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Girisha KM, Nayak SS, Shukla A, Bhat SK. ALOBAR HOLOPROSENCEPHALY, CLEFT LIP/PALATE, URORECTAL SEPTUM MALFORMATION SEQUENCE AND CONGENITAL PERINEAL HERNIA IN A FETUS. GENETIC COUNSELING (GENEVA, SWITZERLAND) 2015; 26:321-325. [PMID: 26625663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We report on a fetus with alobar holoprosencephaly, complete cleft lip and palate, urorectal septum malformation sequence and perineal hernia. To our knowledge this appears to be a novel fetal malformation syndrome.
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Rueff JP, Ablett JM, Céolin D, Prieur D, Moreno T, Balédent V, Lassalle-Kaiser B, Rault JE, Simon M, Shukla A. The GALAXIES beamline at the SOLEIL synchrotron: inelastic X-ray scattering and photoelectron spectroscopy in the hard X-ray range. JOURNAL OF SYNCHROTRON RADIATION 2015; 22:175-179. [PMID: 25537606 DOI: 10.1107/s160057751402102x] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 09/21/2014] [Indexed: 06/04/2023]
Abstract
The GALAXIES beamline at the SOLEIL synchrotron is dedicated to inelastic X-ray scattering (IXS) and photoelectron spectroscopy (HAXPES) in the 2.3-12 keV hard X-ray range. These two techniques offer powerful complementary methods of characterization of materials with bulk sensitivity, chemical and orbital selectivity, resonant enhancement and high resolving power. After a description of the beamline components and endstations, the beamline capabilities are demonstrated through a selection of recent works both in the solid and gas phases and using either IXS or HAXPES approaches. Prospects for studies on liquids are discussed.
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Lathrop MJ, Sage EK, Macura SL, Brooks EM, Cruz F, Bonenfant NR, Sokocevic D, MacPherson MB, Beuschel SL, Dunaway CW, Shukla A, Janes SM, Steele C, Mossman BT, Weiss DJ. Antitumor effects of TRAIL-expressing mesenchymal stromal cells in a mouse xenograft model of human mesothelioma. Cancer Gene Ther 2014; 22:44-54. [DOI: 10.1038/cgt.2014.68] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 10/08/2014] [Accepted: 10/08/2014] [Indexed: 12/27/2022]
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Shukla A, Chitnis VR, Singh BB, Acharya BS, Anupama GC, Bhattacharjee P, Britto RJ, Mannheim K, Prabhu TP, Saha L, Vishwanath PR. MULTI-FREQUENCY, MULTI-EPOCH STUDY OF Mrk 501: HINTS FOR A TWO-COMPONENT NATURE OF THE EMISSION. ACTA ACUST UNITED AC 2014. [DOI: 10.1088/0004-637x/798/1/2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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55
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Ramakrishnan P, Rane A, Dias A, Bhat J, Shukla A, Lakshmi S, Ansari BK, Ramaswamy RS, Reddy RA, Tribulato A, Agarwal AK, SatyaPrasad N, Mushtaq A, Rao PH, Murthy P, Koenig HG. Indian health care professionals' attitude towards spiritual healing and its role in alleviating stigma of psychiatric services. JOURNAL OF RELIGION AND HEALTH 2014; 53:1800-1814. [PMID: 24430129 DOI: 10.1007/s10943-014-9822-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Persons with mental illnesses in India and rest of developing world continue to consult religious/spiritual (R/S) healers or traditional, complementary and alternative medicine (TCAM) professionals prior to seeking psychiatric services that are devoid of spiritual components of care. We aim to understand TCAM and allopathic professionals' perspectives on patients' R/S needs within mental health services, cross-sectional study was conducted at five TCAM and two allopathic tertiary care hospitals in three different Indian states; 393 participants completed RSMPP, a self-administered, semi-structured survey questionnaire. Perspectives of TCAM and allopathic health professionals on role of spirituality in mental health care were compared. Substantial percentage, 43.7 % TCAM and 41.3 % allopathic, of participants believe that their patients approach R/S or TCAM practitioners for severe mental illness; 91.2 % of TCAM and 69.7 % of allopaths were satisfied with R/S healers (p = 0.0019). Furthermore, 91.1 % TCAM and 73.1 % allopaths (p = 0.000) believe that mental health stigma can be minimized by integrating with spiritual care services. Overall, 87 % of TCAM and 73 % of allopaths agreed to primary criterion variable: 'spiritual healing is beneficial and complementary to psychiatric care.' A quarter of allopaths (24.4 %) and 38 % of TCAM physicians reportedly cross-refer their grieving patients to religious/TCAM healer and psychiatrist/psychologist, respectively; on logistic regression, significant (p < 0.05) predictors were clinical interactions/references to r/s healers. Providing spiritual care within the setup of psychiatric institution will not only complement psychiatric care but also alleviate stigma against mental health services. Implications on developing spiritual care services like clinical chaplaincy are discussed.
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Melcher D, Shukla A, Wutz A. Temporal expansion, more information: the role of subjectively distorted time in information accrual. J Vis 2014. [DOI: 10.1167/14.10.1152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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57
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Ramakrishnan P, Dias A, Rane A, Shukla A, Lakshmi S, Ansari BKM, Ramaswamy RS, Reddy AR, Tribulato A, Agarwal AK, Bhat J, SatyaPrasad N, Mushtaq A, Rao PH, Murthy P, Koenig HG. Perspectives of Indian traditional and allopathic professionals on religion/spirituality and its role in medicine: basis for developing an integrative medicine program. JOURNAL OF RELIGION AND HEALTH 2014; 53:1161-1175. [PMID: 23625126 DOI: 10.1007/s10943-013-9721-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Allopathic medical professionals in developed nations have started to collaborate with traditional, complementary, and alternative medicine (TCAM) to enquire on the role of religion/spirituality (r/s) in patient care. There is scant evidence of such movement in the Indian medical community. We aim to understand the perspectives of Indian TCAM and allopathic professionals on the influence of r/s in health. Using RSMPP (Religion, Spirituality and Medicine, Physician Perspectives) questionnaire, a cross-sectional survey was conducted at seven (five TCAM and two allopathic) pre-selected tertiary care medical institutes in India. Findings of TCAM and allopathic groups were compared. Majority in both groups (75% of TCAM and 84.6% of allopathic practitioners) believed that patients' spiritual focus increases with illness. Up to 58% of TCAM and allopathic respondents report patients receiving support from their religious communities; 87% of TCAM and 73% of allopaths believed spiritual healing to be beneficial and complementary to allopathic medical care. Only 11% of allopaths, as against 40% of TCAM, had reportedly received 'formal' training in r/s. Both TCAM (81.8%) and allopathic (63.7%) professionals agree that spirituality as an academic subject merits inclusion in health education programs (p = 0.0003). Inclusion of spirituality in the health care system is a need for Indian medical professionals as well as their patients, and it could form the basis for integrating TCAM and allopathic medical systems in India.
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Bigoniya P, Shukla A. Phytopharmacological screening of Lepidium sativum seeds total alkaloid: Hepatoprotective, antidiabetic and in vitro antioxidant activity along with identification by LC/MS/MS. PHARMANUTRITION 2014. [DOI: 10.1016/j.phanu.2013.11.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Shukla A, Mohapatra TM, Parmar D, Seth K. Neuroprotective potentials of neurotrophin rich olfactory ensheathing cell's conditioned media against 6OHDA-induced oxidative damage. Free Radic Res 2014; 48:560-71. [PMID: 24528157 DOI: 10.3109/10715762.2014.894636] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
On the basis of recent reports, we propose that impaired neurotrophin signaling (PI3k/Akt), low antioxidant levels, and generation of reactive oxygen species (ROS) conjointly participate in the progressive events responsible for the dopaminergic cell loss in Parkinson's disease (PD). In the present study we tried to target these deficits collectively through multiple neurotrophic factors (NTFs) support in the form of Olfactory Ensheathing Cell's Conditioned Media (OEC CM) using human SH-SY5Y neuroblastoma cell line exposed to 6 hydroxydopamine (6OHDA). 6OHDA exposure induced, oxidative stress-mediated apoptotic cell death viz. enhanced ROS generation, diffused cytosolic cytochrome c (cyt c), impaired Bcl-2: Bax levels along with decrease in GSH content. These changes were accompanied by loss in Akt phosphorylation and TH levels in SH-SY5Y cells. OEC CM significantly checked apoptotic cell death by preserving pAkt levels which coincided with enhanced GSH and suppressed oxidative injury. Functional integrity of OEC CM supported cells was evident by maintained tyrosine hydroxylase (TH) expression. Intercepting Akt signaling by specific inhibitor LY294002 blocked the protective effect. Taken together our findings provide important evidence that the key to protective effect of multiple NTF support via OEC CM is enhanced Akt survival signaling which promotes antioxidant defense leading to suppression of oxidative damage.
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Tonev D, Yavahchova MS, Goutev N, de Angelis G, Petkov P, Bhowmik RK, Singh RP, Muralithar S, Madhavan N, Kumar R, Kumar Raju M, Kaur J, Mohanto G, Singh A, Kaur N, Garg R, Shukla A, Marinov TK, Brant S. Candidates for twin chiral bands in 102Rh. PHYSICAL REVIEW LETTERS 2014; 112:052501. [PMID: 24580588 DOI: 10.1103/physrevlett.112.052501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Indexed: 06/03/2023]
Abstract
Excited states in 102Rh, populated in the fusion-evaporation reaction Zr94(11B,3n)102Rh at a beam energy of 36 MeV, were studied using the Indian National Gamma Array spectrometer at Inter University Accelerator Center, New Delhi. The angular correlations and the electromagnetic character of some of the gamma-ray transitions observed were investigated in detail. A new chiral candidate sister band was found. Lifetimes of exited states in both chiral candidate bands of 102Rh were measured for the first time in the A∼100 mass region by means of the Doppler-shift attenuation technique. The derived reduced transition probabilities are compared to the predictions of the two quasiparticles plus triaxial rotor model. Both experimental results and calculations do not support the presence of static chirality in 102Rh.
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Shukla A, Chattopadhyay R, Ghosh S, Haseena S, Goswami S, Chakravarty B. Evaluation of the pregnancy outcomes with surrogacy in infertile women with adenomyosis following failed intracytoplasmic sperm injection (ICSI). Fertil Steril 2013. [DOI: 10.1016/j.fertnstert.2013.07.707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bigoniya P, Shukla A, Singh CS, Gotiya P. Comparative anti-ulcerogenic study of pantoprazole formulation with and without sodium bicarbonate buffer on pyloric ligated rat. J Pharmacol Pharmacother 2013; 2:179-84. [PMID: 21897712 PMCID: PMC3157128 DOI: 10.4103/0976-500x.83283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective: To compare the anti-ulcer activity of buffered pantoprazole tablet against plain pantoprazole in pyloric ligated rats. Materials and Methods: In vivo pyloric ligated ulcerogenesis model was used to assess the effect of buffered pantoprazole on the volume of the gastric content, pH, total and free acidity, and ulcerogenic lesion. Pantoprazole level in gastric content and concurrently in stomach tissue was assessed by High Performance Liquid Chromatography (HPLC) analysis. Results: Buffered tablet effectively increases the pH of the gastric content above 4 up to 6 h (P<0.001) protecting pantoprazole from acid degradation resulting in high concentration in the gastric content and stomach tissue. Conclusions: This study substantiates better, faster and prolonged bioavailability of pantoprazole-buffered tablet compared to plain pantoprazole.
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Abstract
Primary hepatic lymphoma (PHL) is rare and represents approximately 0.016% of all cases of non-Hodgkin's lymphoma (NHL). The majority of these are B-cell NHL of diffuse large B-cell type. Primary T-cell lymphoma constitutes approximately 5-10% of all PHLs arising in the liver, 90% being B-cell type. Peripheral T-cell lymphoma, γδ hepatosplenic T-cell lymphoma and αβ hepatosplenic T-cell lymphoma are the common T-cell lymphomas involving hepatic parenchyma. We encountered a case presenting with gross hepatomegaly extending beyond umbilicus, mild ascites, pedal oedema, icterus and dyspnoea. Haemogram showed moderate anaemia with counts. Bone marrow aspiration showed erythroid hyperplasia with dimorphic anaemia. There was no evidence of atypical lymphoid cells in peripheral blood of bone marrow. We present a rare case of primary T-cell lymphoma presenting as primary liver involvement without splenomegaly, lymphadenopathy, bone marrow or peripheral blood involvement.
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Shukla A, Mohapatra TM, Agrawal AK, Parmar D, Seth K. Salsolinol induced apoptotic changes in neural stem cells: amelioration by neurotrophin support. Neurotoxicology 2013; 35:50-61. [PMID: 23261589 DOI: 10.1016/j.neuro.2012.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Revised: 12/14/2012] [Accepted: 12/14/2012] [Indexed: 11/20/2022]
Abstract
Salsolinol (SAL), a catechol isoquinoline has invited considerable attention due to its structural similarity with dopaminergic neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Its high endogenous presence in Parkinsonian brain implicated its possible association with the disease process. SAL is also present in alcohol beverages and certain food materials and can get access to brain especially in conditions of immature or impaired BBB. Besides this, the effect of SAL on neural stem cells (NSCs) which are potential candidates for adult neurogenesis and transplantation mediated rejuvenating attempts for Parkinson's disease (PD) brain has not been known so far. NSCs in both the cases have to overcome suppressive cues of diseased brain for their survival and function. In this study we explored the toxicity of SAL toward NSCs focusing on apoptosis and status of PI3K survival signaling. NSCs cultured from embryonic day 11 rat fetal brain including those differentiated to TH(+ve) colonies, when challenged with SAL (1-100μM), elicited a concentration and time dependent cell death/loss of mitochondrial viability. 10μM SAL on which significant mitochondrial impairment initiated was further used to study mechanism of toxicity. Morphological impairment, enhanced TUNEL positivity, cleaved caspase-3 and decreased Bcl-2:Bax suggested apoptosis. Sal toxicity coincided with reduced pAkt level and its downstream effectors: pCREB, pGSK-3β, Bcl-2 and neurotrophins GDNF, BDNF suggesting repressed PI3K/Akt signaling. Multiple neurotrophic factor support in the form of Olfactory Ensheathing Cell's Conditioned Media (OEC CM) potentially protected NSCs against SAL through activating PI3K/Akt pathway. This was confirmed on adding LY294002 the PI3K inhibitor which abolished the protection. We inferred that SAL exerts substantial toxicity toward NSCs. These findings will lead to better understanding of endogenous threats that might affect the fate of transplanted NSCs and their probable antidotes.
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Shukla A, Singh A, Singh A, Pathak LP, Shrivastava N, Tripathi PK, Singh MP, Singh K. Inhibition of P. falciparum PFATP6 by curcumin and its derivatives: a bioinformatic study. Cell Mol Biol (Noisy-le-grand) 2012; 58:182-186. [PMID: 23273210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 07/24/2012] [Indexed: 06/01/2023]
Abstract
Curcumin, a yellow spice has been shown to have many pathological uses including cancer and malaria. Recent experimental data have shown the inhibitory effect of curcumin and its two derivatives on the growth of Plasmodium falciparum in cell culture at low micromolar concentrations. Previous studies have suggested that Ca(2+)—ATPase (PfATP6) of P. falciparum is the target of many antimalarial drugs. However, the mechanism of inhibition of Ca(2+)—ATPase (PfATP6) is not known. In addition, it is not clear which specific isomeric form of curcumin is the most potent inhibitor of P. falciparum. Here we address this issue using bioinformatics tools. We generated a molecular model of Ca(2+)—ATPase (PfATP6) of P. falciparum and carried out molecular docking of all curcumin analogues of Zinc database of compounds (zinc.docking.org). Two molecular docking programs Glide and FlexX were used to determine binding feasibility of 351 analogues of curcumin. The comparison of docking parameters showed, more than 20 analogues are better ligands of PfATP6 than curcumin itself. . The binding of curcumin and its analogues to PFATP6 is mediated by both hydrophobic and polar interactions. Our results suggest that curcumin analogues are promising lead compounds for the development of antimalarial drugs.
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Bigoniya P, Shukla A, Srivastava B. Hypoglycemic Activity of Lepidium sativum Linn Seed Total Alkaloid on Alloxan Induced Diabetic Rats. ACTA ACUST UNITED AC 2012. [DOI: 10.3923/rjmp.2012.587.596] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Mishra N, Gill N, Mishra A, Mishra S, Shukla A, Upadhayay A. Evaluation of Antioxidant and Antiulcer Potentials of Prunus domestica Fruit Methanolic and Extract on Wistar Albino Rats. ACTA ACUST UNITED AC 2012. [DOI: 10.3923/jpt.2012.305.311] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bala D, Vyas S, Shukla A, Tiwari H, Bhatt G, Gupta K. 749 Validity and reliability of haemoglobin colour scale and its comparison with clinical signs in diagnosing anaemia in pregnancy in Ahmedabad, India. EASTERN MEDITERRANEAN HEALTH JOURNAL 2012; 18:749-54. [DOI: 10.26719/2012.18.7.749] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Wang Y, Sapolsky R, Venkatapathy S, Stengel G, Estabrook A, Shukla A, Weaver P, Wu W, Huynh V, Greenfield L. 559 A New Molecular Inversion Probe (MIP) Based and Cancer-focused Whole-genome Copy Number Platform Requires Only 75 Ng of Input DNA From FFPE Samples. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)71218-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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70
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Kumar N, Verma A, Gupta G, Dixit P, Shukla A, Prakash G, Patil K, Tawade N. Clinical and Electrical Profile of Patients with Juvenile Myoclonic Epilepsy (P07.121). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Mehta J, Shukla A, Bukhariya V, Charde R. THE MAGIC REMEDY OF MORINGA OLIFERIA: AN OVERVIEW. ACTA ACUST UNITED AC 2011. [DOI: 10.7439/ijbar.v2i6.35] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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72
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Shukla A, Bukhariya V, Mehta J, Bajaj J, Charde R, Charde M, Gandhare B. HERBAL REMEDIES FOR DIABETES: AN OVERVIEW. ACTA ACUST UNITED AC 2011. [DOI: 10.7439/ijbar.v2i1.22] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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73
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Bukhariya V, Shukla A, Mehta J, Charde R. A SIGNIFICANCE OF MICROWAVE ASSIST TECHNIQUE IN GREEN CHEMISTRY. ACTA ACUST UNITED AC 2011. [DOI: 10.7439/ijpc.v1i1.130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Shukla S, Shukla A, Mehboob S, Guha S. Meta-analysis: the effects of gut flora modulation using prebiotics, probiotics and synbiotics on minimal hepatic encephalopathy. Aliment Pharmacol Ther 2011. [PMID: 21251030 DOI: 10.1111/j.1365-2036.2010.04574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Minimal hepatic encephalopathy (MHE) is characterised by subtle neurocognitive deficits without overt clinical manifestations. Although several trials have individually evaluated the role of prebiotics, probiotics and synbiotics, there is yet no consensus on the management of MHE. AIM To estimate the efficacy of prebiotics, probiotics and synbiotics in MHE in randomised controlled trials. METHODS MEDLINE, EMBASE, CINAHL and the Cochrane Database of Systematic Reviews were searched for published studies in all languages. Inclusion and exclusion criteria were defined a priori. Pooled relative risk and heterogeneity were estimated as the measures of association. RESULTS Nine studies met our inclusion criteria. Use of prebiotics, probiotics and synbiotics significantly reduced the pooled relative risk (RR) of no improvement of MHE (RR 0.40, 95% CI 0.32-0.50; P<0.001). Upon subgroup analysis, five studies with lactulose showed significant reduction of risk of no improvement of MHE (RR 0.34, 95% CI 0.24-0.47; P<0.0001) with no inter-trial heterogeneity. In two trials each of probiotics and synbiotics, their use was associated with significant beneficial effects (RR 0.41, 95% CI 0.26-0.65; P<0.0001 and RR of 0.51, 95% CI 0.32-0.80; P=0.004 respectively). There were no major adverse events though probiotics and synbiotics were better tolerated than lactulose. CONCLUSIONS The use of prebiotics, probiotics and synbiotics was associated with significant improvement in minimal hepatic encephalopathy. Among individual agents, lactulose appears to have the most beneficial effect, followed closely by probiotics and synbiotics.
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Shukla S, Shukla A, Mehboob S, Guha S. Meta-analysis: the effects of gut flora modulation using prebiotics, probiotics and synbiotics on minimal hepatic encephalopathy. Aliment Pharmacol Ther 2011; 33:662-71. [PMID: 21251030 DOI: 10.1111/j.1365-2036.2010.04574.x] [Citation(s) in RCA: 135] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Minimal hepatic encephalopathy (MHE) is characterised by subtle neurocognitive deficits without overt clinical manifestations. Although several trials have individually evaluated the role of prebiotics, probiotics and synbiotics, there is yet no consensus on the management of MHE. AIM To estimate the efficacy of prebiotics, probiotics and synbiotics in MHE in randomised controlled trials. METHODS MEDLINE, EMBASE, CINAHL and the Cochrane Database of Systematic Reviews were searched for published studies in all languages. Inclusion and exclusion criteria were defined a priori. Pooled relative risk and heterogeneity were estimated as the measures of association. RESULTS Nine studies met our inclusion criteria. Use of prebiotics, probiotics and synbiotics significantly reduced the pooled relative risk (RR) of no improvement of MHE (RR 0.40, 95% CI 0.32-0.50; P<0.001). Upon subgroup analysis, five studies with lactulose showed significant reduction of risk of no improvement of MHE (RR 0.34, 95% CI 0.24-0.47; P<0.0001) with no inter-trial heterogeneity. In two trials each of probiotics and synbiotics, their use was associated with significant beneficial effects (RR 0.41, 95% CI 0.26-0.65; P<0.0001 and RR of 0.51, 95% CI 0.32-0.80; P=0.004 respectively). There were no major adverse events though probiotics and synbiotics were better tolerated than lactulose. CONCLUSIONS The use of prebiotics, probiotics and synbiotics was associated with significant improvement in minimal hepatic encephalopathy. Among individual agents, lactulose appears to have the most beneficial effect, followed closely by probiotics and synbiotics.
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