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Article ; Online: Antiprogesterone therapy in recurrent meningiomas: A disappointing end to four decades of research?

Chacko, Shireen R / Chacko, Ari G

2019 Volume 67, Issue 3, Page(s) 706–707

MeSH term(s)	Humans ; Meningeal Neoplasms ; Meningioma ; Mifepristone ; Neoplasm Recurrence, Local
Chemical Substances	Mifepristone (320T6RNW1F)
Language	English
Publishing date	2019-07-26
Publishing country	India
Document type	Journal Article ; Comment
ZDB-ID	415522-1
ISSN	1998-4022 ; 0028-3886
ISSN (online)	1998-4022
ISSN	0028-3886
DOI	10.4103/0028-3886.263217
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Article ; Online: A 62-Year-Old Immunocompromised Man With Halo Sign on Chest Imaging.

Chacko, Shireen R / Matta, Atul / Bhat, Rekha / Minimo, Corrado / Benzaquen, Sadia / Gupta, Ena

Chest

2022 Volume 162, Issue 4, Page(s) e177–e181

Abstract: Case presentation: A 62-year-old White man with a history of orthotopic liver transplantation 16 years ago for alcoholic liver cirrhosis on chronic immunosuppression and recurrent decompensated cirrhosis of his graft liver complicated by ascites, ... ...

Abstract	Case presentation: A 62-year-old White man with a history of orthotopic liver transplantation 16 years ago for alcoholic liver cirrhosis on chronic immunosuppression and recurrent decompensated cirrhosis of his graft liver complicated by ascites, hepatic encephalopathy, and esophageal varices presented to the hospital with altered mental status. Over the last few weeks, he had reduced frequency of bowel movements and subsequently developed altered sensorium 3 days before presentation. On arrival to the hospital, he was disoriented and had asterixis consistent with hepatic encephalopathy. He was not in respiratory distress, he was saturating well on room air, and his lungs were clear to auscultation bilaterally. Plain chest radiograph showed multiple ill-defined bilateral airspace opacities. A CT scan of the abdomen and pelvis done on admission incidentally showed bilateral pulmonary nodules with surrounding ground-glass halo in the lower lung zones. Given these findings, a dedicated CT scan of his chest was performed that showed numerous bilateral randomly distributed nodular airspace opacities, many with a central solid component and surrounding ground-glass halo. Antifungal therapy was initiated empirically. Serum aspergillus antigen and 1,3 beta D-glucan were negative. He subsequently underwent a bronchoscopy with BAL and transbronchial biopsy. BAL fluid was negative for bacterial, fungal, and acid-fast bacilli cultures. Pathology from the transbronchial biopsy showed atypical epithelioid cells in intravascular spaces.
MeSH term(s)	Antifungal Agents/therapeutic use ; Glucans ; Hepatic Encephalopathy ; Humans ; Male ; Middle Aged ; Thorax ; Tomography, X-Ray Computed
Chemical Substances	Antifungal Agents ; Glucans
Language	English
Publishing date	2022-09-14
Publishing country	United States
Document type	Case Reports
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1016/j.chest.2022.04.156
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Ui III Zs.45: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
Zs.MO 349: Show issues

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Article ; Online: Selective perioperative steroid supplementation protocol in patients undergoing endoscopic transsphenoidal surgery for pituitary adenomas.

Chacko, Shireen R / Abraham, Ananth P / Asha, Hesarghatta Shyamasunder / Kapoor, Nitin / Rajaratnam, Simon / Chacko, Ari G

Acta neurochirurgica

2020 Volume 162, Issue 10, Page(s) 2381–2388

Abstract: Background: There is no consensus regarding the use of perioperative steroids for transsphenoidal pituitary surgery. We audited the effectiveness and safety of our selective perioperative steroid supplementation protocol in patients with pituitary ... ...

Abstract	Background: There is no consensus regarding the use of perioperative steroids for transsphenoidal pituitary surgery. We audited the effectiveness and safety of our selective perioperative steroid supplementation protocol in patients with pituitary adenomas. Methods: Two hundred ninety-seven patients underwent 306 endoscopic transsphenoidal surgeries for removal of their pituitary tumors. Steroids were given to those with an impaired hypothalamic-pituitary-adrenal (HPA) axis, age ≥ 60 years, clinical apoplexy, hyponatremia, or if the pituitary gland was not preserved at surgery. We excluded 111 patients in whom the integrity of the HPA axis could not be determined. We compared the incidence of early postoperative adrenal insufficiency and complications in 135 patients with intact HPA axes who underwent surgery without steroids (group A) with 60 patients who had compromised preoperative HPA axes and received perioperative steroids (group B). In addition, we audited the total number of protocol violations during this period. Results: Five patients (3.7%) in group A developed postoperative hypocortisolemia. There was no significant difference in the incidence of cerebrospinal fluid leak, diabetes insipidus, or hyponatremia between both groups. There were protocol deviations in 47 (15.4%) patients. Twenty one of these patients did not receive perioperative steroids in violation of the protocol, of whom 4 (19%) developed postoperative hypocortisolemia. Conclusions: Our steroid sparing protocol was both safe and effective. The 15% incidence of protocol deviations is a reminder that the rigorous usage of checklists is mandatory for successful clinical practice.
MeSH term(s)	Adenoma/surgery ; Adult ; Aged ; Cerebrospinal Fluid Leak ; Endoscopy/methods ; Female ; Hormone Replacement Therapy ; Humans ; Hydrocortisone/deficiency ; Hypothalamo-Hypophyseal System ; Male ; Middle Aged ; Neurosurgical Procedures/methods ; Perioperative Care ; Pituitary Neoplasms/surgery ; Pituitary-Adrenal System ; Retrospective Studies ; Sphenoid Bone/surgery ; Steroids/therapeutic use
Chemical Substances	Steroids ; Hydrocortisone (WI4X0X7BPJ)
Language	English
Publishing date	2020-08-09
Publishing country	Austria
Document type	Journal Article
ZDB-ID	80010-7
ISSN	0942-0940 ; 0001-6268
ISSN (online)	0942-0940
ISSN	0001-6268
DOI	10.1007/s00701-020-04530-3
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Article: Inappropriate Sinus Tachycardia: Current Challenges and Future Directions.

Yasin, Omar Z / Vaidya, Vaibhav R / Chacko, Shireen R / Asirvatham, Samuel J

The Journal of innovations in cardiac rhythm management

2018 Volume 9, Issue 7, Page(s) 3239–3243

Language	English
Publishing date	2018-07-15
Publishing country	United States
Document type	Journal Article
ISSN	2156-3977
ISSN	2156-3977
DOI	10.19102/icrm.2018.090706
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Article: Impact of achieving euthyroidism on pulmonary artery systolic pressures in hyperthyroidism-associated pulmonary hypertension - a systematic review.

Chacko, Shireen R / Ram, Pradhum / Fox, Tamaryn / Sooknanan, Naveen / Lo, Kevin Bryan / Menezes, Ritesh G / Lasrado, Savita / Eiger, Glenn / Vaidya, Anjali

American journal of cardiovascular disease

2022 Volume 12, Issue 4, Page(s) 212–223

Abstract: In this systematic review, we seek to clarify the impact of treatment of hyperthyroidism on pulmonary hypertension in patients with both these conditions. We included 39 of 709 articles retrieved, that studied patients with hyperthyroidism and pulmonary ... ...

Abstract	In this systematic review, we seek to clarify the impact of treatment of hyperthyroidism on pulmonary hypertension in patients with both these conditions. We included 39 of 709 articles retrieved, that studied patients with hyperthyroidism and pulmonary hypertension (PH). From these, those with a documented pre-treatment Pulmonary Artery Systolic Pressure (PASP) > 35 mmHg and complete follow up were analyzed, yielding 3 case series and 22 case reports with a total of 81 cases. A significant improvement in PASP was noted with achieving euthyroidism in the 3 case series. The case reports showed a significant reduction in mean PASP from 60.5 ± 13.2 mmHg to 37.5 ± 10.1 mmHg (p < 0.001) in patients with Grave's disease with achieving euthyroidism. No deaths were reported during the follow up period. Achievement of a euthyroid state in patients with hyperthyroidism is associated with statistically significant reductions in PASP.
Language	English
Publishing date	2022-08-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	2616844-3
ISSN	2160-200X
ISSN	2160-200X
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Article ; Online: A Comparison of Long-Term Treatment Outcomes Between Giant and Nongiant Craniopharyngiomas.

Sarkar, Sauradeep / Chacko, Shireen R / Korula, Sophy / Hesarghatta, Asha / Balakrishnan, Rajesh / Mathai, Sarah / Simon, Anna / Chacko, Geeta / Prabhu, Krishna / Chacko, Ari G

World neurosurgery

2022 Volume 162, Page(s) e587–e596

Abstract: Background: There is limited literature on outcomes after surgical treatment of giant craniopharyngiomas in adult and pediatric patients.: Methods: A retrospective review of 159 patients undergoing surgery for craniopharyngiomas at a single ... ...

Abstract	Background: There is limited literature on outcomes after surgical treatment of giant craniopharyngiomas in adult and pediatric patients. Methods: A retrospective review of 159 patients undergoing surgery for craniopharyngiomas at a single institution was performed. Patients with giant craniopharyngiomas (maximum dimension ≥4.5 cm) were compared with nongiant tumors in terms of various clinical and radiological parameters and long-term surgical outcomes. Extent of resection was determined by postoperative magnetic resonance imaging. Factors associated with post-treatment obesity were also analyzed. Results: Giant craniopharyngiomas (n = 66) were characterized by higher rates of childhood presentation, visual impairment, neurological deficits, multicompartmental involvement, and hydrocephalus as compared with nongiant tumors (n = 139). Giant tumors also were less likely to undergo transsphenoidal resection and were associated with a higher rate of postoperative neurological morbidity. There were no significant differences between the 2 groups in terms of extent of resection, use of postoperative radiation therapy, and long-term endocrinological outcomes. Overall recurrence rates over a mean follow-up period of 4.1 years were similar between giant and nongiant tumors; however, recurrences after presumed gross total resection/near total resection were significantly higher in the former subgroup versus the latter (39.4% vs. 18.4%; P = 0.044). Risk factors for post-treatment obesity in giant craniopharyngiomas included adult age (P = 0.001), preoperative obesity (P = 0.003), and hypothalamic involvement (P = 0.012). Conclusion: Gross total resection/near total resection of giant craniopharyngiomas can be achieved at rates comparable to nongiant tumors. However, there remains a greater risk of postoperative neurological morbidity. Radiation therapy mitigates the risk of recurrence on long-term follow-up.
MeSH term(s)	Adult ; Child ; Craniopharyngioma/complications ; Craniopharyngioma/diagnostic imaging ; Craniopharyngioma/surgery ; Humans ; Neoplasm Recurrence, Local/surgery ; Obesity/complications ; Pituitary Neoplasms/complications ; Pituitary Neoplasms/diagnostic imaging ; Pituitary Neoplasms/surgery ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2022-03-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2022.03.073
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Zs.A 1159: Show issues

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Article ; Online: Long-term outcomes following maximal safe resection in a contemporary series of childhood craniopharyngiomas.

Sarkar, Sauradeep / Chacko, Shireen R / Korula, Sophy / Simon, Anna / Mathai, Sarah / Chacko, Geeta / Chacko, Ari George

Acta neurochirurgica

2020 Volume 163, Issue 2, Page(s) 499–509

Abstract: Background: The optimal management of pediatric craniopharyngiomas remains controversial. This study aimed to characterize long-term outcomes in a contemporary cohort of children undergoing surgery for craniopharyngiomas.: Methods: This was a ... ...

Abstract	Background: The optimal management of pediatric craniopharyngiomas remains controversial. This study aimed to characterize long-term outcomes in a contemporary cohort of children undergoing surgery for craniopharyngiomas. Methods: This was a retrospective review of 37 consecutive children who underwent surgery for craniopharyngioma with a median follow-up duration of 79 months (range 5-127 months). Patients were stratified by extent of resection (EOR) and need for adjuvant radiation therapy (RT). Imaging studies were reviewed to grade extent of hypothalamic involvement. Data on functional outcomes, pituitary function, and obesity were analyzed. Results: Gross total resection was achieved in 16 patients (43.2%), near total resection in six patients (16.2%), and subtotal resection (STR) in 15 patients (40.5%). The recurrence-free survival rate was 81.1% and 70.3% at 5- and 10-year follow-up, respectively. Survival analysis showed superior disease control in patients undergoing STR + RT (p = 0.008). Functional outcomes were independent of EOR, postoperative RT or recurrence. Diabetes insipidus was present in 75% and 44.4% of patients required >2 hormone replacements at last follow-up. Obesity was present in 36.1% patients after treatment, and was associated with preoperative obesity (p = 0.019), preoperative hypothalamic involvement (p = 0.047) and STR + RT (p = 0.011). Conclusions: Gross or near total resection may be achieved safely in almost 60% of cases; however, radical surgery does not eliminate the risk of recurrence. Over long-term follow-up, STR + RT offers the best disease control rates. Patients with preoperative hypothalamic involvement, obesity, and those with tumors not amenable to radical resection are at risk for developing obesity on long-term follow-up.
MeSH term(s)	Body Mass Index ; Child ; Child, Preschool ; Cohort Studies ; Craniopharyngioma/complications ; Craniopharyngioma/radiotherapy ; Craniopharyngioma/surgery ; Diabetes Insipidus/etiology ; Female ; Humans ; Male ; Neoplasm Recurrence, Local/surgery ; Pituitary Neoplasms/complications ; Pituitary Neoplasms/radiotherapy ; Pituitary Neoplasms/surgery ; Radiotherapy, Adjuvant ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2020-10-19
Publishing country	Austria
Document type	Journal Article
ZDB-ID	80010-7
ISSN	0942-0940 ; 0001-6268
ISSN (online)	0942-0940
ISSN	0001-6268
DOI	10.1007/s00701-020-04591-4
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Article ; Online: Association of Pre-Admission Statin Use With Reduced In-Hospital Mortality in COVID-19.

Chacko, Shireen R / DeJoy, Robert / Lo, Kevin Bryan / Albano, Jeri / Peterson, Eric / Bhargav, Ruchika / Gu, Fahad / Salacup, Grace / Pelayo, Jerald / Azmaiparashvili, Zurab / Rangaswami, Janani / Patarroyo-Aponte, Gabriel / Benzaquen, Sadia / Gupta, Ena

The American journal of the medical sciences

2021 Volume 361, Issue 6, Page(s) 725–730

Abstract: Background: Coronavirus disease-19 (COVID-19) infection is associated with an uncontrolled systemic inflammatory response. Statins, given their anti-inflammatory properties, may reduce the associated morbidity and mortality. This study aimed to ... ...

Abstract	Background: Coronavirus disease-19 (COVID-19) infection is associated with an uncontrolled systemic inflammatory response. Statins, given their anti-inflammatory properties, may reduce the associated morbidity and mortality. This study aimed to determine the association between statin use prior to hospitalization and in-hospital mortality in COVID-19 patients. Methods: In this retrospective study, clinical data were collected from the electronic medical records of patients admitted to the hospital with confirmed COVID-19 infection from March 1, 2020 to April 24, 2020. A multivariate regression analysis was performed to study the association of pre-admission statin use with in-hospital mortality. Results: Of 255 patients, 116 (45.5%) patients were on statins prior to admission and 139 (54.5%) were not. The statin group had a higher proportion of end stage renal disease (ESRD) (13.8% vs. 2.9%, p = 0.001), diabetes mellitus (63.8% vs. 35.2%, p<0.001), hypertension (87.9% vs. 61.1%, p < 0.001) and coronary artery disease (CAD) (33.6% vs. 5%, p < 0.001). On multivariate analysis, we found a statistically significant decrease in the odds of in-hospital mortality in patients on statins before admission (OR 0.14, 95% CI 0.03- 0.61, p = 0.008). In the subgroup analysis, statins were associated with a decrease in mortality in those with CAD (OR 0.02, 95% CI 0.0003-0.92 p = 0.045) and those without CAD (OR 0.05, 95% CI 0.005-0.43, p = 0.007). Conclusions: Our study suggests that statins are associated with reduced in-hospital mortality among patients with COVID-19, regardless of CAD status. More comprehensive epidemiological and molecular studies are needed to establish the role of statins in COVID-19.
MeSH term(s)	Aged ; Anti-Inflammatory Agents/therapeutic use ; COVID-19/mortality ; COVID-19/therapy ; Comorbidity ; Dyslipidemias/drug therapy ; Dyslipidemias/epidemiology ; Female ; Hospital Mortality ; Hospitalization/statistics & numerical data ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use ; Male ; Mortality ; Outcome Assessment, Health Care ; Retrospective Studies ; Risk Factors ; SARS-CoV-2 ; United States/epidemiology
Chemical Substances	Anti-Inflammatory Agents ; Hydroxymethylglutaryl-CoA Reductase Inhibitors
Language	English
Publishing date	2021-03-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	82078-7
ISSN	1538-2990 ; 0002-9629
ISSN (online)	1538-2990
ISSN	0002-9629
DOI	10.1016/j.amjms.2021.03.001
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Article ; Online: Insulin Use, Diabetes Control, and Outcomes in Patients with COVID-19.

Riahi, Shayan / Sombra, Lorenna Rodrigues Silva / Lo, Kevin Bryan / Chacko, Shireen R / Neto, Alvaro Goncalves Mendes / Azmaiparashvili, Zurab / Patarroyo-Aponte, Gabriel / Rangaswami, Janani / Anastasopoulou, Catherine

Endocrine research

2020 Volume 46, Issue 2, Page(s) 45–50

Abstract: ... ...

Abstract	Background
MeSH term(s)	Aged ; Blood Glucose/analysis ; COVID-19/blood ; COVID-19/complications ; COVID-19/mortality ; Diabetes Mellitus, Type 1/blood ; Diabetes Mellitus, Type 1/complications ; Diabetes Mellitus, Type 1/drug therapy ; Diabetes Mellitus, Type 1/mortality ; Diabetes Mellitus, Type 2/blood ; Diabetes Mellitus, Type 2/complications ; Diabetes Mellitus, Type 2/drug therapy ; Diabetes Mellitus, Type 2/mortality ; Female ; Glycated Hemoglobin A/analysis ; Glycemic Control ; Hospital Mortality ; Hospitalization ; Humans ; Hypoglycemic Agents/administration & dosage ; Hypoglycemic Agents/therapeutic use ; Insulin/administration & dosage ; Insulin/therapeutic use ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Survival Rate
Chemical Substances	Blood Glucose ; Glycated Hemoglobin A ; Hypoglycemic Agents ; Insulin ; hemoglobin A1c protein, human
Language	English
Publishing date	2020-12-04
Publishing country	England
Document type	Journal Article
ZDB-ID	605823-1
ISSN	1532-4206 ; 0743-5800
ISSN (online)	1532-4206
ISSN	0743-5800
DOI	10.1080/07435800.2020.1856865
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