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  1. Article: Rheumatoid arthritis synovial fluid shows enrichment of T-cells producing GMCSF which are polyfunctional for TNFα and IFNγ.

    Khullar, Aastha / Dhir, Varun / Saikia, Biman / Yadav, Ashok Kumar / Leishangthem, Bidyalaxmi / Prasad, Chandra Bhushan / Jayaprakash, Sankar / Jain, Siddharth / Naidu, G S R S N K / Sharma, Shefali K / Sharma, Aman / Jain, Sanjay

    Clinical and experimental rheumatology

    2024  

    Abstract: ... polyfunctionality may be a marker of pathogenicity. Although, higher frequencies of CD4+GMCSF+ T-cells have been ... reported, there are no data on CD8+GMCSF+ T-cells or polyfunctionality.Our objective was to enumerate ... frequencies of CD8+GMCSF+ T cells in RA blood and synovial fluid (SF), and assess their polyfunctionality ...

    Abstract Objectives: GMCSF+T-cells may be involved in pathogenesis of rheumatoid arthritis (RA), and polyfunctionality may be a marker of pathogenicity. Although, higher frequencies of CD4+GMCSF+ T-cells have been reported, there are no data on CD8+GMCSF+ T-cells or polyfunctionality.Our objective was to enumerate frequencies of CD8+GMCSF+ T cells in RA blood and synovial fluid (SF), and assess their polyfunctionality, memory phenotype and cytotoxic ability.
    Methods: This study included RA patients (blood samples,in some with paired synovial fluid (SF)), healthy controls (HC) (blood) and SpA patients (SF). In some RA patients' blood was sampled twice, before and 16-24 weeks after methotrexate (MTX) treatment. After mononuclear cell isolation from blood and SF, ex-vivo stimulation using PMA/Ionomycin was done, and cells were stained (surface and intracellular after permeabilisation/fixation). Subsequently, frequencies of GMCSF+CD8+ and CD4+ T-cells, polyfunctionality (TNFα, IFNγ, IL-17), phenotype (memory) and perforin/granzyme expression were assessed by flowcytometry.
    Results: There was no significant difference in frequencies of GMCSF+CD8+ (3.7, 4.1%, p=0.540) or GMCSF+CD4+ T-cells (4.5, 5.2%, p=0.450) inblood of RA and HC. However, there was significant enrichment of both CD8+GMCSF+ (5.8, 3.9%, p=0.0045) and CD4+GMCSF+ (8.5, 4.5%, p=0.0008) T-cells inSF compared to blood in RA patients. Polyfunctional triple cytokine positive TNFα+IFNγ+GMCSF+CD8+T-cells (81, 36%, p=0.049) and CD4+T-cells (48, 32%, p=0.010) was also higher in SF compared to blood in RA. CD8+ T cells showed higher frequency of effector-memory phenotype and granzyme-B expression in RA-SF. On longitudinal follow-up, blood CD4+GMCSF+ T-cells significantly declined (4.6, 2.9%, p=0.0014) post-MTX.
    Conclusions: We report a novel finding of enrichment of CD8+GMCSF+ in addition to CD4+GMCSF+ T-cells in RA-SF. These cells showed higher polyfunctionality for TNFα and IFNγ, and effector memory phenotype suggesting their involvement in RA pathogenesis.
    Language English
    Publishing date 2024-02-12
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 605886-3
    ISSN 1593-098X ; 0392-856X
    ISSN (online) 1593-098X
    ISSN 0392-856X
    DOI 10.55563/clinexprheumatol/dyjbvf
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Peak troponin T in STEMI: a predictor of all-cause mortality and left ventricular function.

    Khullar, Natasha / Buckley, Anthony James / O'Connor, Cormac / Ibrahim, Abdalla / Ibrahim, Alsamawal / Ahern, Catriona / Cahill, Ciara / Arnous, Samer / Kiernan, Thomas John

    Open heart

    2022  Volume 9, Issue 1

    Abstract: ... the relationship between peak high-sensitivity cardiac troponin T (hs-cTnT) and all-cause mortality at 30 days and ...

    Abstract Background: The clinical significance of peak troponin levels following ST-elevation myocardial infarction (STEMI) has not been definitively established. The purpose of this study was to examine the relationship between peak high-sensitivity cardiac troponin T (hs-cTnT) and all-cause mortality at 30 days and 1 year, and left ventricular ejection fraction (LVEF) in STEMI.
    Methods: A single-centre retrospective observational study was conducted of all patients with STEMI between January 2015 and December 2017. Demographics and clinical data were obtained through electronic patient records. Standard Bayesian statistics were employed for analysis.
    Results: During the study period, 568 patients presented with STEMI. The mean age was 63.6±12 years and 76.4% were men. Of these, 535 (94.2%) underwent primary percutaneous coronary intervention, 12 (2.1%) underwent urgent coronary artery bypass and 21 (3.7%) were treated medically. Mean peak hs-cTnT levels were significantly higher in those who died within 30 days compared with those who survived (12 238 ng/L vs 4657 ng/L, respectively; p=0.004). Peak hs-cTnT levels were also significantly higher in those who died within 1 year compared with those who survived (10 319 ng/L vs 4622 ng/L, respectively; p=0.003). The left anterior descending artery was associated with the highest hs-cTnT and was the most common culprit in those who died at 1 year. An inverse relationship was demonstrated between peak hs-cTnT and LVEF (Pearson's R=0.379; p<0.00001).
    Conclusions: In STEMI, those who died at 30 days and 1 year had significantly higher peak troponin levels than those who survived. Peak troponin is also inversely proportional to LVEF with higher troponins associated with lower LVEF.
    MeSH term(s) Aged ; Bayes Theorem ; Biomarkers ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; ST Elevation Myocardial Infarction/diagnosis ; ST Elevation Myocardial Infarction/therapy ; Stroke Volume ; Troponin ; Troponin T ; Ventricular Function, Left
    Chemical Substances Biomarkers ; Troponin ; Troponin T
    Language English
    Publishing date 2022-05-20
    Publishing country England
    Document type Journal Article ; Observational Study
    ZDB-ID 2747269-3
    ISSN 2053-3624
    ISSN 2053-3624
    DOI 10.1136/openhrt-2021-001863
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Incidence of MicroR-4513C/T Gene Variability in Coronary Artery Disease - A Case-Control Study.

    Mir, Rashid / Jha, Chandan K / Elfaki, Imadeldin / Javid, Jamsheed / Rehman, Suriya / Khullar, Naina / Banu, Shaheena / Chahal, S M S

    Endocrine, metabolic & immune disorders drug targets

    2019  Volume 19, Issue 8, Page(s) 1216–1223

    Abstract: ... the potential association of miR-4513 rs2168518 C>T gene variability with the risk of developing CAD and ... individuals. Genotyping of MicroR-4513 rs2168518C>T gene variability was performed using Amplification ... Results also indicate a potential dominant effect of miR-4513 rs2168518 C/T polymorphism on susceptibility ...

    Abstract Background: Genetic variants in pre-microRNA genes or the 3'UTR of miRNA target genes could influence miRNA-mediated regulation of gene expression and thus contribute to the susceptibility and prognosis of human diseases. Several studies have investigated the association of genetic variants in the seed region of miRNAs with cardiometabolic phenotypes .Therefore the aim of study was to investigate the potential association of miR-4513 rs2168518 C>T gene variability with the risk of developing CAD and its association with different cardiometabolic phenotypes in an Indian cohort to stratify CAD burden in the general population.
    Methods: The study was conducted on 100 clinically confirmed CAD patients and 100 healthy individuals. Genotyping of MicroR-4513 rs2168518C>T gene variability was performed using Amplification refractory mutation system PCR method.
    Results: A significant difference was observed in the genotype distribution among CAD cases and healthy controls. The frequencies of three genotypes CC, CT, TT in CAD patient and healthy controls were 5%, 77%, 18%, and 28%, 45% and 27% respectively. A multivariate analysis showed that miR- 4513 rs2168518 polymorphism is associated with an increased susceptibility to CAD in codominant inheritance model for variant CC vs. CT OR 9.58 CI (3.45-26.57), RR 2.3(1.75-3.02), P=0.001. Results also indicate a potential dominant effect of miR-4513 rs2168518 C/T polymorphism on susceptibility of CAD in dominant inheritance model for variant CC vs. (CT+TT) OR 7.38 (2.71-20.07), RR 1.96 (1.56-2.46), P=0.001. In allelic comparison, T allele weakly increased risk of CAD compared to C allele (OR=1.50, 95% CI (1.09-2.26) RR 1.15 (0.94-1.39) P=0.044.
    Conclusion: It is concluded that CT genotype and T allele of microR-4513 rs2168518 is strongly associated with increased susceptibility to CAD. Furthers studies with larger sample sizes are necessary to confirm this result.
    MeSH term(s) Case-Control Studies ; Coronary Artery Disease/diagnostic imaging ; Coronary Artery Disease/epidemiology ; Coronary Artery Disease/genetics ; Female ; Gene Frequency ; Genetic Association Studies ; Genetic Predisposition to Disease ; Heterozygote ; Homozygote ; Humans ; Incidence ; India/epidemiology ; Male ; MicroRNAs/genetics ; Middle Aged ; Phenotype ; Polymorphism, Single Nucleotide ; Risk Assessment ; Risk Factors
    Chemical Substances MIRN-4513 microRNA, human ; MicroRNAs
    Language English
    Publishing date 2019-04-29
    Publishing country United Arab Emirates
    Document type Journal Article
    ZDB-ID 2228325-0
    ISSN 2212-3873 ; 1871-5303
    ISSN (online) 2212-3873
    ISSN 1871-5303
    DOI 10.2174/1871530319666190417111940
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Linear nonpalpable purpura in a young male: a unique presentation of leukemia cutis in T-cell prolymphocytic leukemia.

    Khullar, Geeti / Singh, Saurabh / Agrawal, Saurabh / Sachdeva, Man Updesh Singh / Saikia, Uma Nahar

    International journal of dermatology

    2017  Volume 56, Issue 3, Page(s) e65–e67

    MeSH term(s) Adult ; Bone Marrow/pathology ; Humans ; Leukemia, Prolymphocytic, T-Cell/complications ; Leukemia, Prolymphocytic, T-Cell/diagnosis ; Lymphadenopathy/etiology ; Lymphadenopathy/pathology ; Male ; Purpura/etiology ; Purpura/pathology
    Language English
    Publishing date 2017-03
    Publishing country England
    Document type Case Reports ; Letter
    ZDB-ID 412254-9
    ISSN 1365-4632 ; 0011-9059 ; 1461-1244
    ISSN (online) 1365-4632
    ISSN 0011-9059 ; 1461-1244
    DOI 10.1111/ijd.13457
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Advancing Anemia Management in Chronic Kidney Disease: Assessing the Superiority of Darbepoetin Alfa Over Erythropoietin Alpha.

    Khullar, Dinesh / Muchhala, Snehal S / T, Abhishek

    Cureus

    2024  Volume 16, Issue 1, Page(s) e51613

    Abstract: Anemia is a prevalent and debilitating complication in patients with chronic kidney disease (CKD). It presents multifaceted challenges that impact patients' quality of life and overall well-being. The advent of darbepoetin alfa (DPO) as a therapeutic ... ...

    Abstract Anemia is a prevalent and debilitating complication in patients with chronic kidney disease (CKD). It presents multifaceted challenges that impact patients' quality of life and overall well-being. The advent of darbepoetin alfa (DPO) as a therapeutic alternative to recombinant human erythropoietin alpha (EPO) has revolutionized the management of CKD-associated anemia. This review article presents a comprehensive comparative analysis highlighting the advantages of DPO over EPO in the effective management of anemia, in both predialysis and dialysis-dependent (DD) CKD patients. DPO's distinct pharmacokinetic advantages play a pivotal role in its efficacy and safety. With a significantly longer half-life and several-fold increased biological activity compared to EPO, DPO enables extended dosing intervals. Through an in-depth examination of diverse clinical trials, it becomes evident that DPO consistently demonstrates remarkable efficacy and safety in improving and maintaining hemoglobin (Hb) levels. Furthermore, its simplified dosage regimen, coupled with the convenience of less frequent administration, not only improves patient adherence but also translates to reduced healthcare costs and resource utilization. In conclusion, this review provides compelling evidence of the advantages of DPO over conventional recombinant human EPO for managing anemia in CKD patients, both in the predialysis and dialysis-dependent CKD patients. DPO's pharmacokinetic advantages, patient-centered advantages, enhanced compliance, and cost-effectiveness converge to establish DPO as a transformative therapeutic option. In both predialysis and dialysis settings, DPO's superior efficacy and patient-centric attributes collectively redefine the landscape of anemia management in CKD.
    Language English
    Publishing date 2024-01-03
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.51613
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Reply to the Letter to the Editors regarding COVID-19 infection and placental histopathology in women delivering at term.

    Patberg, Elizabeth T / Vintzileos, Anthony M / Khullar, Poonam

    American journal of obstetrics and gynecology

    2021  Volume 225, Issue 3, Page(s) 354

    MeSH term(s) COVID-19 ; Female ; Humans ; Infectious Disease Transmission, Vertical ; Placenta ; Pregnancy ; Pregnancy Complications, Infectious ; SARS-CoV-2
    Language English
    Publishing date 2021-05-29
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 80016-8
    ISSN 1097-6868 ; 0002-9378
    ISSN (online) 1097-6868
    ISSN 0002-9378
    DOI 10.1016/j.ajog.2021.05.037
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  7. Article: Patient-reported outcomes on sleep quality and circadian rhythm during treatment with intravenous ketamine for treatment-resistant depression.

    Yan, Raymond / Marshall, Tyler / Khullar, Atul / Nagle, Travis / Knowles, Jake / Malkin, Mai / Chubbs, Brittany / Swainson, Jennifer

    Therapeutic advances in psychopharmacology

    2024  Volume 14, Page(s) 20451253241231264

    Abstract: Background: Intravenous (IV) ketamine is a rapid acting antidepressant used primarily for treatment-resistant depression (TRD). It has been suggested that IV ketamine's rapid antidepressant effects may be partially mediated : Objectives: This study ... ...

    Abstract Background: Intravenous (IV) ketamine is a rapid acting antidepressant used primarily for treatment-resistant depression (TRD). It has been suggested that IV ketamine's rapid antidepressant effects may be partially mediated
    Objectives: This study explores IV ketamine's association with changes in patient-reported sleep quality and circadian rhythm in an adult population with TRD.
    Methods: Adult patients (18-64 years) with TRD scheduled for IV ketamine treatment were recruited to complete patient rated outcomes measures on sleep quality using the Pittsburgh Sleep Quality Index (PSQI) and circadian rhythm using the Morningness-Eveningness Questionnaire (MEQ). Over a 4-week course of eight ketamine infusions, reports were obtained at baseline (T0), prior to second treatment (T1), prior to fifth treatment (T2), and 1 week after eighth treatment (T3).
    Results: Forty participants with TRD (mean age = 42.8, 45% male) were enrolled. Twenty-nine (72.5%) had complete follow-up data. Paired
    Conclusion: IV ketamine may improve sleep quality and advance circadian rhythm in individuals with TRD. Effects may differ in individuals with mixed features of depression as compared to those without. Since this was a small uncontrolled study, future research is warranted.
    Language English
    Publishing date 2024-03-04
    Publishing country England
    Document type Journal Article
    ZDB-ID 2646542-5
    ISSN 2045-1261 ; 2045-1253
    ISSN (online) 2045-1261
    ISSN 2045-1253
    DOI 10.1177/20451253241231264
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  8. Article ; Online: Adjuvant Radiation in Early Stage Vulvar Cancer: A Review of Indications and Optimal Dose.

    Khullar, Karishma / Patrich, Tomas / Jabbour, Salma K / Hathout, Lara

    Applied radiation oncology

    2022  Volume 11, Issue 1, Page(s) 14–20

    Abstract: Vulvar cancer is a relatively rare gynecologic malignancy for which surgery remains the cornerstone of treatment. A wide local excision is the goal for treatment with curative intent in patients with early stage vulvar cancer, given that there are ... ...

    Abstract Vulvar cancer is a relatively rare gynecologic malignancy for which surgery remains the cornerstone of treatment. A wide local excision is the goal for treatment with curative intent in patients with early stage vulvar cancer, given that there are adverse pathologic features shown to increase risk of local recurrence. Specifically, the presence of positive or close margins of < 8 mm or 2 or more positive nodes have been shown to significantly increase the risk of recurrence and have informed guidelines for risk-adapted adjuvant radiation, although the optimal dose for adjuvant radiation is yet to be established. Given the rarity of vulvar cancer, guidelines regarding the indications and dose for adjuvant radiation are based largely on retrospective studies. The purpose of this review is to summarize the evidence underlying the current indications for adjuvant radiation in early stage vulvar cancer as well as to determine the optimal dose for adjuvant radiation.
    Language English
    Publishing date 2022-04-18
    Publishing country United States
    Document type Journal Article
    ISSN 2334-5446
    ISSN (online) 2334-5446
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: CT Imaging Features in Acute Invasive Fungal Rhinosinusitis- Recalling the Oblivion in the COVID Era.

    Khullar, Tamanna / Kumar, Jyoti / Sindhu, Deeksha / Garg, Anju / Meher, Ravi

    Current problems in diagnostic radiology

    2022  Volume 51, Issue 5, Page(s) 798–805

    Abstract: Objective: Recent pandemic of COVID19 infection has witnessed a re-emergence of invasive fungal sinusitis especially of the Mucor species, which has been a rare entity in the pre covid era. Covid associated mucormycosis (CAM) is one of the dreaded and ... ...

    Abstract Objective: Recent pandemic of COVID19 infection has witnessed a re-emergence of invasive fungal sinusitis especially of the Mucor species, which has been a rare entity in the pre covid era. Covid associated mucormycosis (CAM) is one of the dreaded and fatal complications which has surfaced up and early diagnosis is critical for management and survival .It is identified to affect both subset of patients, those with active COVID-19 infection and those who have recovered from the disease in the last 4-6 weeks. Imaging features suggestive of early invasion with supportive imaging examples and relevance of these findings in clinical decision making is presented.
    Methods: This paper reviews the various imaging signs of early invasion in CAM A comprehensive checklist for clinically relevant and quick reporting is also presented.
    Results: Emphysematous or ulcerative mucosal changes in the nasal cavity is an early imaging feature of CAM. Periantral soft tissue and soft tissue within the pterygopalatine fossa are important imaging signs to indicate extrasinus invasion. Disease within pterygopalatine fossa may lead to multidirectional spread and is an important check site. These findings are seen even in absence of bony erosions owing to the neurovascular spread of disease. Intra orbital and intracranial extensions were found to be fairly common and must be sought for.
    Conclusion: The knowledge of early subtle signs of CAM on imaging can aid in prompt diagnosis of this fatal entity in the pertinent clinical setting. Imaging signs of spread of disease and delineation of its extent as inferred from CT imaging aids in prognosis and appropriate surgical management.
    MeSH term(s) Acute Disease ; COVID-19/diagnostic imaging ; Humans ; Sinusitis/complications ; Sinusitis/diagnostic imaging ; Tomography, X-Ray Computed/methods
    Language English
    Publishing date 2022-02-07
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 198954-6
    ISSN 1535-6302 ; 0363-0188
    ISSN (online) 1535-6302
    ISSN 0363-0188
    DOI 10.1067/j.cpradiol.2022.02.001
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  10. Article ; Online: Orbital and ocular perfusion in thyroid eye disease.

    Goel, Ruchi / Shah, Shalin / Sundar, Gangadhara / Arora, Ritu / Gupta, Swati / Khullar, Tamanna

    Survey of ophthalmology

    2023  Volume 68, Issue 3, Page(s) 481–506

    Abstract: Thyroid eye disease (TED) is characterized by enlargement of extraocular muscles, an increase in retrobulbar fat, orbital fibrosis, and fluctuations in plasma thyroid hormone levels in most patients, often associated with raised autoantibody titers. The ... ...

    Abstract Thyroid eye disease (TED) is characterized by enlargement of extraocular muscles, an increase in retrobulbar fat, orbital fibrosis, and fluctuations in plasma thyroid hormone levels in most patients, often associated with raised autoantibody titers. The occurrence of orbital space conflict compromises the orbital perfusion, unchecked progression of which results in irreversible loss of visual acuity and visual fields. The quantitative assessment of orbital perfusion can be done by measurement of blood flow velocities in the superior ophthalmic vein (SOV), ophthalmic artery (OA), central retinal artery (CRA), and posterior ciliary artery by color Doppler imaging. The retinal and choroidal microvasculature is studied by optical coherence tomography and optical coherence tomography angiography. The orbital and ocular perfusion fluctuates during the course of TED. Orbital congestion is reflected by the reduction or reversal of SOV flow and an increase in subfoveal choroidal thickness. The active phase is characterized by high blood flow velocities of the OA and CRA. The onset of dysthyroid optic neuropathy is associated with reduced arterial perfusion and reduction in parafoveal and peripapillary vascular density. Orbital decompression improves the SOV flow and decreases the resistivity index of CRA. Sequential evaluation of orbital hemodynamic changes can thus supplement the clinical scoring systems for monitoring and planning intervention in TED.
    MeSH term(s) Humans ; Graves Ophthalmopathy/diagnosis ; Graves Ophthalmopathy/surgery ; Ultrasonography, Doppler, Color ; Eye ; Orbit/diagnostic imaging ; Orbit/blood supply ; Ophthalmic Artery/diagnostic imaging ; Blood Flow Velocity/physiology ; Perfusion ; Regional Blood Flow/physiology
    Language English
    Publishing date 2023-01-18
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 391346-6
    ISSN 1879-3304 ; 0039-6257
    ISSN (online) 1879-3304
    ISSN 0039-6257
    DOI 10.1016/j.survophthal.2023.01.003
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