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Abstract
BACKGROUND Burnout in pediatric residents is widespread. Certain factors are associated with decreased burnout, such as empathy, self-compassion, mindfulness, and resilience, while perceived stress is associated with increased burnout. Narrative medicine may reduce burnout by its impact on protective and exacerbating factors and can be an active tool to promote wellness. The objective of this pilot study was to evaluate immediate and delayed benefits of a longitudinal narrative medicine intervention for pediatric residents using qualitative and quantitative measures. MATERIALS AND METHODS We designed a voluntary longitudinal narrative medicine intervention implemented via Zoom teleconferencing software over five months for pediatric residents at Nationwide Children's Hospital. It consisted of six one-hour long sessions where residents engaged with literature, responded to a writing prompt, and shared their reflections. It was evaluated using open-ended survey questions and established quantitative assessment tools of well-being with validity evidence. Results were compared before the intervention, immediately after, and six months later using one-way ANOVA and multiple linear regression. Qualitative data was analyzed using thematic analysis. RESULTS Twenty-two (14% of eligible) residents participated in at least one session. After the intervention, the following themes emerged for benefits to resident well-being: the ability to Build Community, have an Outlet for Self-Expression, reap Emotional and Mental Health Benefits, and work on Personal Growth. Benefits were sustained even six months later, which has not been shown previously. While there were significant qualitative findings, between all three time points, there was no change in any quantitative well-being measures. CONCLUSION Our longitudinal narrative medicine pilot study showed meaningful sustained qualitative benefits, though no quantitative changes, in measured well-being outcomes that have been previously associated with lower resident burnout. While not a panacea, narrative medicine can be a useful strategy for residency programs to improve pediatric resident well-being even after completion of planned interventions.Key MessageWe used a mixed-methods approach to assess the effects of a longitudinal narrative medicine intervention on well-being in pediatric residents.Open-ended responses indicated that residents found utility in and appreciated the intervention and experienced sustained improvements in their mental and emotional health, though the sample size was likely too small to show quantitative changes in well-being measures.Narrative medicine is not a panacea, but it can be a useful tool to provide to pediatric residents to promote sustained improvements in their well-being through the framework of relationship-centered care.
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Affiliation(s)
- Nimisha Bajaj
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - James Phelan
- Department of English, The Ohio State University, Columbus, OH, USA
| | - Erin E McConnell
- Internal Medicine/Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Suzanne M Reed
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
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Bajaj N, Reed SM. Thematic analysis comparing stressors for pediatric residents and subspecialty fellows at a large children's hospital. Ann Med 2022; 54:3333-3341. [PMID: 36411680 PMCID: PMC9683061 DOI: 10.1080/07853890.2022.2148731] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Pediatric residents and subspecialty fellows experience a significant number of stressors during training, but they have rarely been self-reported or compared between groups. This qualitative study aimed to identify and compare themes of stressors experienced by pediatric residents and subspecialty fellows at a single large children's hospital. MATERIALS AND METHODS Using an open-ended survey at single time point for each group, we asked residents and fellows to list the stressors they face in training. The survey data was iteratively analyzed using thematic analysis then quantified by its frequency in each group and compared using a chi-square distribution or a Fisher's exact test, as appropriate. RESULTS Twenty-eight of 159 residents (18%) and 38 of 180 fellows (21%) answered the survey question, and an average of 2.8 stressors were identified by each resident and fellow. Two major themes and five major subthemes were shared between both groups. The theme Stressors at Home included the subthemes Difficulty Maintaining Overall Health and External Stressors. The theme Stressors at Work encompassed the subthemes Clinical Stressors Innate to Patient Care, Demanding Workload and Schedule, and Stressors Related to Culture of Work Environment. Within the subthemes, there were differences in categories of stressors between the groups. While there was no statistically significant difference in the distribution of themes, subthemes, or categories of stressors mentioned between groups, in general residents identified stressors associated with lack of autonomy and control whereas fellows focused on clinical uncertainty and complex situations. CONCLUSIONS While residents and fellows shared similar themes and subthemes for stressors, there was variability between individual categories. This study identified individual self-reported stressors that can be used by programs to design interventions to improve trainee well-being, but it also implies that programmatic support at different levels of training should be tailored to the target group.KEY MESSAGEAt our hospital, we found that some self-reported stressors facing pediatric residents and fellows were common and some unique.Stressors included those that can be eliminated or diminished as well as those that cannot.With knowledge that these disparities exist, training programs should use unique strategies to provide support for the two groups and their stressors.
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Affiliation(s)
- Nimisha Bajaj
- Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Suzanne M Reed
- Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH, USA
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Patel K, Bajaj N, Statton B, Li X, Herath NS, Nyamakope K, Davidson R, Stoks J, Purkayastha S, Ware JS, O'Regan DP, Lambiase PD, Cluitmans M, Peters NS, Ng FS. Bariatric surgery reverses ventricular repolarisation heterogeneity in obesity: mechanistic insights into fat-related arrhythmic risk. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.658] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Obesity is a growing global health problem that confers higher risks of atrial arrhythmias and sudden cardiac death. Despite this, the proarrhythmic substrate in obesity and its reversibility with weight loss has not been studied in-depth.
Purpose
To characterise the proarrhythmic substrate in obese patients, and its reversibility with bariatric surgery, using electrocardiographic imaging (ECGi).
Methods
ECGi was performed in 16 obese patients pre-bariatric surgery (PreSurg; mean age 43±12 years, 13 female) and 16 age- and sex-matched non-obese (lean) individuals (42±11 years). 12 of the 16 obese patients also underwent ECGi after bariatric surgery (PostSurg). Over 2000 atrial and ventricular epicardial electrograms were computed using high density body surface mapping (256-lead ECG) and heart-torso geometries from cardiac magnetic resonance imaging, by solving the inverse problem of electrocardiography. Local atrial and ventricular epicardial activation times (AT) were calculated as the steepest downslope of their respective activation complexes, and local ventricular repolarisation times (RT) as the steepest upslope of the T-wave. Atrial activation gradients (ATG) and ventricular repolarisation gradients (RTG) were calculated as the maximum difference within 10 mm radius divided by the corresponding distance.
Results
Body mass index was greater in PreSurg vs lean (46.7±5.5 vs 22.8±2.6 kg/m2, p<0.0001) and decreased with surgery (PostSurg 36.8±6.5 kg/m2, p<0.0001). Epicardial adipose tissue (EAT) was greater in PreSurg vs lean (83±56 vs 28±13 ml, p<0.0001) and decreased post-surgery (PostSurg 69±45 ml, p=0.0010). Total atrial AT was prolonged in PreSurg vs lean (62±15 vs 46±12 ms, p=0.0028), which persisted post-surgery (PostSurg 67±15 ms, p=0.86). Atrial ATG were also greater in PreSurg vs lean (26±11 vs 14±8 ms, p=0.0007) and did not change with weight loss (PostSurg 25±12, p=0.44). Ventricular RTG were greater in PreSurg vs lean (26±11 vs 15±7 ms/mm, p=0.0024) and decreased with weight loss (PostSurg 19±8, p=0.0009). Ventricular RTG were similar between PostSurg and lean (p=0.20). EAT from lean and PreSurg individuals correlated with atrial ATG (r=0.36, p=0.044) and ventricular RTG (r=0.54, p=0.0014). Ventricular AT were similar between lean (31±6 ms), PreSurg (34±5 ms) and PostSurg (35±9 ms); all p>0.05.
Conclusion
Steep ventricular repolarisation gradients and prolonged atrial activation contribute to the proarrhythmic substrate in obesity. Ventricular repolarisation gradients correlate with epicardial adiposity and both regress post-bariatric surgery. By contrast, atrial activation remains prolonged after weight loss. These results provide mechanistic insights into obesity-related arrhythmic risks and their reversibility with weight loss following bariatric surgery.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): British Heart FoundationNational Institute for Health Research (NIHR) Imperial Biomedical Research Centre (BRC).
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Affiliation(s)
- K Patel
- National Heart and Lung Institute , London , United Kingdom
| | - N Bajaj
- National Heart and Lung Institute , London , United Kingdom
| | - B Statton
- Imperial College London , London , United Kingdom
| | - X Li
- National Heart and Lung Institute , London , United Kingdom
| | - N S Herath
- Imperial College London , London , United Kingdom
| | - K Nyamakope
- Imperial College London , London , United Kingdom
| | - R Davidson
- Imperial College London , London , United Kingdom
| | - J Stoks
- Maastricht University , Maastricht , The Netherlands
| | | | - J S Ware
- National Heart and Lung Institute , London , United Kingdom
| | - D P O'Regan
- Imperial College London , London , United Kingdom
| | - P D Lambiase
- University College London , London , United Kingdom
| | - M Cluitmans
- Maastricht University , Maastricht , The Netherlands
| | - N S Peters
- National Heart and Lung Institute , London , United Kingdom
| | - F S Ng
- National Heart and Lung Institute , London , United Kingdom
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Patel K, Bajaj N, Li X, Statton B, Stoks J, Nyamakope K, Davidson R, Savvidou S, Purkayastha S, Ware JS, O’regan D, Lambiase P, Cluitmans M, Peters NS, Ng FS. Bariatric surgery reduces ventricular repolarisation gradients in obese patients - results from an electrocardiographic imaging study. Europace 2022. [DOI: 10.1093/europace/euac053.329] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): National Institute for Health Research (NIHR) British Heart Foundation
Background
Obesity confers higher risks of atrial arrhythmias and is associated with abnormal ventricular repolarisation. Despite this, the proarrhythmic substrate in obesity and its reversibility with weight loss has not been studied in-depth.
Purpose
To characterise the proarrhythmic substrate in obese patients, and its reversibility with bariatric surgery, using electrocardiographic imaging (ECGi).
Methods
ECGi was performed in 8 obese patients before (PreOb) and after (PostOb) bariatric surgery (mean age 39+/-11years, 7 female), and in 8 age- and sex-matched non-obese controls (NOb) (40+/-11 years). ECGi recordings were made at rest, on exercise, and during recovery from exercise. For ECGi analysis, >2000 atrial and ventricular epicardial electrograms were calculated from body surface potential recordings from 256 sites and information from cardiac magnetic resonance imaging, by solving the inverse problem. Local atrial and ventricular epicardial activation times (AT) were calculated as the steepest downslope of their respective activation complexes, and local ventricular repolarisation times (RT) as the steepest upslope of the T-wave. Atrial activation gradients (ATG) and ventricular repolarisation gradients (RTG) were calculated as the maximum difference within 10mm radius divided by the corresponding Euclidean distance.
Results
BMI was greater in PreOb vs NOb (46.6+/-4.8 vs 23.8+/-2.6kg/m2, p<0.0001) and decreased with surgery (PostOb 35.3+/-4.2kg/m2, p<0.0001). Total atrial AT was prolonged in PreOb vs NOb (68+/-12 vs 45+/-10ms, p=0.016) and did not change post-surgery (PreOb vs PostOb: 68+/-12 vs 67+/-16ms, p=0.81). Atrial ATG were also greater in PreOb vs NOb: max 254+/-111 vs 106+/-58ms, p=0.035; mean 24+/-6 vs 12+/-6ms, p=0.0087) and did not change with weight loss (PreOb vs PostOb: max 254+/-111 vs 222+/-69ms/mm, p=0.61; mean 24+/-6 vs 21+/-7ms/mm, p=0.52). Ventricular RTG were greater in PreOb vs NOb (max: 287+/-73 vs 131+/-89ms/mm, p=0.012; mean: 33+/-10 vs 17+/-9ms/mm, p=0.0052). Ventricular RTG decreased with weight loss (PreOb vs PostOb: max 287+/-73 vs 151+/-54ms/mm, p=0.0070; mean: 33+/-10 vs 21+/-8ms/mm, p=0.018), and were similar between PostOb and NOb (max, p=0.81; mean p=0.58). Ventricular AT and RT were non-different in NOb, PreOb and PostOb.
Conclusion
Obesity is associated with pro-arrhythmic electrophysiological remodelling, including steeper ventricular repolarisation gradients and slower atrial activation. At 6 months post-bariatric surgery, there was a reduction in ventricular repolarisation gradients though atrial conduction abnormalities persisted. These findings provide a mechanistic insight into obesity-related arrhythmic risks and its potential reversibility with weight loss surgery.
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Affiliation(s)
- K Patel
- National Heart and Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - N Bajaj
- National Heart and Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - X Li
- National Heart and Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - B Statton
- Imperial College London, London, United Kingdom of Great Britain & Northern Ireland
| | - J Stoks
- Maastricht University, Maastricht, Netherlands (The)
| | - K Nyamakope
- Imperial College London, London, United Kingdom of Great Britain & Northern Ireland
| | - R Davidson
- Imperial College London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Savvidou
- Imperial College London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Purkayastha
- Imperial College London, London, United Kingdom of Great Britain & Northern Ireland
| | - JS Ware
- National Heart and Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - D O’regan
- Imperial College London, London, United Kingdom of Great Britain & Northern Ireland
| | - P Lambiase
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - M Cluitmans
- Maastricht University, Maastricht, Netherlands (The)
| | - NS Peters
- National Heart and Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - FS Ng
- National Heart and Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
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Vita TS, Murphy D, Osborne M, Bajaj N, Abhishek K, Jacob S, Diaz A, Nodoushani A, Bravo P, Bibbo C, Steigner M, Taqueti V, Blankstein R, Di Carli M, Dorbala S. P2769Nonalcoholic fatty liver disease: a marker of coronary microvascular dysfunction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2769] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- T S Vita
- Brigham and Women's Hospital, Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Boston, United States of America
| | - D Murphy
- Brigham and Women's Hospital, Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Boston, United States of America
| | - M Osborne
- Brigham and Women's Hospital, Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Boston, United States of America
| | - N Bajaj
- Brigham and Women's Hospital, Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Boston, United States of America
| | - K Abhishek
- Brigham and Women's Hospital, Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Boston, United States of America
| | - S Jacob
- Brigham and Women's Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology,, Boston, United States of America
| | - A Diaz
- Brigham and Women's Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology,, Boston, United States of America
| | - A Nodoushani
- Brigham and Women's Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology,, Boston, United States of America
| | - P Bravo
- Brigham and Women's Hospital, Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Boston, United States of America
| | - C Bibbo
- Brigham and Women's Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology,, Boston, United States of America
| | - M Steigner
- Brigham and Women's Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology,, Boston, United States of America
| | - V Taqueti
- Brigham and Women's Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology,, Boston, United States of America
| | - R Blankstein
- Brigham and Women's Hospital, Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Boston, United States of America
| | - M Di Carli
- Brigham and Women's Hospital, Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Boston, United States of America
| | - S Dorbala
- Brigham and Women's Hospital, Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Boston, United States of America
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Swallow D, Lawton M, Grosset K, Malek N, Smith C, Bajaj N, Barker R, Ben-Shlomo Y, Burn D, Foltynie T, Morris H, Williams N, Wood N, Grosset D. Variation in recent onset Parkinson’s disease: implications for pre-motor detection. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.1007] [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]
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Swallow D, Lawton M, Grosset K, Malek N, Bajaj N, Barker R, Ben-Shlomo Y, Burn D, Foltynie T, Morris H, Williams N, Wood N, Grosset D. Cardiovascular risk and statin use in recent onset Parkinson's disease. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.1008] [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]
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8
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Pandey R, Chadha D, Malani S, Hasija P, Ghosh A, Bajaj N. Risk factors for degenerative aortic valve disease in India: A case control study. Indian Heart J 2014. [DOI: 10.1016/j.ihj.2014.10.203] [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: 10/24/2022] Open
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9
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Pandey R, Chadha D, Malani S, Hasija P, Ghosh A, Bajaj N. Correlation of body mass index with left ventricular function. Indian Heart J 2014. [DOI: 10.1016/j.ihj.2014.10.186] [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: 10/24/2022] Open
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10
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Ling H, Ling H, de Silva R, Massey LA, Courtney R, Hondhamuni G, Bajaj N, Lowe J, Holton JL, Lees A, Revesz T. Characteristics of progressive supranuclear palsy presenting with corticobasal syndrome: a cortical variant. Neuropathol Appl Neurobiol 2014; 40:149-63. [PMID: 23432126 PMCID: PMC4260147 DOI: 10.1111/nan.12037] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 02/15/2013] [Indexed: 12/11/2022]
Abstract
Aims Since the first description of the classical presentation of progressive supranuclear palsy (PSP) in 1963, now known as Richardson's syndrome (PSP-RS), several distinct clinical syndromes have been associated with PSP-tau pathology. Like other neurodegenerative disorders, the severity and distribution of phosphorylated tau pathology are closely associated with the clinical heterogeneity of PSP variants. PSP with corticobasal syndrome presentation (PSP-CBS) was reported to have more tau load in the mid-frontal and inferior-parietal cortices than in PSP-RS. However, it is uncertain if differences exist in the distribution of tau pathology in other brain regions or if the overall tau load is increased in the brains of PSP-CBS. Methods We sought to compare the clinical and pathological features of PSP-CBS and PSP-RS including quantitative assessment of tau load in 15 cortical, basal ganglia and cerebellar regions. Results In addition to the similar age of onset and disease duration, we demonstrated that the overall severity of tau pathology was the same between PSP-CBS and PSP-RS. We identified that there was a shift of tau burden towards the cortical regions away from the basal ganglia; supporting the notion that PSP-CBS is a ‘cortical’ PSP variant. PSP-CBS also had less severe neuronal loss in the dorsolateral and ventrolateral subregions of the substantia nigra and more severe microglial response in the corticospinal tract than in PSP-RS; however, neuronal loss in subthalamic nucleus was equally severe in both groups. Conclusions A better understanding of the factors that influence the selective pathological vulnerability in different PSP variants will provide further insights into the neurodegenerative process underlying tauopathies.
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Affiliation(s)
| | - H Ling
- Reta Lila Weston Institute of Neurological Studies, Institute of Neurology, University College London, London, UK; Queen Square Brain Bank for Neurological Disorders, Institute of Neurology, University College London, London, UK; Sara Koe PSP Research Centre, Institute of Neurology, University College London, London, UK
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Marrinan S, Bajaj N, Barker R, Ben-Shlomo Y, Emmanuel A, Foltynie T, Grosset D, Morris H, Williams N, Wood N, Burn D. 131 * GASTROPARESIS SYMPTOMS IN EARLY PARKINSON'S DISEASE. Age Ageing 2014. [DOI: 10.1093/ageing/afu047.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mueller C, Pinter B, Reiter E, Schocke M, Scherfler C, Poewe W, Seppi K, Blazejewska AI, Schwarz ST, Bajaj N, Auer DP, Gowland PA. Visualization of nigrosome 1 and its loss in PD: Pathoanatomical correlation and in vivo 7T MRI. Neurology 2014; 82:1752. [DOI: 10.1212/wnl.0000000000000398] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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13
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Bajaj N, Grachev I, Seibyl J, Marek K, Kupsch A, Plotkin M, Hauser R. Sensitivity, specificity, positive and negative predictive values and accuracy of datscan™/INS; for prediction of clinical diagnosis of early parkinsonian syndromes. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.535] [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: 10/26/2022]
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14
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Peall K, Smith D, Kurian M, Wardle M, Waite A, Hedderly T, Lin J, Smith M, Whone A, Pall H, White C, Lux A, Jardine P, Bajaj N, Lynch B, Kirov G, O'Riordan S, Samuel M, Lynch T, King M, Chinnery P, Warner T, Blake D, Owen M, Morris H. ARE PSYCHIATRIC SYMPTOMS A CORE PHENOTYPE OF MYOCLONUS DYSTONIA SYNDROME CAUSED BY SGCE MUTATIONS? J Neurol Psychiatry 2013. [DOI: 10.1136/jnnp-2013-306103.24] [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: 11/04/2022]
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15
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Akhtar N, Shafei R, Lowe J, Bajaj N. P62 STAINING INCLUSIONS IN AN MSA-P PHENOTYPE: A NEW NEURODEGENERATIVE ENTITY? J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2012-304200a.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Madanayake TW, Fidler TP, Fresquez TM, Bajaj N, Rowland AM. Cytochrome P450 2S1 depletion enhances cell proliferation and migration in bronchial epithelial cells, in part, through modulation of prostaglandin E(2) synthesis. Drug Metab Dispos 2012; 40:2119-25. [PMID: 22863683 DOI: 10.1124/dmd.112.046466] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Cytochromes P450 (P450s) contribute to the metabolic activation and inactivation of various endogenous substrates. Despite years of research, the physiological role of CYP2S1 remains unknown. CYP2S1 has demonstrated NADPH P450-reductase-independent metabolism of cyclooxygenase (COX)-derived prostaglandins [e.g., prostaglandin G(2) (PGG(2))] at nanomolar concentrations. Arachidonic acid is converted to prostaglandin precursors [PGG(2) and prostaglandin H(2) (PGH(2))] through COX. These precursors are used to synthesize numerous prostanoids, including PGE(2). Prostaglandin E(2) (PGE(2)) promotes cell proliferation and cell migration and inhibits apoptosis. CYP2S1 metabolism of PGG(2) presumably sequesters PGG(2) and PGH(2), making them unavailable for synthesis of prostanoids such as PGE(2). Whether CYP2S1 contributes to prostaglandin metabolism and influences cell physiological remains to be determined. The purpose of this study was to evaluate the physiological role of CYP2S1, if any, in human bronchial epithelial cells [SV40-derived bronchial epithelial cell line (BEAS-2B)]. To do this, we used small interfering RNA to deplete CYP2S1 mRNA and protein by approximately 75% and evaluated the impact of CYP2S1 depletion on cell proliferation and migration. CYP2S1 depletion enhanced both cell proliferation and migration in BEAS-2B cells. Consistent with the proposed role of CYP2S1 in PGE(2) synthesis, the reduction in CYP2S1 expression doubled intracellular PGE(2) levels. Pharmacological administration of PGE(2) enhanced cell proliferation in BEAS-2B cells but failed to promote migration. Our data reveal an important role for CYP2S1 in the regulation of cell proliferation and migration, occurring in part through modulation of prostaglandin synthesis.
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Affiliation(s)
- T W Madanayake
- Department of Chemistry and Biochemistry, New Mexico State University, Las Cruces, NM 88003, USA
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Abstract
The case presented here is of a 15-year-old girl in whom nearly all the teeth except for lower first molars and lower central incisors showed short roots as observed through panoramic radiograph. At the same time there was difference in the length of roots of various teeth. The patient suffered an acute attack of Stevens-Johnson syndrome (SJS) at the age of 8 years and since no other possible explanation for the short roots anomaly could be found, it could be concluded that the cessation in root development may have been caused by the destruction or damage of the epithelial root sheath during the SJS disease.
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Affiliation(s)
- N Bajaj
- Department of Pedodontics and Preventive Dentistry, PDM Dental College and Research Institute, Bahadurgarh, Haryana, India.
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Grachev I, Kupsch A, Bajaj N, Weiland F, Tartaglione A, Klutmann S, Buitendyk M, Sherwin P, Tate A. Impact of DaTscan SPECT Imaging on Clinical Management, Diagnosis, and Confidence of Diagnosis in Patients with Clinically Uncertain Parkinsonian Syndromes: A Prospective 1-Year Follow-Up Study (P03.123). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p03.123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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19
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Birchall J, Jones I, Bajaj N. 2.012 ARE FP-CIT ABNORMALITIES IN PARKINSON'S DISEASE AND PARKINSON'S DISEASE DEMENTIA CONSISTENT WITH THE BRAAK HYPOTHESIS? Parkinsonism Relat Disord 2012. [DOI: 10.1016/s1353-8020(11)70445-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Marwaha V, Ghosh I, Bajaj N, Reddy ND, Singh B, Narayanan CS, Mathur AD. P28 A clinical study to evaluate the efficacy of viscosupplementation in patients with osteoarthritis of knee. Indian Journal of Rheumatology 2011. [DOI: 10.1016/s0973-3698(11)60138-6] [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: 10/14/2022] Open
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21
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Ghosh I, Marwaha V, Bajaj N, Singh H, Bahl R, Reddy ND, Narayanan CS, Mathur AD. P66 Rheumatological manifestations of HIV infection in a tertiary centre. Indian Journal of Rheumatology 2011. [DOI: 10.1016/s0973-3698(11)60176-3] [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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22
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Szabadi E, Macniven JAB, Bajaj N, Murjan S. PA.15 Chronic auditory hallucinosis and paranoid psychosis in a man with a history of right temporal lobe lesion and alcohol abuse. J Neurol Psychiatry 2011. [DOI: 10.1136/jnnp-2011-300504.42] [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: 11/04/2022]
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23
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Abstract
'Legal highs' are recreational drugs sold over the internet and the so-called 'head shops' all over the UK. They are freely available to buy and use as they are not covered by the Misuse of Drugs Act 1971. Mephedrone (4-methylmethcathinone) was sold as a 'legal high' until 17 April 2010 when it was made a class B drug under the Misuse of Drugs Act 1971. Numerous deaths and self-harm has been associated with mephedrone use. Effects of mephedrone are reported to be empathogenic similar to 3,4-methylenedioxymethamphetamine (MDMA, ecstasy) and stimulant properties similar to cocaine. Not much is known of the effects of mephedrone on mental health. We present a case of dependence and psychosis in a patient using mephedrone (4-methylmethcathinone). The patient needed inpatient hospital care, was treated with antipsychotic olanzapine and recovered well.
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Affiliation(s)
- N Bajaj
- Department of General Adult Psychiatry, Falkirk Royal Infirmary, UK.
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24
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Bajaj N, Schafer A, Wharton S, Gontu V, Bowtell R, Auer DP, Gowland P, Schwartz S, Lotfipour A. PATH53 Magnetic susceptibility of substantia nigra in Parkinson's disease: a 7-T in vivo MRI study. Journal of Neurology, Neurosurgery & Psychiatry 2010. [DOI: 10.1136/jnnp.2010.226340.21] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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25
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Bajaj N, Joshi J, Bajaj S. Chicken Pox with Multisystem Complications. Med J Armed Forces India 2010; 66:280-2. [DOI: 10.1016/s0377-1237(10)80062-0] [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] [Received: 10/09/2009] [Accepted: 04/15/2010] [Indexed: 10/18/2022] Open
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26
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Yang Y, Bajaj N, Xu P, Ohn K, Tsifansky MD, Yeo Y. Development of highly porous large PLGA microparticles for pulmonary drug delivery. Biomaterials 2009; 30:1947-53. [PMID: 19135245 DOI: 10.1016/j.biomaterials.2008.12.044] [Citation(s) in RCA: 183] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2008] [Accepted: 12/15/2008] [Indexed: 11/16/2022]
Abstract
We report a new process of making highly-porous large polymeric microparticles for local drug delivery to the lungs by inhalation. Poly(lactic-co-glycolic acid) (PLGA) microparticles (average diameter, 10-20 microm) were made by the double-emulsion method. To impart favorable aerodynamic properties, an effervescent salt ammonium bicarbonate (ABC) was included in the internal aqueous phase. ABC produced highly-porous structures in the PLGA particles as it escaped as ammonia and carbon dioxide. The fine-particle fraction (FPF) of the microparticles increased as a function of the ratio of ABC to PLGA. Microparticles prepared with 7.5%w/w (ABC/PLGA) had a mass median aerodynamic diameter (MMAD) of 4.0 +/- 1.2 microm and FPF of 32.0 +/- 9.1% when tested with Anderson Cascade Impactor (ACI) and Rotahaler. The highly-porous large particles deposited at the ACI stages corresponding to the trachea and below. The highly-porous large particles avoided phagocytosis by macrophages, while non-porous small particles were quickly taken up by the macrophages. Unlike other encapsulation methods which employ osmogens or extractable porogens, this method could encapsulate lysozyme and doxorubicin.HCl, with high encapsulation efficiency ( approximately 100% for both lysozyme and doxorubicin), in the PLGA microparticles characterized by desirable MMAD (4.5 +/- 0.6 microm lysozyme; 4.6 +/- 0.4 microm doxorubicin) and FPF (29.1 +/- 12.2% lysozyme; 33.8+/-3.6% doxorubicin). Fifty-two percent of encapsulated doxorubicin was released over 4 days from the highly-porous microparticles. This method is an efficient way of making polymeric microparticles for sustained local drug delivery by inhalation.
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Affiliation(s)
- Yan Yang
- School of Pharmacy and Pharmaceutical Sciences, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA
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27
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Affiliation(s)
- N Bajaj
- Neonatal Unit, Northwick Park, Harrow, HA1 3UJ.
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28
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Bajaj A, Bajaj SK, Bajaj N. Bilateral retinoblastoma in early infancy: a case report. Kathmandu Univ Med J (KUMJ) 2007; 5:550-551. [PMID: 18604094] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Retinoblastoma is the most common primary intraocular tumour of childhood. Though congenital, it is not diagnosed at birth, and is usually seen between 1-2 years of age. We here report a case of bilateral retinoblastoma with early presentation at the age of one month.
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Affiliation(s)
- A Bajaj
- Siddhartha Hospital, Kathmandu, Nepal
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29
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Gontu V, Singhal S, Bajaj N, Auer D. 1.267 Serial MRI imaging in extra-pontine myelinolysis – the MRI improves, but the patient worsens. Parkinsonism Relat Disord 2007. [DOI: 10.1016/s1353-8020(08)70507-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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30
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Knibb J, Lenthall R, Bajaj N. Internal carotid artery dissection presenting with ipsilateral tenth and twelfth nerve palsies and apparent mass lesion on MRI. Br J Radiol 2005; 78:659-61. [PMID: 15961853 DOI: 10.1259/bjr/57426025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 11/05/2022] Open
Abstract
We report the case of a 47-year-old man who presented with a few months' history of right-sided headache and dysphagia, with ipsilateral tenth and twelfth cranial nerve palsies on examination. The initial MRI showed an enhancing mass lesion in relation to the right carotid sheath and jugular foramen, and was reported as a possible paraganglioma. Subsequent angiography performed to assess tumour vascularity demonstrated a dissection involving a tonsillar loop of the right internal carotid artery (ICA). Imaging findings at MRI and angiography and the presentations and mechanisms of ICA dissection are briefly discussed.
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Affiliation(s)
- J Knibb
- Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK
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31
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Singal A, Bajaj N, Battacharya SN, Baruah MC. Genital herpes zoster with cutaneous dissemination. Indian J Dermatol Venereol Leprol 1997; 63:254-255. [PMID: 20944347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- A Singal
- From the Department of Dermatology and STD, University College of Medical Science, and Guru Teg Bahadur Hospital, Shahdara, Delhi - 110 095, India,
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32
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Sender PL, Jäger HR, Hersch M, Chaudri KR, Bajaj N, Frackowiak RSJ. Neurosarcoidosis mimicking meningioma en-plaque: report of two cases and review of the literature. Eur J Neurol 1997. [DOI: 10.1111/j.1468-1331.1997.tb00352.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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33
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Miller C, Guidato S, McLoughlin D, Bajaj N. 538 Regulation of neurofilament side-arm phosphorylation by cdk-5 and GSK-3a and GSK-3β. Neurobiol Aging 1996. [DOI: 10.1016/s0197-4580(96)80540-9] [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: 11/15/2022]
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34
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Khaitan BK, Bajaj N, Verma KK. Cutaneous Horn in a lesion of prurigo nodularis. Acta Derm Venereol 1996; 76:85-6. [PMID: 8721510 DOI: 10.2340/00015555768586] [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: 02/01/2023] Open
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35
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Holloway PA, Knox K, Bajaj N, Chapman D, White NJ, O'Brien R, Stacpoole PW, Krishna S. Plasmodium berghei infection: dichloroacetate improves survival in rats with lactic acidosis. Exp Parasitol 1995; 80:624-32. [PMID: 7758543 DOI: 10.1006/expr.1995.1078] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The kinetics of Plasmodium berghei infection and the development of lactic acidosis, hypoglycemia, and anemia were defined in young Wistar rats. This model of metabolic dysfunction, which is similar to that of severe human malaria, was used to test the hypothesis that dichloroacetate, a treatment for lactic acidosis, prolonged survival in rats receiving a single antimalarial dose of quinine (20 mg/kg). Rats with hyperlactatemia (lactate > 5 mmol/liter, N = 183) were randomized to receive either dichloroacetate (100 mg/kg, N = 99) or saline (N = 84) and were monitored for outcome (survival or death) for 50 hr. Logistic regression modeling adjusting for baseline venous lactate concentration demonstrated that dichloroacetate increases survival rates in rats with venous lactate concentrations between 5 and 8.9 mmol/liter (odds ratio > 2.2, P < 0.021). This is the first demonstration that specific intervention to treat lactic acidosis can prolong survival and suggests that dichloroacetate may be useful as adjunctive therapy in the management of lactic acidosis complicating severe falciparum malaria.
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Affiliation(s)
- P A Holloway
- Nuffield Departments of Clinical Biochemistry, John Radcliffe Hospital, Oxford, United Kingdom
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36
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Bajaj N, Joshi P, Bajaj SK. Hunter Disease: A Case Report. J Nepal Paedtr Soc 1970. [DOI: 10.3126/jnps.v28i2.1389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
DOI = 10.3126/jnps.v28i2.1389J. Nepal Paediatr. Soc. Vol.28(2) 2008 p.62-65
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37
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Bajaj N. Febrile Convulsions. J Nepal Paedtr Soc 1970. [DOI: 10.3126/jnps.v28i1.1403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Febrile convulsions are seizures that occur in association with fever but without evidence of intracranial infection or other definable cause in children in the age between 6 months to 5 years. Febrile convulsions have a strong genetic predisposition and a benign outcome in the majority. Febrile convulsions are clinically distinguishable as simple febrile convulsions or they are called complex febrile convulsions when they have focal features and /or are prolonged and/or recurrent in the same illness. Complex febrile convulsions are associated with higher risk of developing subsequent epilepsy. The condition of mesial temporal lobe sclerosis has been linked to prolonged febrile convulsions in childhood. Majority of febrile convulsions need only parental assurance. In few cases intermittent or continuous prophylaxis with antiepileptic drugs may have to be advised. DOI = 10.3126/jnps.v28i1.1403 J. Nepal Paediatr. Soc. Vol.28(1) p.23-26
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