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Abiramalatha T, Ramaswamy VV, Bandyopadhyay T, Somanath SH, Shaik NB, Kallem VR, Pullattayil AK, Kaushal M. Adjuvant therapy in neonatal sepsis to prevent mortality - A systematic review and network meta-analysis. J Neonatal Perinatal Med 2022; 15:699-719. [PMID: 36189501 DOI: 10.3233/npm-221025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Despite appropriate antibiotic therapy, the risk of mortality in neonatal sepsis still remains high. We conducted a systematic review to comprehensively evaluate different adjuvant therapies in neonatal sepsis in a network meta-analysis. METHODS We included randomized controlled trials (RCTs) and quasi-RCTs that evaluated adjuvant therapies in neonatal sepsis. Neonates of all gestational and postnatal ages, who were diagnosed with sepsis based on blood culture or sepsis screen were included. We searched MEDLINE, CENTRAL, EMBASE and CINAHL until 12th April 2021 and reference lists. Data extraction and risk of bias assessment were performed in duplicate. A network meta-analysis with bayesian random-effects model was used for data synthesis. Certainty of evidence (CoE) was assessed using GRADE. RESULTS We included 45 studies involving 6,566 neonates. Moderate CoE showed IVIG [Relative Risk (RR); 95% Credible Interval (CrI): 1.00; (0.67-1.53)] as an adjunctive therapy probably does not reduce all-cause mortality before discharge, compared to standard care. Melatonin [0.12 (0-0.08)] and granulocyte transfusion [0.39 (0.19-0.76)] may reduce mortality before discharge, but CoE is very low. The evidence is also very uncertain regarding other adjunctive therapies to reduce mortality before discharge. Pentoxifylline may decrease the duration of hospital stay [Mean difference; 95% CrI: -7.48 days (-14.50-0.37)], but CoE is very low. CONCLUSION Given the biological plausibility for possible efficacy of these adjuvant therapies and that the CoE from the available trials is very low to low except for IVIG, we need large adequately powered RCTs to evaluate these therapies in sepsis in neonates.
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Affiliation(s)
- T Abiramalatha
- Associate Professor of Neonatology, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
| | - V V Ramaswamy
- Consultant Neonatologist, Ankura Hospital for Women and Children, Hyderabad, India
| | - T Bandyopadhyay
- Departmentof Neonatology, Dr. Ram Manohar Lohia Hospital & Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - S H Somanath
- Department of Neonatology, All India Institute of Medical Sciences, Mangalagiri, India
| | - N B Shaik
- Consultant Neonatologist, Ankura Hospital for Women and Children, Hyderabad, India
| | - V R Kallem
- Consultant Neonatologist, Paramitha Children's Hospital, Hyderabad, India
| | - A K Pullattayil
- Health Sciences Librarian, Queen's University, Kingston, Canada
| | - M Kaushal
- Consultant Neonatologist and Head of Department, Emirates Specialty Hospital, DHCC, U.A.E
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Kaushal M, Shukla A, Mahajan S. P-209 Management of insulinoma, changing trends in developing world. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Kaushal M, Sasidharan K, Kaushal A, Augustine P, Alex M. Increasing the exclusive breastfeeding rate in a private hospital in UAE through quality improvement initiatives. J Neonatal Perinatal Med 2022; 15:179-186. [PMID: 34120921 DOI: 10.3233/npm-210703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Mother's milk is the best, and ideal method for infant feeding. We found that this practice was not being followed in our hospital. A survey was conducted in the unit with regards to breastfeeding practices which revealed that most babies who were discharged from our nursery were on formula supplements. Our goal was to improve established breastfeeding rates in the unit by increasing the number of full-term healthy babies who were discharged on exclusive Breastfeeding. METHOD A project team was formed, and data were collected through direct observations and direct interviews with postnatal mothers. Exclusive Breastfeeding at discharge was defined as a baby being fully on breastfeed with no additional formula supplements for at least 12 hours prior to discharge. The primary outcome was to increase the percentage of babies being discharged on exclusive Breastfeeding. We used the FOCUS PDCA model to measure improvements and 8 PDCA cycles of 4 weeks duration were implemented to test the changes. RESULTS The interventions we put in place led to a considerable nine times overall improvement in the established breastfeeding rates. Among all the interventions, the most promising results were observed during the PDCA cycles involving staff education, the introduction of antenatal classes for mothers, skin to skin contact and rooming in. CONCLUSION Breastfeeding rates in the private sector with nursery services can be improved by reinforcing breastfeeding education for mothers in addition to training the maternal care staff, empowering them to promote and assist in breastfeeding.
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Cyrus K, Wang Q, Sharawi Z, Noguchi G, Kaushal M, Chang T, Rydzewski W, Yeguech W, Gibrel F, Psaltis JB, Haddad BR, Martin MB. Role of calcium in hormone-independent and -resistant breast cancer. Int J Cancer 2021; 149:1817-1827. [PMID: 34289100 DOI: 10.1002/ijc.33745] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 06/03/2021] [Accepted: 06/22/2021] [Indexed: 11/05/2022]
Abstract
Approximately one-third of estrogen receptor (ER) positive breast tumors fail to respond to or become resistant to hormonal therapy. Although the mechanisms responsible for hormone resistance are not completely understood, resistance is associated with alterations in ERα; overexpression of proteins that interact with the receptor; and hormone-independent activation of the receptor by growth factor signal transduction pathways. Our previous studies show that in estrogen dependent breast cancer cells, activation of the epidermal growth factor signaling pathway increases intracellular calcium which binds to and activates ERα through sites in the ligand-binding domain of the receptor and that treatment with extracellular calcium increases the concentration of intracellular calcium which activates ERα and induces hormone-independent cell growth. The present study asked whether overexpression of calcium channels contributes to the hormone-independent and -resistant phenotype of breast cancer cells and whether clinically used calcium channel blockers reverse hormone independence and resistance. The results show that hormone-independent and -resistant cells overexpress calcium channels, have high concentrations of intracellular calcium, overexpress estrogen responsive genes and, as expected, grow in the absence of estradiol and that treatment with calcium channel blockers decreased the concentration of intracellular calcium, the expression of estrogen responsive genes and cell growth. More importantly, in hormone-resistant cells, treatment that combined a calcium channel blocker with an antiestrogen reversed resistance to the antiestrogen.
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Affiliation(s)
- Kedra Cyrus
- Department of Oncology, Georgetown University, Washington, District of Columbia, USA
| | - Qiaochu Wang
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University, Washington, District of Columbia, USA
| | - Zeina Sharawi
- Department of Genetics and Human Genetics, Howard University, Washington, District of Columbia, USA
| | - Glyn Noguchi
- Department of Oncology, Georgetown University, Washington, District of Columbia, USA
| | - Mudit Kaushal
- Department of Oncology, Georgetown University, Washington, District of Columbia, USA
| | - Tiffany Chang
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University, Washington, District of Columbia, USA
| | - William Rydzewski
- Department of Oncology, Georgetown University, Washington, District of Columbia, USA
| | - William Yeguech
- Department of Oncology, Georgetown University, Washington, District of Columbia, USA
| | - Fatima Gibrel
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University, Washington, District of Columbia, USA
| | - John B Psaltis
- Department of Oncology, Georgetown University, Washington, District of Columbia, USA
| | - Bassem R Haddad
- Department of Oncology, Georgetown University, Washington, District of Columbia, USA
| | - Mary Beth Martin
- Department of Oncology, Georgetown University, Washington, District of Columbia, USA.,Department of Biochemistry and Molecular & Cellular Biology, Georgetown University, Washington, District of Columbia, USA
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Rong LQ, Kaushal M, Mauer E, Pryor KO, Kenfield M, Shore-Lesseron L, Gaudino MFL, Neuburger PJ. Two- or 3-Dimensional Echocardiography-Derived Cardiac Output Cannot Replace the Pulmonary Artery Catheter in Cardiac Surgery. J Cardiothorac Vasc Anesth 2020; 34:2691-2697. [PMID: 32693966 DOI: 10.1053/j.jvca.2020.06.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Three-dimensional (3D) transesophageal echocardiography (TEE) has been shown to be more accurate than 2D TEE for the evaluation of the left ventricular outflow tract area. The aim of the present study was to compare the agreement of 3D echocardiography-derived cardiac output (CO) with thermodilution-derived CO (TDCO) before and after cardiopulmonary bypass (CPB). DESIGN This was a prospective observational study of patients who underwent cardiac surgery between 2016 and 2018. SETTING Weill Cornell Medicine, a single large academic medical center. PARTICIPANTS The study comprised 78 patients undergoing elective cardiac surgery. INTERVENTIONS CPB, TEE, pulmonary artery catheter, and elective cardiac surgery. MEASUREMENTS AND MAIN RESULTS Two-dimensional CO, 3D CO-diameter, and 3D CO-area values pre-CPB were strongly correlated with one another both pre-CPB and post-CPB. The 3D CO-diameter and the 3D CO-area were mildly correlated, with TDCO measurements pre-CPB (r = 0.46 and 0.39, respectively) and post-CBP (r = 0.43 and 0.47, respectively). Pre-CPB 3D CO-diameter had the most agreement with TDCO in terms of bias (-0.13 L/min); however, the limits of agreement (LOA) were wide (-2.2- to- 2.45 L/min). Post-CPB, 3D CO-diameter had the most agreement with TDCO in terms of bias (0.41) but with wide LOA (-3.29 to 2.47). All pre-CPB echocardiography-derived CO (2D CO, 3D CO-diameter, 3D CO-area) had more agreement with TDCO than did post-CPB measurements. CONCLUSIONS Three-dimensional CO measurements were only modestly correlated with pulmonary artery catheter-derived CO pre-bypass and post-bypass. Despite low bias, the wide LOA from 2D CO, 3D CO-diameter, and 3D-area compared with TDCO suggested that the 2 methods are not interchangeable.
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Affiliation(s)
- Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian, New York, NY.
| | - Mudit Kaushal
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian, New York, NY
| | - Elizabeth Mauer
- Department of Health Policy and Research, Weill Cornell Medicine/New York Presbyterian, New York, NY
| | - Kane O Pryor
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian, New York, NY
| | - Meaghan Kenfield
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian, New York, NY
| | | | - Mario F L Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine/New York Presbyterian, New York, NY
| | - Peter J Neuburger
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Langone Medical Center, New York, NY
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Kaushal M, Schwartz J, Gupta N, Im J, Leff J, Jakobleff WA, Leyvi G. Patient Demographics and Extracorporeal Membranous Oxygenation (ECMO)-Related Complications Associated With Survival to Discharge or 30-Day Survival in Adult Patients Receiving Venoarterial (VA) and Venovenous (VV) ECMO in a Quaternary Care Urban Center. J Cardiothorac Vasc Anesth 2019; 33:910-917. [DOI: 10.1053/j.jvca.2018.08.193] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Indexed: 11/11/2022]
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Tanaka CY, Kaushal M, Leff JD. Challenges in Grading Low-Flow, Low-Gradient Aortic Stenosis. A A Pract 2019; 12:180-182. [PMID: 30299294 DOI: 10.1213/xaa.0000000000000896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Christopher Y Tanaka
- From the Department of Anesthesiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
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Tanaka CY, Kaushal M, Leff JD. Challenges in Grading Low-Flow, Low-Gradient Aortic Stenosis. A A Pract 2018. [DOI: 10.1213/02054229-900000000-99763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kaushal M, Leff J, Gross J, Jakobleff WA, Forest S, Leyvi G. Reporting the First Subcutaneous ICD Placed in the Immediate Postorthotopic Heart Transplant Period for Acute Cellular Rejection-Associated Cardiac Arrest and Investigating the Role of Secondary Prevention ICDs in This Population. J Cardiothorac Vasc Anesth 2017; 31:1784-1788. [PMID: 28764990 DOI: 10.1053/j.jvca.2017.03.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Mudit Kaushal
- Department of Anesthesiology, Montefiore Medical Center, Bronx, NY.
| | - Jonathan Leff
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Montefiore Medical Center, Bronx, NY
| | - Jay Gross
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, NY
| | - William Alex Jakobleff
- Division of Cardiothoracic Surgery, Department of Surgery, Montefiore Medical Center, Bronx, NY
| | - Stephen Forest
- Division of Cardiothoracic Surgery, Department of Surgery, Montefiore Medical Center, Bronx, NY
| | - Galina Leyvi
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Montefiore Medical Center, Bronx, NY
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Abstract
Novel anticoagulants (NAGs) have emerged as the preferred alternatives to vitamin K antagonists. In patients being considered for regional anesthesia, these drugs present a layer of complexity in the preprocedure evaluation. There are no established tests to monitor anticoagulant activity and our experience is short with these drugs. These authors believe it is important to review the relevant hematology, orthopedics, and anesthesiology literature to provide a valuable reference for the clinician who is met with these challenges. In addition to discussing NAGs, we also review the existing American Society of Regional Anesthesia guidelines for heparin, low-molecular-weight heparin, and antiplatelet agents.
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Affiliation(s)
- Mudit Kaushal
- Department of Anesthesiology, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA
| | - Ryan E Rubin
- Department of Anesthesiology, Louisiana State University School of Medicine, 1542 Tulane Avenue, Room 658, New Orleans, LA 70112, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University School of Medicine, 1542 Tulane Avenue, Room 658, New Orleans, LA 70112, USA
| | - Karina Gritsenko
- Department of Anesthesiology, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA.
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Tilak AS, Wani SP, Datta A, Patil MD, Kaushal M, Reddy KR. Evaluation of Ageratum conyzoides in field scale constructed wetlands (CWs) for domestic wastewater treatment. Water Sci Technol 2017; 75:2268-2280. [PMID: 28541934 DOI: 10.2166/wst.2017.119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Ageratum conyzoides were evaluated in field scale subsurface flow constructed wetlands (CWs) to quantify its nitrogen (N) and phosphorus (P) uptake and compare with wetland plants (Pistia stratiotes, Typha latifolia and Canna indica). The two-field scale subsurface flow CWs, located in the International Crops Research Institute for Semi-Arid Tropics, received wastewater from an urban colony. The CW1 and CW2 had the same dimensions (length:10 m, width:3 m, total depth:1.5 m and sand and gravel:1 m), similar flow rates (3 m3/d), hydraulic loading rates (HLRs-10 cm/d) and hydraulic retention time (HRT-5 days) from July 2014-August 2015. The vegetation in both CWs consisted of Pistia stratiotes, Typha latifolia, Canna indica, and Ageratum conyzoides, respectively. The CW1 (% reduction with respect to concentrations) reduced total suspended solids (TSS) (68%), NH4-N (26%), NO3-N (30%), soluble reactive P (SRP) (20%), chemical oxygen demand (COD) (45%) and fecal coliforms (71%), while the CW2 (%-reduction with respect to concentrations) reduced TSS (63%), NH4-N (32%), NO3-N (26%), SRP (35%), COD (39%) and fecal coliforms (70%). Ageratum conyzoides can be used in combination with Pistia stratiotes, Typha latifolia and Canna indica to enhance removal of excessive N, P and fecal coliforms from domestic wastewater.
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Affiliation(s)
- A S Tilak
- International Crops Research Institute for the Semi-Arid Tropics (ICRISAT), ICRISAT Development Centre (IDC), Patancheru Hyderabad 502324, India E-mail:
| | - Suhas P Wani
- International Crops Research Institute for the Semi-Arid Tropics (ICRISAT), ICRISAT Development Centre (IDC), Patancheru Hyderabad 502324, India E-mail:
| | - A Datta
- International Crops Research Institute for the Semi-Arid Tropics (ICRISAT), ICRISAT Development Centre (IDC), Patancheru Hyderabad 502324, India E-mail:
| | - M D Patil
- International Crops Research Institute for the Semi-Arid Tropics (ICRISAT), ICRISAT Development Centre (IDC), Patancheru Hyderabad 502324, India E-mail:
| | - M Kaushal
- International Crops Research Institute for the Semi-Arid Tropics (ICRISAT), ICRISAT Development Centre (IDC), Patancheru Hyderabad 502324, India E-mail:
| | - K R Reddy
- Soil and Water Science Department, University of Florida, Gainesville, USA
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Kaushal M, Wani SP, Patil MD, Datta A. Monitoring Efficacy of Constructed Wetland for Treating Domestic Effluent-Microbiological Approach. CURR SCI INDIA 2016. [DOI: 10.18520/cs/v110/i9/1710-1715] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Dhillon M, John R, Prabhakar S, Sharma S, Kaushal M. Drill bit failure and retrieval during arthroscopic ACL reconstruction. J Clin Orthop Trauma 2016; 7:80-82. [PMID: 28018080 PMCID: PMC5167445 DOI: 10.1016/j.jcot.2016.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 02/04/2016] [Accepted: 06/10/2016] [Indexed: 10/21/2022] Open
Abstract
A case of broken drill bit during arthroscopic ACL reconstruction and the technique adopted to overcome this complication is presented. We also review the literature for intra-operative incidents and technical complications during arthroscopic ACL reconstruction and various precautions we should implement to prevent such technical pitfalls from coming into reality.
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Affiliation(s)
| | - R. John
- Corresponding author. Tel.: +91 9781335111.
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Cyrus K, Kaushal M, Sharawi Z, Noguchi G, Chang T, Rydzewski W, Gibrel F, Yeguech W, Haddad B, Martin MB. Abstract 5040: Calcium channels: Potential new therapeutic targets for hormone independent and resistant breast cancers. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-5040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Estrogen receptor alpha (ERα) is central to the growth and progression of a subset of breast cancers. As such, therapies that target ERα are a standard of care in the treatment of ERα -positive disease. Unfortunately, one-third of patients receiving hormonal therapies develop resistance. Several factors are believed to contribute to resistance including increased hormone independent activation of ERα by activated signal transduction pathways such as the epidermal growth factor (EGF) signaling pathway. We have shown that calcium mediates the cross talk between the EGF signaling pathway and ERα by directly binding to and activating the ligand binding domain of ERα suggesting a role for calcium in the development and progression of hormone independent and resistant breast cancer. Preliminary results from this study show that compared to normal (MCF10A) or hormone dependent (MCF-7) breast cells, hormone independent and resistant breast cancer cells (MCF7-2A, LCC-9, and MCF7-RR) have higher expression of the L-type and T-type calcium channels and higher concentrations of intracellular calcium. When hormone resistant (LCC-9) cells were treated with the intracellular calcium chelator BAPTA-AM, the L-type calcium channel blocker methoxyverapamil, or the T-type calcium channel blocker mibefradil, there was a significant decrease in the expression of the ERα regulated gene progesterone receptor that was reversed by the addition of estradiol. More importantly, when hormone independent (MCF7-2A) and hormone independent (LCC-9) cells were treated with the calcium channel blockers, there was in a significant decrease in growth and a re-sensitization of the antiestrogen resistant LCC-9 cells to tamoxifen and fulvestrant. Taken together, the preliminary results suggest that increased expression of calcium channels and intracellular calcium contribute to the hormone independent activation of ERα and point to a potential new therapeutic target for hormone independent and resistant breast cancer.
Citation Format: Kedra Cyrus, Mudit Kaushal, Zeina Sharawi, Glyn Noguchi, Tiffany Chang, William Rydzewski, Fatima Gibrel, William Yeguech, Bassam Haddad, Mary Beth Martin. Calcium channels: Potential new therapeutic targets for hormone independent and resistant breast cancers. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 5040. doi:10.1158/1538-7445.AM2015-5040
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Kaushal M, Agarwal R, Aggarwal R, Singal A, Upadhyay M, Srinivas V, Paul VK, Deorari AK. Cling wrap, an innovative intervention for temperature maintenance and reduction of insensible water loss in very low-birthweight babies nursed under radiant warmers: a randomized, controlled trial. ACTA ACUST UNITED AC 2013; 25:111-8. [PMID: 15949199 DOI: 10.1179/146532805x45700] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
AIM The value of polythene film ('cling wrap') to improve thermal control and reduce postnatal weight loss in preterm, very low-birthweight babies was investigated. METHODS Consecutively born babies with birthweights between 750 and 1500 g were stratified by birthweight (<1250 g, 1251-1500 g) and randomised either to the cling wrap (CW) or no cling wrap (NCW) group. The baby bassinette of the RW was covered with cling wrap up to the level of the neck in the CW group for the 1st 7 days. The primary outcome variables were the incidence of hypothermia (axillary temperature < or = 36 degrees C) after initial stabilisation during the first 7 days and cumulative weight loss (percentage of birthweight) at 48 hours of age. RESULTS Of 51 babies, 26 were randomised to the CW and 25 to the NCW group. None of the babies in the CW group developed hypothermia in the 1st 7 days but 36% in the NCW group (p = 0.001) did. Babies who were hypothermic on admission took less time to reach normal temperature in the CW group. Cumulative weight loss in the 1st 48 hours was 5.0 + 5.6% in the CW group and 8.6 + 7.0% in the NCW group (p = 0.06). CONCLUSION Use of CW might be a simple method of maintaining temperature in very low-birthweight babies in developing countries.
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Affiliation(s)
- M Kaushal
- Neonatal Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Satpute R, Lomash V, Kaushal M, Bhattacharya R. Neuroprotective effects of alpha-ketoglutarate and ethyl pyruvate against motor dysfunction and oxidative changes caused by repeated 1-methyl-4-phenyl-1,2,3,6 tetrahydropyridine exposure in mice. Hum Exp Toxicol 2013; 32:747-58. [DOI: 10.1177/0960327112468172] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) is a neurotoxin associated with drug abuse and causes permanent symptoms of Parkinson's disease (PD) by destroying dopaminergic neurons in the substantia nigra of the brain. In the present study, the neuroprotective effects of two carboxylic acid compounds, viz. alpha-ketoglutarate (A-KG), a Kreb’s cycle intermediate and ethyl pyruvate (EP), a lipid-soluble analogue of pyruvate, were evaluated against MPTP intoxication in mice and compared with madopar (MD; combination of levodopa plus benserazide), a standard drug. Animals received oral treatment of A-KG (500 mg/kg), EP (100 mg/kg) or MD (5 mg/kg) daily for 5 days followed by intraperitoneal administration of MPTP (20 mg/kg) and posttreatment (+10 min) of A-KG, EP or MD daily for the remaining 5 days. MPTP caused the inhibition of complex I of electron transport chain accompanied by oxidative stress in the brain. It also caused cytotoxicity in the midbrain region as characterized by histology and immunohistochemistry. Treatments of A-KG and EP were found to resolve the loss of motor coordination, oxidative stress, diminished complex I activity and tyrosine hydroxylase–positive neurons in midbrain. A-KG and EP also regressed the histological damage in the brain and minimized the accumulation of alpha-synuclein in the midbrain region. The data suggest that A-KG and EP which are nontoxic carboxylic acid compounds could be of potential therapeutic value in the treatment of PD.
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Affiliation(s)
- R. Satpute
- Toxicology Laboratory, Defence Research and Development Establishment, Nagpur, India
| | - V. Lomash
- Division of Pharmacology and Toxicology, Defence Research and Development Establishment, Gwalior, India
| | - M. Kaushal
- BIMR College of Life Sciences, Gwalior, India
| | - R. Bhattacharya
- Division of Pharmacology and Toxicology, Defence Research and Development Establishment, Gwalior, India
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Shaw S, Kaushal M, Halbert K. A soft, inflatable patient support. Ann R Coll Surg Engl 2013. [PMID: 23485007 PMCID: PMC4098592 DOI: 10.1308/003588413x13511609958055g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- S Shaw
- Wrightington, Wigan and Leigh NHS Foundaiton Trust, UK.
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Shaw S, Kaushal M, Halbert K. A soft, inflatable patient support. Ann R Coll Surg Engl 2013; 95:158-9. [DOI: 10.1308/rcsann.2013.95.2.158a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- S Shaw
- Wrightington, Wigan and Leigh NHS Foundaiton Trust, UK
| | - M Kaushal
- Wrightington, Wigan and Leigh NHS Foundaiton Trust, UK
| | - K Halbert
- Wrightington, Wigan and Leigh NHS Foundaiton Trust, UK
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Gupta AK, Kaushal M. P5-23-07: Treatment Strategy of Locally Advanced Breast Cancer in Sub Group (T3N1M0, T4bN1M0) in Developing Countries. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p5-23-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
With the recent advances in modern day chemotherapy and hormonal therapy for locally advanced breast cancer [stage III, T3 N1 and T4bN1], most of the oncologist around the globe now prefer to give neoadjuvent chemotherapy and, or hormonal therapy followed by surgery in the treatment of these cases.
Randomized research have also shown that this strategy provides ‘pathological complete resolution’ as compared to surgery and then adjuvant chemotherapy in terms of decreasing in size of tumar, decrease in vascularity of tumor mass and micrometastasis. Some author believes that this improve the overall survival duration of patients.
This protocol is widely accepted but ….
BUT WHAT IF YOU LOSE YOUR PATIENT ON FOLLOWUP …
Especially in the developing countries of south east asian region and African continent, where there is poor socioeconomic status and lack of education among common people. The patient gets frustrated after first few doses of neoadjuvent therapy, due to side effects of chemotherapy and don't consider chemotherapy as a treatment compare to surgery. Thus the patient loses faith in treatment strategy itself and go untraceable after one or two sessions of the therapy. The government of developing countries lack resources in terms of manpower and money for satisfactory completion of treatment making the above condition even worse. In our study we followed 230 patients of locally advanced breast cancer in subgroup of stage III [T3 N1, T4bN1] and divided them into two plans on random basis. In first plan we approached with the surgical management followed by adjuvant chemotherapy & counseled the patients for completion of chemotherapy. This plan was shown to 115 patients, out of which 100 patients provided good acceptance & completed the course of chemotherapy. There were 15 patients who remained untraceable after surgery.
On the other hand in the 2 group the patients were counseled for neoadjuvent chemotherapy and then surgery in next stage. In this group 115 patients were introduced, out of which 60 patients were lost on follow up after 2–3 sessions. The majority of patients complained about the side effects of chemotherapy and financial reasons and did not come back. Rest of the patients completed the whole course. With no doubt about the result of the treatment, the second group has equivocal survival advantages in terms of morbidity and mortality, but we lost more than half of the patients of second group before completion of treatment.
Primarily the acceptance of surgical treatment is more in developing countries, as it is quite more feasible for government and even economical for common people. Thus we prefer the strategy of surgery followed by adjuvant chemo/hormonal therapy in locally advanced breast cancer [stage III T3N1, T4bN1] especially in developing countries like India.
THE MOTTO OF THIS STRATEGY IS TO PROVIDE BENEFIT OF COMPLETE TREATMENT TO THE PATIENT THAN TO LOSE THE PATIENT COMPLETELY BEFORE TREATMENT.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-23-07.
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Affiliation(s)
- AK Gupta
- 1Mahatma Gandhi Memorial Medical College and Maharaja Yashwantrao Hospital, Indore, Madhya Pradesh, India
| | - M Kaushal
- 1Mahatma Gandhi Memorial Medical College and Maharaja Yashwantrao Hospital, Indore, Madhya Pradesh, India
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Kaushal M, Chattopadhyay I, Phukan R, Purkayastha J, Mahanta J, Kapur S, Saxena S. Contribution of germ line BRCA2 sequence alterations to risk of familial esophageal cancer in a high-risk area of India. Dis Esophagus 2010; 23:71-5. [PMID: 19473207 DOI: 10.1111/j.1442-2050.2009.00975.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The incidence of esophageal squamous cell carcinoma (ESCC) is very high in the northeast region of India. An earlier study from China and Iran suggested that mutations in BRCA2 gene may play a role in the etiology of familial ESCC. However, the frequency of BRCA2 gene germ line mutations and its contribution to risk of familial aggregation of ESCC in high-risk region of India are not known. In the current study of 317 cases of esophageal cancer, 92 (29%) cases had a family history of esophageal and/or other cancers. Of these 92 patients, 45 (49%) patients had a family history of esophageal cancer. The risk of developing esophageal cancer was higher in cases where family history showed occurrence of cancers in first-degree relatives (odds ratio [OR]: 3.1; confidence interval [CI]: 1.9-5.3) than in second-degree relatives (OR: 1.3; CI: 0.25-3.2). Moreover, the risk of developing esophageal cancer was higher in subjects whose predegree suffered from esophageal cancer (OR: 2.4; CI: 1.1-4.1) than from any other cancers (OR: 1.1; CI: 0.32-3.3). The subjects with family history of cancer were more likely to develop ESCC if they were tobacco chewers (OR: 4.2; CI: 2.1-5.8) and betel quid users (OR: 3.6; CI: 1.8-4.6). Screening for mutations of the BRCA2 gene in the germ line DNA was carried out for 20 familial and 80 nonfamilial ESCC patients. One hundred unrelated healthy controls from the same population were included in this study. Nonsynonymous variants in exon 18 (K2729N) and exon 27 (I3412V) of BRCA2 gene were found in 3 of 20 patients with familial ESCC. No sequence alterations were found in 80 nonfamilial ESCC cases (P=0.01) and 100 healthy controls (P=0.0037), suggesting that germ line BRCA2 gene mutation may play a role in familial aggregation of ESCC in high-risk region of India.
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Affiliation(s)
- M Kaushal
- Institute of Pathology, Indian Council of Medical Research, Safdarjung Hospital Campus, New Delhi, India
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Date R, Kaushal M, Ramesh A. A review of the management of gallstone disease and its complications in pregnancy. Am J Surg 2008; 196:599-608. [DOI: 10.1016/j.amjsurg.2008.01.015] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Revised: 01/19/2008] [Accepted: 01/14/2008] [Indexed: 10/21/2022]
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Kaushal M, Shukla S, Mathur R, Kaushal D, Gupta R, Songara M. Complications of surgery in management of locally advanced breast carcinoma. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)70617-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Abstract
Congenital stridor is one of the rare presentations of respiratory distress at birth. The commonest cause of congenital stridor is laryngomalacia, which accounts for 60% of the causes. The other common causes are congenital subglottic stenosis and vocal cord palsy (VCP). VCP is usually unilateral and most often linked with birth trauma, and is temporary. Bilateral palsy can be associated with other congenital anomalies. The current report describes a case of congenital bilateral VCP, not related to birth trauma and severe enough to require tracheostomy.
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Affiliation(s)
- M Kaushal
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Kaushal M, Narayan S, Aggarwal A, Kapil A, Deorari AK. In vitro use of epidural filters for prevention of bacterial infection. Indian Pediatr 2004; 41:1133-7. [PMID: 15591663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- M Kaushal
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India
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Kaushal M, Mishra A, Mishra SK. Thyroid surgery and voice-related outcomes. ANZ J Surg 2001; 71:611. [PMID: 11552938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Argani P, Shaukat A, Kaushal M, Wilentz RE, Su GH, Sohn TA, Yeo CJ, Cameron JL, Kern SE, Hruban RH. Differing rates of loss of DPC4 expression and of p53 overexpression among carcinomas of the proximal and distal bile ducts. Cancer 2001. [PMID: 11283934 DOI: 10.1002/1097-0142(20010401)91] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Biliary tract carcinomas are clinically heterogeneous. It is not known if molecular heterogeneity underlies the clinical differences. METHODS The authors evaluated 128 bile duct carcinomas, 88 of the distal common bile duct and 40 of more proximal origin (28 perihilar carcinomas, 12 intrahepatic carcinomas), immunohistochemically for abnormalities in the expression of the products of the DPC4 and p53 tumor-suppressor genes. Prognostic factors were evaluated in the series of distal bile duct carcinomas for which follow-up information was available. RESULTS The authors found that a significantly higher percentage of distal bile duct carcinomas (55%) demonstrated loss of DPC4 expression than did the proximal bile duct carcinomas (15%; P < 0.001). They also found that a significantly higher percentage of the distal tumors abnormally expressed the p53 gene product (51% vs. 26%; P < 0.001). Among the distal common bile duct carcinomas, the presence of poorly differentiated histology correlated with decreased survival in multivariate analysis, while labeling for p53 or Dpc4, margin status, lymph node status, and tumor dimension did not correlate significantly with survival. CONCLUSIONS These results demonstrate that abnormalities in DPC4 and p53 gene expression are frequent in distal common bile duct carcinomas, just as they are in pancreatic ductal adenocarcinoma, suggesting that these two tumor types might share a similar molecular pathogenesis. They also show that proximal and distal bile duct carcinomas have different patterns of inactivation of tumor-suppressor genes, indicating that they often arise through different molecular mechanisms likely reflecting their differing etiologies.
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Affiliation(s)
- P Argani
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
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Montgomery E, Goggins M, Zhou S, Argani P, Wilentz R, Kaushal M, Booker S, Romans K, Bhargava P, Hruban R, Kern S. Nuclear localization of Dpc4 (Madh4, Smad4) in colorectal carcinomas and relation to mismatch repair/transforming growth factor-beta receptor defects. Am J Pathol 2001; 158:537-42. [PMID: 11159190 PMCID: PMC1850322 DOI: 10.1016/s0002-9440(10)63995-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The tumor-suppressor protein Dpc4 (Smad4, Madh4) regulates gene expression. On binding of an extracellular ligand of the extensive transforming growth factor (TGF) superfamily to its cognate receptor complex, latent cytoplasmic Dpc4 is activated and translocated into the nucleus to function as part of various DNA-binding transcriptional activator complexes. The most relevant ligand/receptor pair to control the tumor suppressive function of Dpc4 remains uncertain, but is usually assumed to be TGF-beta and its heteromeric receptor. We exploited a fortuitous experiment of nature to directly test this hypothesis: the TGF-beta type II receptor gene is inactivated by mutation in nearly all colorectal carcinomas having microsatellite instability, as seen in hereditary nonpolyposis colorectal cancer (HNPCC) and in sporadic medullary colorectal cancers. Using a specific and sensitive immunohistochemical label for Dpc4, we examined nuclear localization of Dpc4 in 13 HNPCC, six medullary, and 41 sporadic nonmedullary colorectal carcinomas. In agreement with published rates, two (5%) of 41 sporadic tumors showed complete loss of Dpc4 protein, indicative of genetic inactivation. All 13 HNPCC and six medullary tumors had intact cytoplasmic and nuclear Dpc4 localization. The TGFBR2 gene was sequenced in three of the cancers from patients with HNPCC, and all of these harbored inactivating mutations. The specificity of the immunohistochemical assay was demonstrated in xenograft tumors of syngeneic cell lines that differed in DPC4 genetic status because of an engineered gene knockout. Thus, nuclear localization of Dpc4 can be maintained in cells with inactivated TGF-beta type II receptors, suggesting the persistence of tumor-suppressive action of an upstream signaling input, most likely a ligand/receptor complex distinct from TGF-beta. Identification of the relevant input would be expected to have implications for the understanding of tumorigenesis and the design of rational biological therapy.
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MESH Headings
- Animals
- Carcinoma, Medullary/genetics
- Carcinoma, Medullary/metabolism
- Carcinoma, Medullary/pathology
- Cell Nucleus/chemistry
- Colorectal Neoplasms/genetics
- Colorectal Neoplasms/metabolism
- Colorectal Neoplasms/pathology
- Colorectal Neoplasms, Hereditary Nonpolyposis/genetics
- Colorectal Neoplasms, Hereditary Nonpolyposis/metabolism
- Colorectal Neoplasms, Hereditary Nonpolyposis/pathology
- DNA Mutational Analysis
- DNA Repair
- DNA, Neoplasm/chemistry
- DNA, Neoplasm/genetics
- DNA-Binding Proteins/genetics
- DNA-Binding Proteins/metabolism
- Genotype
- Humans
- Immunohistochemistry
- Mice
- Mice, Nude
- Mutation
- Neoplasm Transplantation
- Phenotype
- Protein Serine-Threonine Kinases
- Receptor, Transforming Growth Factor-beta Type II
- Receptors, Transforming Growth Factor beta/genetics
- Receptors, Transforming Growth Factor beta/metabolism
- Smad4 Protein
- Trans-Activators/genetics
- Trans-Activators/metabolism
- Transplantation, Heterologous
- Tumor Cells, Cultured
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Affiliation(s)
- E Montgomery
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Nagpaul JP, Kaushal M, Majumdar S, Mahmood A. Effect of various doses of medroxyprogesterone acetate on intestinal functions in rats. Indian J Gastroenterol 1990; 9:45-7. [PMID: 2307501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The dose relationship between medroxyprogesterone acetate (MPA), a long acting contraceptive, and rat intestinal digestive and absorptive functions has been investigated. The study revealed that the activities of brush border sucrase, lactase and leucine aminopeptidase were stimulated only at high doses, viz 70 mg/kg (180 mumol/kg) body weight and above, whereas the activity of alkaline phosphate was depressed at comparatively low dose (17.5 mg/kg; 45 mumol/kg body weight). This decrease was found to be significant (p less than 0.001) at all the doses tested. The inhibition in the intestinal uptake of calcium paralleled the decrease in alkaline phosphatase activity. Relatively high amount of MPA (140 mg/kg; 360 mumol/kg) was required to augment the uptake of glucose and amino acid. The results obtained do not indicate a close relationship between the dose of the drug and the extent of alteration in the rat intestinal digestive and absorptive functions. The study appears to confirm the association between brush border enzymes activities and uptake of nutrients in rat intestine.
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Affiliation(s)
- J P Nagpaul
- Department of Biochemistry, Punjab University, Chandigarh
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