http://hdl.handle.net/10027/98 Sat, 25 May 2013 22:23:01 GMT 2013-05-25T22:23:01Z http://hdl.handle.net/10027/8760 Diagnostic and Therapeutic Challenges Genead, Mohamed Ali; Fishman, Gerald A.; Landeman, Martin; Pennesi, Mark E.; Traboulsi, Elias I. Post print version of article may differ from published version. The definitive version is available through Lippincott, Williams & Wilkins at DOI:10.1097/IAE.0b013e31825e1d4e Tue, 01 Feb 2011 06:00:00 GMT http://hdl.handle.net/10027/8760 2011-02-01T06:00:00Z http://hdl.handle.net/10027/8757 Adverse Effects of Systemic Immunosuppression in Keratolimbal Allograft Krakauer, M.; Welder, J. D.; Pandya, H. K.; Nassiri, N.; Djalilian, A. R. Purpose. Keratolimbal allograft (KLAL) is a treatment for limbal stem cell deficiency. One disadvantage is systemic immunosuppression to avoid rejection. Our purpose was to examine the adverse effects of systemic immunosuppression in KLAL. Methods. A retrospective case review of 16 patients with KLAL who received systemic immunosuppression consisting of a corticosteroid, an antimetabolite, and/or a calcineurin inhibitor was performed. Patients were monitored for signs, symptoms, or laboratory evidence of toxicity. Results. Eleven of 16 patients (68%) experienced an adverse effect. The average age of those with adverse effects was 43.5 years and without was 31.4 years. Ten of 11 patients (91%) had resolution during mean followup of 16.4 months. No serious adverse effects occurred. The most common included anemia, hyperglycemia, elevated creatinine, and elevated liver function tests. Prednisone and tacrolimus were responsible for the most adverse effects. Patients with comorbidities were more likely to experience an adverse effect (82% versus 20%, P = 0.036). Conclusions. KLAL requires prolonged systemic immunosuppression. Our data demonstrated that systemic immunosuppression did not result in serious adverse effects in our population and is relatively safe with monitoring for toxicity. In addition, we demonstrated that adverse effects are more likely in older patients with comorbidities Copyright © 2012 M. Krakauer et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Thu, 22 Dec 2011 06:00:00 GMT http://hdl.handle.net/10027/8757 2011-12-22T06:00:00Z http://hdl.handle.net/10027/8683 Stimulus chromatic properties affect period doubling in the human cone flicker ERG Alexander, Kenneth R.; Gowrisankaran, Sowjanya Introduction: Period doubling in the full-field cone flicker electroretinogram (ERG) refers to an alternation in waveform amplitude and/or shape from cycle to cycle, presumably owing to the operation of a nonlinear gain control mechanism. This study examined the influence of stimulus chromatic properties on the characteristics of period doubling in order to better understand the underlying mechanism. Methods: ERGs were acquired from 5 visually normal subjects in response to sinusoidally modulated flicker presented at frequencies from 25 to 100 Hz. The test stimuli and the pre-test-stimulus adaptation were either long wavelength (R), middle wavelength (G), or an equal combination of long and middle wavelengths (Y), all equated for photopic luminance. Fourier analysis was used to obtain the response amplitude at the stimulus frequency F and at a harmonic frequency of 3F/2, which was used as the index of period doubling. Results: The frequency-response function for 3F/2 typically showed two peaks, occurring at approximately 33.3 and 50 Hz. However, the magnitude of period doubling within these frequency regions was dependent on the chromatic properties of both the test stimulus and the pre-stimulus adaptation. Period doubling was generally smallest when an R test was used, even though the stimuli were luminance-equated and the amplitude of F did not differ between the various conditions. Discussion: The pattern of results indicates that the mechanism that generates period doubling is influenced by chromatic signals from both the test stimulus and the pre-stimulus adaptation, even though the high stimulus frequencies presumably favor the achromatic luminance system. Post print version of article may differ from published version. The final publication is available at springerlink.com; DOI:10.1007/s10633-012-9326-1 Wed, 01 Aug 2012 05:00:00 GMT http://hdl.handle.net/10027/8683 2012-08-01T05:00:00Z http://hdl.handle.net/10027/8599 Association of Apolipoprotein E Genotype with Duration of Time to Achieve a Stable Warfarin Dose in African-American Patients Cavallari, L.H.; Butler, C.; Langaee, T.Y.; Wardak, N.; Patel, S.R.; Viana, M.A.G.; Shapiro, N.L.; Nutescu, E.A. Study Objective. To test the hypothesis that genotypes for proteins affecting vitamin K availability influence the duration of time required to achieve a stable warfarin dose in African-American patients. Design. Retrospective cohort study Setting. Pharmacist-managed antithrombosis clinic. Patients. Ninety-two African-American adults whose warfarin therapy was initiated between September 2, 1999, and July 8, 2009. Measurements and Main Results, During a routine anticoagulation clinic visit, a sample was collected from each patient for genetic analysis. Genotyping was performed for the following variants: apolipoprotein E epsilon 2, epsilon 3, and epsilon 4; NAD(P)H:quinone oxidoreductase (NQO1)*2; cytochrome P450 (CYP) 4F2 V433M; CYP2C9*2, *3, *5, *8, and *11; and vitamin K epoxide reductase complex 1 (VKORC1) -1639G>A. Patients' medical records were then reviewed, and data were collected retrospectively for each anticoagulation clinic visit during the first 6 months of warfarin therapy or until dose stabilization. The median time required to reach a stable warfarin dose, defined as the dose that produced therapeutic anticoagulation for three consecutive clinic visits, was 83 days. Compared with the 46 patients who achieved a stable warfarin dose within 83 days, the 46 patients who required longer durations for dose stabilization had a higher frequency of the apolipoprotein E epsilon 3/epsilon 3 genotype (37% vs 59%, p=0.037). Sixty-one percent of patients with the epsilon 3/epsilon 3 genotype versus 40% of those with an epsilon 2 or epsilon 4 allele had a delay in achieving a stable dose (p=0.037). Neither the CYP4F2 nor NQO1 genotype was associated with warfarin dose stabilization. Conclusion. Our data support the hypothesis that the apolipoprotein E genotype is associated with duration of time to reach a stable warfarin dose in African-American patients. Further insight into the genetic effects on warfarin dose stabilization could reveal novel methods to improve anticoagulation control during the warfarin initiation period. © 2011 by IOS Press, Pharmacotherapy Post print version of article may differ from published version. The definitive version is available through IOS Press at DOI:10.1592/phco.31.8.785 Mon, 01 Aug 2011 05:00:00 GMT http://hdl.handle.net/10027/8599 2011-08-01T05:00:00Z