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Paramanandam VS, Lensen S, Gabes M, Kann G, Donhauser T, Waters NF, Li AD, Peate M, Susanto NS, Caughey LE, Rangoonwal F, Liu J, Condron P, Obalowu IA, Archer DF, Bell RJ, Christmas M, Davies M, Davis SR, Giblin K, Iliodromiti S, Jaisamrarn U, Khandelwal S, Kiesel L, Aggarwal N, Mitchell CM, Mishra GD, Nappi RE, Panay N, Roberts H, Rozenberg S, Shifren J, Simon JA, Stute P, Vincent AJ, Wolfman W, Hickey M. Recommended measurement instruments for genitourinary symptoms associated with menopause: the COMMA (Core outcomes in menopause) consortium. Menopause 2024:00042192-990000000-00327. [PMID: 38743907 DOI: 10.1097/gme.0000000000002369] [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: 05/16/2024]
Abstract
OBJECTIVE The aim of the study is to identify appropriate definitions and patient-reported outcome measures (PROMs) for each of the eight core outcomes previously selected for genitourinary symptoms associated with menopause: pain with sex, vulvovaginal dryness, vulvovaginal discomfort or irritation, discomfort or pain when urinating, change in most bothersome symptom, distress, bother or interference of genitourinary symptoms, satisfaction with treatment, and side effects. METHODS We conducted a systematic review to identify possible definitions and PROMs, including their measurement properties. Identified definitions and relevant PROMs with acceptable measurement properties were entered into an international consensus process involving 28 participants from 10 countries to achieve final recommendations for each core outcome. RESULTS A total of 87 publications reporting on 34 PROMs were identified from 21,207 publications screened. Of these 34 PROMs, 29 were not considered to sufficiently map onto the core outcomes, and 26 of these also had insufficient measurement properties. Therefore, only five PROMs corresponding to two core outcomes were considered for recommendation. We recommend the PROMIS Scale v2.0 - Sexual Function and Satisfaction: Vaginal Discomfort with Sexual Activity to measure the outcome of "pain with sexual activity" and the Day-to-Day Impact of Vaginal Aging (DIVA) Questionnaire to measure "distress, bother or interference" from genitourinary symptoms. Six definitions of "side effects" were identified and considered. We recommend that all trials report adverse events in study participants, which is a requirement of Good Clinical Practice. CONCLUSIONS Suitable PROMs and definitions were identified to measure three of eight core outcomes. Because of the lack of existing measures, which align with the core outcomes and have evidence of high-quality measurement properties, future work will focus on developing or validating PROMs for the remaining five core outcomes.
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Affiliation(s)
| | - Sarah Lensen
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Michaela Gabes
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | | | - Theresa Donhauser
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Niamh F Waters
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Anna D Li
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Michelle Peate
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Nipuni S Susanto
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Lucy E Caughey
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Fatema Rangoonwal
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Jingbo Liu
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Patrick Condron
- University Library, The University of Melbourne, Parkville, Australia
| | | | - David F Archer
- Obstetrics and Gynaecology, Eastern Virginia Medical School, Norfolk, VA
| | - Robin J Bell
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Monica Christmas
- Department of Obstetrics and Gynaecology, University of Chicago, Chicago, IL
| | - Melanie Davies
- Institute for Women's Health, University College London, UK
| | - Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Karen Giblin
- Red Hot Mamas North America, Inc., Bridgewater, New Jersey, United States
| | - Stamatina Iliodromiti
- Women's Health Research Unit, Wolfson Institute of Population Health, QMUL, London, UK
| | - Unnop Jaisamrarn
- Menopause Research Group, Department of Obstetrics and Gynaecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sunila Khandelwal
- Department of Obstetrics and Gynaecology, Fortis Escort Hospital, Jaipur, India
| | - Ludwig Kiesel
- Department of Gynaecology and Obstetrics, University of Muenster, Muenster, Germany
| | - Neelam Aggarwal
- Department of Gynaecology and Obstetrics, PostGraduate Institute of Medical Education & Research, Chandigarh, India
| | - Caroline M Mitchell
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA
| | - Gita D Mishra
- Australian Women and Girls' Health Research Centre, School of Public Health, University of Queensland, St Lucia, Australia
| | - Rossella E Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Nick Panay
- Queen Charlotte's & Chelsea and Chelsea and Westminster Hospitals, Imperial College London, London, UK
| | - Helen Roberts
- Auckland District Health Board, Auckland, New Zealand
| | - Serge Rozenberg
- Department of Ob-Gyn CHU St Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Jan Shifren
- Midlife Women's Health Center, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - James A Simon
- Department of Obstetrics and Gynecology, George Washington University, Washington, DC
| | - Petra Stute
- Department of Obstetrics and Gynecology, University Clinic Inselspital, Bern, Switzerland
| | - Amanda J Vincent
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - Wendy Wolfman
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
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Lensen S, Paramanandam VS, Gabes M, Kann G, Donhauser T, Waters NF, Li AD, Peate M, Susanto NS, Caughey LE, Rangoonwal F, Liu J, Condron P, Anagnostis P, Archer DF, Avis NE, Bell RJ, Carpenter JS, Chedraui P, Christmas M, Davies M, Hillard T, Hunter MS, Iliodromiti S, Jaff NG, Jaisamrarn U, Joffe H, Khandelwal S, Kiesel L, Maki PM, Mishra GD, Nappi RE, Panay N, Pines A, Roberts H, Rozenberg S, Rueda C, Shifren J, Simon JA, Simpson P, Siregar MFG, Stute P, Garcia JT, Vincent AJ, Wolfman W, Hickey M. Recommended measurement instruments for menopausal vasomotor symptoms: the COMMA (Core Outcomes in Menopause) consortium. Menopause 2024:00042192-990000000-00324. [PMID: 38688464 DOI: 10.1097/gme.0000000000002370] [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: 05/02/2024]
Abstract
OBJECTIVE The aim of the study is to identify suitable definitions and patient-reported outcome measures (PROMs) to assess each of the six core outcomes previously identified through the COMMA (Core Outcomes in Menopause) global consensus process relating to vasomotor symptoms: frequency, severity, distress/bother/interference, impact on sleep, satisfaction with treatment, and side effects. METHODS A systematic review was conducted to identify relevant definitions for the outcome of side-effects and PROMs with acceptable measurement properties for the remaining five core outcomes. The consensus process, involving 36 participants from 16 countries, was conducted to review definitions and PROMs and make final recommendations for the measurement of each core outcome. RESULTS A total of 21,207 publications were screened from which 119 reporting on 40 PROMs were identified. Of these 40 PROMs, 36 either did not adequately map onto the core outcomes or lacked sufficient measurement properties. Therefore, only four PROMs corresponding to two of the six core outcomes were considered for recommendation. We recommend the Hot Flash Related Daily Interference Scale to measure the domain of distress, bother, or interference of vasomotor symptoms and to capture impact on sleep (one item in the Hot Flash Related Daily Interference Scale captures interference with sleep). Six definitions of "side effects" were identified and considered. We recommend that all trials report adverse events, which is a requirement of Good Clinical Practice. CONCLUSIONS We identified suitable definitions and PROMs for only three of the six core outcomes. No suitable PROMs were found for the remaining three outcomes (frequency and severity of vasomotor symptoms and satisfaction with treatment). Future studies should develop and validate PROMs for these outcomes.
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Affiliation(s)
- Sarah Lensen
- From the Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | | | | | | | - Theresa Donhauser
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Niamh F Waters
- From the Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Anna D Li
- From the Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Michelle Peate
- From the Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Nipuni S Susanto
- From the Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Lucy E Caughey
- From the Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Fatema Rangoonwal
- From the Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Jingbo Liu
- From the Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Patrick Condron
- University Library, The University of Melbourne, Parkville, Australia
| | - Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, 1 Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - David F Archer
- Department of Obstetrics and Gynaecology, Eastern Virginia Medical School, Norfolk, VA
| | - Nancy E Avis
- Wake Forest University School of Medicine, Winston-Salem, NC
| | - Robin J Bell
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Peter Chedraui
- Escuela de Posgrado en Salud, Universidad Espíritu Santo, Samborondón, Ecuador
| | - Monica Christmas
- Department of Obstetrics and Gynaecology, University of Chicago, Chicago, IL
| | - Melanie Davies
- Institute for Women's Health, University College London, UK
| | - Tim Hillard
- Department of Obstetrics and Gynaecology, University Hospitals Dorset NHS Trust, Poole, Dorset, UK
| | - Myra S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stamatina Iliodromiti
- Women's Health Research Unit, Wolfson Institute of Population Health, QMUL, London, United Kingdom
| | - Nicole G Jaff
- Department of Chemical Pathology, National Health Laboratory Service and University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Unnop Jaisamrarn
- Center of Excellence in Menopause and Aging Women Health, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Hadine Joffe
- Connors Center for Women's Health and Gender Biology and the Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sunila Khandelwal
- Department of Obstetrics and Gynaecology, Fortis Escort Hospital, Jaipur, India
| | - Ludwig Kiesel
- Department of Gynaecology and Obstetrics, University of Muenster, Germany
| | - Pauline M Maki
- University of Illinois at Chicago, Departments of Psychiatry, Psychology and Obstetrics and Gynecology, Chicago, IL
| | - Gita D Mishra
- Australian Women and Girls' Health Research Centre, School of Public Health, University of Queensland, St Lucia, Australia
| | - Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy
| | - Nick Panay
- Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
| | - Amos Pines
- Tel-Aviv University School of Medicine, Tel-Aviv, Israel
| | - Helen Roberts
- Menopause clinic, Te Toka Tumai, Auckland Hospital, Auckland, New Zealand
| | - Serge Rozenberg
- Department of Ob-Gyn CHU St Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Camilo Rueda
- University La Sábana, Country Clinic, Bogotá, Colombia
| | - Jan Shifren
- Midlife Women's Health Center, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - James A Simon
- Department of Obstetrics and Gynecology, George Washington University, Washington, DC
| | - Paul Simpson
- Department of Obstetrics & Gynaecology, Norfolk & Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Muhammad Fidel Ganis Siregar
- Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Sumatera Utara, Sumatera Utara, Indonesia
| | - Petra Stute
- Department of Obstetrics and Gynecology, University Clinic Inselspital, Bern, Switzerland
| | - Joan Tan Garcia
- Menopause Clinic, Department of Obstetrics & Gynecology, St Lukes Medical Center, Quezon City, Philippines
| | - Amanda J Vincent
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia
| | - Wendy Wolfman
- Department of Obstetrics and Gynaecology and Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Martha Hickey
- From the Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
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Meeta M, Sharma S, Unni J, Khandelwal S, Choranur A, Malik S. Cardiovascular and osteoporosis protection at menopause with lycopene: A placebo-controlled double-blind randomized clinical trial. J Midlife Health 2022; 13:50-56. [PMID: 35707307 PMCID: PMC9190964 DOI: 10.4103/jmh.jmh_61_22] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/15/2022] [Accepted: 03/19/2022] [Indexed: 11/04/2022] Open
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Khandelwal S, Meeta M, Tanvir T. Menopause hormone therapy, migraines, and thromboembolism. Best Pract Res Clin Obstet Gynaecol 2021; 81:31-44. [PMID: 34974967 DOI: 10.1016/j.bpobgyn.2021.11.011] [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: 09/29/2021] [Revised: 11/25/2021] [Accepted: 11/25/2021] [Indexed: 11/02/2022]
Abstract
Migraine, a common form of headache, is a highly prevalent and disabling condition with a predilection for females. Migraines are neurovascular diseases. The two main types of migraines are migraines with and without aura, and several subtypes exist. There is a strong link between sex steroids and migraines. In women, migraine remissions are associated with stable and critical oestrogen levels. The literature reveals an association between migraine with aura and stroke, with a higher incidence in the young compared with that in the old. The absolute risk of stroke is low; tobacco use and a high dose of oral oestrogens may increase the risk. Early diagnosis, follow-up, and nonhormonal symptomatic and preventive treatments address the neglected area of migraines. Judicious use of hormones throughout the lifespan as needed would improve the quality of life.
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Affiliation(s)
- Sunila Khandelwal
- Fortis Escorts Hospital and Apex Hospital Pvt. Ltd. Professor & Head, Department of Ob & Gyn, MGMC&H, Jaipur, India.
| | - Meeta Meeta
- Tanvir Hospital, 8-3-833/100, Phase.1, Kamalapuri Colony, Hyderabad, 500073, India.
| | - Tanvir Tanvir
- Tanvir Hospital, 8-3-833/100, Phase.1, Kamalapuri Colony, Hyderabad, 500073, India.
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5
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Lensen S, Bell RJ, Carpenter JS, Christmas M, Davis SR, Giblin K, Goldstein SR, Hillard T, Hunter MS, Iliodromiti S, Jaisamrarn U, Khandelwal S, Kiesel L, Kim BV, Lumsden MA, Maki PM, Mitchell CM, Nappi RE, Niederberger C, Panay N, Roberts H, Shifren J, Simon JA, Stute P, Vincent A, Wolfman W, Hickey M. A core outcome set for genitourinary symptoms associated with menopause: the COMMA (Core Outcomes in Menopause) global initiative. Menopause 2021; 28:859-866. [PMID: 33973541 DOI: 10.1097/gme.0000000000001788] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 11/25/2022]
Abstract
OBJECTIVE Genitourinary symptoms, such as vaginal dryness and pain with sex, are commonly experienced by postmenopausal women. Comparing treatments for these genitourinary symptoms are restricted by the use of different outcome measures in clinical trials and the omission of outcomes, which may be relevant to women. The aim of this project was to develop a Core Outcome Set (COS) to be reported in clinical trials of treatments for genitourinary symptoms associated with menopause. METHODS We performed a systematic review of randomized controlled trials of treatments for genitourinary symptoms associated with menopause and extracted their outcomes. This list was refined and entered into a two-round modified Delphi survey, which was open to clinicians, researchers, and postmenopausal women from November 2019 to March 2020. Outcomes were scored on a nine-point scale from "not important" to "critically important." The final COS was determined following two international consensus meetings. RESULTS A total of 26 unique outcomes were included in the Delphi process, which was completed by 227 participants of whom 58% were postmenopausal women, 34% clinicians, and 8% researchers. Predefined thresholds were applied to the Delphi scores to categorize outcomes by importance, which informed the e consensus meetings, attended by 43 participants from 21 countries. The final COS includes eight outcomes: (1) pain with sex, (2) vulvovaginal dryness, (3) vulvovaginal discomfort or irritation, (4) discomfort or pain when urinating, (5) change in most bothersome symptom, (6) distress, bother or interference of genitourinary symptoms, (7) satisfaction with treatment, (8) side effects of treatment. CONCLUSION These eight core outcomes reflect the joint priorities of postmenopausal women, clinicians, and researchers internationally. Standardized collection and reporting of these outcomes in clinical trials will facilitate the comparison of different treatments for genitourinary symptoms, advance clinical practice, and ultimately improve outcomes for symptomatic women.
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Affiliation(s)
- Sarah Lensen
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Robin J Bell
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University. Melbourne, Australia
| | | | - Monica Christmas
- Department of Obstetrics and Gynaecology, University of Chicago, Chicago, IL
| | - Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University. Melbourne, Australia
| | | | - Steven R Goldstein
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY
| | - Tim Hillard
- Department of Obstetrics and Gynaecology, University Hospitals Dorset NHS Trust, Poole, Dorset, UK
| | - Myra S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stamatina Iliodromiti
- Centre for Women's Health, Institute of Population Health Sciences, Queen Mary University London, UK
| | - Unnop Jaisamrarn
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sunila Khandelwal
- Department of Obstetrics and Gynaecology, Fortis Escort Hospital, Jaipur, India
| | - Ludwig Kiesel
- Department of Gynaecology and Obstetrics, University of Muenster, Muenster, Germany
| | - Bobae V Kim
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Mary Ann Lumsden
- Department of Reproductive and Maternal Medicine, School of Medicine, University of Glasgow, Glasgow, UK
| | - Pauline M Maki
- Departments of Psychiatry, Psychology and Obstetrics and Gynecology, University of Illinois at Chicago, Chicago IL
| | - Caroline M Mitchell
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA
| | - Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, University of Pavia, Pavia, Italy
| | | | - Nick Panay
- Queen Charlotte's and Chelsea and Westminster Hospitals, Imperial College London, London, UK
| | - Helen Roberts
- Auckland District Health Board, Auckland, New Zealand
| | - Jan Shifren
- Department of Obstetrics and Gynecology, Midlife Women's Health Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - James A Simon
- Department of Obstetrics and Gynecology, George Washington University, Washington, DC
| | - Petra Stute
- Department of Obstetrics and Gynecology, University Clinic Inselspital Bern, Bern, Switzerland
| | - Amanda Vincent
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Wendy Wolfman
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
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Lensen S, Archer D, Bell RJ, Carpenter JS, Christmas M, Davis SR, Giblin K, Goldstein SR, Hillard T, Hunter MS, Iliodromiti S, Jaisamrarn U, Joffe H, Khandelwal S, Kiesel L, Kim BV, Lambalk CB, Lumsden MA, Maki PM, Nappi RE, Panay N, Roberts H, Shifren J, Simon JA, Vincent A, Wolfman W, Hickey M. A core outcome set for vasomotor symptoms associated with menopause: the COMMA (Core Outcomes in Menopause) global initiative. Menopause 2021; 28:852-858. [PMID: 33906204 DOI: 10.1097/gme.0000000000001787] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 01/19/2023]
Abstract
OBJECTIVE Vasomotor symptoms (VMS) (hot flashes and night sweats) affect most women over the menopause transition. Comparing the safety and effectiveness of treatments for vasomotor symptoms is limited by the use of inconsistent outcome measures, and uncertainty as to which outcomes are most important to symptomatic women. To address this, we have developed a Core Outcome Set (COS) for use in clinical trials of treatments for VMS. METHODS We systematically reviewed the primary outcomes measured in randomized controlled trials of treatments for VMS. These were refined and entered into a two-round modified Delphi survey completed by clinicians, researchers, and postmenopausal women between November 2019 and March 2020. Outcomes were scored on a nine-point scale from "not important" to "critically important." Two international consensus meetings were held to finalize the COS. RESULTS Based on the systematic review, 13 separate outcomes were included in the Delphi process. This was completed by 227 participants of whom 58% were postmenopausal women, 34% clinicians, and 8% researchers. Predefined thresholds were applied to categorize importance scores obtained during Round 2 of the Delphi survey. These informed discussions at the consensus meetings which were attended by 56 participants from 28 countries. The final COS includes six outcomes: 1) frequency of VMS, 2) severity of VMS, 3) distress, bother or interference caused by VMS, 4) impact on sleep, 5) satisfaction with treatment, and 6) side-effects of treatment. CONCLUSION Implementation of this COS will: better enable research studies to accurately reflect the joint priorities of postmenopausal women, clinicians and researchers, standardize outcome reporting, and facilitate combining and comparing results from different studies, and ultimately improve outcomes for women with bothersome VMS.
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Affiliation(s)
- Sarah Lensen
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - David Archer
- Obstetrics and Gynaecology, Eastern Virginia Medical School, Norfolk, VA
| | - Robin J Bell
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Monica Christmas
- Department of Obstetrics and Gynaecology, University of Chicago, Chicago, IL
| | - Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Karen Giblin
- Red Hot Mamas North America, Inc, Town of Ridgefield, CT
| | - Steven R Goldstein
- Obstetrics and Gynecology, New York University School of Medicine, New York, NY
| | - Tim Hillard
- Department of Obstetrics and Gynaecology, University Hospitals Dorset NHS Trust, Poole, Dorset, UK
| | - Myra S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stamatina Iliodromiti
- Centre for Women's Health, Institute of Population Health Sciences, Queen Mary University London, London, UK
| | - Unnop Jaisamrarn
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Hadine Joffe
- Connors Center for Women's Health and Gender Biology and the Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sunila Khandelwal
- Department of Obstetrics and Gynaecology, Fortis Escort Hospital, Jaipur, India
| | - Ludwig Kiesel
- Department of Gynaecology and Obstetrics, University of Muenster, Muenster, Germany
| | - Bobae V Kim
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Cornelis B Lambalk
- Amsterdam Reproduction and Development, Center for Reproductive Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Mary Ann Lumsden
- Department of Reproductive and Maternal medicine, School of Medicine, University of Glasgow, Glasgow, UK
| | - Pauline M Maki
- University of Illinois at Chicago, Departments of Psychiatry, Psychology and Obstetrics and Gynecology, Chicago, IL
| | - Rossella E Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Nick Panay
- Queen Charlotte's and Chelsea and Chelsea and Westminster Hospitals, Imperial College London, London, UK
| | - Helen Roberts
- Auckland District Health Board, Auckland, New Zealand
| | - Jan Shifren
- Midlife Women's Health Center, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - James A Simon
- Department of Obstetrics and Gynecology, George Washington University, Washington, DC
| | - Amanda Vincent
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Wendy Wolfman
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
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Khandelwal S, Goel P, Chaudhary D, Sancheti S, Goel A, Dora T, Sharma R. 30P Male breast cancer: A rural based peripheral cancer center experience. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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8
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Abstract
As the rate of obesity increases globally, so does the incidence of other non-communicable diseases such as diabetes, cardiovascular disease, cancer, osteoporosis, osteoarthritis, and dementia, which have been referred to as 'adiposity-based chronic disease'. With timely lifestyle modification such as behavioral changes, implementation of a healthy diet, and proper physical activity, many of these diseases can be prevented. Weight gain is one of the major health concerns of midlife. Midlife body changes are the result of aging, menopause, and other influences unique to menopausal women which interfere with adoption of a healthy lifestyle. Reduced metabolism levels lead to low energy levels, which discourage physical activity. In addition, with the onset of bone loss, menopausal women begin to lose muscle mass and gain more fat, resulting in osteopenic sarco-obesity. Adoption of a healthy lifestyle is a first-line option in the treatment for these midlife changes. Lifestyle medicine offers a broad set of network-based interventions, which need to be brought to the forefront in preventing and managing obesity at all stages. This review article focuses on evidence-based lifestyle changes and their benefits for reducing morbidity and mortality related to obesity and its complications prevalent at midlife and beyond.
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Affiliation(s)
- S Khandelwal
- Department of Obstetrics and Gynaecology, Fortis Escort Hospital, Jaipur, India
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Khandelwal S, Gollahon L, Boylan M, Spallholz J. Abstract P1-08-07: Withdrawn. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-08-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
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Affiliation(s)
| | | | - M Boylan
- Texas Tech University, Lubbock, TX
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Al-Zoubi IA, Patil SR, Alam MK, Khandelwal S, Khattak A, PH R. A Radiographic Study of Prevalence and Location of Enamel Pearls in a Saudi Arabian Adolescent Population. Pesqui bras odontopediatria clín integr 2018. [DOI: 10.4034/pboci.2018.181.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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11
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Khandelwal S. Early age at menopause: How should we empower them with health? Maturitas 2017. [DOI: 10.1016/j.maturitas.2017.03.238] [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: 10/19/2022]
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Abstract
The therapeutic efficacy of Picroliv-a standardized-was investigated in male rats exposed to CdCl2 (0.5 mg/kg, sc), 5 days/week for 18 weeks. Picroliv at two doses (6 and 12 mg/kg, po) was given to the cadmium (Cd)-administered group for the last 4 weeks (ie, weeks 15 -18). The Cd altered oxidative stress indices, such as increased lipid peroxidation and membrane fluidity, reduced levels of non-protein sulphydryls (NPSHs), and Na-K-ATPase activity in the liver and kidney were found close to the control values by Picroliv treatment, suggesting its antioxidant potential. The hepatoprotective action of Picroliv was evident by its ability to lower the Cd-induced liver function parameters-the serum enzymes, such as alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), g-glutamyl transpeptidase (GGT) and lactate dehydrogenase (LDH). Bile flow and biliary Cd also increased as a result of Picroliv's choleretic property. The Cd-induced serum urea and urinary excretion of proteins, calcium (Ca), Cd and enzymes, such as Nacetyl-b-D-glucosaminidase (NAG) and LDH, were less marked on Picroliv treatment, indicating recovery from nephrotoxicity. Organ uptake of Cd and essential metals by Cd exposure was reduced on Picroliv treatment. Cdinduced hepatic metallothionein (MT) was lowered by Picroliv, whereas renal MT was unaltered. Cd-induced hepatic damage was also minimized. However, the renal morphological changes were marginally protected by Picroliv. The 12-mg Picroliv dose was more effective than the 6-mg dose in causing amelioration of the above parameters. This study has provided clear evidence for the hepato-and renal protective efficacy of Picroliv against experimental Cd toxicity.
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Affiliation(s)
- N Yadav
- Industrial Toxicology Research Centre, MG Marg, Lucknow-226001, India
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Abstract
The potential of Picroliv, a herbal extract against acute cadmium (Cd) intoxication, was evaluated in male rats. Biochemical and histopathological profile in rats pretreated with Picroliv (12 mg/kg, oral) followed by a single dose of Cd as cadmium chloride (CdCl2) (3 mg/kg, ip) revealed marked suppression of oxidative stress in liver and testes. The Cd-induced enhanced levels of lipid peroxidation, membrane fluidity and reduced levels of nonprotein sulphydryls and Na+K+ATPase were significantly restored to near normal by Picroliv pretreatment. In addition, the Cd-induced serum levels of glutamate oxaloacetate transaminase, glutamate pyruvate transaminase, gamma glutamyl transpeptidase and lactate dehydrogenase were restored to near basal levels. Hepatic and testicular histopathological damage was also minimized. The results strongly suggest definite hepatoand testicular protection by Picroliv. The antioxidant potential of the herbal extract in the major part, and not its chelating property, seems to be responsible for its ameliorative action.
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Affiliation(s)
- N Yadav
- Industrial Toxicology Research Centre, Lucknow, India
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Banerjee A, Werba J, Neto J, Nambiar L, Saxena M, Peck V, Moniruzzaman M, Quinto K, Khandelwal S, Leong D. PS205 Health System Barriers to and Facilitators of Adherence to Medications for the Secondary Prevention of Cardiovascular Disease: A Systematic Review. Glob Heart 2016. [DOI: 10.1016/j.gheart.2016.03.167] [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: 10/21/2022] Open
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Sood M, Ranjan R, Chadda R, Khandelwal S. Changing Pattern of Clinical Profile of First Contact Patients Attending Outpatient Services At the General Hospital Psychiatric Units In India Over the Last 50 Years. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.1784] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IntroductionOver the last eight decades, general hospital psychiatric units (GHPUs) have become important mental health service set-ups in India. This period has seen a large number of radical changes in the Indian society. In this background, it is important to know if it had any effects on the patients attending the GHPUs.MethodologyA total of five hundred subjects, attending a GHPU were recruited prospectively for the study. The subjects were assessed using a semi-structured proforma. A comparison was made with similar studies conducted in GHPU settings over the last 5 decades.ResultsNeurotic, stress related and somatoform disorders was the commonest diagnostic group (33%) followed by psychotic disorders (17%) and mood disorders (15%). The finding is broadly similar to the studies done at different times in the last 5 decades. However, there were lesser number of patients with mental retardation, organic brain syndrome and seizure disorder.ConclusionThe study highlights the strengths of GHPU set-ups like inter-speciality referrals, fewer stigmas, patients travelling from far off places to seek treatment and involvement of family in the care of mentally ill.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Ali K, Khandelwal S, Agarwal N, Amer K, Khan A. P-202VIDEO-ASSISTED THORACOSCOPIC AND ROBOTIC-ASSISTED THORACOSCOPIC RESECTION OF MEDIASTINAL ECTOPIC PARATHYROID ADENOMA. Interact Cardiovasc Thorac Surg 2015. [DOI: 10.1093/icvts/ivv204.202] [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: 11/14/2022] Open
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Joglekar M, Khandelwal S, Cines DB, Poncz M, Rauova L, Arepally GM. Heparin enhances uptake of platelet factor 4/heparin complexes by monocytes and macrophages. J Thromb Haemost 2015; 13:1416-27. [PMID: 25960020 PMCID: PMC4516590 DOI: 10.1111/jth.13003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 04/23/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND Heparin-induced thrombocytopenia (HIT) is an iatrogenic complication of heparin therapy caused by antibodies to a self-antigen, platelet factor (4) and heparin. The reasons why antibodies form to PF4/heparin, but not to PF4 bound to other cellular glycosaminoglycans are poorly understood. OBJECTIVE To investigate differences in cellular responses to cell-bound PF4 and PF4/heparin complexes, we studied the internalization of each by peripheral blood-derived monocytes, dendritic cells and neutrophils. METHODS AND RESULTS Using unlabeled and fluorescently-labeled antigen and/or labeled monoclonal antibody to PF4/heparin complexes (KKO), we show that PF4/heparin complexes are taken up by monocytes in a heparin-dependent manner and are internalized by human monocytes and dendritic cells, but not by neutrophils. Complexes of PF4/low-molecular-weight heparin and complexes composed of heparin and murine PF4, protamine or lysozyme are internalized similarly, suggesting a common endocytic pathway. Uptake of complexes is mediated by macropinocytosis, as shown by inhibition using cytochalasin D and amiloride. Internalized complexes are transported intact to late endosomes, as indicated by co-staining of vesicles with KKO and lysosomal associated membrane protein-2 (LAMP-2). Lastly, we show that cellular uptake is accompanied by expression of MHCII and CD83 co-stimulatory molecules. CONCLUSIONS Taken together, these studies establish a distinct role for heparin in enhancing antigen uptake and activation of the initial steps in the cellular immune response to PF4-containing complexes.
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Affiliation(s)
- M Joglekar
- Division of Hematology, Duke University Medical Center, Durham, NC, USA
| | - S Khandelwal
- Division of Hematology, Duke University Medical Center, Durham, NC, USA
| | - D B Cines
- Department of Pathology and Laboratory Medicine, Perelman-University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - M Poncz
- Division of Hematology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - L Rauova
- Division of Hematology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - G M Arepally
- Division of Hematology, Duke University Medical Center, Durham, NC, USA
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Nambiar L, Bhimjiyani A, Khandelwal S. A systematic review to assess the impact of physical activity intervention on people with metabolic syndrome. J Sci Med Sport 2014. [DOI: 10.1016/j.jsams.2014.11.080] [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: 11/15/2022]
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19
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Chen Q, Siebers J, Khandelwal S. SU-E-T-393: Investigation of Hot Spots in Tomotherapy 3D Conformal Breast Plan. Med Phys 2014. [DOI: 10.1118/1.4888726] [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: 11/07/2022] Open
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Affiliation(s)
- S Khandelwal
- Public Health Foundation of India, New Delhi, India
| | - A Kurpad
- Nutrition Division, St John's Medical College, Bangalore, India
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Lunawat A, Mehta D, Datey S, Charles N, Khandelwal S, Shaam B, Yadav JK. Pigmented villonodular synovitis great toe. Indian J Surg 2014; 75:373-5. [PMID: 24426620 DOI: 10.1007/s12262-012-0715-1] [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: 02/24/2010] [Accepted: 07/18/2012] [Indexed: 10/28/2022] Open
Abstract
A young boy of 14 years. presented with swelling over dorsal aspect of right great toe, which was slightly tender, non fluctuant. It was excised under subarachnoid block. The mass was golden brown in colour encircling the extensor tendon (Extensor Hallucis Longus Tendon). Histopathology reported to be Pigmented Villonodular Synovitis.
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Affiliation(s)
- Ajay Lunawat
- Department of Surgery, Shri Aurobindo Institute of Medical Sciences, Indore, India
| | - Dharmendra Mehta
- Department of Surgery, Shri Aurobindo Institute of Medical Sciences, Indore, India
| | - Sanjay Datey
- Department of Surgery, Shri Aurobindo Institute of Medical Sciences, Indore, India
| | - N Charles
- Department of Surgery, Shri Aurobindo Institute of Medical Sciences, Indore, India
| | - S Khandelwal
- Department of Surgery, Shri Aurobindo Institute of Medical Sciences, Indore, India
| | - B Shaam
- Department of Surgery, MGM medical College, Indore, India
| | - J K Yadav
- Department of Surgery, Shri Aurobindo Institute of Medical Sciences, Indore, India
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Khandelwal S, Reddy KS. Eliciting a policy response for the rising epidemic of overweight-obesity in India. Obes Rev 2013; 14 Suppl 2:114-25. [PMID: 24103051 DOI: 10.1111/obr.12097] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [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: 08/13/2013] [Accepted: 08/14/2013] [Indexed: 11/30/2022]
Abstract
India is experiencing multiple transitions with respect to nutrition patterns, epidemiology and demography. Along with staggering childhood undernutrition, a rapid rise in chronic diseases and their risk factors including overweight-obesity (O-O), among all sections of society, is compounding India's health challenges. We present an overview of the O-O scenario (prevalence, determinants) and profile existing initiatives to address this modifiable risk factor in India. Urgent attention from all sectors, committed resources, policy support and targeted actions are warranted to combat the dual burden of malnutrition. The health systems should be reoriented and strengthened, in addition to enabling actions in other sectors, to address prevention and control of non-communicable diseases and associated risk factors like O-O.
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Affiliation(s)
- S Khandelwal
- Public Health Foundation of India, New Delhi, India
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Chen Q, Mallory M, Best R, Crandley E, Khandelwal S. Tomotherapy Fixed-Beam 3DCRT for Accelerated Whole Breast Irradiation With Concomitant Boost. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.589] [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]
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Khan AZ, Khandelwal S. V-065ROBOTIC RESECTION OF SECOND RIB TUMOUR. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt288.65] [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: 11/12/2022] Open
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Khandelwal S. Is yoga beneficial for menopausal symptoms? Climacteric 2013; 16:402-404. [PMID: 23814883] [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: 06/02/2023]
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Kman N, Bernard A, Khandelwal S, Martin D. 54 A Tiered Mentorship Program Improves Number of Students With an Identified Mentor. Ann Emerg Med 2012. [DOI: 10.1016/j.annemergmed.2012.07.077] [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]
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Bernard A, Kman N, Rund D, Khandelwal S. 78 Direct Observation: There Is an App for That! Ann Emerg Med 2012. [DOI: 10.1016/j.annemergmed.2012.07.102] [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: 10/27/2022]
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Khandelwal S, Patil S. Oral mucoceles - review of the literature. Minerva Stomatol 2012; 61:91-99. [PMID: 22402300] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Oral mucoceles are mucin filled cavities and lined by ductal epithelium or covered by granulation tissue in retention or extravasation type respectively. The extra-vasation type is very common in the minor salivary glands (particularly in the labial glands), but very infrequent in the major salivary glands, whilst most of the retention cyst affect the major salivary glands. Partial obstruction of duct and spillage of mucin following trauma are the chief etiological factors. Though the two lesions are clinically indistinguishable, the patients are typically older than in the case of extra-vasation type. The case history along with heedful clinical examination of the lesion is crucial for diagnosing mucoceles correctly, but to avoid recurrences histopathological examination is mandatory. The surgical approach to mucoceles is the most common mode of treatment amongst various other techniques including cryosurgery, laser and so on.
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Affiliation(s)
- S Khandelwal
- Department of Oral Pathology and Microbiology, Desh Bhagat Dental College, Punjab, India.
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Khandelwal S, Kumar A, Pant MC, Singh HS. Determinants of oxidative stress and DNA damage (8-OhdG) in squamous cell carcinoma of head and neck. Indian J Cancer 2012; 49:309-15. [DOI: 10.4103/0019-509x.104499] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [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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Abstract
Background: In earlier days, hormone replacement therapy (HRT) was recommended for menopause symptoms and also gained much popularity. However, the Women's Health Initiative (WHI) studies suggested an increased risk of cardiovascular and Alzheimer's disease. These findings led to a dramatic decrease in hormone therapy (HT) prescriptions all over the world. However, the WHI conclusions remain debatable especially because of contradictory results from antecedent studies. Inspite of these controversies, post-WHI, most gynecologists refrain from prescribing MHT (menopausal hormone replacement therapy, MHT). Furthermore, many Indian gynecologists prefer to prescribe alternative treatments that would help alleviate symptoms and thus avoid HRT. We decided to carry out a survey and document the current opinions regarding indications of HRT and alternative therapies and prescribing practices of Jaipur-based gynecologists. Objective: This study was designed to find out the current attitudes and practices of gynecologists (Jaipur) towards management of menopause. Materials and Methods: A questionnaire concerning attitudes, management strategies, and use of HT was mailed out to gynecologists, and they are asked to complete the questionnaire. Data were analyzed using the total number of respondents (n = 321). The results were analyzed using a simple percentage method as this was most suitable for this kind of studies. Results: From the results, 69.04% gynecologists were currently prescribing MHT. Hot flashes were the most common indication for MHT prescriptions and 78.57% were familiar with controversies surrounding WHI study. Also, 61.9% would consider using MHT for themselves. Alternative therapy was adopted by 83.48% in their prescribing practice. The reason cited by 71% for preferring alternative therapies was that it was safer and less controversial. Conclusions: The prescribing practices of Jaipur gynecologists in lieu of ongoing controversies surrounding HT have shifted and now also support alternative therapies for menopause management. In this era of phasic prescriptions, for immediate relief of hot flashes and mood swings, MHT was favored. However, for long-term management of women with poor compliance, alternative therapies were considered a safer option.
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Affiliation(s)
- Shuchita Meherishi
- Department of Obstetrics and Gynecology, Mahatma Gandhi Medical College, Jaipur, Rajasthan, India
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Abstract
INTRODUCTION The UK Government has prioritised methicillin-resistant Staphylococcus aureus (MRSA) screening and new operational guidance has instructed that all day-case surgical patients should be screened from April 2009. We sought to identify the number of MRSA-positive patients in the vascular day-case population over a 1-year period and to profile this cohort in terms of risk-factors for MRSA. We also sought to identify whether the new guidance from the Department of Health (DH) had resulted in increased screening rates. PATIENTS AND METHODS Electronic records and laboratory culture results were prospectively consulted to identify whether patients had been screened and if MRSA had been isolated. Consideration was given to whether any patients had a delayed discharge or subsequent admission with an MRSA-related complication. RESULTS Six patients (2.1%) screened MRSA-positive (DH estimate 7%); five were previously known to be MRSA-positive, therefore only 0.36% patients were newly-identified as MRSA-positive. The proportion of patients screened increased from 35% to 72.5% after April 2009, in accordance with DH guidance. Successful decolonisation was proved in two patients (33.3%). CONCLUSIONS There is dispute with several of the key assumptions behind the DH's impact assessment justifying an expanded MRSA-screening policy. It is not cost-effective to screen all vascular day-case admissions. We recommend selective screening for patients previously identified as MRSA-positive, or considered high risk.
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Affiliation(s)
- Y Ahmad
- Department of Vascular Surgery, Selly Oak Hospital, University Hospitals Birmingham NHS Foundation Trust, UK.
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Abstract
OBJECTIVES This study was designed to assess the effectiveness of self-administered osteoporosis risk score sheet, body mass index (BMI), and bone mineral density (BMD) (ultrasound) in screening females with low bone mass, and how the results of the tools correlate with each other. MATERIALS AND METHODS The study was conducted on 536 postmenopausal women, who attended public awareness camps on Midlife Women Health held at the Menopause Research Unit, MGMCH, Sitapura, Jaipur. At these camps, in addition to several informational sessions on issues related to menopause, ultrasonic measurement of BMD was conducted on each participant. A broad questionnaire to identify midlife health problems was developed, and osteoporosis specific score sheet was designed to be self-administered. Patients were required to complete the osteoporosis specific risk score sheet and women health questionnaire (WHQ). BMI was determined. Statistical analysis was carried out to find the correlation between various variables. Sensitivity and specificity of the each risk score ascertained and cutoff risk score for identifying osteopenia was derived by comparing area under curve of each risk score on drawing receiver operational curve (ROC). RESULTS Sensitivity of risk score system was calculated to be 78.33% with 95% confidence interval being 73.24-82.86% and specificity was 27.12% with 95% confidence interval being 21.56-33.27%, keeping the cutoff point at nine. There was statistically significant inverse relationship between risk score and BMD values with Pearson correlation coefficient of (-) 0.22 and positive relationship between BMD and BMI with correlation coefficient of 0.192. CONCLUSION By noting down the risk factors and BMI, we can screen out the women who require further evaluation and management, thus, it is an effective tool, particularly in developing countries like India, where most of the patients cannot afford expensive DEXA scans, although considered as the gold standard for BMD assessment. With the help of such scoring systems, health resources can be judiciously utilized.
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Affiliation(s)
- Seema Sharma
- Department of Obstetrics and Gynaecology, Mahatma Gandhi Medical College and Hospital, Sitapura, Jaipur, Rajasthan, India
| | - Sunila Khandelwal
- Department of Obstetrics and Gynaecology, Mahatma Gandhi Medical College and Hospital, Sitapura, Jaipur, Rajasthan, India
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Khandelwal S, Demonty I, Jeemon P, Lakshmy R, Mukherjee R, Gupta R, Singh Y, Passi S, Prabhakaran D, Reddy S. P185 IMPACT OF PLANT STEROLS, FISH OIL OMEGA-3S AND THEIR COMBINATION ON LDL-C AND LDL PARTICLE-SIZE IN INDIAN ADULTS. ATHEROSCLEROSIS SUPP 2010. [DOI: 10.1016/s1567-5688(10)70252-x] [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: 11/30/2022]
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Khandelwal S. Midlife health: A mission. J Midlife Health 2010; 1:1-2. [PMID: 21799628 PMCID: PMC3139255 DOI: 10.4103/0976-7800.66982] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Khandelwal S, Wall J, Kaide C, Katz G. Case report: successful use of hyperbaric oxygen therapy for a complete scalp degloving injury. Undersea Hyperb Med 2008; 35:441-445. [PMID: 19175199] [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: 05/27/2023]
Abstract
We report a case of a complete scalp degloving injury in a 43-year-old previously healthy, tobacco-using female whose hair was caught in a tractor power take-off causing an instantaneous total scalping injury. Microsurgical replantation was started 4 hours after injury with the surgical procedure lasting 4 hours. Only the superficial temporal arteries were reanastomosed with no venous anastomosis possible. Hyperbaric oxygen (HBO2) treatment at 2.5 atmospheres absolute (ATA) for 90 minutes was administered immediately after surgery due to duskiness of the flap. Further HBO2 treatments were administered twice daily for seven days and then once daily for 30 days. Additionally, leech therapy was used for the first ten postoperative days. The patient's right auricle and most of the left auricle were completely lost. Despite the tenuous vascular inflow and initially absent venous drainage, at 3 month follow-up there was reepithelialization of her scalp except for an area of granulation tissue in the occipitoparietal area. At one year follow-up the area of granulation tissue was reduced, but there was no detectable hair growth or nerve function. We propose that HBO2 may facilitate tissue survival in scalp degloving injuries in the face of incomplete surgical revascularization.
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Affiliation(s)
- S Khandelwal
- Department of Emergency Medicine, The Comprehensive Wound Center, The Ohio State University, 170 A Means Hall, 1654 Upham Drive, Columbus, Ohio 43210, USA
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Khandelwal S, Demonty I, Jeemon P, Lakshmy R, Mukherjee R, Gupta R, Snehi U, Niveditha D, Singh Y, Passi S, Prabhakaran D, Reddy K. PLANT STEROLS, FISH OIL OMEGA-3S, AND THEIR COMBINATION IMPROVE THE PLASMA LIPID PROFILE IN MILDLY HYPERLIPIDEMIC INDIAN ADULTS. ATHEROSCLEROSIS SUPP 2008. [DOI: 10.1016/s1567-5688(08)70551-8] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Khandelwal S, Perez L, Richardson S, Williams S, White L, Cantrell S. 188. Ann Emerg Med 2006. [DOI: 10.1016/j.annemergmed.2006.07.644] [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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Maheshwari M, Khandelwal S, Maheshwari S. Elephantiasis nostras: complication of third degree acid burn. J Assoc Physicians India 2006; 54:713. [PMID: 17212019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Monika Maheshwari
- Department of Medicine, JLN, Assoc. Group of Hospitals, Ajmer, Rajasthan
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Sodhi KS, Saxena AK, Suri S, Khandelwal S. Images of interest. Gastrointestinal: juvenile polyposis syndrome. J Gastroenterol Hepatol 2005; 20:154. [PMID: 15610462 DOI: 10.1111/j.1440-1746.2004.03753.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- K S Sodhi
- Department of Radio-Diagnosis, Post-Graduate Institute of Medical Education & Research (PGIMER), Chandigarh-160012, India
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Hartwig A, Asmuss M, Blessing H, Hoffmann S, Jahnke G, Khandelwal S, Pelzer A, Bürkle A. Interference by toxic metal ions with zinc-dependent proteins involved in maintaining genomic stability. Food Chem Toxicol 2002; 40:1179-84. [PMID: 12067581 DOI: 10.1016/s0278-6915(02)00043-1] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.7] [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: 01/06/2023]
Abstract
Metal ions are essential components of biological systems; nevertheless, even essential elements may have toxic or carcinogenic properties. Thus, besides As(III) and Cd(II), also Ni(II) and Co(II) have been shown previously to disturb different types of DNA repair systems at low, non-cytotoxic concentrations. Since some metals exert high affinities for SH groups, we investigated whether zinc finger structures in DNA-binding motifs of DNA repair proteins are potential targets for toxic metal ions. The bacterial formamidopyrimidine-DNA glycosylase (Fpg protein) involved in base excision repair was inhibited by Cd(II), Cu(II) and Hg(II) with increasing efficiencies, whereas Co(II), As(III), Pb(II) and Ni(II) had no effect. Furthermore, Cd(II) still disturbed enzyme function when bound to metallothionein. Strong inhibition was also observed in the presence of phenylselenyl chloride, followed by selenocystine, while selenomethionine was not inhibitory. Regarding the mammalian XPA protein involved in the recognition of DNA lesions during nucleotide excision repair, its DNA-binding capacity was diminished by Cd(II), Cu(II), Ni(II) and Co(II), while Hg(II), Pb(II) and As(III) were ineffective. Finally, the H(2)O(2)-induced activation of the poly(ADP-ribose)polymerase (PARP) involved in DNA strand break detection and apoptosis was greatly reduced by Cd(II), Co(II), Ni(II) and As(III). Similarly, the disruption of correct p53 folding and DNA binding by Cd(II), Ni(II) and Co(II) has been shown by other authors. Therefore, zinc-dependent proteins involved in DNA repair and cell-cycle control may represent sensitive targets for some toxic metals such as Cd(II), Ni(II), Co(II) and Cu(II), as well as for some selenium compounds. Relevant mechanisms of inhibition appear to be the displacement of zinc by other transition metals as well as redox reactions leading to thiol/disulfide interchange.
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Affiliation(s)
- A Hartwig
- Institut für Lebensmittelchemie und Toxikologie, Universität Karlsruhe, Postfach 6980, D-76128, Karlsruhe, Germany.
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Khandelwal S, Shukla LJ, Shanker R. Modulation of acute cadmium toxicity by Emblica officinalis fruit in rat. Indian J Exp Biol 2002; 40:564-70. [PMID: 12622203] [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] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The efficacy of Emblica officinalis in modifying the acute cytotoxicity of cadmium in male rats was evaluated. Oral administration of Emblica fruit juice (500 mg/kg, b.w.) for 8 days followed by a single toxic dose of Cd as CdCl2 (3 mg/kg,b.w. ip), considerably reduced the mortality in rats as well as prevented to some extent the cadmium induced histopathological damage in testis, liver and kidneys. Biochemical investigation also revealed reduced levels of Cd induced serum glutamate oxaloacetate transaminase, glutamate pyruvate transaminase and gamma glutamyltranspeptidase. The enhanced levels of Cd and lipid peroxidation in liver, kidney, and testes and metallothionein and total sulphydryl in liver and kidney by Cd were significantly reduced by Emblica pretreatment. These results suggest cytoprotective potential of Emblica fruit in acute cadmium toxicity which could be due to its multiple role in biological system.
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Affiliation(s)
- S Khandelwal
- Industrial Toxicology Research Centre Lucknow 226001, India.
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Abstract
OBJECTIVES Adolescent obesity is becoming an increasing public health problem. This study determines: 1) differences in teen and parental report of obesity, 2) amount of misclassification using body mass index (BMI) from self-reported versus measured height and weight as an indicator of obesity, and 3) whether misclassification varies by gender and socioeconomic status. DESIGN Weighted data from 15 483 baseline (T1) youth and parental interviews from the National Longitudinal Study of Adolescent Health were used. Seventy-four percent of teens were reinterviewed 1 year later (T2). Parents reported socioeconomic status indicators and whether their teen was obese. Teens reported height, weight, and weight perception. BMI was calculated from both self-reported height and weight at T1 and T2 and from measured height and weight at T2. Those with a BMI > or =95% corrected for age and gender were considered obese. RESULTS At T1, nearly one half of teens (47%) reporting they were very overweight were not obese by BMI. For teens obese by BMI, 19.6% were reported to be obese by both parent and teen, 6.4% by teen only, 29. 9% by parent only, and 44.2% by neither teen nor parent. For those with persistent obesity, teen and/or parental report failed to identify more than one third (34%) as obese; 23.4% were identified by both teen and parent report, 5.4% by teen report only, and 37.2% by parent only. At T2, the correlation between BMI calculated from self-reported versus measured height and weight for the overall population was very strong (r = .92). Specificity of obesity status based on self-reported BMI, compared with obesity status based on measured BMI was .996; sensitivity, .722; positive predictive value, .860; and negative predictive value, .978. Overall, 3.8% of teens were misclassified using self-report measures. Girls were no more likely than boys to be misclassified as obese using BMI from self-reported height and weight. CONCLUSIONS Parental report is a better indicator of obesity than teen report of weight status, but parental and teen reports are both poor predictors of adolescent obesity. Using BMI based on self-reported height and weight correctly classified 96% as to obesity status. Thus, studies can use self-reported height and weight to understand teen obesity and its correlates/sequelae.
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Affiliation(s)
- E Goodman
- Division of Adolescent/Young Adult Medicine, Children's Hospital, Boston, Massachusetts, USA.
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Prasad S, Khandelwal S. Medicine in the Internet: should you be a participant? J Indian Med Assoc 1998; 96:315-6, 319. [PMID: 10063302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- S Prasad
- Department of Ophthalmology, Arrowe Park Hospital, Upton, Merseyside, Wirral, UK
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Subramoniam A, Khandelwal S, Dwivedi PD, Khanna S, Shanker R. Dibutyltin dilaurate induced thymic atrophy and modulation of phosphoinositide pathway of cell signalling in thymocytes of rats. Immunopharmacol Immunotoxicol 1994; 16:645-77. [PMID: 7876466 DOI: 10.3109/08923979409019744] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [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: 01/27/2023]
Abstract
A marked dose dependent reduction in thymus weight and its nucleated cell counts with histological alterations was observed in rats exposed to oral dibutyltin dilaurate (DBTL) for 2 weeks at 2, 4, 8 or 16 mg/kg body weight. The incorporation of [3H]-inositol into all the three major phosphoinositides was drastically reduced in thymocytes in a dose dependent manner. Furthermore, the basal and the mitogen (Con A) stimulated [3H]-inositol phosphates generation was diminished significantly in 8 mg DBTL group. However, in vitro incubation of DBTL with thymocytes failed to evoke any change in phosphoinositide hydrolysis. Similarly, a time and dose dependent inhibition in phosphoinositide synthesis with as high as 80% by 10 microM DBTL was exhibited under in vitro conditions. A 130% and 600% enhancement of protein kinase C (PKC) activity in thymocytes was seen in 4 mg and 8 mg DBTL group, respectively. Addition of DBTL to the cell free assay system of thymocytes resulted in a concentration dependent activation of the enzyme activity. A dose dependent increase in intracellular calcium was also evident when DBTL was added to thymocytes under in vitro conditions. These results are of significance and may bear close relationship to the observed thymic atrophy by DBTL.
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Affiliation(s)
- A Subramoniam
- Immunotoxicology Division, Industrial Toxicology Research Centre, Lucknow, India
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Abstract
The influence of dietary iron deficiency on acute nickel, lead or cadmium toxicity as reflected by the induction of hepatic, renal, and intestinal metallothionein (MT), disposition of the metals and alterations in hematological parameters, was investigated in young rats to ascertain whether the toxic effects of these metals modify under anemic conditions. The administration of Cd induced hepatic, renal and intestinal MT while that of Ni or Pb induced hepatic MT only. While dietary Fe deficiency did not affect MT induction by Cd, it enhanced the synthesis of renal and intestinal MT by Ni and Pb. The accumulation of Pb in liver and kidney and that of Cd in liver only, were enhanced by Fe deficiency; the tissue deposition of Ni remained unaffected by Fe deficiency. The induction of hepatic MT by Ni, Pb or Cd appears to be related to the concomitant rise in the hepatic Zn, Ca and Fe levels in normal rats. However, dietary Fe deficiency increased the hepatic Zn in response to Ni or Cd and the hepatic Ca in response to Pb administration.
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Affiliation(s)
- S K Tandon
- Industrial Toxicology Research Centre, Lucknow, India
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Schmidt-Ullrich RK, Johnson CR, Khandelwal S, Wazer DE. Concomitant boost-accelerated, superfractionated irradiation for the treatment of advanced carcinomas of the oral cavity and oropharynx. Recent Results Cancer Res 1994; 134:69-79. [PMID: 8153444 DOI: 10.1007/978-3-642-84971-8_9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Abstract
The influence of dietary iron deficiency on acute nickel, lead or cadmium toxicity as reflected by the induction of hepatic, renal and intestinal metallothionein (MT), disposition of the metals, and alterations in hematological parameters was investigated in rats. The administration of cadmium induced the hepatic, renal and intestinal MT while that of nickel or lead induced hepatic MT only. However, dietary iron deficiency did not influence the cadmium induced tissue MT but enhanced the ability of nickel or lead to restore the normal synthesis of renal and intestinal MT lowered under the influence of reduced body iron status. The accumulation of lead in liver and kidney and that of cadmium enhanced in liver only, while tissue deposition of nickel remained unaffected by iron deficiency. The induction of hepatic MT by three metals appears related to the concomitant rise in the hepatic zinc, calcium and iron levels in normal rats. However, dietary iron deficiency increased the hepatic zinc in response to nickel or cadmium and that of heptic calcium in response to lead.
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Affiliation(s)
- S K Tandon
- Industrial Toxicology Research Centre, Lucknow, India
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Abstract
The exact relation between gastro-oesophageal reflux and asthma remains poorly understood. To determine whether gastro-oesophageal reflux in asthmatics results in oesophagitis, endoscopy and oesophageal biopsy were performed on 186 consecutive adult asthmatics. The presence or absence of reflux symptoms was not used as a selection criterion for asthmatics. Endoscopy was performed by two endoscopists using predefined criteria. All asthmatics had discrete wheezing and either a previous diagnosis of asthma or documented reversible airways obstruction of at least 20%. The oesophageal mucosa was graded as normal if no erosions or ulcerations were present in the tubular oesophagus; as oesophagitis if a mucosal break with exudate (erosions and/or ulcerations) was present; and as Barrett's if specialised (intestinal) columnar epithelium was present. A hiatal hernia was diagnosed if greater than or equal to 2 cm of gastric mucosa appeared above the diaphragm during endoscopy. Thirty nine per cent of the patients with asthma had oesophagitis or Barrett's oesophagus, or both. There was no difference in the oesophageal mucosal status between asthmatics who required and those who did not require bronchodilators. Fifty eight per cent of asthmatics had a hiatal hernia. It is concluded that oesophagitis is common and independent of the use of bronchodilator therapy in asthmatics.
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Affiliation(s)
- S J Sontag
- Department of Ambulatory Care, Veterans Administration Hospital, Hines, Illinois 60141
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Abstract
Dose- and time-related effects of Cd (II) (0.5 or 1.0 mg/kg, Cd as CdCl2.H2O, subcutaneously, daily for 48 h, 1, 3, or 6 wk) were investigated in rats. A dose-related increase in the activity of plasma alkaline phosphatase (ALP), lactate dehydrogenase (LDH), aspartate aminotransferase (GOT), and alanine aminotransferase (GPT) was evident only at 6 wk, whereas an early rise in ALP and LDH was seen at 3 wk in 1.0 mg Cd group only. The hepatic and renal metallothionein (MT) induction displayed a dose- as well as time-related increase with Cd accumulation. A significant increase in hepatic Zn and renal Cu, no change in hepatic Cu, and a slight increase in renal Zn was observed. Urinary ALP and leucine aminopeptidase (LAP) showed an initial increase at 48 h, thereafter returned to near normal. A second phase of enzymuria (ALP, LAP, GOT, GPT, gamma-glutamyl transpeptidase), proteinuria, and aminoaciduria occurred at 6 wk in a dose-related manner. The urinary excretion of specific renal enzymes appeared closely related to the MT induction and organ Cd levels.
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Affiliation(s)
- S Khandelwal
- Industrial Toxicology Research Centre, Mahatma-Gandhi Marg, Lucknow, India
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