Ortuño, Fabio R Farias, Fabio Fimiani, Fabrizio Rolfo, Fa-Chang Yu, Fadi Hage, Fadi Matar, Fahim Haider Jafary, Fang Feng, Fang Liu, Fatima Ranjbaran, Fatima Rodriguez, Fausto J Pinto, Fauzia Rashid, Federica Ramani, Fei Wang, Fernanda Igansi, Filipa Silva, Filippo Ottani, Fiona Haines, Firas Al Solaiman, Flávia Egydio, Flavio Lyra, Florian Egger, Fran Farquharson, Frances Laube, Francesc Carreras Costa, Francesca de Micco, Francesca Bianchini, Francesca Pezzetta, Francesca Pietrucci, Francesco Orso, Francesco Pisano, Francis Burt, Francisca Patuleia Figueiras, Francisco Fernandez-Aviles, Francois Pierre Mongeon, Frans Van de Werf, Franziska Guenther, Fraser N Witherow, Fred Mohr, Frederico Dall'Orto, Fumiyuki Otsuka, G De La Morena, G Karthikeyan, Gabor Dekany, Gabor Kerecsen, Gabriel Galeote, Gabriel Grossmann, Gabriel Vorobiof, Gabriela Sanchez de Souza, Gabriela Guzman, Gabriela Zeballos, Gabriele Gabrielli, Gabriele Jakl-Kotauschek, Gail A Shammas, Gail Brandt, Gang Chen, Gary E Lane, Gary J Luckasen, Gautam Sharma, Gelmina Mikolaitiene, Gennie Yee, Georg Nickenig, George E Revtyak, George J Juang, Gerald Fletcher, Gerald Leonard, Gerard Patrick Devlin, Gerard Esposito, Gergely Ágoston, Gervasio Lamas, Geza Fontos, Ghada Mikhail, Gia Cobb, Gian Piero Perna, Gianpiero Leone, Giles Roditi, Gilles Barone-Rochette, Girish Mishra, Giuseppe Tarantini, Glenda Wong, Glenn S Hamroff, Glenn Rayos, Gong Cheng, Gonzalo Barge-Caballero, Goran Davidović, Goran Stankovic, Gordana Stevanovic, Grace Jingyan Wang, Grace M Young, Graceanne Wayser, Graciela Scaro, Graham S Hillis, Graham Wong, Grazyna Anna Szulczyk, Gregor Simonis, Gregory Kumkumian, Gretchen Ann Peichel, Grzegorz Gajos, Gudrun Steinmaurer, Guilherme G Rucatti, Guilherme Portugal, Guilhermina Cantinho Lopes, Guillem Pons Lladó, Gunnar Frostfelt, Gurpreet S Wander, Gurpreet Gulati, Gustavo Pucci, Hafidz Abd Hadi, Haibo Zhang, Haitao Wang, Halina Marciniak, Han Chen, Hanan Kerr, Hani Najm, Hanna Douglas, Hannah Phillips, Hao Dai, Haojian Dong, Haqeel Jamil, Harikrishnan Sivadasanpillai, Harry Suryapranata, Hassan Reda, Hayley Pomeroy, Heather Barrentine, Heather Golden, Heather Hurlburt, Heidi Wilson, Helen C Tucker, Helene Abergel, Hemalata Siddaram, Hermine Osseni, Herwig Schuchlenz, Hesong Zeng, Hicham Skali, Hilda Solomon, Hollie Horton, Holly Hetrick, Holly Little, Holly Park, Hongjie Chi, Hossam Mahrous, Howard A Levite, Hristo Pejkov, Huajun Li, Hugo Bloise-Adames, Hugo Marques, Hui Zhong, Hui-Min Zhang, Humayrah Hashim, Hung-I Yeh, Hussien El Fishawy, Ian Webb, Iftikhar Kullo, Igor O Grazhdankin, Ihab Hamzeh, Ikraam Hassan, Ikuko Ueda, Ileana L Pina, Ilona Tamasauskiene, Ilse Bouwhuis, Imran Arif, Ina Wenzelburger, Inês Zimbarra Cabrita, Ines Rodrigues, Inga H Robbins, Inga Soveri, Ingela Schnittger, Iqbal Karimullah, Ira M Dauber, Iram Rehman, Irena Peovska Mitevska, Irene Marthe Lang, Irina Subbotina, Irma Kalibataite-Rutkauskiene, Irni Yusnida, Isabel Estela Carvajal, Isabella C Palazzo, Isabelle Hogan, Isabelle Roy, Ishba Syed, Ishita Tejani, Ivan A Naryshkin, Ivana Jankovic, Iwona Niedzwiecka, J David Knight, Jacek Kusmierek, Jackie M White, Jackie Chow, Jacob Udell, Jacqueline E Tamis-Holland, Jacqueline Fannon, Jacquelyn A Quin, Jacquelyn Do, Jaekyeong Heo, Jakub Maksym, James E Davies, James H O'Keefe Jr, James J Jang, James Cha, James Harrison, James Hirsch, James Stafford, James Tatoulis, Jamie Rankin, Jan Henzel, Jan Orga, Jana Tancredi, Janaina Oliveira, Jane Burton, Jane Eckstein, Jane Marucci, Janet P Knight, Janet Blount, Janet Halliday, Janetta Kourzenkova, Janitha Raj, Jan-Malte Sinning, Jaqueline Pozzibon, Jaroslaw Drozdz, Jaroslaw Karwowski, Jason D Glover, Jason Loh Kwok, Jason T Call, Jason Linefsky, Jassira Gomes, Jati Anumpa, Javier J Garcia, Javier Courtis, Jay Meisner, K Jayakumar, Jayne Scales, Jean E Denaro, Jean Michel Juliard, Jean Ho, Jeanette K Stansborough, Jean-Michel Juliard, Jeanne Russo, Jeannette J M Schoep, Jeet Thambyrajah, Jeff Leimberger, Jeffery A Breall, Jeffrey A Kohn, Jeffrey C Milliken, Jeffrey Anderson, Jeffrey Blume, Jeffrey Kanters, Jeffrey Lorin, Jeffrey Moses, Jelena J Stepanovic, Jelena Celutkiene, Jelena Djokic, Jelena Stojkovic, Jenne M Jose, Jenne Manchery, Jennifer A Mull, Jennifer H Czerniak, Jennifer L Stanford, Jennifer Gillis, Jennifer Horst, Jennifer Isaacs, Jennifer Langdon, Jennifer Thomson, Jennifer Tomfohr, Jennifer White, Jen-Yuan Kuo, Jeremy Rautureau, Jerome Fleg, Jessica Berg, Jessica Rodriguez, Jessica Waldron, Jhina Patro, Jia Li, Jiajia Mao, Jiamin Liu, Jian'an Wang, Jianhua Li, Jianxin Zhang, Jie Qi, Jihyun Lyo, Jill Marcus, Jim Blankenship, Jing Zhang, Jingjing Liu, Jing-Yao Fan, Jiun-Yi Li, Jiwan Pradhan, Jiyan Chen, J M Rivera Caravaca, Jo Evans, Joan Garcia Picart, Joan Hecht, Joanna Jaroch, Joanna Zalewska, Joanne Kelly, Joanne Taaffe, João Reynaldo Abbud, João V Vitola, Joaquín V Peñafiel, Jocelyne Benatar, Jody Bindeman, Joe Sabik, Joel Klitch, Johann Christopher, Johannes Aspberg, John D Friedman, John F Beltrame, John F Heitner, John Joseph Graham, John R Davies, John Doan, John Kotter, John Kurian, John Mukai, John Pownall, Jolanta Sobolewska, Jon Kobashigawa, Jonathan L Goldberg, Jonathan W Bazeley, Jonathan Byrne, Jonathan Himmelfarb, Jonathan Leipsic, Jonean Thorsen, Jorge F Trejo Gutierrez, Jorge Escobedo, Jorik Timmer, José A Ortega-Ramírez, José Antonio Marin-Neto, Jose D Salas, Jose Enrique Castillo, Jose Francisco Saraiva, José J Cuenca-Castillo, Jose L Diez, José Luis Narro Villanueva, José Luiz da Vieira, José M Flores-Palacios, Jose Ramon Gonzalez, Jose Seijas Amigo, Jose Fragata, Josep Maria Padró, Josheph F X McGarvey Jr, Joseph Hannan, Joseph Sacco, Joseph Sweeny, Joseph Wiesel, Josephine D Abraham, Joshua P Loh, Joy Burkhardt, Joyce R White, Joyce Riestenberg-Smith, Judit Sebo, Judith L Meadows, Judith Wright, Judy Mae Foltz, Judy Hung, Judy Otis, Juergen Stumpf, Jui-Peng Tsai, Julia S Dionne, Julia de Aveiro Morata, Julie Bunke, Julie Morrow, Julio César Figal, Jun Fujita, Jun Jiang, Junhua Li, Junqing Yang, Juntima Euathrongchit, Jyotsna Garg, K Manjula Rani, K Preethi, Kaatje Goetschalckx, Kai Eggers, Kamalakar Surineni, Kanae Hirase, T R Kapilamoorthy, Karen Calfas, Karen Gratrix, Karen Hallett, Karen Hultberg, Karen Nugent, Karen Petrosyan, Karen Swan, Karolina Kryczka, Karolina Wojtczak-Soska, Karolina Wojtera, Karsten Lenk, Karthik Ramasamy, Katarzyna Łuczak, Katarzyna Malinowska, Kate Pointon, Kate Robb, Katherine Martin, Kathleen Claes, Kathryn Carruthers, Kathy E Siegel, Katia Drouin, Katie Fowler-Lehman, Kavita Rawat, Kay Rowe, Keiichi Fukuda, Keith A A Fox, Ken Mahaffey, Kendra Unterbrink, Kenneth Giedd, Kerrie Van Loo, Kerry Lee, Kerstin Bonin, Kevin R Bainey, Kevin T Harley, Kevin Anstrom, Kevin Chan, Kevin Croce, Kevin Landolfo, Kevin Marzo, Keyur Patel, Khaled Abdul-Nour, Khaled Alfakih, Khaled Dajani, Khaled Ziada, Khaula Baloch, Khrystyna Kushniriuk, Kian-Keong Poh, Kim F Ireland, Kim Holland, Kimberly Ann Byrne, Kimberly E Halverson, Kimberly Elmore, Kimberly Miller-Cox, Kiran Reddy, Kirsten J Quiles, Kirsty Abercrombie, Klaus Matschke, Konrad Szymczyk, Koo Hui Chan, Kotiboinna Preethi, Kozhaya Sokhon, Krissada Meemuk, Kristian Thygesen, Kristin M Salmi, Kristin Newby, Kristina Wippler, Kristine Arges, Kristine Teoh, Krystal Etherington, Krystyna Łoboz-Grudzień, Krzysztof W Reczuch, Krzysztof Bury, Krzysztof Drzymalski, Krzysztof Kukuła, Kuo-Tzu Sung, Kurt Huber, Ladda Douangvila, Lance Sullenberger, Larissa Miranda Trama, Laszlone Matics, Laura Drew, Laura Flint, Laura Keinaite, Laura Sarti, Laurel Kolakaluri, Lawrence M Phillips, Lawrence Friedman, Lawrence Phillips, Lazar Velicki, Leah Howell, Leandro C Maranan, Leanne Cox, Ledjalem Daba, Lei Zhang, Lekshmi Dharmarajan, Leo Bockeria, Leonardo Pizzol Caetano, Leonardo Bridi, Leonid L Bershtein, Leszek Sokalski, Li Hai Yan, Li Li, Lia Nijmeijer, Lidia Sousa, Lihong Xu, Lihua Zhang, Lili Zhang, Lilia Schiavi, Lilian Mazza Barbosa, Lillian L Khor, Lina Felix-Stern, Linda L Hall, Linda M Hollenweger, Linda Arcand, Linda Davidson-Ray, Linda Schwarz, Lindsey N Sikora, Lingping Chi, Lino Patricio, Liping Zhang, Lisa Chaytor, Lisa Hatch, Lisa McCloy, Lisa Wong, Liselotte Persson, Lixin Jiang, Liz Low, Ljiljana Pupic, Loïc Bière, Lorenzo Monti, Lori Christensen, Lori Pritchard, Loriane Black, Lori-Ann Desimone, Lori-Ann Larmand, Lorraine McGregor, Louise Morby, Louise Thomson, Luc Harvey, Luciana de Pádua Baptista, Lucilla Garcia, Ludivine Eliahou, Ludmila Helmer, Luis F Smidt, Luis Bernanrdes, Luis Guzman, Luiz A Carvalho, Luyang Xiong, Lynette L Teo, Lynn M Neeson, Lynne Winstanley, M Barbara Srichai-Parsia, M Quintana Giner, M Sowjanya Reddy, M Valdés Chávarri, M Grazia Rossi, Maarten Simoons, Maayan Konigstein, Maciej Lesiak, Maciej Olsowka, Mafalda Selas, Magalie Corfias, Magdalena Madero Rovalo, Magdalena Łanocha, Magdalena Miller, Magdalena Misztal-Teodorczyk, Magdalena Rantinella, Magdy Abdelhamid, Magnolia Jimenez, Mahboob Alam, Mahevamma Mylarappa, Mahfouz El Shahawy, Mahmoud Mohamed, Mahmud Al-Bustami, Majo X Joseph, Malgorzata Frach, Małgorzta Celińska-Spodar, Malte Helm, Manas Chacko, Mandy Murphy, Manitha Vinod, Manjula Rani, Manu Dhawan, Manuela Mombelli, Marcel Weber, Marcello Galvani, Marcelo Jamus Rodrigues, Marcia F Dubin, Marcia F Werner Bayer, Marcin Szkopiak, Marco Antonio Monsalve, Marco Bizzaro Santos, Marco Magnoni, Marco Marini, Marco Sicuro, Marco Zenati, Marcos Valério Coimbra Resende, Marek Roik, Margalit Bentzvi, Margaret Gilsenan, Margaret Iraola, Margot C 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Jr, Matthew Budoff, Matthew Jezior, Matthew Luckie, Matthias Friedrich, Mauren P Haeffner, Maximilian Tscharre, Max-Paul Winter, Mayana Almeida, Mayil S Krishnam, Mayuri Patel, Meenakshi Mishra, Megan Manocchia, Meghana Kakade, Melanie J Munro, Melissa D Chaplin, Melissa LeFevre, Mervyn Andiapen, Michael A Gibson, Michael B Rubens, Michael C Turner, Michael D Shapiro, Michael W Lee, Michael Berlowitz, Michael Davidson, Michael Mack, Michael McDaniel, Michael Mumma, Michal Wlodarczyk, Michel G Khouri, Michel S Slama, Michele Rawlins, Michelle M Bonner, Michelle M Seib, Michelle Chang, Michelle Crowder, Michelle Dixon, Michelle Mayon, Michelle McEvoy, Michelle Yee, Miguel M Fernandes, Miguel Nobre Menezes, Miguel Souto Bayarri, Miguel Barrero, Mikhail T Torosoff, Milan R Dobric, Milan Dobric, Milica Nikola Dekleva, Milind Avdhoot Gadkari, Millie Gomez, Min Tun Kyaw, Miriam Brooks, Miroslav Stevo Martinovic, Mitchel B Lustre, Mohammad Tariq Vakani, Mohammad El-Hajjar, Mohammed Al-Amoodi, Mohammed Hussain, Mohammed Saleem, Moisés Blanco-Calvo, Moisés Jiménez-Santos, Mona Bhatia, Monica Rosca, Monika Laukyte, Montserrat Gracida Blanca, Montserrat Vila Perales, Mouaz H Al-Mallah, Moysés de Oliveira Filho, Mpiko Ntsekhe, Muhamed Saric, Mulei Chen, Myriam Brousseau, Myrthes Emy Takiuti, Nada Cemerlic-Adjic, Nadia Asif, Nadia Gakou, Nafisa Hussain, Nana O Katamadze, Nancy L Clapp, Nancy Aedy, Nandita Nataraj, Nanette K Wenger, Naomi Uchida, Nasrul Ismail, Natalia S Oliveira, Natalia de Carvalho Maffei, Natalie Spitzer, Natasha C Putnam, Naved Aslam, Neamat Mowafy, Neeraj Pandit, Neeraj Parakh, Nevena Garcevic, Ngaire Meadows, Nhi N Tran, Nicholas Danchin, Nicki Lakeman, Nicola Johnston, Nicolas W Shammas, Nicole Saint Vrestil, Nicole Deming, Nier Zhong, Niket Patel, Nikola N Boskovic, Nikolaos Karogiannis, Nikos Werner, Nina Johnston, Ning Zhang, Ning Zhou, Niree Hindoyan, Nirmal Kumar, Nitika Chadha, Nitish Naik, Nodira Aripova, Noloyiso Mtana, Nona A Eskelson, Noor Syamira 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Paula García-González, Paulo Cury Rezende, Paulo Ricardo Caramori, Pavel S Kozlov, Pedro Canas Silva, Pedro Gabriel Melo Barros E Silva, Pedro Píccaro de Oliveira, Pedro Carvalho, Pedro Modas, Pedro Rio, Peeyush Jain, Peiyu He, Peter A McCullough, Peter H Stone, Peter M Pollak, Peter Douglass, Peter Henriksen, Peter OKane, Peter Ong, Philip Jones, Philip Rogal, Philippe Généreux, Philippe Menasche, Philippe Rheault, Phoebe Goold, Pierre Gervais, Pierre Michaud, Pilar Calvillo, Ping Chai, Piotr Jakubowski, Piotr Pruszczyk, Piotr Slomka, Piyamitr Sritara, Poay-Huan Loh, Poonam Sonawane, Pouneh Samadi, Pragnesh P Parikh, Prakash Deedwania, Pranav M Patel, Praneeth Polamuri, Pratiksha Sharma, Precilia Vasquez, Preeti Kamath, Prince Thomas, Priyadarshani Arambam, Puja K Mehta, Purvez Grant, Pushpa Naik, Qi Zhong, Qian Zhao, Qiang Zhou, Qianqian Yuan, Qin Yu, Qingxian Li, Qiulan Xie, Qiutang Zeng, R J Vindhya, R James Gerlach, Rachel King, Rada Vučić, Radmila Lyubarova, Radoslaw Pracon, 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Stephanie M Lane, Stephanie Ferket, Stephanie Kelly, Stephanie Wasmiller, Stephen H McKellar, Stephen P Hoole, Stephen Fremes, Stephen Preston, Steve Leung, Steven A Fein, Steven J Lindsay, Steven P Sedlis, Steven Giovannone, Steven Michael, Steven Weitz, Stijn van Vugt, Subhash Banerjee, Sudhir Naik, Suellen Hosino, Sukie Desire, Sukit Yamwong, Suku T Thambar, Sulagna Mookherjee, Suman Singh, Sundeep Mishra, Sunil Kumar Verma, Supap Kulthawong, Supatchara Khwakhong, Surendra Naik, Suresh Babu, Surin Woragidpoonpol, Suryaprakash Narayanappa, Susan Derbyshire, Susan Gent, Susan Mathus, Susan Milbrandt, Susan Moore, Susan Regan, Susan Stinson, Susan Webber, Susana Silva, Susanna Stevens, Susanne Gruensfelder, Suthara Aramcharoen, Suvarna Kolhe, Suzana Tavares, Suzanne Arnold, Suzanne Welsh, Svetlana Apostolovic, Swapna Kunhunny, Ta-Chuan Hung, Taissa Zappernick, Tali Sharir, Talita Silva, Tamara Colaiácovo Soares, Tapan Umesh Pillay, Tarun K Mittal, Tatiana Trifonova, Tauane Bello Duarte, Tauqir Huk, Téodora Dutoiu, Terrance Chua, Terry Weyand, Thabitha Charles, Theodoros Kofidis, Theresa McCreary, Thierry Lefevre, Thippeekaa Arumairajah, Thitipong Tepsuwan, Thomas J Mulhearn, Thomas M Meyer, Thomas P Rocco, Thomas R Downes, Thomas Crain, Thomas Haldis, Thomas Mathew, Thomas Redick, Thounaojam Indira Devi, Thuraia Nageh, Tia Cauthren, Tiago Silva, Tiffany Little, Tijana Andric, Tina Harding, Titus Lau, Tiziana Formisano, Tiziano Moccetti, Tomasz Ciurus, Tomasz Mazurek, Tomasz Tarchalski, Toshiyuki Nagai, Tri Tran, Tricia Youn, Trish Tucker, Trudie Milner, Tuhina Bose, Tushar Kotecha, Udo Sechtem, Uma S Valeti, Umberto Cucchini, Umesh Badami, Upendra Kaul, V K Bahl, V S Narain, Valentina Casali, Valeria Godoy, Valerie Robesyn, Vamshi P Priya, Vandana Yadav, Vera McKinney, Veronica De Lenges, Veronica Tinnirello, Vicente Miro, Victor Navarro, Victoria Gumerova, Victoria Hernandez, Vidya Seeratan, Vijay Kumar, Vikentiy Y Kozulin, Viktoria Bulkley, Vilmar Veiga Jr, Vincent Setang, C P Vineeth, Virginai Pubull Nuñez, Virginia Fernández-Figares, Vitor Gomes, Viviana Gabriel, Viviane Dos Santos, Viviane Almeida, Vlad A Iliescu, Vladan Mudrenovic, Vladimir Dzavik, Vojislav L Giga, Walter Enrique Mogrovejo, Wan Xian Chan, Wanda C Marfori, Wanda Parker, Warangkana Mekara, Wassim Nona, Wayne Old, Wayne Pennachi, Weerachai Nawarawong, Wei Chen, Wei Su, Weibing Xing, Wei-Ren Lan, Wenda Crawford, Wendy L Stewart, Wendy Drewes, Wenhua Lin, William B Abernethy, William D Salerno, William F Fearon, William Vergoni, William Weintraub, Winnie C Sia, Wlodzimierz J Musial, Xacobe Flores-Ríos, Xavier Garcia-Moll Marimon, Xi Su, Xiang Ma, Xiangqiong Gu, Xiao Wang, Xiaomei Li, Xiaowei Yao, Xin Fu, Xin Su, Xin Zeng, Xinchun Yang, Xiuhong Li, Xuehua Fang, Xutong Wang, Yaming Geng, Yan Yan, Yanek Pépin-Dubois, Yanfu Wang, Yang Wang, Yanmeng Tian, Yaping Huang, Yechen Han, Yesenia Zambrano, Yi-Hsuan Yang, Ying Tung Sia, Yining Yang, Yitong Ma, Yolayfi Peralta, Yongjian Wu, Yu Kunwu, Yu Zhao, Yudong Peng, Yueh-Hung Lin, Yulan Zhao, Yumei Dong, Yunhai Zhao, Yutthaphan Wannasopha, Yvonne Taul, Zakir Sahul, Zalina Kudzoeva, Zbigniew Kalarus, Zeljko Z Markovic, Zhen Huang, Zheng Ji, Zhenyu Liu, Zhou Yue, Zhulin Zhang, Zhuxi Li, Zile Singh Meharwal, Ziliang Bai, Zixiang Yu, Zohra Huda, Zoltan Davidovits
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Male ,Cardiac Catheterization ,Computed Tomography Angiography ,medicine.medical_treatment ,Myocardial Ischemia ,Coronary Disease ,Coronary Artery Disease ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Coronary Angiography ,ISCHEMIA Research Group ,law.invention ,Angina ,Coronary artery disease ,0302 clinical medicine ,Randomized controlled trial ,law ,Cardiovascular Disease ,Myocardial Revascularization ,030212 general & internal medicine ,Coronary Artery Bypass ,11 Medical and Health Sciences ,Cardiac catheterization ,General Medicine ,Middle Aged ,humanities ,Cardiovascular Diseases ,Cardiology ,Female ,Human ,medicine.medical_specialty ,Ischemia ,Article ,03 medical and health sciences ,Geriatric cardiology ,Percutaneous Coronary Intervention ,General & Internal Medicine ,Internal medicine ,medicine ,Humans ,Angina, Unstable ,Aged ,business.industry ,Coronary Artery Bypa ,Percutaneous coronary intervention ,Bayes Theorem ,medicine.disease ,Heart failure ,Quality of Life ,business - Abstract
BACKGROUND: Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS: We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS: Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, -1.8 percentage points; 95% CI, -4.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS: Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA ClinicalTrials.gov number, NCT01471522.).
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- 2020
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26. Association of dyslipidemia with severity of meibomian gland dysfunction in a tertiary care hospital of Uttarakhand region
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Tarannum Shakeel and Aeshvarya Dhawan
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,dyslipidemia ,Meibomian gland dysfunction ,meibomian gland dysfunction ,Tertiary care hospital ,medicine.disease ,lipid profile ,lcsh:Ophthalmology ,lcsh:RE1-994 ,Internal medicine ,Medicine ,lipids (amino acids, peptides, and proteins) ,business ,Lipid profile ,Dyslipidemia - Abstract
AIM: To analyse the association between dyslipidemia and severity of meibomian gland dysfunction (MGD) in a tertiary care hospital of Uttarakhand region. METHODS: This prospective observational study was conducted over a period of one year including 50 consecutive patients of MGD. Patients underwent detailed history (including Ocular Surface Disease Index Questionnaire) and examination (including meibum quality, expressibility and numerical staining). MGD was graded according to the guidelines submitted by the International Workshop on Meibomian Gland Dysfunction and Management in 2011. Fasting lipid profile of all the patients was done. Various parameters of lipid profile including total cholesterol (TC), triglycerides (TG), low density lipoproteins (LDL), high density lipoproteins (HDL) and very low density lipoproteins (VLDL) were correlated with MGD severity. Chi-square test was done for statistical analysis (P200 mg/dL), TG (>150 mg/dL), LDL (>130 mg/dL) and VLDL (>22 mg/dL) levels had a significant positive correlation with the severity of MGD (P=0.001, 0.019, 0.001, 0.016 respectively). CONCLUSION: Monitoring the fasting lipid levels may aid in establishing the severity of MGD and further studies may be conducted to establish the role of treatment of dyslipidemia in MGD.
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- 2021
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27. Systematic Review: Vulnerability of Metabolic Syndrome in COVID-19
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Deepika Dhawan and Sheel Sharma
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medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Scopus ,Vulnerability ,General Medicine ,Disease ,medicine.disease ,Organ damage ,Pandemic ,medicine ,Metabolic syndrome ,Intensive care medicine ,business - Abstract
SARS-CoV-2 infection has become a widely spread disease around the world causing rapid hospitalization and death, especially in people with metabolic syndrome. There is very limited literature that goes to present the clinical implications and management of metabolic syndrome in this pandemic. Hence an attempt has been made towards meeting this end. A literature review has been done extracting articles from scopus database following PRISMA guidelines. The manuscripts were studied to identify articles that report metabolic syndrome and its components in COVID-19 infection. A total of 25 manuscripts were included in this systematic review. These studies report systematic inflammation and organ damage in metabolic syndrome that has up regulated SARS-CoV-2 infection. Various treatment strategies have also been suggested and hypothesized. The results of this analysis indicate that patients suffering from metabolic syndrome are vulnerable to COVID-19 owing a sequence of complications.
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- 2021
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28. Cavitary Covid Lesions - An Unusual Imaging Feature
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Vaishali Patil Dhawan, Suresh Phatak, Rajasbala Pradeep Dhande, Gaurav Mishra, and Soumya Jain
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Imaging Feature ,medicine.medical_specialty ,business.industry ,Medicine ,Radiology ,business - Abstract
On January 30, 2020, the coronavirus disease 2019 (Covid-19), formerly known as the 2019 novel coronavirus (2019-nCoV), was declared as a global health emergency by the World Health Organization. Coronavirus disease 2019 (Covid-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Imaging plays an essential role in the evaluation of Covid-19, with chest computed tomography (CT) being the major modality in diagnosing and managing Covid-19 pneumonia. Common signs of Covid-19 pneumonia on chest CT scan are ground-glass opacities, consolidation, nodules, and linear opacities, halo and reverse halo signs. It can be accompanied by a “crazy-paving” pattern, air bronchograms, pleural hypertrophy, and pleural effusion. Cavitations are known to occur but are rare presentations. There are cases reported in the literature of the development of pulmonary cavity after bacterial infection in the late recovery stage in SARS patients. We present a case report of this rare entity in Covid-19 infection in a previously stable patient
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- 2021
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29. Study of Acute Liver Failure in Children Using Next Generation Sequencing Technology
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Melissa Sambrotta, Sandra Strautnieks, S. Lillis, Sanjay Bansal, Tassos Grammatikopoulos, Robert Hegarty, Sian Ellard, Richard J. Thompson, Anil Dhawan, Roshni Vara, P. S. Gibson, Julia Baptista, and Pierre Foskett
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Male ,Pediatrics ,medicine.medical_specialty ,Candidate gene ,Compound heterozygosity ,DNA sequencing ,Cohort Studies ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,030225 pediatrics ,Humans ,Medicine ,030212 general & internal medicine ,Child ,MPV17 ,Survival rate ,Exome sequencing ,business.industry ,Infant, Newborn ,High-Throughput Nucleotide Sequencing ,Infant ,Liver Failure, Acute ,medicine.disease ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Etiology ,Female ,business - Abstract
Objective To use next generation sequencing (NGS) technology to identify undiagnosed, monogenic diseases in a cohort of children who suffered from acute liver failure (ALF) without an identifiable etiology. Study design We identified 148 under 10 years of age admitted to King's College Hospital, London, with ALF of indeterminate etiology between 2000 and 2018. A custom NGS panel of 64 candidate genes known to cause ALF and/or metabolic liver disease was constructed. Targeted sequencing was carried out on 41 children in whom DNA samples were available. Trio exome sequencing was performed on 4 children admitted during 2019. A comparison of the clinical characteristics of those identified with biallelic variants against those without biallelic variants was then made. Results Homozygous and compound heterozygous variants were identified in 8 out of 41 children (20%) and 4 out of 4 children (100%) in whom targeted and exome sequencing were carried out, respectively. The genes involved were NBAS (3 children); DLD (2 children); and CPT1A, FAH, LARS1, MPV17, NPC1, POLG, SUCLG1, and TWINK (1 each). The 12 children who were identified with biallelic variants were younger at presentation and more likely to die in comparison with those who did not: median age at presentation of 3 months and 30 months and survival rate 75% and 97%, respectively. Conclusions NGS was successful in identifying several specific etiologies of ALF. Variants in NBAS and mitochondrial DNA maintenance genes were the most common findings. In the future, a rapid sequencing NGS workflow could help in reaching a timely diagnosis and facilitate clinical decision making in children with ALF.
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- 2021
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30. The predictive ability of the 313 variant–based polygenic risk score for contralateral breast cancer risk prediction in women of European ancestry with a heterozygous BRCA1 or BRCA2 pathogenic variant
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Lakeman, Inge M. M., Van Den Broek, Alexandra J., Vos, Juliën A. M., Barnes, Daniel R., Adlard, Julian, Andrulis, Irene L., Arason, Adalgeir, Arnold, Norbert, Arun, Banu K., Balmaña, Judith, Barrowdale, Daniel, Giraud, Sophie, Golmard, Lisa, Hake, Christopher R., Houdayer, Claude, Risch, Harvey A., Lasset, Christine, Laurent, Maïté, Spurdle, Amanda B., Hooning, Maartje J., Hopper, John L., Kets, Carolien M., Leroux, Dominique, Longy, Michel, Mari, Véronique, Mazoyer, Sylvie, Mebirouk, Noura, Mortemousque, Isabelle, Blok, Marinus J., Prieur, Fabienne, Hamann, Ute, Pujol, Pascal, Konstantopoulou, Irene, Heemskerk Gerritsen, Bernadette A. M., Isaacs, Claudine, Saule, Claire, Piedmonte, Marion, Schuster, Helene, Sevenet, Nicolas, Sobol, Hagay, Sokolowska, Johanna, Gómez Garcia, Encarna B., Venat Bouvet, Laurence, Claes, Kathleen B. M., Ahmed, Munaza, Teixeira, Manuel R., Barwell, Julian, Brady, Angela, Izatt, Louise, Hogervorst, Frans B. L., Brennan, Paul, Harrington, Patricia A., Henderson, Alex, Hodgson, Shirley, Kwong, Ava, Borg, Ake, Kennedy, M. John, Porteous, Mary E., Rogers, Mark T., Side, Lucy E., Snape, Katie, Walker, Lisa, Collée, J. Margriet, Jakubowska, Anna, Couch, Fergus J., Hahnen, Eric, Daly, Mary B., Dennis, Joe, Teo, Soo Hwang, Jensen, Uffe Birk, Rantala, Johanna, Dhawan, Mallika, Benitez, Javier, Domchek, Susan M., Eeles, Ros, Engel, Christoph, Legrand, Clémentine, Evans, D. Gareth, James, Paul A., Feliubadaló i Elorza, Maria Lídia, Teulé-Vega, Àlex, Foretova, Lenka, Castera, Laurent, Friedman, Eitan, Frost, Debra, Rennert, Gad, Ganz, Patricia A., Leslie, Goska, Garber, Judy, Hulick, Peter J., Imyanitov, Evgeny N., Glendon, Gord, Thomassen, Mads, Janavicius, Ramunas, Mulligan, Anna Marie, Hollestelle, Antoinette, Jager, Agnes, Koppert, Linetta B., Cook, Jackie, Koudijs, Marco, Kriege, Mieke, Meijers Heijboer, Hanne E. J., Schmutzler, Rita K., Mensenkamp, Arjen R., Dunning, Alison M., Mooij, Thea M., Oosterwijk, Jan C., Caux Moncoutier, Virginie, Singer, Christian F., Berthet, Pascaline, Caldés, Trinidad, Van den Ouweland, Ans M. W., Van der Baan, Frederieke H., Van der Hout, Annemieke H., Van der Kolk, Lizet E., Van der Luijt, Rob B., Thull, Darcy L., Van Deurzen, Carolien H. M., Sharma, Priyanka, Van Doorn, Helena C., Bignon, Yves Jean, Colas, Chrystelle, Van Engelen, Klaartje, Brewer, Carole, Van Hest, Liselotte P., Van Os, Theo A. M., Caligo, Maria A., Verhoef, Senno, Tischkowitz, Marc, Vogel, Maartje J., Wijnen, Juul T., Lalloo, Fiona, Beesley, Jonathan, Fox, Stephen, Collonge Rame, Marie Agnès, Simard, Jacques, Holland, Helene, Jiao, Yue, John, Esther M., Joseph, Vijai, Gerdes, Anne Marie, Karlan, Beth Y., Lesueur, Fabienne, Loud, Jennifer T., Lubiński, Jan, Manoukian, Siranoush, Mcguffog, Lesley, Miller, Austin, Coupier, Isabelle, Gomes, Denise Molina, Barouk Simonet, Emmanuelle, Montagna, Marco, Miller, Clare, Elan, Camille, Davidson, Rosemarie, Mouret Fourme, Emmanuelle, Gayther, Simon A., Nathanson, Katherine L., Neuhausen, Susan L., Nevanlinna, Heli, Yie, Joanne Ngeow Yuen, Pauw, Antoine de, Olah, Edith, Morrison, Patrick J., Olopade, Olufunmilayo I., Van Asperen, Christi J., Park, Sue K., Parsons, Michael T., Donaldson, Alan, Belotti, Muriel, Peterlongo, Paolo, Stadler, Zsofia, Stoppa Lyonnet, Dominique, Sutter, Christian, Ong, Kai Ren, Delnatte, Capucine, Tan, Yen Yen, Toland, Amanda E., Tung, Nadine, Van Rensburg, Elizabeth J., Vega, Ana, Wappenschmidt, Barbara, Devilee, Peter, Eason, Jacqueline, Chung, Wendy K., Bernstein, Jonine L., Offit, Kenneth, Aalfs, Cora M., Hanson, Helen, Godwin, Andrew K., Easton, Douglas F., Bonadona, Valérie, Rookus, Matti A., Chenevix-Trench, Georgia, Antoniou, Antonis C., O’shaughnessy Kirwan, Aoife, Robson, Mark, Eccles, Diana M., Schmidt, Marjanka K., Adank, Muriel A., Gemo Study Collaborators, Phillips, Kelly Anne, Embrace Collaborators, Ocgn Investigators, Goldgar, David E., Hebon Investigators, Perkins, Jo, Kconfab Investigators, Bressac de Paillerets, Brigitte, Buecher, Bruno, Caputo, Sandrine, Ausems, Margreet G. E. M., Gregory, Helen, Caron, Olivier, Faivre, Laurence, Fert Ferrer, Sandra, Gauthier Villars, Marion, Radice, Paolo, Gesta, Paul, Clinical Genetics, Medical Oncology, Surgery, Pathology, Gynecological Oncology, Schmidt, Marjanka K. [0000-0002-2228-429X], Apollo - University of Cambridge Repository, Targeted Gynaecologic Oncology (TARGON), Damage and Repair in Cancer Development and Cancer Treatment (DARE), Schmidt, Marjanka K [0000-0002-2228-429X], HUS Gynecology and Obstetrics, Department of Obstetrics and Gynecology, Institut Català de la Salut, [Lakeman IMM] Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands. Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands. [van den Broek AJ, Vos JAM] Division of Molecular Pathology, The Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. [Barnes DR] Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. [Adlard J] Yorkshire Regional Genetics Service, Chapel Allerton Hospital, Leeds, UK. [Andrulis IL] Fred A. Litwin Center for Cancer Genetics, Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, Toronto, ON, Canada. Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada. [Balmaña J] Hereditary cancer Genetics Group, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain. Servei d’Oncologia Mèdica, Vall d’Hebron Hospital Universitari, Barcelona, Spain, Vall d'Hebron Barcelona Hospital Campus, Pediatric surgery, Human genetics, Amsterdam Neuroscience - Complex Trait Genetics, CCA - Cancer biology and immunology, Epidemiology and Data Science, Human Genetics, ARD - Amsterdam Reproduction and Development, APH - Personalized Medicine, APH - Quality of Care, Chapel Allerton Hospital, University of Leeds, Departments of Molecular Genetics and Laboratory Medicine and Pathobiology, University of Toronto-Cancer Care Ontario, Reykjavík University, Division of Oncology, Department of Gynaecology and Obstetrics, University Hospital Schleswig–Holstein, The University of Texas M.D. Anderson Cancer Center [Houston], Unitat d'Alt Risc i Prevenció del Càncer, Vall d'Hebron University Hospital [Barcelona], University of Cambridge [UK] (CAM), Group of Human Genetics, Human Cancer Genetics Programme, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), ISCIII, Department of Oncology, Clinical Sciences, Lund University [Lund]-Skåne University Hospital, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos [Madrid, Spain] (IdISSC), Section of Genetic Oncology, University of Pisa - Università di Pisa, Columbia University [New York], Ghent University Hospital, Department of Clinical Genetics, Erasmus University Medical Center [Rotterdam] (Erasmus MC)-Family Cancer Clinic, Department of Laboratory Medicine and Pathology, Mayo Clinic, Division of Population Science, Fox Chase Cancer Center, Institut Curie [Paris], Mines Paris - PSL (École nationale supérieure des mines de Paris), Université Paris sciences et lettres (PSL), CHU Grenoble, CHI Poissy-Saint-Germain, Unité de génétique et biologie des cancers (U830), Institut Curie [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle (MIVEGEC), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud]), RS: GROW - R4 - Reproductive and Perinatal Medicine, MUMC+: DA KG Lab Centraal Lab (9), MUMC+: DA KG Polikliniek (9), and Klinische Genetica
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0301 basic medicine ,Percentile ,Pathological Conditions, Signs and Symptoms::Pathologic Processes::Disease Attributes::Disease Susceptibility::Genetic Predisposition to Disease [DISEASES] ,Neoplasms::Neoplasms by Site::Breast Neoplasms [DISEASES] ,SUSCEPTIBILITY ALLELES ,Diàtesi ,FAMILIES ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,MESH: BRCA2 Protein ,Breast cancer ,0302 clinical medicine ,MESH: Risk Factors ,Risk Factors ,Other subheadings::/diagnosis [Other subheadings] ,Medicine and Health Sciences ,Medicine ,Mama - Càncer - Diagnòstic ,Family history ,skin and connective tissue diseases ,Genetics (clinical) ,MESH: Heterozygote ,neoplasias::neoplasias por localización::neoplasias de la mama [ENFERMEDADES] ,Factors de risc en les malalties ,BRCA1 Protein ,Hazard ratio ,MESH: Genetic Predisposition to Disease ,1184 Genetics, developmental biology, physiology ,article ,OVARIAN ,BRCA2 Protein/genetics ,Women's cancers Radboud Institute for Health Sciences [Radboudumc 17] ,3. Good health ,030220 oncology & carcinogenesis ,Female ,Malalties congènites ,Adult ,Heterozygote ,medicine.medical_specialty ,MESH: Mutation ,Risk factors in diseases ,Otros calificadores::/diagnóstico [Otros calificadores] ,Breast Neoplasms ,Context (language use) ,MUTATION CARRIERS ,Càncer de mama ,afecciones patológicas, signos y síntomas::procesos patológicos::atributos de la enfermedad::susceptibilidad a enfermedades::predisposición genética a la enfermedad [ENFERMEDADES] ,03 medical and health sciences ,SDG 3 - Good Health and Well-being ,Internal medicine ,Humans ,Genetic Predisposition to Disease ,MESH: BRCA1 Protein ,Retrospective Studies ,BRCA2 Protein ,MESH: Humans ,business.industry ,Proportional hazards model ,CONSORTIUM ,Breast Neoplasms/diagnosis ,MESH: Adult ,MESH: Retrospective Studies ,Retrospective cohort study ,medicine.disease ,Confidence interval ,030104 developmental biology ,[SDV.GEN.GH]Life Sciences [q-bio]/Genetics/Human genetics ,Mutation ,BRCA1 Protein/genetics ,3111 Biomedicine ,business ,MESH: Female ,MESH: Breast Neoplasms - Abstract
Predicció de risc de càncer de mama; Dones europees; Variant patògena heterozigota Predicción del riesgo de cáncer de mama; Mujeres europeas; Variante patógena heterocigota Breast cancer risk prediction; European women; Heterozygous pathogenic variant Purpose To evaluate the association between a previously published 313 variant–based breast cancer (BC) polygenic risk score (PRS313) and contralateral breast cancer (CBC) risk, in BRCA1 and BRCA2 pathogenic variant heterozygotes. Methods We included women of European ancestry with a prevalent first primary invasive BC (BRCA1 = 6,591 with 1,402 prevalent CBC cases; BRCA2 = 4,208 with 647 prevalent CBC cases) from the Consortium of Investigators of Modifiers of BRCA1/2 (CIMBA), a large international retrospective series. Cox regression analysis was performed to assess the association between overall and ER-specific PRS313 and CBC risk. Results For BRCA1 heterozygotes the estrogen receptor (ER)-negative PRS313 showed the largest association with CBC risk, hazard ratio (HR) per SD = 1.12, 95% confidence interval (CI) (1.06–1.18), C-index = 0.53; for BRCA2 heterozygotes, this was the ER-positive PRS313, HR = 1.15, 95% CI (1.07–1.25), C-index = 0.57. Adjusting for family history, age at diagnosis, treatment, or pathological characteristics for the first BC did not change association effect sizes. For women developing first BC
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- 2021
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31. Nearly One-Third of Published Systematic Reviews and Meta-analyses Yield Inconclusive Conclusions: A Systematic Review
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Joshua D. Harris, Aman Dhawan, Jefferson C. Brand, Mark P. Cote, and Erik Hohmann
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030222 orthopedics ,medicine.medical_specialty ,Sports medicine ,business.industry ,Publications ,Level iv ,Evidence-based medicine ,Sports Medicine ,Logistic regression ,03 medical and health sciences ,Orthopedics ,0302 clinical medicine ,Systematic review ,Meta-Analysis as Topic ,Family medicine ,North America ,Orthopedic surgery ,medicine ,Humans ,Orthopedic Procedures ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,business ,Systematic Reviews as Topic - Abstract
Purpose To perform a systematic review that determines the percentage of published orthopedic surgery and sports medicine systematic reviews and meta-analyses that have a conclusive conclusion. Methods A systematic review was performed using PRISMA guidelines. Six high-quality orthopedics journals were chosen for analysis over a 10-year eligibility period. Systematic reviews and meta-analyses published in these journals were included in the investigation. Narrative, scoping, and umbrella reviews were excluded. A systematic review or meta-analysis was defined as having an inconclusive conclusion if the conclusion in the manuscript body or abstract was stated directly as inconclusive, indeterminate, unknown, or having a lack of evidence (or no evidence). A conclusive conclusion stated a direct answer to the study’s primary and/or accessory outcomes. Due to the categorical nature of the data, comparisons were made using χ2 test and logistic regression. Results There were 1,108 systematic reviews/meta-analyses analyzed (30.9 ± 70.3 studies analyzed per review). More reviews (69.9%) were published with conclusive conclusions rather than without (30.1%). More reviews were surgical (73%) rather than nonsurgical. The United States and North America published the most reviews by country and continent, respectively. There were statistically significant differences between countries (highest proportion with China) and continents (highest proportion with Asia) based on the number of conclusive conclusions in published reviews, respectively. There were no significant differences in the proportion of conclusive conclusion reviews between the 6 analyzed journals. Australia published the largest proportion on nonsurgical reviews. The British Journal of Sports Medicine published a significantly higher proportion of nonsurgical reviews than the other 5 journals. There was no temporal relationship with the proportion of conclusive conclusion reviews. Conclusions This systematic review observed that only 70% of orthopedic systematic reviews and meta-analyses published in 6 high-quality orthopedic journals over a 10-year eligibility period had conclusive conclusions. Level of Evidence Level IV, systematic review and/or meta-analysis of studies with Levels I to IV.
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- 2021
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32. Basal and Luminal Molecular Subtypes in Naturally-Occurring Canine Urothelial Carcinoma are Associated with Tumor Immune Signatures and Dog Breed
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Deepika Dhawan, Christopher M. Fulkerson, Audrey Ruple, Elaine A. Ostrander, Deborah W. Knapp, Sagar M. Utturkar, Lindsey M. Fourez, Heidi G. Parker, Michael O. Childress, Noah M. Hahn, Alexander W. Enstrom, José A. Ramos-Vara, and Breann C. Sommer
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0301 basic medicine ,Pathology ,medicine.medical_specialty ,business.industry ,Urology ,Breed ,03 medical and health sciences ,Basal (phylogenetics) ,030104 developmental biology ,0302 clinical medicine ,Immune system ,Oncology ,030220 oncology & carcinogenesis ,medicine ,business ,Urothelial carcinoma - Abstract
BACKGROUND: Improved therapies are needed for patients with invasive urothelial carcinoma (InvUC). Tailoring treatment to molecular subtypes holds promise, but requires further study, including studies in pre-clinical animal models. Naturally-occurring canine InvUC harbors luminal and basal subtypes, mimicking those observed in humans, and could offer a relevant model for the disease in people. OBJECTIVE: To further validate the canine InvUC model, clinical and tumor characteristics associated with luminal and basal subtypes in dogs were determined, with comparison to findings from humans. METHODS: RNA sequencing (RNA-seq) analyses were performed on 56 canine InvUC tissues and bladder mucosa from four normal dogs. Data were aligned to CanFam 3.1, and differentially expressed genes identified. Data were interrogated with panels of genes defining luminal and basal subtypes, immune signatures, and other tumor features. Subject and tumor characteristics, and outcome data were obtained from medical records. RESULTS: Twenty-nine tumors were classified as luminal and 27 tumors as basal subtype. Basal tumors were strongly associated with immune infiltration (OR 52.22, 95%CI 4.68–582.38, P = 0.001) and cancer progression signatures in RNA-seq analyses, more advanced clinical stage, and earlier onset of distant metastases in exploratory analyses (P = 0.0113). Luminal tumors were strongly associated with breeds at high risk for InvUC (OR 0.06, 95%CI 0.01 –0.37, P = 0.002), non-immune infiltrative signatures, and less advanced clinical stage. CONCLUSIONS: Dogs with InvUC could provide a valuable model for testing new treatment strategies in the context of molecular subtype and immune status, and the search for germline variants impacting InvUC onset and subtype.
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- 2021
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33. Phase I/II Trial of Vemurafenib in Dogs with Naturally Occurring, BRAF-mutated Urothelial Carcinoma
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Uma K. Aryal, Paul M Rossman, Christopher M. Fulkerson, Noel Dybdal, Mark Merchant, Jackeline Franco, Deepika Dhawan, Sagar M. Utturkar, Audrey Ruple, Matthew Breen, Alexander W. Enstrom, Elaine R Murray, Dietrich Tuerck, Lindsey M. Fourez, José A. Ramos-Vara, Deborah W. Knapp, Tanja S. Zabka, Rodrigo Mohallem, Ketaki Bhide, and Liling Liu
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Cancer Research ,business.industry ,Invasive urothelial carcinoma ,Cancer ,Drug resistance ,medicine.disease ,Immune system ,Oncology ,Pharmacokinetics ,Pharmacodynamics ,Cancer research ,Medicine ,business ,Adverse effect ,Vemurafenib ,medicine.drug - Abstract
BRAF-targeted therapies including vemurafenib (Zelboraf) induce dramatic cancer remission; however, drug resistance commonly emerges. The purpose was to characterize a naturally occurring canine cancer model harboring complex features of human cancer, to complement experimental models to improve BRAF-targeted therapy. A phase I/II clinical trial of vemurafenib was performed in pet dogs with naturally occurring invasive urothelial carcinoma (InvUC) harboring the canine homologue of human BRAFV600E. The safety, MTD, pharmacokinetics, and antitumor activity were determined. Changes in signaling and immune gene expression were assessed by RNA sequencing and phosphoproteomic analyses of cystoscopic biopsies obtained before and during treatment, and at progression. The vemurafenib MTD was 37.5 mg/kg twice daily. Anorexia was the most common adverse event. At the MTD, partial remission occurred in 9 of 24 dogs (38%), with a median progression-free interval of 181 days (range, 53–608 days). In 18% of the dogs, new cutaneous squamous cell carcinoma and papillomas occurred, a known pharmacodynamic effect of vemurafenib in humans. Upregulation of genes in the classical and alternative MAPK-related pathways occurred in subsets of dogs at cancer progression. The most consistent transcriptomic changes were the increase in patterns of T lymphocyte infiltration during the first month of vemurafenib, and of immune failure accompanying cancer progression. In conclusion, the safety, antitumor activity, and cutaneous pharmacodynamic effects of vemurafenib, and the development of drug resistance in dogs closely mimic those reported in humans. This suggests BRAF-mutated canine InvUC offers an important complementary animal model to improve BRAF-targeted therapies in humans.
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- 2021
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34. Change in the profile of the service utilizers of a community-based drug treatment clinic: a retrospective study from India
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Biswadip Chatterjee, Siddharth Sarkar, Anju Dhawan, and Snehil Gupta
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Community based ,Service (business) ,medicine.medical_specialty ,Drug treatment ,Health (social science) ,business.industry ,Family medicine ,medicine ,Medicine (miscellaneous) ,Retrospective cohort study ,sense organs ,business - Abstract
Community-based drug treatment clinics (CB-DTC) aim to reduce the barriers to treatment-seeking among substance users. Literature is lacking in assessing the change in the profile of the clients se...
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- 2021
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35. Low-dose radiation therapy for osteoarthritis and enthesopathies: a review of current data
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Edward J. Calabrese, Farzad Taghizadeh-Hesary, Nooshin Nazeminezhad, Danial Fazilat-Panah, Ruhollah Ghahramani-Asl, Mohammad Nematshahi, Seyed Alireza Javadinia, James S Welsh, Rachna Kapoor, Davood Soroosh, Babak PeyroShabany, Seyedeh Naeimeh Saberhosseini, Gaurav Dhawan, and Arezoo Mehrabian
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medicine.medical_specialty ,Radiological and Ultrasound Technology ,business.industry ,Pain relief ,Scopus ,Osteoarthritis ,Enthesopathy ,Clinical literature ,medicine.disease ,Joint disease ,Quality of life ,Internal medicine ,Quality of Life ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Clinical efficacy ,business ,Prospective cohort study ,Retrospective Studies - Abstract
Background Osteoarthritis (OA), the most common degenerative joint disease, is associated with severe functional limitation and impairment of quality of life. Numerous reports have documented the clinical efficacy of low-dose radiotherapy (LD-RT) in the management of various inflammatory disorders, including OA. In this paper, we assessed the clinical literature involving the use of LD-RT in the treatment of OA, its dose-response features, possible underlying mechanistic features, and optimal therapeutic dose range. Methods We carried out a systematic review based on the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statements and evaluated articles meeting the inclusion criteria for this review. Results A total of 361 articles were identified from databases, such as Scopus, PubMed, Embase, and Science Direct out of which 224 articles were duplicates and were discarded. Of the remaining 137 articles, 74 articles were un-related, 27 articles were review articles, eight were conference abstracts, three were letters, two were editorials, two were notes, and one was a book chapter. Finally, 20 articles met all the inclusion criteria and were included in this systematic review. Discussion Several single-arm retrospective/prospective studies showed advantages for LD-RT in the management of OA in terms of pain relief, improvement of mobility and function, and showed minimal side effects. Mechanistic considerations involve positive subcellular effects mediated by the activation of a nuclear factor erythroid 2-related transcription factor (Nrf2) mediated antioxidant response. Further research on both the short- and long-term effects of LD-RT on OA and other inflammatory disorders is recommended.
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- 2021
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36. Abdominal Obesity A Stepping Stone to Non Communicable Diseases in South Asia
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Deepika Dhawan and Sheel Sharma
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South asia ,business.industry ,Environmental health ,Stepping stone ,medicine ,General Pharmacology, Toxicology and Pharmaceutics ,medicine.symptom ,General Agricultural and Biological Sciences ,business ,General Biochemistry, Genetics and Molecular Biology ,Abdominal obesity - Abstract
This article provides an overview of the relationship between abdominal obesity (AO) and Non-Communicable Diseases (NCDs) in South Asia. A literature review has been conducted using key words: Abdominal obesity, Non-Communicable Diseases, Adipokines and South Asia, searching Scopus, Pubmed, Google scholar and Medline databases. South Asians suffer from abdominal obesity that results in systematic inflammation giving rise to excess production of harmful adipokines that eventually leads to the occurrence of NCDs. The incidence of NCDs related mortality ranges between 44 per cent - 84 per cent. Impaired developments during pregnancy may also have a linkage with AO and NCDs. Adipokines and fat derivatives produced in abundance by the abdominal fat tissues have a crucial implication in the progression of NCDs. South Asians have unhealthy metabolic profile leading to several forms of NCDs. Further research needs to be done in the population groups suffering from abdominal obesity to derive interventional strategies to prevent as well as manage NCDs in clinical settings.
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- 2021
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37. Clinical outcomes as a function of the number of samples taken during stereotactic needle biopsies: a meta-analysis
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Bob S. Carter, Sanjay Dhawan, Andrew S. Venteicher, William E. Butler, and Clark C. Chen
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Cancer Research ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Morbidity risk ,Open surgery ,Brain tumor ,medicine.disease ,Neurology ,Oncology ,Meta-analysis ,Needle biopsy ,Biopsy ,Medicine ,Tissue diagnosis ,Neurology (clinical) ,Radiology ,Neurosurgery ,business - Abstract
Stereotactic needle biopsy remains the cornerstone for tissue diagnosis for tumors located in regions of the brain that are difficult to access through open surgery. We perform a meta-analysis of the literature to examine the relation between number of samples taken during biopsy and diagnostic yield, morbidity and mortality. We identified 2416 patients from 28 cohorts in studies published in PubMed database that studied stereotactic needle biopsies for tumor indications. Meta-analysis by proportions and meta-regression analyses were performed. On meta-analysis, the morbidity profile of the published needle biopsy studies clustered into three groups: studies that performed 6 samples during biopsy (n = 7). Pooled estimates for biopsy related morbidity were 4.3%, 16.3%, and 17% for studies reporting 6 biopsy samples, respectively. While these morbidity estimates significantly differed (p 6 samples were comparable. Pooled estimates of diagnostic yield for these three groups were 90.4%, 93.8%, and 88.1%, respectively. Mortality did not significantly differ between studies reporting differing number of samples taken during biopsy. Our meta-analysis suggests that morbidity risk in needle biopsy is non-linearly associated with the number of samples taken. There was no association between the number of biopsies taken, and diagnostic yield or mortality.
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- 2021
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38. The Matilda Effect: Underrecognition of Women in Hematology and Oncology Awards
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Katerina Castillo, Ana I. Velazquez, Andrea Anampa-Guzmán, Snegha Ananth, Urshila Durani, Frederique St Pierre, Shruti R. Patel, Amy S. Oxentenko, Narjust Duma, and Natasha Dhawan
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Male ,Oncology ,Cancer Research ,medicine.medical_specialty ,Health Outcomes and Economics of Cancer Care ,media_common.quotation_subject ,education ,Awards and Prizes ,Workforce diversity ,Physicians ,Internal medicine ,medicine ,Humans ,Academic medicine ,health care economics and organizations ,Societies, Medical ,Retrospective Studies ,media_common ,International level ,business.industry ,Hematology ,humanities ,Female ,Observational study ,Gender gap ,business ,Inclusion (education) ,Diversity (politics) ,Career development - Abstract
Background The proportion of women in the field of hematology and oncology (H&O) has increased over recent decades, but the representation of women in leadership positions remains poor. In an effort to close the gender gap in academia, it is important to report on such inequities in hopes to close these gaps and improve career development. Materials and Methods We conducted a retrospective, observational study of published award recipients from 1994 to 2019 from the seven major H&O societies in the world. Gender was determined based on publicly available data. The χ2 and Cochran-Armitage tests were used for data analysis. Results Of the 1,642 awardees over the past 26 years, 915 met inclusion criteria. Award recipients were overwhelmingly men (77.9%) and non-Hispanic White (84.7%). Women awardees received 30.3% of the humanistic and education-related awards, whereas only receiving 16.0% of basic science awards (p Conclusion From 1994 to 2019, women were less likely to receive recognition awards from the seven major H&O societies studied compared with men. We also observed a considerably low proportion of minority awardees across all oncology subspecialties. Further studies examining how selection criteria favor either gender would be warranted in order to achieve equal representation in academic awards. Implications for Practice In this study, women and minority groups were found to be underrepresented amongst award recipients. Significant disparities were seen in disciplines that have been historically male predominant, such as basic sciences. As awards on an international level enhance academic resumes and assist with career advancement, it is important that awards are being given in an equitable manner. First steps to promote diversity and inclusion in academic medicine is reporting of gender and racial disparities in various areas of academia.
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- 2021
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39. iDoc-X: An artificial intelligence model for tuberculosis diagnosis and localization
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Satvik Vats, Sanjay Dhawan Frcr, Gaurav Kala, Sunny Singh, and Rahul Tarar
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medicine.medical_specialty ,Algebra and Number Theory ,Tuberculosis ,Tuberculosis diagnosis ,Lung disease ,business.industry ,Applied Mathematics ,medicine ,macromolecular substances ,medicine.disease ,Intensive care medicine ,business ,Analysis - Abstract
For decades, tuberculosis (TB) is an unavoidable lung disease and epidemic for several developing nations. It proceeds to be the main cause of demises worldwide. It is because of poor access to med...
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- 2021
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40. Interdigitating dendritic cell sarcoma of pleura, diagnostic challenges of a rare disease
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Ritu Verma, Shashi Dhawan, Ethel Shangne Belho, Nitin Gupta, and Rinky Agarwal
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medicine.medical_specialty ,Pathology ,medicine.diagnostic_test ,business.industry ,Soft tissue ,Case Report ,Spleen ,Dendritic cell ,medicine.disease ,medicine.anatomical_structure ,Surgical oncology ,Interdigitating dendritic cell sarcoma ,Biopsy ,medicine ,Histopathology ,business ,Rare disease - Abstract
Interdigitating dendritic cell sarcoma (IDCS) is an extremely rare subtype of dendritic cell tumour. The solitary lymph node disease is most commonly seen, but may occasionally present extranodally in skin, intestines, soft tissue, liver or spleen. Here we present a case of IDCS in pleura in 53-year-old man, who presented with loss of appetite and chest pain. The initial biopsy was inconclusive. The patient was started on anti-tubercular treatment considering the higher prevalence of the disease in this part of the world. However, the symptoms worsened after 2 months and repeat PET-CT scan revealed extensive FDG avid lesions in the multiple sites in the body. Repeat PET guided biopsy confirmed this rare IDCS neoplasm. Diagnostic challenges of this rare tumour are discussed.
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- 2021
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41. Patulin in food: A mycotoxin concern for human health and its management strategies
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Pradeep Kumar, Madhu Kamle, Shikha Pandhi, Kajal Dhawan, Diwakar Mishra, Dipendra Kumar Mahato, Bharti Sharma, Arvind Kumar, Sheetal Devi, Namita Ashish Singh, Shalini Arora, and R. Selvakumar
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0106 biological sciences ,Food Contamination ,Toxicology ,01 natural sciences ,Patulin ,03 medical and health sciences ,chemistry.chemical_compound ,Human health ,Humans ,Mycotoxin ,0303 health sciences ,Aspergillus ,Byssochlamys ,biology ,business.industry ,010604 marine biology & hydrobiology ,030302 biochemistry & molecular biology ,Penicillium ,food and beverages ,biology.organism_classification ,Biotechnology ,chemistry ,Agriculture ,Fruit ,Malus ,Penicillium expansum ,business ,Food contaminant - Abstract
The mycotoxin patulin is primarily produced as a secondary metabolite by numerous fungal species and predominantly by Aspergillus, Byssochlamys, and Penicillium species. It is generally associated with fungal infected food materials. Penicillium expansum is considered the only fungal species liable for patulin contamination in pome fruits, especially in apples and apple-based products. This toxin in food poses serious health concerns and economic threat, which has aroused the need to adopt effective detection and mitigation strategies. Understanding its origin sources and biosynthetic mechanism stands essential for efficiently designing a management strategy against this fungal contamination. This review aims to present an updated outline of the sources of patulin occurrence in different foods and their biosynthetic mechanisms. It further provides information regarding the detrimental effects of patulin on human and agriculture as well as its effective detection, management, and control strategies.
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- 2021
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42. Role of Multidetector Computed Tomography in Patients of Acute Mesenteric Ischaemia and its Comparison with Clinicosurgical Outcome: A Cross-sectional Study
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Ritu Dhawan, Amandeep Singh Nar, Narinder Salhotra, Anisha Galhotra, Chandan Kakkar, Arnav Galhotra, Devinder Pal Singh Dhanota, and Kamini Gupta
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medicine.medical_specialty ,non occlusive ,Cross-sectional study ,business.industry ,Clinical Biochemistry ,General Medicine ,arterial thrombosis ,Acute ischemia ,acute abdomen ,Multidetector computed tomography ,medicine ,Medicine ,In patient ,Radiology ,cardiovascular diseases ,business - Abstract
Introduction: Acute mesenteric ischaemia is an abdominal emergency occurring in nearly 1% of patients presenting with acute abdomen. Early diagnosis is very important for the improved survival of the patient. Acute mesenteric ischaemia frequently presents with non specific features such as vomiting, loose stools and abdominal distension. The classical triad of fever, haematochezia and abdominal pain is seen in only 30% of the patients so, it is difficult to diagnose clinically. Multidetector Computed Tomography (MDCT) is gold standard and first line test to diagnose intestinal ischaemia. Aim: To assess the efficacy of MDCT in the diagnosis of acute mesenteric ischaemia and to compare its outcome with surgical and/or clinical findings. Materials and Methods: In this cross-sectional descriptive study conducted from 1st November 2018 to 31st May 2020, MDCT was performed on 40 patients (23 male; 17 female, age range: 28-93 years). Axial and reconstructed images of each patient were evaluated for evidence of bowel wall thickening, bowel wall attenuation, abnormal wall enhancement, bowel dilatation, mesenteric stranding, ascites, solid organ infarcts, pneumatosis intestinalis or portomesenteric gas, and mesenteric arterial or venous thrombosis. Multidetector CT findings were compared with the surgical findings and clinical outcome. Results were expressed in terms of frequency and percentages. Results: Out of 40 patients, most common cause of acute mesenteric ischaemia was arterial thrombosis, seen in 20 patients (50%) while 13 patients (32.5%) had portomesenteric venous thrombosis and 7 (17.5%) patients were diagnosed with non occlusive mesenteric ischaemia. CT finding of bowel wall thickening and bowel dilatation however non specific were seen in majority of patients (62.5% and 70%, respectively). Mesenteric fat stranding and ascites were seen in 95% and 77.5% cases respectively. Specific signs of acute mesenteric ischaemia includes hypoenhancing and non enhancing bowel walls seen in 27 patients (67.5%). Pneumatosis intestinalis and portomesenteric pneumatosis in 20% patients. A total of 27 patients underwent surgery and 13 patients were managed conservatively. On comparing the CT findings with intraoperative/ histopathological findings, accuracy of MDCT in the diagnosis of acute mesenteric ischaemia in this study was 96.39%. Conclusion: MDCT should be the first line imaging modality to diagnose acute mesenteric ischaemia and to exclude other causes of acute abdomen. It is an excellent and fast modality to diagnose bowel ischaemia, as it can visualise both the bowel and mesenteric changes as well as accurately depict the mesenteric vasculature.
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- 2021
43. Does endoscopic intervention prevent subsequent gastrointestinal bleeding in patients with left ventricular assist devices? A retrospective study
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Laurel R. Fisher, Edo Y. Birati, Shazia M. Siddique, Afshin Parsikia, Sonali Palchaudhuri, Joyce Wald, and Ishita Dhawan
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Gastrointestinal bleeding ,medicine.medical_specialty ,Endoscopic intervention, Inpatient care ,Risk Factors ,Intervention (counseling) ,medicine ,Retrospective Cohort Study ,Humans ,In patient ,Hospital readmissions ,Retrospective Studies ,Heart Failure ,business.industry ,Gastroenterology ,Recurrent bleeding ,Retrospective cohort study ,Endoscopy ,General Medicine ,medicine.disease ,humanities ,Surgery ,body regions ,Left ventricular-assist device ,Heart-Assist Devices ,business ,Gastrointestinal Hemorrhage - Abstract
BACKGROUND Patients with left ventricular assist devices (LVADs) are at increased risk for recurrent gastrointestinal bleeding (GIB) and repeat endoscopic procedures. We assessed the frequency of endoscopy for GIB in patients with LVADs and the impact of endoscopic intervention on preventing a subsequent GIB. AIM To evaluate for an association between endoscopic intervention and subsequent GIB. Secondary aims were to assess the frequency of GIB in our cohort, describe GIB presentations and sources identified, and determine risk factors for recurrent GIB. METHODS We conducted a retrospective cohort study of all patients at a large academic institution who underwent LVAD implantation from January 2011 – December 2018 and assessed all hospital encounters for GIB through December 2019. We performed a descriptive analysis of the GIB burden and the outcome of endoscopic procedures performed. We performed multivariate logistic regression to evaluate the association between endoscopic intervention and subsequent GIB. RESULTS In the cohort of 295 patients, 97 (32.9%) had at least one GIB hospital encounter. There were 238 hospital encounters, with 55.4% (132/238) within the first year of LVAD implantation. GIB resolved on its own by discharge in 69.8% (164/235) encounters. Recurrent GIB occurred in 55.5% (54/97) of patients, accounting for 59.2% (141/238) of all encounters. Of the 85.7% (204/238) of encounters that included at least one endoscopic evaluation, an endoscopic intervention was performed in 34.8% (71/204). The adjusted odds ratio for subsequent GIB if an endoscopic intervention was performed during a GIB encounter was not significant (odds ratio 1.18, P = 0.58). CONCLUSION Patients implanted with LVADs whom experience recurrent GIB frequently undergo repeat admissions and endoscopic procedures. In this retrospective cohort study, adherence to endoscopic guidelines for performing endoscopic interventions did not significantly decrease the odds of subsequent GIB, thus suggesting the uniqueness of the LVAD population. A prospective study is needed to identify patients with LVAD at risk of recurrent GIB and determine more effective management strategies.
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- 2021
44. Proliferative fasciitis arising from the abdominal wall: A rare tumour excised by laparoscopy
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Shashi Dhawan, Anmol Ahuja, Ashish Dey, Vinod K. Malik, Tarun Mittal, and Mohd Taha Mustafa Sheikh
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medicine.medical_specialty ,Flank ,medicine.diagnostic_test ,RD1-811 ,business.industry ,Fascia ,RC799-869 ,Diseases of the digestive system. Gastroenterology ,medicine.disease ,Surgery ,Abdominal wall ,Lesion ,medicine.anatomical_structure ,pseudosarcoma ,abdominal wall tumor ,proliferative fasciitis ,medicine ,Abdomen ,Sarcoma ,Radiology ,Presentation (obstetrics) ,medicine.symptom ,Laparoscopy ,business - Abstract
Proliferative fasciitis (PF) is a rare pseudosarcomatous lesion arising from the subcutaneous fascia and the fibrous septa. Only few hundred cases have been reported in the literature. In the largest series of 53 patients, only two patients had PF lesion arising from the flank. The most common site of origin is extremities followed by abdomen and head and neck. Its origin from the abdominal wall layer and presentation as the fever has been rarely reported in the literature. A PF lesion larger than 5 cm dimension has been sparsely noted. We report the presence of this rare entity in a 68-year-old gentleman who presented to us with low-grade fever and the presence of large lump arising from the abdominal wall. In our patient, the lesion was arising from transervsalis fascia and was excised in toto laparoscopically without damaging the abdominal muscles. It is imperative to differentiate both these lesions from sarcoma on histopathological examination as the follow-up treatment protocols for both vary.
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- 2022
45. Reply: The tools of our trade
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Richa Dhawan
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business.industry ,Medicine ,business - Published
- 2022
46. 1,25‐Dihydroxyvitamin D 3 and dietary vitamin D reduce inflammation in mice lacking intestinal epithelial cell Rab11a
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Ivor Joseph, Shiyan Yu, Sheila Bandyopadhyay, Jared Bianchi-Smak, Sylvia Christakos, Juan Flores, Iyshwarya Balasubramanian, Sayantani Goswami, Derya M. Mücahit, Nan Gao, and Puneet Dhawan
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0301 basic medicine ,medicine.medical_specialty ,Chemokine ,Physiology ,medicine.medical_treatment ,Clinical Biochemistry ,Inflammation ,Proinflammatory cytokine ,Enteritis ,03 medical and health sciences ,0302 clinical medicine ,Immune system ,Internal medicine ,medicine ,Vitamin D and neurology ,biology ,business.industry ,Cell Biology ,medicine.disease ,030104 developmental biology ,Endocrinology ,Cytokine ,030220 oncology & carcinogenesis ,Knockout mouse ,biology.protein ,medicine.symptom ,business - Abstract
A number of studies have examined the effects of 1,25-dihydroxyvitamin D3 (1,25(OH)2 D3 ) on intestinal inflammation driven by immune cells, while little information is currently available about its impact on inflammation caused by intestinal epithelial cell (IEC) defects. Mice lacking IEC-specific Rab11a a recycling endosome small GTPase resulted in increased epithelial cell production of inflammatory cytokines, notably IL-6 and early onset of enteritis. To determine whether vitamin D supplementation may benefit hosts with epithelial cell-originated mucosal inflammation, we evaluated in vivo effects of injected 1,25(OH)2 D3 or dietary supplement of a high dose of vitamin D on the gut phenotypes of IEC-specific Rab11a knockout mice (Rab11aΔIEC ). 1,25(OH)2 D3 administered at 25 ng, two doses per mouse, by intraperitoneal injection, reduced inflammatory cytokine production in knockout mice compared to vehicle-injected mice. Remarkably, feeding mice with dietary vitamin D supplementation at 20,000 IU/kg spanning fetal and postnatal developmental stages led to improved bodyweights, reduced immune cell infiltration, and decreased inflammatory cytokines. We found that these vitamin D effects were accompanied by decreased NF-κB (p65) in the knockout intestinal epithelia, reduced tissue-resident macrophages, and partial restoration of epithelial morphology. Our study suggests that dietary vitamin D supplementation may prevent and limit intestinal inflammation in hosts with high susceptibility to chronic inflammation.
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- 2021
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47. COVID-19 vaccine hesitancy – reasons and solutions to achieve a successful global vaccination campaign to tackle the ongoing pandemic
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Manish Dhawan, Saad Alhumaid, Ruchi Tiwari, Khan Sharun, Kuldeep Dhama, Ali A. Rabaan, and Talha Bin Emran
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Economic growth ,COVID-19 Vaccines ,030231 tropical medicine ,Immunology ,Disease ,Herd immunity ,03 medical and health sciences ,0302 clinical medicine ,Leverage (negotiation) ,Pandemic ,Global health ,Humans ,Immunology and Allergy ,Letters ,030212 general & internal medicine ,Pandemics ,Pharmacology ,Vaccines ,Government ,Immunization Programs ,SARS-CoV-2 ,Vaccination ,COVID-19 ,Common Variable Immunodeficiency ,Public trust ,Business - Abstract
The ongoing coronavirus disease (COVID-19) vaccination drive aims to achieve global vaccination coverage that will help to control the pandemic. Therefore, the individuals who are reluctant to be vaccinated or forego COVID-19 vaccination can delay the progress of overall vaccination coverage, leading to slower vaccination rates and may create obstacles in global efforts to control the circulation of SARS-CoV-2 as unvaccinated individuals can act as reservoirs of SARS-CoV-2 and could drive further outbreaks. Vaccine hesitancy is one of the major threats that directly impact global health as it challenges our ability to eradicate infectious diseases and achieve significant herd immunity through vaccination. One of the strategies to counter vaccine hesitancy is to follow a multisectoral approach that involves the collaboration between various stakeholders, such as government, private companies, religious groups, and other agencies, to leverage the knowledge, expertise, and resources, thereby enabling the creation of longstanding public trust of vaccines.
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- 2021
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48. Characterization and Evaluation of Recycling Potential for Discarded Laptops
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Shaila Mir and Nikhil Dhawan
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Battery (electricity) ,Materials science ,business.product_category ,Mechanical Engineering ,Metallurgy ,Metals and Alloys ,chemistry.chemical_element ,General Chemistry ,Integrated circuit ,Geotechnical Engineering and Engineering Geology ,Electronic waste ,law.invention ,Printed circuit board ,chemistry ,Control and Systems Engineering ,law ,visual_art ,Laptop ,Electronic component ,Materials Chemistry ,visual_art.visual_art_medium ,Lithium ,Tin ,business - Abstract
The emerging problem of electronic waste has promoted the interest in exploring metal recovery from secondary sources under the umbrella of urban mining. This study presents the physical and chemical characterization of various components present in end-of-life laptops to help ascertain the sites of metallic values and develop sustainable and environment-friendly recycling. The recycling potential of a laptop is evaluated by sequential disassembly, separation, and characterization of components such as body (49.8 wt.%), printed circuit board (9.7 wt.%), hard disk drive (4.9 wt.%), and battery (12.4 wt.%). The printed circuit boards comprise metallic values, majorly copper (25 wt.%), tin (5.8 wt.%), and lead (3.1 wt.%). The precious metals (Au, Ag) with an economic advantage are abundantly present in electronic components such as integrated circuits, capacitors, resistors, and processors. Critical elements such as lithium, cobalt, and rare earth elements are detected in the discarded laptops' batteries and hard disk drives. The recycling potential representing the amount of material that can be recycled in various components, depending on the type, concentration, and purity, is determined in the range of 36–100%. On average, a unit laptop contains~ 386 g of Cu (14.45 wt. %), 49.73 g Co (1.86 wt. %), ~346 mg Ag, ~141.2 mg Au, ~650 mg of rare earth elements (Nd, Dy). This study presents a database for investigating integrated and economical recycling techniques from different components of a laptop, and an overall process flow is also proposed.
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- 2021
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49. Comparison of two dose escalation strategies of methotrexate in active rheumatoid arthritis: a multicentre, parallel group, randomised controlled trial
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Varun Dhir, Shefali Khanna Sharma, Amita Aggarwal, Siddharth Jain, Aastha Khullar, Bidyalaxmi Leishangthem, Supriya Maurya, Ranjan Gupta, Aman Sharma, Sanjay Jain, Shankar Naidu, and Veena Dhawan
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Gastrointestinal Diseases ,Immunology ,Arthritis ,Gastroenterology ,Drug Administration Schedule ,General Biochemistry, Genetics and Molecular Biology ,law.invention ,Arthritis, Rheumatoid ,Young Adult ,Rheumatology ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Humans ,Immunology and Allergy ,Young adult ,Leukopenia ,Dose-Response Relationship, Drug ,business.industry ,Middle Aged ,medicine.disease ,Thrombocytopenia ,Methotrexate ,Treatment Outcome ,Polyglutamic Acid ,Tolerability ,Antirheumatic Agents ,Rheumatoid arthritis ,Transaminitis ,Female ,Chemical and Drug Induced Liver Injury ,medicine.symptom ,business ,medicine.drug - Abstract
ObjectivesThere are no head-to-head trials of different dose escalation strategies of methotrexate (MTX) in RA. We compared the efficacy, safety and tolerability of ‘usual’ (5 mg every 4 weeks) versus ‘fast’ (5 mg every 2 weeks) escalation of oral MTX.MethodsThis multicentre, open-label (assessor blinded) RCT included patients 18-55 years of age having active RA with disease duration Results178 patients with mean DAS28-CRP of 5.4(1.1) were randomized to usual (n=89) or fast escalation groups (n=89). At 16 weeks, there was no difference in good EULAR response in the usual (28.1%) or fast escalation (22.5%) groups (p=0.8). There was no difference in mean ΔDAS28-CRP at 8 weeks (-0.9, -0.8, p=0.72) or 16 weeks (-1.3, -1.3, p=0.98). Even at 24 weeks (extended follow-up), responses were similar. There were no inter-group differences in ΔHAQ, or MTX-polyglutamates 1-3 levels at 8 or 16 weeks. Gastrointestinal AE were higher in the fast escalation group over initial 8 weeks (27%, 40%, p=0.048), but not over 16 weeks. There was no difference in cytopenias, transaminitis, or drug discontinuation/dose reduction between the groups. No serious AE were seen.ConclusionA faster MTX escalation strategy in RA was not more efficacious over 16-24 weeks, and did not significantly increase AE, except higher gastrointestinal AE initially.Trial registration numberCTRI/2018/12/016549
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- 2021
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50. Biomechanical Effects of Δ9-Tetrahydrocannabinol (THC) and Cannabidiol (CBD), the Major Constituents of Cannabis, in a Sprague Dawley Rat Achilles Tendon Surgical Repair Model: A Pilot Study
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Gregory S. Lewis, Christopher M. Stauch, Daniel Morgan, Diana Sepulveda, Aman Dhawan, Brittany Ammerman, Michael Aynardi, and Matthew R. Garner
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Population ,Pilot Projects ,Physical Therapy, Sports Therapy and Rehabilitation ,Achilles Tendon ,Rats, Sprague-Dawley ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Animals ,Cannabidiol ,Orthopedics and Sports Medicine ,Dronabinol ,education ,Cannabis ,Achilles tendon ,education.field_of_study ,biology ,Athletes ,business.industry ,Chronic pain ,030229 sport sciences ,biology.organism_classification ,medicine.disease ,Rats ,Tendon ,medicine.anatomical_structure ,Opioid ,Anesthesia ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Background: The use of cannabis is common among athletes and the US population at large. Cannabinoids are currently being evaluated as alternatives to opioid medications for chronic pain management. However, the effects of recreational and/or medical use of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) on musculoskeletal injury and healing remain largely unknown. Hypothesis/Purpose: The purpose of this study was to evaluate the biomechanical effects of CBD and THC on tendon-to-tendon healing in a rat Achilles tendon repair model. The hypothesis was that rats administered CBD would demonstrate decreased tensile load to failure of surgically repaired Achilles tendons compared with the THC and control groups. Study Design: Controlled laboratory study. Methods: A total of 33 Sprague Dawley rats underwent Achilles tendon surgical transection and repair and were randomized to receive subcutaneous injection of THC, CBD, or vehicle once daily starting on the day of surgery and for 5 total days. After sacrifice, biomechanical tensile load-displacement testing was performed to determine Achilles tendon load to failure and stiffness. Data were analyzed by 1-way analysis of variance. Results: The THC group demonstrated the highest median load to failure, 18.7 N (95% CI, 15.3-19.2 N); the CBD group had the second highest at 16.9 N (95% CI, 15.1-19.8 N), and the control group had the lowest at 14.4 N (95% CI, 12.1-18.3 N). Stiffness was highest in the THC group at 4.1 N/mm (95% CI, 2.7-5.1 N/mm) compared with 3.6 N/mm (95% CI, 2.9-4.1 N/mm) for the CBD group and 3.6 N/mm (95% CI, 2.8-4.3 N/mm) for the control group. No statistically significant differences for strength and stiffness were observed between the groups. Conclusion: In this pilot study using an animal tendon-to-tendon repair model, neither THC nor CBD resulted in altered biomechanical characteristics compared to control. Clinical Relevance: Cannabinoids do not appear to adversely affect Achilles tendon healing.
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- 2021
- Full Text
- View/download PDF
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