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Taneja R, Nahata MC, Scarim J, Pande PG, Scarim A, Hoddinott G, Fourie CL, Jew RK, Schaaf HS, Hesseling AC, Garcia-Prats AJ, Inabathina KR. A novel home-based method for preparing suspensions of anti-TB drugs. Int J Tuberc Lung Dis 2023; 27:810-815. [PMID: 37880886 PMCID: PMC10599413 DOI: 10.5588/ijtld.23.0165] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/08/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND: Tablets are the most widely available dosage form for the treatment of TB; however, adult tablets fail to meet the needs of young children who cannot swallow these tablets or require dose titration. We tested a new, simple device (XTEMP-R®) and the methodology for converting tablets of TB drugs into a homogeneous suspension for home use by children and caregivers.METHODS: XTEMP-R is a new device used for converting tablets into liquid preparations. Four TB drugs - pretomanid, delamanid, clofazimine and bedaquiline - were dispersed in the device utilizing water and simple syrup. The reproducibility of accurately delivering aliquots from the suspension upon preparation and upon redispersion after storing for 2 days was studied.RESULTS: Suspensions of each of the drugs tested were easily prepared in about 10 min and were visually uniform in consistency. Dosages in 2 and 5 mL were assessed in suspension, and those in 5 mL tested upon redispersion after 2 days. The observed range for these dosages spanned from 94.6% to 101.1% of the theoretical concentration for the suspensions under examination. The cleaned device had no detectable residual drug.CONCLUSION: XTEMP-R can be used at home by caregivers to prepare doses of suspensions accurately for children and patients who cannot swallow tablets.
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Affiliation(s)
- R Taneja
- Global Alliance for TB drug Development (TB Alliance), New York, NY
| | - M C Nahata
- Institute of Therapeutic Innovations and Outcomes, Colleges of Pharmacy and Medicine, The Ohio State University, Columbus, OH
| | | | - P G Pande
- Global Alliance for TB drug Development (TB Alliance), New York, NY
| | | | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg
| | - C L Fourie
- Metro TB Complex, Department of Health, Pretoria, South Africa
| | - R K Jew
- Institute for Safe Medication Practices, Plymouth Meeting, PA
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg
| | - A J Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - K Rao Inabathina
- Global Alliance for TB drug Development (TB Alliance), New York, NY
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Taneja R, Singh AK, Sharma A, Taneja N, Raheja A. Validation study of new clinical scoring - "Apollo Clinical Scoring system" for bladder pain syndrome/interstitial cystitis and comparison of outcome with standard "O'Leary-Sant score". Int Urogynecol J 2023:10.1007/s00192-023-05641-y. [PMID: 37642668 DOI: 10.1007/s00192-023-05641-y] [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] [Received: 05/04/2023] [Accepted: 07/05/2023] [Indexed: 08/31/2023]
Abstract
AIM Validation of the recently published newer clinical scoring system for bladder pain syndrome/interstitial cystitis and comparison of the results with the pre-existing standard O'Leary-Sant score. INTRODUCTION The symptoms are our primary guide to disease severity analysis, treatment, and response monitoring. The combined ICSI/ICPI (O'Leary-Sant Interstitial Cystitis Symptom and Problem Index) consist of a four-item symptom and problem index focusing on urgency, frequency, nocturia, and pain. A new scale, assigning more weight to pain and nocturia and adding the domains of sexual dysfunction and psychological impact, has been published by one of the authors (El Khoudary et al. J Women's Health 2002. 18:1361-1368; 7). MATERIAL AND METHODS This is a prospective study conducted to validate a newer clinical scoring system, namedht e 'Apollo Clinical Scoring' (ACS) system for patients with bladder pain syndrome/ interstitial cystitis (BPS/IC), and to compare its outcome with the simultaneously applied standard O'Leary-Sant (OLS) score. Thirty-five patients of BPS/IC diagnosed using the ESSIC definition were enrolled in the study and followed for 6 months. Intraclass correlation coefficient (ICC) for test-retest reliability, and Cronbach's α for measure of internal consistency, were applied to both scoring systems. RESULTS Intraclass correlation coefficient for ACS was 0.715 and for OLS was 0.689. Cronbach's α for ACS was 0.736 and for OLS was 0.698. CONCLUSION The present study suggests that the recently devised Apollo Clinical Scoring (ACS) system for patients of BPS/IC is internally consistent and a reliable scoring system. When compared with OLS in parallel setting, the newer ACS appeared to be marginally better.
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Affiliation(s)
- Rajesh Taneja
- Department of Urology and Robotic Surgery, Indraprastha Apollo Hospitals, Room number 1019, New Delhi, 110070, India.
| | - Ashutosh Kumar Singh
- Department of Urology and Robotic Surgery, Indraprastha Apollo Hospitals, Room number 1019, New Delhi, 110070, India
| | - Ankur Sharma
- Department of Urology and Robotic Surgery, Indraprastha Apollo Hospitals, Room number 1019, New Delhi, 110070, India
| | - Nilesh Taneja
- Department of Urology and Robotic Surgery, Indraprastha Apollo Hospitals, Room number 1019, New Delhi, 110070, India
| | - Apeksha Raheja
- Department of Urology and Robotic Surgery, Indraprastha Apollo Hospitals, Room number 1019, New Delhi, 110070, India
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Taneja R, Nahata MC, Scarim J, Pande PG, Scarim A, Hoddinott G, Fourie CL, Jew RK, Schaaf HS, Garcia-Prats AJ, Hesseling AC. Stable, compounded bedaquiline suspensions to support practical implementation of pediatric dosing in the field. Int J Tuberc Lung Dis 2023; 27:189-194. [PMID: 36855042 PMCID: PMC9983625 DOI: 10.5588/ijtld.22.0440] [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: 03/02/2023] Open
Abstract
BACKGROUND: Bedaquiline (BDQ) tablets are indicated as part of a combination regimen for the treatment of multidrug-resistant TB in adults, adolescents and children. A dispersible tablet formulation is now approved but is not currently available in all settings. The aim of this study was to develop stable extemporaneous liquid formulations of BDQ that can be stored at room temperature or 30°C for several weeks, to support pragmatic pediatric dosing in the field and reduce wastage.METHODS: BDQ tablets were suspended in simple syrup and a sugar-free vehicle. Each 20 mg/mL formulation was stored at room temperature or 30°C for 30 days in amber dispensing bottles. Appearance, BDQ potency, pH and microbial counts were determined on Days 0, 15 and 30.RESULTS: The BDQ potency in both formulations remained at 98-101% of the theoretical concentration for 30 days. The appearance, pH and microbial count of sugar-free formulation did not change during the 30-day storage. The simple syrup formulation was stable for 15 days as microbial growth was observed on Day 30.CONCLUSIONS: BDQ may be prepared in syrup or sugar-free suspensions: syrup suspensions can be stored for 15 days at room temperature and 30C, whereas sugar-free suspensions can be stored for 30 days at room temperature and 30C. This information will support practical BDQ dosing for children in the field.
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Affiliation(s)
- R Taneja
- Global Alliance for TB Drug Development (TB Alliance), New York, NY, USA
| | - M C Nahata
- Institute of Therapeutic Innovations and Outcomes, Colleges of Pharmacy and Medicine, The Ohio State University, Columbus, OH, USA
| | - J Scarim
- JSAS Services Inc Tucson, AZ, USA
| | - P G Pande
- Global Alliance for TB Drug Development (TB Alliance), New York, NY, USA
| | - A Scarim
- JSAS Services Inc Tucson, AZ, USA
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - C L Fourie
- Metro TB Complex, Department of Health, Pretoria, South Africa
| | - R K Jew
- Institute for Safe Medication Practices (ISMP), Plymouth Meeting, PA, USA
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A J Garcia-Prats
- Department of Pediatrics University of Wisconsin School of Medicine and Public Health, Madison, WI, USA, Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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Rahnama’i MS, Marand AJB, Janssen D, Mostafaei H, Gatsos S, Hajebrahimi S, Apostolidis A, Taneja R. Botulinum Toxin Therapy for Bladder Pain Syndrome/Interstitial Cystitis. Curr Bladder Dysfunct Rep 2023. [DOI: 10.1007/s11884-023-00695-6] [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: 02/19/2023]
Abstract
Abstract
Purpose of Review
Bladder pain syndrome (BPS)/interstitial cystitis (IC) can also be classified as either non-ulcerative or ulcerative, corresponding to the characteristic cystoscopic findings under hydrodistention. Promising therapeutic effects, including decreased bladder pain, have been reported from recent clinical trials using botulinum toxin A (BoNTA) for the treatment of BPS/IC. This review summarizes the current state of the literature on the underlying mechanisms of BoNTA therapy in BPS/IC as well as new forms of its application.
Recent Findings
BoNTA has its effect in the central nervous system in the afferent nerves as well as in the bladder wall. Besides the well-known effects of BoNTA in the nervous system, pain control as well as reduction of urinary urgency in BPS patients could be achieved by mast cell stabilization effecting histamine release as well as modulation of TRPV and PGE2 pathways, among other systems. In addition, new forms of BoNTA administration have focused on intravesical instillation of the drug in order to circumvent bladder wall injections. Hyperthermia, intravesical hydrogel, and lysosomes have been studied as new ways of BoNTA application in BPS/IC patients. From the available studies, bladder instillation of BoNTA in combination with EMDA is the most promising and effective novel approach.
Summary
The most promising novel application methods for BoNTA in patient with BPS/IC are bladder instillations. Future research needs to point out if bladder instillations with BoNTA with some form of bladder absorption enhancement such as hyperthermia or EMDA would be able to replace BoNTA injections in patients with BPS/IC
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Taneja R, Nahata MC, Scarim J, Pande PG, Scarim A, Hoddinott G, Fourie CL, Jew RK, Schaaf HS, Hesseling AC, Garcia-Prats AJ. Extemporaneously compounded liquid formulations of clofazimine. Int J Tuberc Lung Dis 2023; 27:106-112. [PMID: 36853102 PMCID: PMC9904399 DOI: 10.5588/ijtld.22.0331] [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] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND: Clofazimine (CFZ) is routinely used worldwide for the treatment of leprosy and TB. However, no liquid or dispersible tablet formulations of CFZ are currently available commercially for patients with challenges ingesting soft gelatin capsules or solid formulations. The aim of this research was to develop stable extemporaneous liquid formulations of CFZ that can be stored at room temperature for several weeks to enable practical dosing in the field.METHODS: Two formulations were prepared in syrup and sugar-free vehicles with CFZ tablets using a simple method that can be used in a routine pharmacy. Suspensions were stored at room temperature and at 30°C for 30 days. Formulation aliquots were tested on Days 0, 15 and 30 for appearance, pH, potency and microbial counts.RESULTS: Appearance remained unchanged during storage. The pH of both formulations was between 4.0 and 6.0. Potency was between 90% and 110% for 30 days in the syrup formulation and for 15 days in the sugar-free formulation. Microbial counts met United States Pharmacopeia <1111> limits for oral aqueous liquids and specific organisms were absent.CONCLUSIONS: A simple field-friendly method was successfully developed for the preparation of CFZ liquid formulations using commonly available ingredients. This will permit practical dosing and titration for children and other patients with swallowing challenges.
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Affiliation(s)
- R Taneja
- Global Alliance for TB drug Development (TB Alliance), New York, NY, USA
| | - M C Nahata
- Institute of Therapeutic Innovations and Outcomes, Colleges of Pharmacy and Medicine, The Ohio State University, Columbus, OH, USA
| | - J Scarim
- JSAS Services Inc, Tucson, AZ, USA
| | - P G Pande
- Global Alliance for TB drug Development (TB Alliance), New York, NY, USA
| | - A Scarim
- JSAS Services Inc, Tucson, AZ, USA
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - C L Fourie
- Metro TB Complex, Department of Health, Pretoria, South Africa
| | - R K Jew
- Institute for Safe Medication Practices, Plymouth Meeting, PA, USA
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A J Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Taneja R, Pandey S, Priyadarshi S, Goel A, Jain A, Sharma R, Purohit N, Bandukwalla V, Tanvir, Ragavan M, Agrawal A, Shah A, Girn Z, Ajwani V, Mete U. Diagnostic and therapeutic cystoscopy in bladder pain syndrome/interstitial cystitis: systematic review of literature and consensus on methodology. Int Urogynecol J 2023:10.1007/s00192-023-05449-w. [PMID: 36708406 DOI: 10.1007/s00192-023-05449-w] [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] [Received: 08/20/2022] [Accepted: 12/31/2022] [Indexed: 01/29/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Cystoscopy has been routinely performed in patients suspected to be suffering from bladder pain syndrome/interstitial cystitis (BPS/IC) across the globe. The methodology reported by various guidelines appears to have differences in the techniques and hence there is a need for a review of all those techniques in order to arrive at a consensus. The aim was to review the literature describing the prevalent techniques of cystoscopy for patients of BPS/IC and try to evolve a consensus. METHODS The group the Global Interstitial Cystitis, Bladder Pain Society (GIBS) has worked collectively to systematically review the literature using the key words, "Cystoscopy in Hunner's lesions, bladder pain syndrome, painful bladder syndrome and interstitial cystitis" in the PubMed, COCHRANE, and SCOPUS databases. A total of 3,857 abstracts were studied and 96 articles referring to some part of technique of cystoscopy were short-listed for review as full-length articles. Finally, six articles with a description of a technique of cystoscopy were included for final tabulation and comparison. The group went on to arrive at a consensus for a stepwise technique of diagnostic and therapeutic cystoscopy in cases of BPS/IC. This technique has been compared with the previously described techniques and may serve to be a useful practical guide for treating physicians. CONCLUSION It is important to have a uniform standardized technique for performing a diagnostic and therapeutic cystoscopy in patients with BPS/IC. Consensus on one such a technique has been arrived at and described in the present article.
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Affiliation(s)
- Rajesh Taneja
- Urology and Robotic Surgery, Indraprastha Apollo Hospitals, New Delhi, 110070, India.
| | - Sanjay Pandey
- Urology and Renal Transplant, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
| | | | - Apul Goel
- Department of Urology, King George Medical University, Lucknow, India
| | - Amita Jain
- Institute of Urology and Robotics, Medanta The Medicity, Gurugram, India
| | - Ranjana Sharma
- Gynecology and Robotic Surgery, Indraprastha Apollo Hospitals, New Delhi, India
| | - Navita Purohit
- Department of Physiatry, Kokilaben Dhitubhai Ambani hospital, Mumbai, India
| | | | - Tanvir
- Tanvir Hospital, Hyderabad, India
| | | | | | - Amit Shah
- Surgery and Urology, Naval Hospital, Mumbai, India
| | | | - Vikky Ajwani
- The Cure Urology Hospital, Vadodara, Gujarat, India
| | - Uttam Mete
- Urology and Robotic Surgery, PGIMER, Chandigarh, India
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Jaw-Tsai S, Barry R, Pande PG, Taneja R, Yang T. Comparison of pharmacokinetics and bioavailability of bedaquiline fumarate, benzoate and maleate in dogs. Int J Tuberc Lung Dis 2023; 27:28-33. [PMID: 36853125 PMCID: PMC9879086 DOI: 10.5588/ijtld.22.0326] [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] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND: Bedaquiline (BDQ) as a fumarate salt is indicated as part of a regimen to treat multidrug-resistant TB (MDR-TB). BDQ benzoate and maleate have been identified as promising alternatives that will encourage generic pharmaceutical houses to manufacture this drug. Our study compared the pharmacokinetics (PK) of BDQ fumarate vs. the maleate and benzoate salts in dogs.METHODS: The PK of BDQ and its active N-desmethyl metabolite M2 following intravenous administration of 1 mg/kg BDQ (as fumarate) and oral administration of 10 mg/kg BDQ as fumarate, benzoate, or maleate salts in suspension to fasted male beagle dogs was evaluated in a parallel-group and crossover study with N = 4 per group. BDQ and M2 plasma concentrations were determined up to 168 h post-dose. T-tests were conducted to compare the area under the curve, AUC0-t among groups.RESULTS: Orally administered fumarate, benzoate, and maleate salts, in parallel-group design, resulted in mean BDQ AUC0-t of 9,267 ± SD 10,182, 19,258 ± SD 11,803, and 15,396 ± SD 9,170 ng.h/ml, respectively; and in a crossover design of 9,267 ± SD 10,182, 17,441 ± SD 24,049, and 18,087 ± SD 19,758 ng.h/ml, respectively. P values were >0.05.CONCLUSION: There was no statistically significant difference in BDQ and M2 AUC0-t following oral administration of fumarate, benzoate and maleate salts in dogs.
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Affiliation(s)
- S Jaw-Tsai
- Sarah Jaw-Tsai Consulting Services, San Francisco, CA, USA
| | - R Barry
- RTI International, Research Triangle Park, NC, USA
| | - P G Pande
- Global Alliance for TB Drug Development (TB Alliance), New York, NY, USA
| | - R Taneja
- Global Alliance for TB Drug Development (TB Alliance), New York, NY, USA
| | - T Yang
- 3DC, Deerfield Management, New York, NY, USA
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Taneja R, Nahata MC, Scarim J, Pande PG, Scarim A, Hoddinott G, Fourie CL, Jew RK, Schaaf HS, Garcia-Prats AJ, Hesseling AC. Sugar and sugar-free liquid formulations of delamanid for patients with rifampicin-resistant TB. Int J Tuberc Lung Dis 2023; 27:13-18. [PMID: 36853133 PMCID: PMC9879082 DOI: 10.5588/ijtld.22.0329] [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] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND: Delamanid (DLM) tablets are recommended for the treatment of rifampicin-resistant TB. However, no liquid or dispersible tablet formulation of DLM is currently commercially available for patients with challenges ingesting these tablets. The aim of this study was to develop stable extemporaneous liquid formulations of DLM that can be stored at room temperature for several weeks.METHODS: DLM tablets were suspended in 1) simple syrup and 2) a specially formulated sugar-free vehicle. These suspensions containing DLM 5 mg/mL were stored in plastic prescription bottles at room temperature or 30°C for 30 days. These suspensions were evaluated for appearance, potency, pH, and microbial counts at Days 0, 15, and 30.RESULTS: The potency of DLM in each formulation remained at 98-104% of the theoretical concentration for 30 days. The appearance, pH, and microbial count did not change for the sugar-free formulation during the 30-day storage period. Microbial growth, however, was observed in the simple syrup formulation on Day 30 but not on Day 15.CONCLUSION: DLM can be formulated in sugar or sugar-free suspensions and stored at room temperature or 30°C for at least 15 and 30 days, respectively.
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Affiliation(s)
- R Taneja
- Global Alliance for TB Drug Development (TB Alliance), New York, NY, USA
| | - M C Nahata
- Institute of Therapeutic Innovations and Outcomes, Colleges of Pharmacy and Medicine, The Ohio State University, Columbus, OH, USA
| | - J Scarim
- JSAS Services Inc, Tucson, AZ, USA
| | - P G Pande
- Global Alliance for TB Drug Development (TB Alliance), New York, NY, USA
| | - A Scarim
- JSAS Services Inc, Tucson, AZ, USA
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - C L Fourie
- Metro TB Complex, Department of Health, Pretoria, South Africa
| | - R K Jew
- Institute for Safe Medication Practices, Horsham, PA, USA
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A J Garcia-Prats
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA, Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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Taneja R, Nahata MC, Scarim J, Pande PG, Scarim A, Hoddinott G, Fourie CL, Jew RK, Schaaf HS, Garcia-Prats AJ, Hesseling AC. Stable sugar and sugar-free suspensions of pretomanid. Int J Tuberc Lung Dis 2022; 26:1112-1117. [PMID: 36447311 PMCID: PMC9728945 DOI: 10.5588/ijtld.22.0330] [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: 12/05/2022] Open
Abstract
BACKGROUND: Pretomanid (PMD) tablets are indicated as part of a combination regimen for the treatment of adults with pulmonary extensively drug-resistant, treatment-intolerant or non-responsive multidrug-resistant TB. No commercial liquid formulation is currently available for patients unable to swallow these tablets.OBJECTIVE: To develop stable extemporaneous liquid formulations of PMD that can be stored at room temperature or 30°C for at least 4 weeks.METHODS: Crushed PMD tablets were formulated into 20 mg/mL suspensions in a simple syrup and sugar-free formulation. The PMD formulations were stored at room temperature and at 30°C for 30 days in dispensing bottles. Appearance, pH, potency and microbial counts of the suspensions were determined on Days 0, 15 and 30.RESULTS: The potency of PMD remained at 99.7-103.4% of the theoretical concentration in each formulation. The appearance, pH and microbial count did not change during the 30-day storage period. Simple syrup formulations did not require preservatives for microbial stability.CONCLUSIONS: PMD oral suspension formulations in simple syrup or in sugar-free vehicle were easily prepared by utilising commonly available equipment and ingredients and were stable for 30 days. These formulations are appropriate alternatives for patients with swallowing difficulties.
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Affiliation(s)
- R. Taneja
- Global Alliance for TB Drug Development (TB Alliance), New York, NY, USA
| | - M. C. Nahata
- Institute of Therapeutic Innovations and Outcomes, Colleges of Pharmacy and Medicine, Ohio State University, Columbus, OH, USA
| | | | - P. G. Pande
- Global Alliance for TB Drug Development (TB Alliance), New York, NY, USA
| | | | - G. Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - C. L. Fourie
- Metro TB Complex, Department of Health, Pretoria, South Africa
| | - R. K. Jew
- Institute for Safe Medication Practices, Horsham, PA, USA
| | - H. S. Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A. J. Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
,Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - A. C. Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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Taneja R, Taneja N. Urological problems in elderly patients of tuberculosis. Indian J Tuberc 2022; 69 Suppl 2:S295-S300. [PMID: 36400526 DOI: 10.1016/j.ijtb.2022.10.020] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
Development of tuberculosis is closely linked to poor socioeconomic condition, poor immune functioning and mental health including depression and anxiety. Elderly population becomes an important target group for the disease and deserves special attention. Unique problem with genito urinary tuberculosis (GUTB) in elderly population is the diagnosis. One of the earliest symptoms of GUTB is increased urinary frequency which a large majority in elderly population may already have, owing to their enlarged prostates or an overactive bladder/detrusor over activity mediated centrally or peripherally, which are not uncommon in this group. When left undiagnosed and thereby untreated, GUTB usually leads to irreversible tissue damage and consequences range from abscesses, small capacity urinary bladder to renal failure.
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Affiliation(s)
- Rajesh Taneja
- Urology and Robotic Surgery, Indraprastha Apollo Hospitals, New Delhi, India.
| | - Nilesh Taneja
- Urology and Robotic Surgery, Indraprastha Apollo Hospitals, New Delhi, India
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Abdul Rouf M, Kumar V, Agarwal A, Sharma M, Rawat SK, Taneja R. Effect of a novel technique of posterior reconstruction of pubourethralis on 'early' return of continence after robot assisted radical prostatectomy (RARP): A comparative study. Urologia 2021; 88:315-320. [PMID: 33781134 DOI: 10.1177/03915603211007052] [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: 11/15/2022]
Abstract
OBJECTIVE To study the effect of a novel technique of posterior reconstruction of pubourethralis on early return of continence after robot assisted radical prostatectomy (RARP). MATERIALS AND METHODS The study included 206 patients of organ confined prostate cancer managed at our centre between March 2014 and December 2018.The patients were randomly distributed into two comparable groups with respect to age, height, weight and BMI, with 100 patients in control and 106 patients in study group. After standard excision of the specimen, the posterior reconstruction in the form of Rocco stitch was done in control group while in addition to Rocco stitch pubourethralis was approximated posteriorly in midline at the proposed site of vesicourethral anastomosis in study group. Continence was defined as the need to use 0-1 pad in 24 h. The data was collected on day 0, 3, 7, 15, 30, 90 and 180 after removal of catheter. RESULTS At day zero, 3,7, 15, 30, 90 and 180 days after catheter removal continence rates (⩽1 pad usage per day) were observed to be 18.8% versus 0%, 22.6% versus 0%, 50.9% versus 5%, 72.6% versus 20%, 84.9 versus 32%, 97.1% versus 83%, and 97.1% versus 91% in the study and control group respectively. CONCLUSION Despite small number of patients in this study the results with respect to early return of continence are encouraging in the reconstruction group and there by in favour of this technique .Furthermore the technique is easily reproducible and may be seen as one more additional step to be applied in order to enhance the recovery of continence after RARP. However it is necessary to further validate the efficacy of this procedure through multicenteric controlled trials.
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Abstract
Lack of a standard definition of neonatal sepsis and a swift diagnostic method has proven detrimental in the management of this serious condition. Biomarkers have emerged as a beacon that might help us detect neonatal sepsis more effectively. The use of point-of-care biomarkers can aid in early diagnosis and timely initiation of treatment. Procalcitonin, presepsin, interleukin-6, highly specific C-reactive protein, and neutrophil gelatinase-associated lipocalin have been proven to aid in early diagnosis and timely initiation of treatment, thereby reducing sepsis-induced morbidity and mortality. These biomarkers have been found to be useful in reducing the duration of hospital stay and monitoring the response to therapy. When used in combination with each other, or with clinical scores, they have been proven to be advantageous over the gold standard by eliminating the waiting time for blood culture results. The use of biomarkers as a point of care investigation holds a future over the traditional method. We present a state of science review of literature summarizing the current status of these biomarkers in neonatal sepsis.
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Affiliation(s)
- R Taneja
- Department of Pediatrics, University College of Medical Sciences, Delhi, India.,Guru Teg Bahadur Hospital, Delhi, India
| | - P Batra
- Department of Pediatrics, University College of Medical Sciences, Delhi, India.,Guru Teg Bahadur Hospital, Delhi, India
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Rouf MA, Taneja R, Kumar V. Clinicopathological correlation of pre-biopsy quantitative PSMA uptake in patients with persistently raised serum PSA: initial experience in 74 patients with simultaneous 68-Ga PSMA PET/MRI. Journal of Clinical Urology 2020. [DOI: 10.1177/2051415820956406] [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
Objective: To analyze 68-Ga prostate-specific membrane antigen (PSMA) uptake pattern of the prostate and its correlation with prostate-specific antigen (PSA), digital rectal examination (DRE), and Gleason’s score in the diagnosis of carcinoma of the prostate (CaP). Methods: This was a retrospective study conducted between June 2015 and August 2017. Patients who had undergone whole body 68-Ga PSMA HBED-CC simultaneous positron emission tomography (PET) or magnetic resonance imaging (MRI) for the diagnosis or staging of CaP were eligible. Patients who presented with persistently raised serum PSA (>4 ng/mL) and normal urine routine and negative culture were included in the study. Results: A total of 74 patients were included in the study. Significant positive correlation was observed between PSMA delayed uptake with the Prostate Imaging Reporting and Data System (PI-RADS) score ( p<0.001, ρ=0.750), PSA level ( p<0.001, ρ=0.414), DRE ( p<0.002, ρ=0.400), and Gleason’s score ( p<0.300, ρ=0.02). There was a significant difference between early and delayed phase of PSMA uptake in malignant prostatic lesions ( p<0.001). Delayed phase of PSMA uptake was able to characterize prostate lesions with an area under curve (AUC) of 0.91. Combined receiver operating characteristic analysis of PI-RADS score derived from multiparametric MRI and differential PSMA uptake to characterize prostatic lesions improved AUC to 0.94. Conclusion: Results demonstrated that the correlation with clinicopathological features (PSA, DRE, and Gleason’s score) could be used in prognostication of prostatic lesion along with PSMA PET/MRI.
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Affiliation(s)
- Malik A Rouf
- Department of Urology, Indraprastha Apollo Hospitals, New Delhi, India
| | - Rajesh Taneja
- Department of Urology, Indraprastha Apollo Hospitals, New Delhi, India
| | - Venkatesh Kumar
- Department of Urology, Indraprastha Apollo Hospitals, New Delhi, India
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Taneja R. Current status of oral pentosan polysulphate in bladder pain syndrome/interstitial cystitis. Int Urogynecol J 2020; 32:1107-1115. [PMID: 32894327 DOI: 10.1007/s00192-020-04517-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 06/19/2020] [Accepted: 08/21/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Oral pentosan polysulphate (PPS) has been used in the treatment of bladder pain syndrome/interstitial cystitis (BPS/IC) for almost 35 years. However, in some recent studies, questions have been raised about its efficacy in treating this condition. We aimed to evaluate the published medical literature and discuss the clinical utility of oral PPS in the treatment of BPS/IC. METHODS PUBMED was searched for BPS/IC, treatment and PPS. Of the initial 398 articles screened, 7 randomized controlled trials, 3 systematic reviews and 3 meta-analyses were finally included in this study (Fig. 1). Other relevant literature such as observational studies and various clinical guidelines was also reviewed. The inclusion criteria, intervention methodology and end points of the studies were examined. RESULTS Of the seven RCTs, five found a clear beneficial role of oral PPS in IC/BPS. The only study which did not have cystoscopy as a diagnostic and inclusion criterion failed to show any benefit of oral PPS compared to placebo. Two out of three meta-analyses clearly concluded that oral PPS had a positive role to play in the treatment of BPS/IC. Various open-label studies did conclude in favour of oral PPS as a treatment modality for these patients. CONCLUSION Oral PPS remains a useful pharmacological agent for treatment of BPS/IC, even though it may be effective only in a subgroup of patients.
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Affiliation(s)
- Rajesh Taneja
- Indraprastha Apollo Hospitals, Room Number 1019, Sarita Vihar, New Delhi, 110070, India.
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Fall M, Nordling J, Cervigni M, Oliveira PD, Fariello J, Hanno P, Kabjörn-Gustafsson C, Logadottir Y, Meijlink J, Moldwin R, Nasta L, Quaghebeur J, Sairanen J, Taneja R, Tomoe H, Ueda T, Wennevik GE, Wyndaele JJ, Zaitcev A. Comments to Editorial by J. Curtis Nickel. It is premature to categorize Hunner lesion interstitial cystitis as a distinct disease entity. Scandinavian Journal of Urology 2020, Vol. 54, No. 2, 99-100; https://doi.org/10.1080/21681805.2020.1744714. Scand J Urol 2020; 54:355-356. [PMID: 32588705 DOI: 10.1080/21681805.2020.1784269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Magnus Fall
- Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Jørgen Nordling
- Department of Urology, Herlev University Hospital, Herlev, Denmark
| | - Mauro Cervigni
- Department of Urogynecology, San Carlo Hospital, Rome, Italy
| | - Paulo Dinis Oliveira
- Department of Urology, Hospital de Sao Joao, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jennifer Fariello
- The Arthur Smith Institute for Urology, Pelvic Pain Treatmemt Center, Garden City, NY, USA
| | - Philip Hanno
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Yr Logadottir
- Department of Urology, Institute of Clinical Sciences, Gothenburg, Sweden
| | - Jane Meijlink
- International Painful Bladder Foundation, Narden, The Netherlands
| | - Robert Moldwin
- Zucker School of Medicine at Hofstra-Northwell, The Arthur Smith Institute for Urology, Lake Success, NY, USA
| | | | | | - Jukka Sairanen
- Department of Urology, Helsinki University Central Hospital, Helsinki, Finland
| | - Rajesh Taneja
- Department of Urology Andrology and Robotic Surgery, Indraprastha Apollo Hospital, New Delhi, India
| | - Hikaru Tomoe
- Department of Urology, Tokyo Women's Medical University Medical Center East Tokyo, Japan, Tokyo, Japan
| | | | | | | | - Andrew Zaitcev
- Department of Urology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
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Rahnama'i MS, Javan A, Vyas N, Lovasz S, Singh N, Cervigni M, Pandey S, Wyndaele JJ, Taneja R. Bladder Pain Syndrome and Interstitial Cystitis Beyond Horizon: Reports from the Global Interstitial Cystitis/Bladder Pain Society (GIBS) Meeting 2019 Mumbai - India. Anesth Pain Med 2020; 10:e101848. [PMID: 32944561 PMCID: PMC7472163 DOI: 10.5812/aapm.101848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 03/19/2020] [Revised: 04/04/2020] [Accepted: 04/12/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose of the Meeting Bladder pain syndrome/interstitial cystitis is a prevalent but underserved disease. At the Global Interstitial Cystitis/Bladder Pain Syndrome Society (GIBS) meeting, the organization and participants were committed to delivering word-class expertise and collaboration in research and patient care. Under the umbrella of GIBS, leading research scholars from different backgrounds and specialties, as well as clinicians, from across the globe interested in the science and art of practice of Bladder Pain Syndrome (BPS)/Interstitial Cystitis (IC) were invited to deliberate on various dimensions of this disease. The meeting aimed to have global guidelines to establish firm directions to practicing clinicians and patients alike on the diagnosis and treatment of this disease entity. Chronic Pelvic Pain Syndrome (CPPS) is defined by pain in the pelvic area that can have different etiologies. This can be due to urologic, gynecologic, musculoskeletal, gastrointestinal, neurologic, and autoimmune or rheumatologic diseases. At the GIBS meeting held in Mumbai, India, in August 2019, a multidisciplinary expert panel of international urologists, gynecologists, pain specialists, and dietitians took part in a think tank to discuss the development of evidence-based diagnostic and treatment algorithms for BPS/IC. Summary of Presented Findings The diagnosis of BPS/IC is difficult in daily clinical practice. Patients with BPS/IC present with a variety of signs and symptoms and clinical test results. Hence, they might be misdiagnosed or underdiagnosed, and the correct diagnosis might take a long time. A good history and physical examination, along with cystoscopy, is a must for the diagnosis of IC/BPS. For the treatment, besides lifestyle management and dietary advice, oral medication and bladder instillation therapy, botulinum toxin, and sacral neuromodulation were discussed. The innovation in bladder instillation applicators, as well as battery-free neuromodulation through the tibial nerve, was discussed, as well. Recommendation for Future Research As BPS/IC is complex, for many patients, several treatments are necessary at the same time. This was presented at GIBS 2019 as the piano model. In this way, a combination of treatments is tailored to an individual patient depending on the symptoms, age, and patients' characteristics. In the art of medicine, especially when dealing with BPS/IC patients, pressing the right key at the right time makes the difference.
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Affiliation(s)
- Mohammad Sajjad Rahnama'i
- Urology Department, Uniklinik RWTH Aachen, Germany
- Society of Urological Research and Education (SURE), Heerlen, The Netherlands
- Corresponding Author: University Hospital Aachen, Germany Pauwelsstrasse 30 D52074 Aachen, Germany.
| | - Aida Javan
- Society of Urological Research and Education (SURE), Heerlen, The Netherlands
- Urology Department, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Navita Vyas
- Pain and Rehab Medicine, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | | | | | | | - Sanjay Pandey
- Kokilaben Dhirubhai Ambani Hospital and Research institute, Mumbai, India
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Fall M, Nordling J, Cervigni M, Dinis Oliveira P, Fariello J, Hanno P, Kåbjörn-Gustafsson C, Logadottir Y, Meijlink J, Mishra N, Moldwin R, Nasta L, Quaghebeur J, Ratner V, Sairanen J, Taneja R, Tomoe H, Ueda T, Wennevik G, Whitmore K, Wyndaele JJ, Zaitcev A. Hunner lesion disease differs in diagnosis, treatment and outcome from bladder pain syndrome: an ESSIC working group report. Scand J Urol 2020; 54:91-98. [PMID: 32107957 DOI: 10.1080/21681805.2020.1730948] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [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: 12/13/2022]
Abstract
Objectives: There is confusion about the terms of bladder pain syndrome (BPS) and Interstitial Cystitis (IC). The European Society for the Study of IC (ESSIC) classified these according to objective findings [9]. One phenotype, Hunner lesion disease (HLD or ESSIC 3C) differs markedly from other presentations. Therefore, the question was raised as to whether this is a separate condition or BPS subtype.Methods: An evaluation was made to explore if HLD differs from other BPS presentations regarding symptomatology, physical examination findings, laboratory tests, endoscopy, histopathology, natural history, epidemiology, prognosis and treatment outcomes.Results: Cystoscopy is the method of choice to identify Hunner lesions, histopathology the method to confirm it. You cannot distinguish between main forms of BPS by means of symptoms, physical examination or laboratory tests. Epidemiologic data are incomplete. HLD seems relatively uncommon, although more frequent in older patients than non-HLD. No indication has been presented of BPS and HLD as a continuum of conditions, one developing into the other.Conclusions: A paradigm shift in the understanding of BPS/IC is urgent. A highly topical issue is to separate HLD and BPS: treatment results and prognoses differ substantially. Since historically, IC was tantamount to Hunner lesions and interstitial inflammation in the bladder wall, still, a valid definition, the term IC should preferably be reserved for HLD patients. BPS is a symptom syndrome without specific objective findings and should be used for other patients fulfilling the ESSIC definitions.
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Affiliation(s)
- Magnus Fall
- Department of Urology, Sahlgrenska Academy at the University Gothenburg, Institute of Clinical Sciences, Göteborg, Sweden
| | - Jørgen Nordling
- Department of Urology, Herlev University Hospital, Copenhagen, Denmark
| | - Mauro Cervigni
- Female Pelvic Medicine & Reconstructive Surgery Center, Catholic University, Rome, Italy
| | - Paulo Dinis Oliveira
- Department of Urology, Hospital de Sao Joao, University of Porto Faculty of Medicine, Porto, Portugal
| | - Jennifer Fariello
- The Arthur Smith Institute for Urology, Zucker School of Medicine at Hofstra-Northwell, Hempstead, NY, USA
| | - Philip Hanno
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Yr Logadottir
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden
| | - Jane Meijlink
- International Painful Bladder Foundation, Naarden, The Netherlands
| | - Nagendra Mishra
- Pramukh Swami Medical College, Shree Krishna Hospital, Karamsad, India
| | - Robert Moldwin
- The Arthur Smith Institute for Urology, Zucker School of Medicine at Hofstra-Northwell, Hempstead, NY, USA
| | | | - Jorgen Quaghebeur
- Department of Urology, Small Pelvis Clinic, University Hospital Antwerpen, Antwerp, Belgium
| | - Vicki Ratner
- Interstitial Cystitis Association of America, San Jose, CA, USA
| | - Jukka Sairanen
- Department of Urology, Helsinki University Central Hospital, Helsinki, Finland
| | - Rajesh Taneja
- Department of Urology and Andrology, Indraprastha Apollo Hospitals, New Delhi, India
| | - Hikaru Tomoe
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Tomohiro Ueda
- Comfortable Urology Network, Ueda Clinic, Kyoto, Japan
| | - Gjertrud Wennevik
- Department of Urology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Kristene Whitmore
- Department of Urology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Jean Jacques Wyndaele
- Department of Urology, University of Antwerp Faculty of Medicine and Health Sciences, Antwerp, Belgium
| | - Andrew Zaitcev
- Department of Urology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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Taneja R. Urology practice in COVID-19 era, Indian perspective. Apollo Med 2020. [DOI: 10.4103/am.am_67_20] [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] Open
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Taneja R, Massand S. A modified clinical scoring system for bladder pain syndrome: Long term experience. Int J Urol 2019; 26 Suppl 1:61-67. [PMID: 31144746 DOI: 10.1111/iju.13977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 03/18/2019] [Accepted: 03/18/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To document a modified clinical scoring system in patients with bladder pain syndrome that increases weightage to pain and nocturia and includes measures for sexual dysfunction and psychological impact. The clinical outcome of a set combination of treatment modalities linked to the clinical score at entry was also made. METHODS The new proposed scale was used to assess and treat 190 enrolled patients from January 2009 to September 30, 2017. The patients were evaluated using the new scoring system at the time of induction, after 1, 3 and 6 months after commencement of treatment. Thereafter, they were followed every 6 months. The new scoring system included increased weightage to pain and nocturia and added domains of sexual dysfunction and psychological impact. The patients were treated with a protocol followed by the authors and published in the year 2007. A pictorial linkage of treatment modalities used with the clinical score of the patient was also described. RESULTS A total of 174 evaluable patients had a follow up between 6 and 105 months (mean 64 months). The patients had age distribution between 24 and 76 years and included 19 male patients. 154 out of 174 patients (88.5%) had good or excellent response to treatment using the proposed scale at the end of 6 months. CONCLUSIONS The proposed clinical scale appeared to aid clinical stratification of severity of the disease at the induction and during follow up. The treatment protocol could be linked with the clinical score at the time of induction.
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Affiliation(s)
- Rajesh Taneja
- Urology, Andrology and Robotic Surgery, Indraprastha Apollo Hospitals, New Delhi, India
| | - Sameer Massand
- Division of Plastic Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
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Pushkar P, Taneja R, Agarwal A. A prospective study to compare changes in male sexual function following holmium laser enucleation of prostate versus transurethral resection of prostate. Urol Ann 2019; 11:27-32. [PMID: 30787567 PMCID: PMC6362791 DOI: 10.4103/ua.ua_44_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Indexed: 11/04/2022] Open
Abstract
Introduction Transurethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP), both are considered standard endosurgical treatment of benign prostatic hyperplasia (BPH). Many studies have evaluated changes in sexual function following treatment of BPH. However, data are sparse on comparative study between the two standard options of the treatment of BPH. Aim The aim of this study was to compare changes in sexual function following HoLEP versus TURP using the International Index of Erectile Function-15 (IIEF-15) questionnaire. Materials and Methods A prospective study carried out for 4 years from May 2013 to April 2017. All patients with bothersome lower urinary tract symptoms due to BPH, who got admitted to the hospital for surgical management, were enrolled for the study and they underwent either HoLEP or TURP. Postoperatively, they were followed for 6 months at 1-, 3-, and 6-month interval. Main Outcome Measures Statistical testing was conducted with the Statistical Package for the Social Science system version 17.0. Continuous variables are presented as mean ± standard deviation, and categorical variables are presented as absolute numbers and percentage. The comparison of normally distributed continuous variables between the groups was performed using Student's t-test. For within the groups, paired t-test was used at 1 month, 3 months, and 6 months from the baseline. Results All the five domains of sexual function based on the IIEF-15 questionnaire remained significantly low at 6-month postsurgery in both the groups. Conclusions By comparing the changes in sexual function between HoLEP and TURP group at the end of our study (6 months), we found no difference between the groups with regard to erectile function or overall sexual function as assessed by total IIEF-15 score.
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Affiliation(s)
- Praveen Pushkar
- Department of Urology, Asian Institute of Medical Sciences, Faridabad, Haryana, India
| | - Rajesh Taneja
- Department of Urology, Indraprastha Apollo Hospital, New Delhi, India
| | - Anshuman Agarwal
- Department of Urology, Indraprastha Apollo Hospital, New Delhi, India
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Wyndaele JJJ, Riedl C, Taneja R, Lovász S, Ueda T, Cervigni M. GAG replenishment therapy for bladder pain syndrome/interstitial cystitis. Neurourol Urodyn 2018; 38:535-544. [PMID: 30592544 DOI: 10.1002/nau.23900] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/30/2018] [Accepted: 11/12/2018] [Indexed: 02/01/2023]
Abstract
AIMS To present a rationale for the inclusion of urothelial coating dysfunction in the etipathogenesis of bladder pain syndrome/interstitial cystitis (BPS/IC) and the preclinical and clinical evidence in support of glycosaminoglycan (GAG) replenishment therapy in the treatment of BPS/IC, supplemented by the clinical experience of medical experts in the field and patient advocates attending a symposium on GAG replenishment at ESSIC'17, the annual Meeting of the International Society for the Study of Bladder Pain Syndrome, held in Budapest, Hungary in 2017. RESULTS The urothelial GAG layer has a primary role in providing a permeability barrier to prevent penetration of urinary toxins and pathogens into the bladder wall. Disruption of the GAG layer contributes to the development of BPS/IC. The evidence shows that replenishment of GAGs can restore the GAG layer in BPS/IC, reducing inflammation, pain, and other symptoms. CONCLUSIONS Although data from large randomized controlled studies are limited, long clinical observation and the experience of clinicians and patients support the beneficial effects of intravesical GAG replenishment therapy for providing symptomatic relief for patients with BPS/IC.
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Affiliation(s)
| | - Claus Riedl
- Urology Department, Landesklinikum Thermenregion, Baden, Austria
| | - Rajesh Taneja
- Urology and Robotic Surgery, Indraprastha Apollo Hospitals, New Delhi, India
| | | | | | - Mauro Cervigni
- Female Pelvic Medicine & Reconstructive Surgery Center Catholic University, Catholic University, Rome, Italy
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Kumar V, Rouf MA, Taneja R. Phantom Pain after Robotic Cystoprostatectomy for Bladder Pain Syndrome. J Clin Diagn Res 2018. [DOI: 10.7860/jcdr/2018/37575.12385] [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: 11/24/2022]
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Taneja R, Garcia-Prats AJ, Furin J, Maheshwari HK. Paediatric formulations of second-line anti-tuberculosis medications: challenges and considerations. Int J Tuberc Lung Dis 2016; 19 Suppl 1:61-68. [PMID: 26564545 DOI: 10.5588/ijtld.15.0435] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
There is a growing number of children worldwide accessing second-line anti-tuberculosis drugs for multidrug-resistant tuberculosis (TB); however, there are very few child-friendly formulations. For paediatric use, dispersible tablets offer distinct advantages over liquid formulations and other approaches. This is particularly relevant for TB, where stability, long shelf-life and reduced manufacturing, transport and storage costs are all critical to ensuring that drugs are accessible and affordable. In addition, fixed-dose combinations that reduce the pill burden and provide adequate taste masking may promote long-term adherence to anti-tuberculosis treatment and prevention regimens likely to last many months in children. Partial adherence may result in treatment failure and the further selection and spread of resistant mycobacteria. Unfortunately, no second-line TB paediatric drugs exist in dispersible formulations. We discuss here the main obstacles to developing such tablets and present strategies for overcoming them. We also advocate for timely anticipation of paediatric use when new TB drugs are being developed, and for the development of child-friendly anti-tuberculosis formulations in general.
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Affiliation(s)
- R Taneja
- The Global Alliance for TB Drug Development, New York, New York, USA
| | - A J Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - J Furin
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Taneja R, Geelani IA. Role of Robotic Partial Nephrectomy in the treatment of renal cell carcinoma. Apollo Medicine 2015. [DOI: 10.1016/j.apme.2015.07.004] [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: 11/29/2022] Open
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Li L, Ng DSW, Mah WC, Almeida FF, Rahmat SA, Rao VK, Leow SC, Laudisi F, Peh MT, Goh AM, Lim JSY, Wright GD, Mortellaro A, Taneja R, Ginhoux F, Lee CG, Moore PK, Lane DP. A unique role for p53 in the regulation of M2 macrophage polarization. Cell Death Differ 2014; 22:1081-93. [PMID: 25526089 DOI: 10.1038/cdd.2014.212] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 11/14/2014] [Accepted: 11/17/2014] [Indexed: 12/30/2022] Open
Abstract
P53 is critically important in preventing oncogenesis but its role in inflammation in general and in the function of inflammatory macrophages in particular is not clear. Here, we show that bone marrow-derived macrophages exhibit endogenous p53 activity, which is increased when macrophages are polarized to the M2 (alternatively activated macrophage) subtype. This leads to reduced expression of M2 genes. Nutlin-3a, which destabilizes the p53/MDM2 (mouse double minute 2 homolog) complex, promotes p53 activation and further downregulates M2 gene expression. In contrast, increased expression of M2 genes was apparent in M2-polarized macrophages from p53-deficient and p53 mutant mice. Furthermore, we show, in mice, that p53 also regulates M2 polarization in peritoneal macrophages from interleukin-4-challenged animals and that nutlin-3a retards the development of tolerance to Escherichia coli lipopolysaccharide. P53 acts via transcriptional repression of expression of c-Myc (v-myc avian myelocytomatosis viral oncogene homolog) gene by directly associating with its promoter. These data establish a role for the p53/MDM2/c-MYC axis as a physiological 'brake' to the M2 polarization process. This work reveals a hitherto unknown role for p53 in macrophages, provides further insight into the complexities of macrophage plasticity and raises the possibility that p53-activating drugs, many of which are currently being trialled clinically, may have unforeseen effects on macrophage function.
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Affiliation(s)
- L Li
- p53 Laboratory, A*Star, 8A Biomedical Grove, Immunos, Singapore 138648
| | - D S W Ng
- Neurobiology Program, Life Science Institute and Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - W-C Mah
- Division of Medical Sciences, National Cancer Centre, Singapore and NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore
| | - F F Almeida
- Singapore Immunology Network, A*Star, Singapore
| | - S A Rahmat
- p53 Laboratory, A*Star, 8A Biomedical Grove, Immunos, Singapore 138648
| | - V K Rao
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - S C Leow
- Singapore Institute of Clinical Sciences, A*Star, Singapore
| | - F Laudisi
- Singapore Immunology Network, A*Star, Singapore
| | - M T Peh
- Neurobiology Program, Life Science Institute and Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - A M Goh
- p53 Laboratory, A*Star, 8A Biomedical Grove, Immunos, Singapore 138648
| | - J S Y Lim
- Microscopy Unit, Institute of Medical Biology, A*Star, Singapore
| | - G D Wright
- Microscopy Unit, Institute of Medical Biology, A*Star, Singapore
| | | | - R Taneja
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - F Ginhoux
- Singapore Immunology Network, A*Star, Singapore
| | - C G Lee
- 1] Division of Medical Sciences, National Cancer Centre, Singapore and NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore [2] Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore and Cancer and Stem Cell Biology Program, DUKE-NUS Graduate Medical School, Singapore
| | - P K Moore
- Neurobiology Program, Life Science Institute and Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - D P Lane
- p53 Laboratory, A*Star, 8A Biomedical Grove, Immunos, Singapore 138648
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Singh DV, Taneja R. Anterior urethral valves without diverticulae: a report of two cases and a review of the literature. Congenit Anom (Kyoto) 2014; 54:120-2. [PMID: 24118555 DOI: 10.1111/cga.12032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 06/21/2013] [Accepted: 09/11/2013] [Indexed: 11/29/2022]
Abstract
Two unusual cases of anterior urethral valves (AUV) without diverticulae are presented. The first case is a male child born with prenatal diagnosis of bilateral hydronephrosis. On cystoscopy, iris-like diaphragm valves were encountered about 3 mm distal to the skeletal sphincter. In the second case, an 18-month-old male child was investigated for recurrent febrile urinary tract infections and obstructed urinary symptoms. Cystoscopy confirmed the presence of slit-like valves 5 mm distal to the skeletal sphincter. Fulguration of the AUVs was performed in both cases. It may be worthwhile to review all cases of anterior urethral obstruction collectively and re-categorize them appropriately to include the unusual AUVs without diverticulum in that classification.
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Affiliation(s)
- Dig Vijay Singh
- Department of Urology, Post Graduate Institute of Medical Education & Research, Chandigarh, India; Department of Urology, Indraprastha Apollo Hospitals, New Delhi, India
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Abstract
We present the imaging and histopathological characteristics of a giant renal angiomyolipoma (AML) in a 49-year-old female patient, who presented with bloating sensation in the abdomen and a steadily increasing abdominal girth for about 3 years. Contrast enhanced computed tomography (CECT) scan films of abdomen revealed that a large fat containing tumor had replaced the left kidney while displacing the rest of the abdominal contents toward the other side of the midline. Intraoperatively the left kidney was completely replaced by a fat containing tumor. The recovered surgical specimen measured 39 cm × 25 cm × 9 cm and weighed 7500 g. Histopathological investigation with immuno-histochemical staining of the specimen with hydroxy beta-methylbutyric acid-45 confirmed this lesion as AML. CECT scan of the head did not show any lesion suggestive of tuberous sclerosis. The giant tumor of the present case is the heaviest AML in both syndromic and sporadic categories and largest by dimensions as sporadic AML ever reported in the literature.
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Affiliation(s)
- Rajesh Taneja
- Department of Urology, Indraprastha Apollo Hospitals, New Delhi, India
| | - Dig Vijay Singh
- Department of Urology, Mohandai Oswal Hospital, Ludhiana, Punjab, India
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Abstract
A rare case of incomplete transverse vesical septum with urinary tract tuberculosis is being reported. A 52-year-old male presented with lower urinary tract and systemic symptoms. On investigation he had anemia, leucocytosis, and high serum creatinine. On cystopanendoscopy, there was a transverse ledge of tissue connecting the two lateral walls of the bladder approximately 4 cm proximal to the bladder neck dividing the caudal vesical cavity into anterior and posterior parts. Also, the left ureteric orifice had double barrel look. To our knowledge this is the first ever reported case of incomplete transverse vesical septum.
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Affiliation(s)
- Rajesh Taneja
- PSRI Hospital for Liver Renal and Digestive diseases, Press Enclave Road, New Delhi, India
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Almaani M, Alnabi MA, Bainbridge D, Taneja R. Transthoracic echocardiography performed by intensive care fellows: is minimal focused training enough? Crit Care 2011. [PMCID: PMC3061655 DOI: 10.1186/cc9445] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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31
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Taneja R, Kiran S. Anaesthetic management of appendectomy in a patient with cerebral arteriovenous malformation. Southern African Journal of Anaesthesia and Analgesia 2010. [DOI: 10.1080/22201173.2010.10872714] [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]
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32
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Kiran S, Taneja R. Case study: An unusual cause of clotted blood in epidural catheter. Southern African Journal of Anaesthesia and Analgesia 2010. [DOI: 10.1080/22201173.2010.10872671] [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]
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Abstract
OBJECTIVE Interstitial cystitis is a condition with a poorly understood etiology and, consequently, various treatment options have been described in the literature, with a less than optimal outcome. The aim of this study was to examine the role of a combination of intravesical hydrocortisone and heparin, together with oral bladder sedatives and systemic triamcinolone, for the treatment of interstitial cystitis. MATERIAL AND METHODS A total of 26 patients who were diagnosed as having interstitial cystitis were treated with weekly intravesical hydrocortisone (200 mg) and heparin (25,000 IU) in physiological saline for 6 weeks. In addition, they were given oral bladder sedatives such as oxybutynin or tolterodine. Ulcerative, refractory and recurrent cases were treated with intramuscular triamcinolone (40 mg) weekly for 6 weeks. RESULTS All patients experienced an improvement in symptoms within 48 h of their first intravesical instillation. While 19 patients (73%) experienced almost complete pain relief, five of the remaining seven patients improved with intramuscular triamcinolone. Frequency reduced from a mean of 23.2 to 10.9 voids per day and was acceptable in 21 patients (80%). Six patients (23%) had a relapse of symptoms in the form of pain and were treated satisfactorily by means of intramuscular triamcinolone. The mean duration of follow-up was 18.3 months. CONCLUSION A combination of intravesical hydrocortisone and heparin, along with oral bladder sedatives and systemic steroids, has been used with encouraging results in a small group of patients with interstitial cystitis.
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Affiliation(s)
- Rajesh Taneja
- Surgical Division, Pushpawati Singhania Research Institute, Press Enclave Road, Sheikh Sarai, Phase II, New Delhi, India.
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34
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Taneja R, Singh DV. Holmium laser treatment of a vesical calculus secondary to TVT procedure. Int Urogynecol J 2009; 20:999-1001. [DOI: 10.1007/s00192-009-0810-4] [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] [Received: 09/11/2008] [Accepted: 01/09/2009] [Indexed: 11/25/2022]
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35
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Ghai A, Wadhera R, Kiran S, Taneja R. An unusual complication with xylocaine spray in microlaryngeal surgery. Southern African Journal of Anaesthesia and Analgesia 2008. [DOI: 10.1080/22201173.2008.10872538] [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]
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Abstract
INTRODUCTION Erectile dysfunction (ED) is a complex condition wherein men with minimal organic ED may develop a variable degree of psychogenic component sufficient to reduce the efficacy of medical management. A combination of trazodone with sildenafil has been used to overcome both organic as well as psychogenic components, thus improving the results of medical management. AIM To evaluate the efficacy of combination of trazodone with sildenafil citrate in treatment of ED in men with initial failure to sildenafil citrate alone. MAIN OUTCOME MEASURES The symptoms of ED were evaluated using the Erectile Dysfunction Intensity Scale (EDIS) before and after the treatment. METHODS Eighteen men with ED who initially failed to respond to sildenafil citrate alone were enrolled in the study between February 2004 and December 2004. All these men were given a priming dose of trazodone for a 2-week period before giving them sildenafil citrate. RESULTS Of the 18 men, 12 responded favorably to the above treatment and continued to enjoy good sexual activity while on trazodone and sildenafil. The score on EDIS improved considerably in 12 (66.7%) men, marginally in two (11.1%) men, and did not improve at all in four (22.2%) men. CONCLUSIONS Priming the patients with trazodone appears to be a reasonably good alternative in patients who have initial failure to oral sildenafil citrate and have been found to have no organic cause of ED. However, large double-blind studies are required to potentiate this hypothesis.
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Affiliation(s)
- Rajesh Taneja
- Pushpawati Singhania Research Institute--Surgical Division, New Delhi, India.
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37
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Wang LF, Taneja R, Farley K, McCormack DG, Mehta S. INDUCIBLE NITRIC OXIDE SYNTHASE (INOS) IN MURINE PULMONARY MICROVASCULAR ENDOTHELIAL CELLS (PMEC) MODULATES NEUTROPHIL APOPTOSIS. FASEB J 2007. [DOI: 10.1096/fasebj.21.5.a446-a] [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: 11/11/2022]
Affiliation(s)
- LF Wang
- CCIRRespirology Div, LHRI, Depts of Med, Physio/Pharm
| | - R Taneja
- AnesthesiaUniversity of Western Ontario800 Commissioners Rd. EastLondon, 0N6A 4G5Canada
| | - K Farley
- CCIRRespirology Div, LHRI, Depts of Med, Physio/Pharm
| | - DG McCormack
- CCIRRespirology Div, LHRI, Depts of Med, Physio/Pharm
| | - S Mehta
- CCIRRespirology Div, LHRI, Depts of Med, Physio/Pharm
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38
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Arango MF, Mejia-Mantilla JH, Taneja R. Intensive care sedation and analgesia for head-injury patients. Hippokratia 2005. [DOI: 10.1002/14651858.cd005241] [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: 10/25/2022]
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39
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Taneja R. SIRS--a syndrome, disease or a chef d'oeuvre? Br J Anaesth 2003; 91:756; author reply 756. [PMID: 14570807 DOI: 10.1093/bja/aeg632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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40
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Kondraske GV, Hamilton EC, Scott DJ, Fischer CA, Tesfay ST, Taneja R, Brown RJ, Jones DB. Surgeon workload and motion efficiency with robot and human laparoscopic camera control. Surg Endosc 2002; 16:1523-7. [PMID: 12098023 DOI: 10.1007/s00464-001-8272-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2002] [Accepted: 04/09/2002] [Indexed: 11/25/2022]
Abstract
BACKGROUND Surgeons are now being assisted by robotic systems in a wide range of laparoscopic procedures. Some reports have suggested that robot-assisted camera control (RACC) may be superior to a human driver in terms of quality of view and directional precision, as well as long-term cost savings. Therefore, we setout to investigate the impact of RACC of surgeon motion efficiency. METHODS Twenty pigs were randomized to undergo a standardized laparoscopic Nissen fundoplication with either a human or RACC system, the AESOP 2000. All procedures were performed by the same surgical fellow. Time was recorded for dissection and suture phases. Inertial motion sensors were used to monitor both the surgeon's hands and the camera. Digitized data were analyzed to produce summary measures related to overall motion. RESULTS The operative times were slightly longer with RACC (mean 80.2 +/- 20.6 vs 73.1 +/- 15.4 min, not significant). With regard to operative times and surgeon motion measures, the only statistically significant differences were for setup and breakdown times, which contributed <15% to the total time for the procedure. CONCLUSION In terms of impact on surgeon motion efficiency and operative time under normal surgical conditions, RACC is essentially the same as an expert human driver. However, careful planning and structuring of the surgical suite may yield some small gains in operative time.
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Affiliation(s)
- G V Kondraske
- Department of Surgery, Southwestern Center for Minimally Invasive Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9092, USA.
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41
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Taneja R, Bansal P, Sharma MK, Singh D. Albumin Fractions from Different Species Stimulate In Vitro Progesterone Production by Granulosa Cells in Buffalo. Asian Australas J Anim Sci 2002. [DOI: 10.5713/ajas.2002.1559] [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: 11/27/2022]
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42
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Marshall JC, Hui Jia S, Taneja R. Dysregulated Neutrophil Apoptosis in the Pathogenesis of Organ Injury in Critical Illness. Mechanisms of Organ Dysfunction in Critical Illness 2002. [DOI: 10.1007/978-3-642-56107-8_7] [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] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Abstract
Stra13, a basic helix-loop-helix transcription factor, is up-regulated upon activation of CD4+ T cells. Here we show that Stra13-deficient mice exhibit defects in several phases of CD4+ T cell activation. In vivo, Stra13 deficiency results in ineffective elimination of activated T and B cells, which accumulate progressively, leading to lymphoid organ hyperplasia. Consequently, aging Stra13-/- mice develop autoimmune disease characterized by accumulation of spontaneously activated T and B cells, circulating autoantibodies, infiltration of T and B lymphocytes in several organs and immune complex deposition in glomeruli. Our studies identify Stra13 as a key regulator of lymphocyte activation that is vital for maintenance of self-tolerance and for constraint of autoimmunity.
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Affiliation(s)
- H Sun
- Department of Biochemistry and Molecular Biology, Mount Sinai School of Medicine, New York, NY 10029, USA
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Dhar M, Taneja R. Cross-regulatory interaction between Stra13 and USF results in functional antagonism. Oncogene 2001; 20:4750-6. [PMID: 11498797 DOI: 10.1038/sj.onc.1204637] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2001] [Revised: 04/24/2001] [Accepted: 05/09/2001] [Indexed: 11/09/2022]
Abstract
Transcription factors belonging to the basic helix-loop-helix (bHLH) family are critical regulators of cellular proliferation and differentiation. The functional activity of these proteins can be regulated by heterodimerization through the HLH domain, as a result of formation of functional or non-functional heterodimers. The presence of a leucine zipper in bHLH-leucine zipper (bHLHZip) proteins, however, prevents such heterodimeric interactions via the HLH domain between bHLH and bHLHZip proteins. To identify cellular proteins that directly interact with and modulate transcriptional repression mediated by the bHLH protein Stra13, we carried out a yeast two hybrid screen. The bHLHZip protein USF (Upstream Stimulatory factor) was identified as a Stra13 interacting protein. We demonstrate a direct interaction between Stra13 and USF that is dependent upon the C-terminal repression domain of Stra13 and the DNA-binding domain of USF. Stra13 and USF also colocalize and functionally interact in mammalian cells. Co-expression of USF abrogates Stra13-mediated repression of target genes and conversely, Stra13 inhibits DNA-binding and USF-mediated transactivation. Taken together, our data demonstrate that Stra13 and USF interact physically and functionally, and identify a novel mode of cross regulatory interaction between members of the bHLH and bHLHZip families that abrogates their functional activity.
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Affiliation(s)
- M Dhar
- Department of Biochemistry and Molecular Biology, Mount Sinai School of Medicine, One Gustave L Levy Place, New York, NY 10029-6574, USA
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45
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Taneja R. Efficiency in intensive care--we must get it right. Anaesthesia 2001; 56:692. [PMID: 11437785 DOI: 10.1046/j.1365-2044.2001.02137-4.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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46
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Gharat L, Taneja R, Weerapreeyakul N, Rege B, Polli J, Chikhale PJ. Targeted drug delivery systems 6: Intracellular bioreductive activation, uptake and transport of an anticancer drug delivery system across intestinal Caco-2 cell monolayers. Int J Pharm 2001; 219:1-10. [PMID: 11337161 DOI: 10.1016/s0378-5173(01)00599-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [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: 10/18/2022]
Abstract
We demonstrate transport across, intracellular accumulation and bioreductive activation of a conformationally constrained, anticancer drug delivery system (the CH(3)-TDDS) using Caco-2 cell monolayers (CCMs) as an in vitro model of the human intestinal mucosa. Reverse-phase High Performance Liquid Chromatography (HPLC) coupled with UV detection was used to detect CH(3)-TDDS, the bioreduction product (lactone) and the released drug (melphalan methyl ester; MME). Upon incubation of the CH(3)-TDDS with the apical (AP) surface of 21-day-old CCM, we observed rapid decrease in the AP concentration of the CH(3)-TDDS (60%/hr) as a result of cellular uptake. Rapid intracellular accumulation of the CH(3)-TDDS was followed by bioreductive activation to deplete the cellular levels of CH(3)-TDDS. The drug part (MME) and lactone, as well as CH(3)-TDDS, were detected in the basolateral (BL) chamber. Intracellular Caco-2 levels of TDDS and lactone were also detectable. Bioreductive activation of the CH(3)-TDDS was additionally confirmed by formation of lactone after incubation of the CH(3)-TDDS in the presence of freshly prepared Caco-2 cell homogenates. During transport studies of melphalan or MME alone (as control), the intact drug was not detected in the intracellular compartment or in the BL chamber. These observations demonstrate that CH(3)-TDDS has potential for improving intestinal delivery of MME. TDDS could be useful in facilitating oral absorption of MME as well as the oral delivery of other agents.
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Affiliation(s)
- L Gharat
- Department of Pharmaceutical Sciences, University of Maryland, 20 North Pine Street, Baltimore, MD 21201, USA
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48
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Taneja R, Yared JP, Hammel J, O'Connor MS, Insler S, Starr NJ. Hyperdynamic circulation following cardiopulmonary bypass predisposes to postoperative bleeding. Crit Care 2001. [PMCID: PMC3333297 DOI: 10.1186/cc1177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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49
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Taneja R, Read MS. Inclusion criteria in sepsis trials should include severity of organ dysfunction. Crit Care 2001. [PMCID: PMC3333418 DOI: 10.1186/cc1298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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50
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Abstract
Neutrophil-mediated inflammation is terminated through the programmed cell death or apoptosis of the neutrophil, a process that can be inhibited by soluble mediators released during an inflammatory response. It has been reported, however, that the phagocytosis of intact bacteria can accelerate apoptosis. We evaluated the effects of the phagocytosis of a common nosocomial pathogen, Candida albicans, on the expression of apoptosis. Phagocytosis of killed Candida induced a dose-dependent increase in the apoptosis of normal neutrophils after 18 h of in vitro culture, from 40.7+/-9.1% to 81.7+/-4.5%, while supernatants from neutrophil:Candida co-cultures actually inhibited apoptosis. Induction of apoptosis was not dependent on phagocytosis, since opsonization of yeast with serum failed to increase apoptosis, while inhibition of phagocytosis with latrunculin B resulted in a slightly increased apoptotic rate. Increased apoptosis induced by Candida was associated with increased activity of the membrane-associated apoptotic enzyme, caspase 8, and with increased expression of the active form of the key executioner caspase, caspase 3. Increased apoptosis was associated with depletion of intracellular glutathione (GSH), and could be inhibited by the addition of exogenous GSH. These data demonstrate an important physiologic role for host-pathogen interactions in the resolution of inflammation and suggest that the response to an invading pathogen is an important stimulus to the restoration of normal immunologic homeostasis.
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Affiliation(s)
- D Rotstein
- Sepsis Research Laboratories, the Toronto General Hospital, University Health Network, Ontario, Canada
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