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Jegadheeshwari S, Velayutham M, Gunasekaran K, Kesavan M. DbGTi: Thermostable trypsin inhibitor from Dioscorea bulbifera L. ground tubers: assessment of antioxidant and antibacterial properties and cytotoxicity evaluation using zebrafish model. Int J Biol Macromol 2024; 263:130244. [PMID: 38387638 DOI: 10.1016/j.ijbiomac.2024.130244] [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: 09/24/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 02/24/2024]
Abstract
Oxidative stress disorders and diseases caused by drug-resistant bacteria have emerged as significant public health concerns. Plant-based medications like protease inhibitors are growing despite adverse effects therapies. Consecutively, in this study, trypsin inhibitors from Dioscorea bulbifera L. (DbGTi trypsin inhibitor) ground tubers were isolated, purified, characterized, and evaluated for their potential cytotoxicity, antibacterial, and antioxidant activities. DbGTi protein was purified by Q-Sepharose matrix, followed by trypsin inhibitory activity. The molecular weight of the DbGTi protein was found to be approximately 31 kDa by SDS-PAGE electrophoresis. The secondary structure analysis by circular dichroism (CD) spectroscopy revealed that the DbGTi protein predominantly comprises β sheets followed by α helix. DbGTi protein showed competitive type of inhibition with Vmax = 2.1372 × 10-1 μM/min, Km = 1.1805 × 102 μM, & Ki = 8.4 × 10-9 M and was stable up to 70 °C. DbGTi protein exhibited 58 % similarity with Dioscorin protein isolated from Dioscorea alata L. as revealed by LC-MS/MS analysis. DbGTi protein showed a non-toxic effect, analyzed by MTT, Haemolytic assay and in vivo studies on zebrafish model. DbGTi protein significantly inhibited K. pneumoniae and has excellent antioxidant properties, confirmed by various antioxidant assays. The results of anti-microbial, cytotoxicity and antioxidant assays demonstrate its bioactive potential and non-toxic nature.
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Affiliation(s)
- S Jegadheeshwari
- Department of Biotechnology, School of Bioengineering, SRM Institute of Science and Technology, Kattankulathur 603 203, Tamil Nadu, India; Interdisciplinary Institute of Indian System of Medicine, SRM Institute of Science and Technology, Kattankulathur 603 203, Tamil Nadu, India
| | - Manikandan Velayutham
- Institute of Biotechnology, Department of Medical Biotechnology, Integrative Physiology, Saveetha Institute of Medical and Technical Sciences, Saveetha Nagar, Thandalam, Kanchipuram, India
| | - K Gunasekaran
- Department of Crystallography and Biophysics, University of Madras, Chennai, India
| | - M Kesavan
- Interdisciplinary Institute of Indian System of Medicine, SRM Institute of Science and Technology, Kattankulathur 603 203, Tamil Nadu, India; Department of Physics and Nanotechnology, Faculty of Engineering and Technology, SRM Institute of Science and Technology, Kattankulathur 603203, Tamil Nadu, India.
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Bye AP, Kriek N, Sage T, Rawlings SJ, Prodger C, Kesavan M, Lees C, Booth S, Cowen LG, Shefferd K, Desborough MJ, Gibbins JM, Eyre TA. Pirtobrutinib results in reversible platelet dysfunction compared to ibrutinib and acalabrutinib. Haematologica 2023; 108:1429-1435. [PMID: 36519322 PMCID: PMC10153540 DOI: 10.3324/haematol.2022.281402] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
- Alexander P Bye
- Molecular and Clinical Sciences Research Institute, St George's University, Cranmer Terrace, London, United Kingdom; Institute for Cardiovascular and Metabolic Research, School of Biological Sciences, University of Reading, Reading, RG6 6EX.
| | - Neline Kriek
- Institute for Cardiovascular and Metabolic Research, School of Biological Sciences, University of Reading, Reading, RG6 6EX
| | - Tanya Sage
- Institute for Cardiovascular and Metabolic Research, School of Biological Sciences, University of Reading, Reading, RG6 6EX
| | - Suzannah J Rawlings
- Institute for Cardiovascular and Metabolic Research, School of Biological Sciences, University of Reading, Reading,
| | - Catherine Prodger
- Department of Clinical Haematology, Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE
| | - Murali Kesavan
- Department of Clinical Haematology, Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE
| | - Charlotte Lees
- Department of Clinical Haematology, Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE
| | - Stephen Booth
- Department of Clinical Haematology, Royal Berkshire Hospital NHS Foundation Trust, Reading, RG1 5AN
| | - Louise G Cowen
- Haematology Late Phase Clinical Trial Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE
| | - Kirsty Shefferd
- Haematology Late Phase Clinical Trial Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE
| | - Michael J Desborough
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE
| | - Jonathan M Gibbins
- Institute for Cardiovascular and Metabolic Research, School of Biological Sciences, University of Reading, Reading, RG6 6EX
| | - Toby A Eyre
- Department of Clinical Haematology, Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford,
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Selvaraj S, Ram Kumar A, Ahilan T, Kesavan M, Gunasekaran S, Kumaresan S. Multi spectroscopic and computational investigations on the electronic structure of oxyclozanide. J INDIAN CHEM SOC 2022. [DOI: 10.1016/j.jics.2022.100676] [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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Murray SM, Barbanti M, Campbell C, Brown A, Chen L, Dhanapal J, Tseu B, Pervaiz O, Peters L, Springett S, Danby R, Adele S, Phillips E, Malone T, Amini A, Stafford L, Deeks AS, Dunachie S, Klenerman P, Peniket A, Barnes E, Kesavan M. Impaired humoral and cellular response to primary COVID-19 vaccination in patients less than 2 years after allogeneic bone marrow transplant. Br J Haematol 2022; 198:668-679. [PMID: 35655410 PMCID: PMC9348196 DOI: 10.1111/bjh.18312] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 11/29/2022]
Abstract
Allogeneic haematopoietic stem cell transplant (HSCT) recipients remain at high risk of adverse outcomes from coronavirus disease 2019 (COVID-19) and emerging variants. The optimal prophylactic vaccine strategy for this cohort is not defined. T cell-mediated immunity is a critical component of graft-versus-tumour effect and in determining vaccine immunogenicity. Using validated anti-spike (S) immunoglobulin G (IgG) and S-specific interferon-gamma enzyme-linked immunospot (IFNγ-ELIspot) assays we analysed response to a two-dose vaccination schedule (either BNT162b2 or ChAdOx1) in 33 HSCT recipients at ≤2 years from transplant, alongside vaccine-matched healthy controls (HCs). After two vaccines, infection-naïve HSCT recipients had a significantly lower rate of seroconversion compared to infection-naïve HCs (25/32 HSCT vs. 39/39 HCs no responders) and had lower S-specific T-cell responses. The HSCT recipients who received BNT162b2 had a higher rate of seroconversion compared to ChAdOx1 (89% vs. 74%) and significantly higher anti-S IgG titres (p = 0.022). S-specific T-cell responses were seen after one vaccine in HCs and HSCT recipients. However, two vaccines enhanced S-specific T-cell responses in HCs but not in the majority of HSCT recipients. These data demonstrate limited immunogenicity of two-dose vaccination strategies in HSCT recipients, bolstering evidence of the need for additional boosters and/or alternative prophylactic measures in this group.
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Affiliation(s)
- Sam M. Murray
- Peter Medawar Building for Pathogen Research Nuffield Department of MedicineUniversity of OxfordOxfordUK
| | - Maria Barbanti
- Department of Haematology, NIHR Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Cori Campbell
- Peter Medawar Building for Pathogen Research Nuffield Department of MedicineUniversity of OxfordOxfordUK
- NIHR Oxford Biomedical Research CentreUniversity of OxfordOxfordUK
| | - Anthony Brown
- Peter Medawar Building for Pathogen Research Nuffield Department of MedicineUniversity of OxfordOxfordUK
| | - Lucia Chen
- Department of Haematology, NIHR Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Jay Dhanapal
- Department of Haematology, NIHR Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Bing Tseu
- Department of Haematology, NIHR Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Omer Pervaiz
- Department of Haematology, NIHR Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Louis Peters
- Department of Haematology, NIHR Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Sally Springett
- Department of Haematology, NIHR Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Robert Danby
- Department of Haematology, NIHR Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Sandra Adele
- Peter Medawar Building for Pathogen Research Nuffield Department of MedicineUniversity of OxfordOxfordUK
| | - Eloise Phillips
- Peter Medawar Building for Pathogen Research Nuffield Department of MedicineUniversity of OxfordOxfordUK
| | - Tom Malone
- Peter Medawar Building for Pathogen Research Nuffield Department of MedicineUniversity of OxfordOxfordUK
| | - Ali Amini
- Oxford University Hospitals NHS Foundation TrustOxfordUK
- Oxford Liver Unit, Translational Gastroenterology Unit, Experimental Medicine Division Oxford University Hospitals NHS Foundation TrustUniversity of OxfordOxfordUK
| | | | - Alexandra S. Deeks
- Peter Medawar Building for Pathogen Research Nuffield Department of MedicineUniversity of OxfordOxfordUK
- Oxford University Hospitals NHS Foundation TrustOxfordUK
| | - Susanna Dunachie
- Peter Medawar Building for Pathogen Research Nuffield Department of MedicineUniversity of OxfordOxfordUK
- Oxford University Hospitals NHS Foundation TrustOxfordUK
- Oxford Centre for Global Health Research, Nuffield Department of MedicineUniversity of OxfordOxfordUK
| | - Paul Klenerman
- Peter Medawar Building for Pathogen Research Nuffield Department of MedicineUniversity of OxfordOxfordUK
- Oxford University Hospitals NHS Foundation TrustOxfordUK
| | - Andrew Peniket
- Department of Haematology, NIHR Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Eleanor Barnes
- Peter Medawar Building for Pathogen Research Nuffield Department of MedicineUniversity of OxfordOxfordUK
- Oxford Liver Unit, Translational Gastroenterology Unit, Experimental Medicine Division Oxford University Hospitals NHS Foundation TrustUniversity of OxfordOxfordUK
| | - Murali Kesavan
- Department of Haematology, NIHR Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUK
- Department of Oncology, Medical Sciences DivisionUniversity of OxfordOxfordUK
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Barbanti MC, Appleby N, Kesavan M, Eyre TA. Cellular Therapy in High-Risk Relapsed/Refractory Chronic Lymphocytic Leukemia and Richter Syndrome. Front Oncol 2022; 12:888109. [PMID: 35574335 PMCID: PMC9095984 DOI: 10.3389/fonc.2022.888109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Despite the development of highly effective, targeted inhibitors of B-cell proliferation and anti-apoptotic pathways in chronic lymphocytic leukemia (CLL), these treatments are not curative, and many patients will develop either intolerance or resistance to these treatments. Transformation of CLL to high-grade lymphoma—the so-called Richter syndrome (RS)—remains a highly chemoimmunotherapy-resistant disease, with the transformation occurring following targeted inhibitors for CLL treatment being particularly adverse. In light of this, cellular therapy in the form of allogenic stem cell transplantation and chimeric antigen receptor T-cell therapy continues to be explored in these entities. We reviewed the current literature assessing these treatment modalities in both high-risk CLL and RS. We also discussed their current limitations and place in treatment algorithms.
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Affiliation(s)
- Maria Chiara Barbanti
- Department of Clinical Haematology, Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.,Clinical Trials Unit, Department of Oncology, Churchill Hospital, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, United Kingdom
| | - Niamh Appleby
- Department of Clinical Haematology, Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.,Clinical Trials Unit, Department of Oncology, Churchill Hospital, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, United Kingdom
| | - Murali Kesavan
- Department of Clinical Haematology, Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.,Clinical Trials Unit, Department of Oncology, Churchill Hospital, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, United Kingdom
| | - Toby Andrew Eyre
- Department of Clinical Haematology, Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.,Clinical Trials Unit, Department of Oncology, Churchill Hospital, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, United Kingdom
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Rengasamy R, Raj JP, Vijayalakshmi K, Punitha N, Kesavan M, Vajjiravel M, Elangovan J. Tunable Synthesis of 1,2,3‐Triazoles and Enamines through Deacylative Azide‐Alkene Cycloaddition. European J Org Chem 2022. [DOI: 10.1002/ejoc.202101470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- R. Rengasamy
- Rajah Serfoji Government College Chemistry INDIA
| | - J. Paul Raj
- BS Abdur Rahman University: B S Abdur Rahman Crescent Institute of Science & Technology Chemistry INDIA
| | | | - N. Punitha
- Rajah Serfoji Government College Chemistry INDIA
| | - M. Kesavan
- SRM-RI: SRM Research Institute Kattankulathur IISM INDIA
| | - M Vajjiravel
- BS Abdur Rahman University: B S Abdur Rahman Crescent Institute of Science & Technology Chemistry INDIA
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Kesavan M, Turner JH. Myeloid Toxicity of Radionuclide Cancer Therapy. Cancer Biother Radiopharm 2021; 37:164-172. [PMID: 34871036 DOI: 10.1089/cbr.2021.0286] [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: 11/12/2022] Open
Abstract
Emergent genomic analytic techniques in patients with cancer offer the potential to define the risk of myelo dysplastic syndrome (MDS) and acute leukemia (AL) manifesting following targeted radionuclide therapy of metastatic lymphoma, neuroendocrine tumors (NETs), and prostate cancer. Characterization of the genetic profile will allow risk stratification of patients before theranostic radionuclide management of advanced cancers and offers the opportunity to minimize toxicity while preserving optimal individualized efficacy in the practice of personalized precision nuclear oncology. Our review of a single-center experience of prospective radionuclide theranostic management of metastatic non-Hodgkin lymphoma (NHL), NETs, and castration-resistant prostate cancer (metastatic castrate-resistant prostate cancer [mCRPC]) over the past decade, and comparison with published studies, shows that while the risk of significant myelotoxicity is generally low, at <3%, the consequences in the small minority of patients who develop MDS or AL are substantial, and survival is poor. Timely identification of patients at heightened risk of hematologic toxic complication, using novel genomic technology before institution of radionuclide therapy, will facilitate amelioration of myelotoxicity. In current clinical practice, the minimal hematological toxicity of chemo-free theranostic management of advanced cancer is significantly less compared with newly adopted chemotherapy -immunotherapy regimens, and the financial toxicity associated with these novel agents is avoided.
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Affiliation(s)
- Murali Kesavan
- Department of Hematology, School of Health and Medical Sciences, The University of Western Australia, Perth, Australia
| | - J Harvey Turner
- Department of Hematology, School of Health and Medical Sciences, The University of Western Australia, Perth, Australia
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Kesavan M, Zammar G, McQuillan JT, Macdonald WBG, Turner JH, McQuillan AD. Long-term efficacy and safety of chemotherapy-free first-line iodine-131-rituximab radioimmunotherapy of follicular lymphoma. Br J Haematol 2021; 196:237-241. [PMID: 34368952 DOI: 10.1111/bjh.17758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Murali Kesavan
- School of Medicine, The University of Western Australia, Perth, Australia
| | - Ghassan Zammar
- Department of Haematology, Fiona Stanley Hospital, Perth, Australia
| | | | - William B G Macdonald
- Department of Molecular Imaging and Therapy, Fiona Stanley Hospital, Perth, Australia
| | - J Harvey Turner
- School of Medicine, The University of Western Australia, Perth, Australia
| | - Andrew D McQuillan
- School of Medicine, University of Notre Dame, Fremantle, Australia.,Hollywood Private Hospital, Perth, Australia
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Booth SW, Eyre TA, Whittaker J, Campo L, Wang LM, Soilleux E, Royston D, Rees G, Kesavan M, Hildyard C, Kazmi F, La Thangue N, Kerr D, Middleton MR, Collins GP. A Phase 2a cohort expansion study to assess the safety, tolerability, and preliminary efficacy of CXD101 in patients with advanced solid-organ cancer expressing HR23B or lymphoma. BMC Cancer 2021; 21:851. [PMID: 34301221 PMCID: PMC8306282 DOI: 10.1186/s12885-021-08595-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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/06/2021] [Indexed: 12/01/2022] Open
Abstract
Background This Phase 2a dose expansion study was performed to assess the safety, tolerability and preliminary efficacy of the maximum tolerated dose of the oral histone de-acetylase (HDAC) inhibitor CXD101 in patients with relapsed / refractory lymphoma or advanced solid organ cancers and to assess HR23B protein expression by immunohistochemistry as a biomarker of HDAC inhibitor sensitivity. Methods Patients with advanced solid-organ cancers with high HR23B expression or lymphomas received CXD101 at the recommended phase 2 dose (RP2D). Key exclusions: corrected QT > 450 ms, neutrophils < 1.5 × 109/L, platelets < 75 × 109/L, ECOG > 1. Baseline HR23B expression was assessed by immunohistochemistry. Results Fifty-one patients enrolled between March 2014 and September 2019, 47 received CXD101 (19 solid-organ cancer, 28 lymphoma). Thirty-four patients received ≥80% RP2D. Baseline characteristics: median age 57.4 years, median prior lines 3, male sex 57%. The most common grade 3–4 adverse events were neutropenia (32%), thrombocytopenia (17%), anaemia (13%), and fatigue (9%) with no deaths on CXD101. No responses were seen in solid-organ cancers, with disease stabilisation in 36% or patients; the overall response rate in lymphoma was 17% with disease stabilisation in 52% of patients. Median progression-free survival was 1.2 months (95% confidence interval (CI) 1.2–5.4) in solid-organ cancers and 2.6 months (95%CI 1.2–5.6) in lymphomas. HR23B status did not predict response. Conclusions CXD101 showed acceptable tolerability with efficacy seen in Hodgkin lymphoma, T-cell lymphoma and follicular lymphoma. Further studies assessing combination approaches are warranted. Trial registration ClinicalTrials.gov identifier NCT01977638. Registered 07 November 2013. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08595-w.
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Affiliation(s)
- Stephen W Booth
- Department of Haematology, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, UK.
| | - Toby A Eyre
- Department of Haematology, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, UK
| | | | - Leticia Campo
- Department of Oncology, University of Oxford, Oxford, UK
| | - Lai Mun Wang
- Department of Cellular Pathology, Oxford University Hospitals, Oxford, UK
| | | | - Daniel Royston
- Department of Cellular Pathology, Oxford University Hospitals, Oxford, UK
| | - Gabrielle Rees
- Department of Cellular Pathology, Oxford University Hospitals, Oxford, UK
| | - Murali Kesavan
- Department of Haematology, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, UK
| | - Catherine Hildyard
- Department of Haematology, Milton Keynes University Hospital, Milton Keynes, UK
| | - Farasat Kazmi
- Department of Oncology, University of Oxford, Oxford, UK
| | - Nick La Thangue
- Celleron Therapeutics Ltd, Oxford, UK.,Department of Oncology, University of Oxford, Oxford, UK
| | - David Kerr
- Celleron Therapeutics Ltd, Oxford, UK.,Department of Oncology, University of Oxford, Oxford, UK
| | | | - Graham P Collins
- Department of Haematology, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, UK
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Kesavan M, Grover P, Lam WS, Claringbold PG, Turner JH. Long-term hematologic toxicity of 177Lu-octreotate-capecitabine-temozolomide therapy of GEPNET. Endocr Relat Cancer 2021; 28:521-527. [PMID: 34010146 DOI: 10.1530/erc-21-0082] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/19/2021] [Indexed: 11/08/2022]
Abstract
Thirty-seven patients with advanced gastroenteropancreatic neuroendocrine tumors (GEPNETs) were treated on a prospective phase II single-center study with four cycles of 7.8 GBq 177Lu-octreotate combined with capecitabine and temozolomide chemotherapy (CAPTEM). Each 8-week cycle combined radiopeptide therapy with 14 days of capecitabine (1500 mg/m2) and 5 days of temozolomide (200 mg/m2). The incidence of grade ≥ 3 hematologic toxicity was analyzed. At a median follow-up of 7-years (range 1-10), six (16%) patients developed persistent hematologic toxicity (PHT) (defined as sustained grade ≥ 3 hematologic toxicity beyond 36-months follow-up) and three (8%) developed MDS/AL with a median time-to-event of 46 and 34 months, respectively. The estimated cumulative incidence of MDS/AL was 11% (95% CI: 3.45-24.01). Development of PHT was the only significant risk factor for secondary MDS/AL (RR, 16; 95% CI: 2.53 to 99.55; P < 0.001). The median PFS was 48 months (95% CI: 40.80-55.20), and the median OS was 86 months (95% CI: 56.90-115.13). Twenty-one deaths were recorded, including 13 (62%) due to progressive disease and all 3 (14%) patients with MDS/AL. 177Lu-octreotate CAPTEM therapy for GEPNETs is associated with a risk of long-term hematologic toxicity. The rising cumulative incidence of MDS/AL > 10% mandates the long-term monitoring of treated patients. However, time to onset is unpredictable, and incidence does not correlate with conventional baseline risk factors. Novel methods are required for the stratification of prospective patients based on genetic risk.
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Affiliation(s)
- Murali Kesavan
- Department of Oncology, School of Medicine, The University of Western Australia, Perth, Australia
| | - Piyush Grover
- Department of Oncology, Fiona Stanley Hospital, Perth, Australia
| | - Wei-Sen Lam
- Department of Oncology, Fiona Stanley Hospital, Perth, Australia
| | - Phillip G Claringbold
- Department of Oncology, School of Medicine, The University of Western Australia, Perth, Australia
| | - J Harvey Turner
- Department of Oncology, School of Medicine, The University of Western Australia, Perth, Australia
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Vivekanantham A, Kesavan M, Evans J, Matin RN, Elliott I, Luqmani R. POS1453 OVERLAPPING FEATURES OF RELAPSING POLYCHONDRITIS AND SWEET’S SYNDROME: COULD THIS BE VEXAS (VACUOLES, UBIQUITIN A1E MUTATION, X-LINKED, AUTOINFLAMMATORY, SOMATIC) SYNDROME? Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:An 83-year-old male presented to the infectious diseases team with intermittent fevers associated with tension headaches, malaise and fatigue for two years, with recent worsening. He had noted a progressive decline in his mobility over the past year following replacement of his right knee for osteoarthritis. His past medical history included atopic eczema, malaria and bilateral cataract extractions.On examination, he had a widespread non-scaly annular urticated rash. He had persistently raised inflammatory markers (CRP 40mg/L, ESR 82mm/hour), normocytic anaemia (Hb 102 g/L, MCV 101.9 fL), lymphopenia (0.70 x10^9/L), fluctuating eosinophilia (0.88-1.25 x10^9/L) and a mildly elevated lactate dehydrogenase (243IU/L). A thorough work up for pyrexia of unknown origin showed no evidence of infection/ vasculitis/ immune pathology. The only positive finding was prior exposure to schistosomiasis, treated with a single dose of praziquantel. An echocardiogram and serial PET-CT scans were normal. Given the deterioration in mobility since the right knee replacement, an MRI knee was performed, and cobalt/ chromium levels to look for allergic responses to the prosthesis, but these tests did not reveal any findings of significance.An initial haematology work-up did not identify an abnormality of concern (screening for a myeloproliferative neoplasm including BCR-ABL studies were negative and mast cell tryptase was not elevated). Due to a worsening skin rash, he was reviewed by dermatology where a skin biopsy showed features of superficial neutrophilic dermatosis which can be observed with Sweet’s syndrome. However, it was felt that this was an unlikely explanation for the persistent systemic symptoms. He proceeded to a bone marrow biopsy which showed reactive features including vacuolation of myeloid precursors with normal cytogenics.During follow up appointments, the patient described new recurrent violaceous patches with episodes of inflammation of the pinna of the ear, suggesting a diagnosis of relapsing polychondritis and so the patient was started on high dose prednisolone (80mg per day [1mg per kg]) and referred for rheumatological assessment. He had an excellent response to prednisolone (fever, ear swelling and rash subsided). The overlapping features of relapsing polychondritis and Sweet’s syndrome in an elderly man suggested a diagnosis of VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory and somatic) syndrome. The prednisolone dose was rapidly reduced to 10mg per day and the patient was commenced on methotrexate, as a steroid-sparing agent. Further blood tests have been sent for genetic analysis for VEXAS syndrome but results are pending.Objectives:N/AMethods:N/AResults:N/AConclusion:VEXAS syndrome is a newly identified genetically defined syndrome, described by Beck et al in October 2020 consisting of somatic mutations in the UBA1 gene, affecting bone marrow stem cells. In a study of 25 patients with this mutation, diagnostic/ classification criteria for relapsing polychondritis (n=15), Sweet’s syndrome (n=8), polyarteritis nodosa (n=3) or giant cell arteritis (n=1) were met and patients often had severe refractory disease with overlapping systemic inflammatory and haematologic features. Features of VEXAS include the presence of vacuoles in myeloid cells, somatic mutations in the UBA1 (ubiquitin-activating enzyme) gene, X-linkage (therefore only occurring in males), in older people with autoinflammatory syndromes. Although VEXAS syndrome is a relatively rare condition, it was a relevant consideration in this case.References:[1]Beck et al. Somatic Mutations in UBA1 and Severe Adult-Onset Autoinflammatory Disease. N Engl J Med 2020; 383:2628-2638. DOI: 10.1056/NEJMoa2026834Disclosure of Interests:None declared
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Naik S, Bose A, Mehta U, Arumugham S, Kesavan M, Ganesan V, Thirthalli J. P146 Cathodal tDCS perturbation-based motor cortical plasticity and its cognitive correlates in schizophrenia: A sham-controlled study. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.257] [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: 11/25/2022]
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Selvaraj S, Rajkumar P, Kesavan M, Thirunavukkarasu K, Gunasekaran S, Devi NS, Kumaresan S. Spectroscopic and structural investigations on modafinil by FT-IR, FT-Raman, NMR, UV-Vis and DFT methods. Spectrochim Acta A Mol Biomol Spectrosc 2020; 224:117449. [PMID: 31422339 DOI: 10.1016/j.saa.2019.117449] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/03/2019] [Accepted: 08/03/2019] [Indexed: 06/10/2023]
Abstract
Chiral sulfoxide based smart drug modafinil were studied experimentally and theoretically. Vibrational spectra were recorded in the mid IR region and electronic spectra were recorded in UV-Visible region. The molecular geometry, vibrational spectra, magnetic spectra and electronic spectra were simulated using Density Functional Theory (DFT) employed with B3LYP/6-311++G(d,p) basis set. The molecular geometry optimization, vibrational frequencies, chemical shifts and solvent effect on electronic properties were reported. The intermolecular interactions have been studied by Hirshfeld surface analysis. There is good agreement was found between calculated and observed values, thereby to confirm the molecular structure of modafinil.
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Affiliation(s)
- S Selvaraj
- Spectrophysics Research Laboratory, PG and Research Department of Physics, Arignar Anna Government Arts College, Cheyyar, 604407, Tamil Nadu, India; Department of Physics, Indo - American College, Cheyyar 604407, Tamil Nadu, India.
| | - P Rajkumar
- Spectrophysics Research Laboratory, PG and Research Department of Physics, Arignar Anna Government Arts College, Cheyyar, 604407, Tamil Nadu, India; PG and Research Department of Physics, King Nandhivarman College of Arts and Science, Thellar 604406, Tamil Nadu, India
| | - M Kesavan
- Interdisciplinary Institute of Indian System of Medicine, SRM Institute of Science and Technology, Kattankulathur, Chennai 603203, Tamil Nadu, India
| | - K Thirunavukkarasu
- Spectrophysics Research Laboratory, PG and Research Department of Physics, Arignar Anna Government Arts College, Cheyyar, 604407, Tamil Nadu, India
| | - S Gunasekaran
- Sophisticated Analytical Instrumentation Facility, St. Peter's Institute of Higher Education and Research, St. Peters University, Avadi, Chennai 600054, Tamil Nadu, India
| | - N Saradha Devi
- PG and Research Department of Chemistry, Arignar Anna Government Arts College, Cheyyar 604407, Tamil Nadu, India; Department of Chemistry, Annamalai University, Annamalai Nagar, Chidambaram 608002, Tamil Nadu, India
| | - S Kumaresan
- Spectrophysics Research Laboratory, PG and Research Department of Physics, Arignar Anna Government Arts College, Cheyyar, 604407, Tamil Nadu, India
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Abstract
PURPOSE OF REVIEW Rituximab-based chemoimmunotherapy has resulted in a marked improvement in the survival of diffuse large B cell lymphoma (DLBCL). We reflect upon the history front-line (1L) therapy and highlight advances in management. RECENT FINDINGS Since the introduction of R-CHOP, the majority of randomized studies in the front-line treatment of DLBCL have failed to show a benefit. Such studies have involved treatment intensification, adding novel agents to the R-CHOP backbone and targeting such novel agents to biologically defined subgroups. R-CHOP therefore remains standard-of-care for most but new insights into the molecular biology of these diseases, and the development of active targeted molecules offers promise for the future. Accumulating evidence in the very elderly suggests dose attenuation does not compromise survival. Intensification in primary mediastinal B cell lymphoma may avoid the need for radiotherapy, but must be balanced against the risks. PET-CT- and ctDNA-based response assessment may now enable response adapted therapy and early prognostication, improving patient selection and potentially outcomes. Novel technologies and therapies in combination with novel molecular diagnostics will likely become the standard-of-care approach for the personalized therapy of DLBCL but need to be proven in well-designed and conducted randomized trials.
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Affiliation(s)
- Murali Kesavan
- Department of Clinical Haematology, Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, OX3 7LE UK
- University of Oxford Department of Oncology Clinical Trials Unit, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Toby A. Eyre
- Department of Clinical Haematology, Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, OX3 7LE UK
- University of Oxford Department of Oncology Clinical Trials Unit, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Graham P. Collins
- Department of Clinical Haematology, Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, OX3 7LE UK
- University of Oxford Department of Oncology Clinical Trials Unit, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
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Shanbhag V, Sreeraj S V, Bose A, Narayanswamy J, Rao N, Kesavan M, Venkatasubramanian G. Effect of tACS on Working Memory and Processing speed in Schizophrenia: An Open Label Study. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Selvaraj S, Rajkumar P, Kesavan M, Gunasekaran S, Kumaresan S. Experimental and theoretical investigations on spectroscopic properties of tropicamide. J Mol Struct 2018. [DOI: 10.1016/j.molstruc.2018.06.097] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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17
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Thirunavukkarasu K, Rajkumar P, Selvaraj S, Suganya R, Kesavan M, Gunasekaran S, Kumaresan S. Vibrational (FT-IR and FT-Raman), electronic (UV–Vis), NMR (1H and 13C) spectra and molecular docking analyses of anticancer molecule 4-hydroxy-3-methoxycinnamaldehyde. J Mol Struct 2018. [DOI: 10.1016/j.molstruc.2018.07.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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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18
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Durgalakshmi D, Ajay Rakkesh R, Kesavan M, Ganapathy S, Ajithkumar TG, Karthikeyan S, Balakumar S. Highly reactive crystalline-phase-embedded strontium-bioactive nanorods for multimodal bioactive applications. Biomater Sci 2018; 6:1764-1776. [PMID: 29808842 DOI: 10.1039/c8bm00362a] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In the present work, a crystallization-induced strontium-bioactive material, with a composition similar to Bioglass 45S5 system, was obtained using a sol-gel-assisted microwave method with nanorod morphologies of 30-80 nm in size. The effect of crystallization induced in the glass network, and its influence on the bioactivity and mechanical properties of bone and dentin regeneration, were the main novel findings of this work. Rietveld analysis of X-ray diffraction spectra showed the best fit with sodium (combeite, Na2Ca2Si3O9) and calcium (clinophosinaite, Ca2Na6O14P2Si2; calcium strontium silicate, Ca1.5O4SiSr0.5; and calcium carbonate, CaCO3) enriched crystal systems. Multinuclear solid-state NMR studies provided detailed atomistic insight into the presence of crystalline mineral phases in the bioactive material. The dentin matrix and antibacterial studies showed good results for 5% strontium-substituted calcium compared with basic 45S5 composition due to its smaller particle size (30 nm), which suggested applications to dentin regeneration. Simulation studies have been demonstrated with clinophosinaite crystal data from the XRD spectra, with the glycoprotein salivary metabolites also showing that 5% strontium-substituted calcium has a higher binding affinity for the salivary compound, which is suitable for dentin regeneration applications. In vitro apatite formation studies showed that this material is suitable for bone regeneration applications.
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Affiliation(s)
- D Durgalakshmi
- National Centre for Nanoscience and Nanotechnology, University of Madras, Chennai, India.
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Kesavan M, Arulraj A, Sannasi V, Rajendran K, Anbarasu P, Jeyakumar D, Ramesh M. Performance of cross-linked polymers based gel electrolyte in the fabrication of quasi-solid state dye-sensitized solar cells. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/14328917.2018.1537105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M. Kesavan
- Department of Electronics, Government Arts College, Kulithalai, Tamil Nadu, India
- Department of Electronics, Government Arts College, Paramakudi, Tamil Nadu, India
- Functional Materials Division, CSIR-Central Electrochemical Research Institute, Karaikudi, Tamil Nadu, India
| | - A. Arulraj
- Functional Materials Division, CSIR-Central Electrochemical Research Institute, Karaikudi, Tamil Nadu, India
- Department of Physics, University College of Engineering – Bharathidasan Institute of Technology (BIT) campus, Anna University, Tiruchirappalli, Tamil Nadu, India
| | - V. Sannasi
- Functional Materials Division, CSIR-Central Electrochemical Research Institute, Karaikudi, Tamil Nadu, India
| | - K. Rajendran
- Department of Electronics, Government Arts College, Kulithalai, Tamil Nadu, India
- Department of Electronics, LRG Govt. Arts College (W), Tirupur, Tamil Nadu, India
| | - P. Anbarasu
- Department of Electronics, Government Arts College, Kulithalai, Tamil Nadu, India
| | - D. Jeyakumar
- Functional Materials Division, CSIR-Central Electrochemical Research Institute, Karaikudi, Tamil Nadu, India
| | - M. Ramesh
- Functional Materials Division, CSIR-Central Electrochemical Research Institute, Karaikudi, Tamil Nadu, India
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Kesavan M, Turner JH, Meyrick D, Yeo S, Cardaci G, Lenzo NP. Salvage Radiopeptide Therapy of Advanced Castrate-Resistant Prostate Cancer with Lutetium-177-Labeled Prostate-Specific Membrane Antigen: Efficacy and Safety in Routine Practice. Cancer Biother Radiopharm 2018; 33:274-281. [DOI: 10.1089/cbr.2017.2403] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Murali Kesavan
- Department of Haematology, The University of Western Australia, School of Medicine, Perth, Australia
- Department of Nuclear Medicine, The University of Western Australia, School of Medicine, Perth, Australia
| | - J. Harvey Turner
- Department of Haematology, The University of Western Australia, School of Medicine, Perth, Australia
- Department of Nuclear Medicine, The University of Western Australia, School of Medicine, Perth, Australia
| | - Danielle Meyrick
- Department of Haematology, The University of Western Australia, School of Medicine, Perth, Australia
- Department of Nuclear Medicine, The University of Western Australia, School of Medicine, Perth, Australia
| | - Sharon Yeo
- Department of Haematology, The University of Western Australia, School of Medicine, Perth, Australia
- Department of Nuclear Medicine, The University of Western Australia, School of Medicine, Perth, Australia
| | - Giuseppe Cardaci
- Department of Nuclear Medicine, School of Medicine, The University of Notre Dame, Fremantle, Australia
| | - Nat P. Lenzo
- Department of Haematology, The University of Western Australia, School of Medicine, Perth, Australia
- Department of Nuclear Medicine, The University of Western Australia, School of Medicine, Perth, Australia
- Theranostics Australia, East Fremantle, Australia
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Kesavan M, Prabhu J. A Survey, Design and Analysis of IoT Security and QoS Challenges. International Journal of Information System Modeling and Design 2018. [DOI: 10.4018/ijismd.2018070103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
IoT is a technological exemplar with a vision of “Everything is connected” enabling everyone to publish their generated data collected from different heterogeneous and homogenous systems onto the web. The basic concept of IoT is connectivity, a set of physical objects that use network support to exchange data. These objects can be software, boards, sensors, etc. In the real end to end network deployment, IoT is a platform and cloud is one part of it. In order to turn the IoT vision into reality high reliability, security and QoS are required to support the communications between the homogenous and heterogeneous networks. The security and QoS are critical factors in the real End to End topology. In this article, the authors proposed the various challenges for IoT security, and IoT routing between the edge and cloud.
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Affiliation(s)
- M Kesavan
- Research Scholar, SITE, VIT University, Vellore, India
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Raguvaran R, Manuja A, Manuja BK, Riyesh T, Singh S, Kesavan M, Dimri U. Sodium alginate and gum acacia hydrogels of zinc oxide nanoparticles reduce hemolytic and oxidative stress inflicted by zinc oxide nanoparticles on mammalian cells. Int J Biol Macromol 2017; 101:967-972. [DOI: 10.1016/j.ijbiomac.2017.03.180] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/27/2017] [Accepted: 03/29/2017] [Indexed: 01/13/2023]
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Kesavan M, Boucek J, MacDonald W, McQuillan A, Turner JH. Imaging of Early Response to Predict Prognosis in the First-Line Management of Follicular Non-Hodgkin Lymphoma with Iodine-131-Rituximab Radioimmunotherapy. Diagnostics (Basel) 2017; 7:diagnostics7020026. [PMID: 28498337 PMCID: PMC5489946 DOI: 10.3390/diagnostics7020026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 02/27/2017] [Revised: 05/04/2017] [Accepted: 05/09/2017] [Indexed: 12/13/2022] Open
Abstract
The purpose of this study was to evaluate prediction of prognosis after first-line radioimmunotherapy (RIT) of advanced follicular non-Hodgkin lymphoma (FL), by imaging with fluorine-18-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG-PET/CT) three months after induction treatment by Iodine-131-rituximab (131I-rituximab). Objective response was determined using the Deauville 5-point scale in 68 prospective clinical trial patients. Baseline 18F-FDG-PET/CT studies were used to calculate total-metabolic-tumor-volume (TMTV). Non-imaging studies included the Follicular lymphoma international prognostic index (FLIPI) and absolute baseline monocyte and lymphocyte counts. Patients were monitored for over ten years (median follow-up 59 months), and no patient was lost to follow-up. Complete response (CR) of 88% predicted excellent prognosis with median time-to-next-treatment (TTNT) not yet reached. Those patients (12%) who failed to achieve CR (Deauville ≤ 3) on 18F-FDG-PET/CT at three months had significantly poorer outcomes (p < 0.0001) with a median TTNT of 41 months. Requirement for re-treatment was predicted by FLIPI and absolute baseline monocyte count but not lymphocyte count. The TTNT was accurately predicted by 18F-FDG-PET/CT Deauville response at three months following first-line therapy of FL with RIT. Early response demonstrated by imaging does, therefore, foretell prognosis in the individual FL patients.
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Affiliation(s)
- Murali Kesavan
- Departments of Haematology and Nuclear Medicine, The University of Western Australia, School of Medicine, Crawley 6009, Western Australia, Australia.
| | - Jan Boucek
- Departments of Haematology and Nuclear Medicine, The University of Western Australia, School of Medicine, Crawley 6009, Western Australia, Australia.
| | - William MacDonald
- Departments of Haematology and Nuclear Medicine, The University of Western Australia, School of Medicine, Crawley 6009, Western Australia, Australia.
| | - Andrew McQuillan
- Departments of Haematology and Nuclear Medicine, The University of Western Australia, School of Medicine, Crawley 6009, Western Australia, Australia.
| | - J Harvey Turner
- Departments of Haematology and Nuclear Medicine, The University of Western Australia, School of Medicine, Crawley 6009, Western Australia, Australia.
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Kulkarni K, Arasappa R, Prasad K, Zutshi A, Chand P, Murthy P, Kesavan M. Comorbid depressive symptoms in persistent delusional disorder: A retrospective study from India. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.02.210] [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: 11/26/2022] Open
Abstract
BackgroundPrevious studies have reported depressive symptoms in patients with persistent delusional disorder (PDD). Patients with PDD and depression may need antidepressants for treatment.AimThe aim of the study was to compare the sociodemographic profile, clinical presentation and treatment response in patients with PDD with and without comorbid depressive symptoms.MethodsWe conducted a retrospective chart review of patients diagnosed with PDD (ICD-10) from 2000 to 2014 (n = 455). We divided the patients into PDD + depression (n = 187) and PDD only (n = 268) for analysis.ResultsOf the 187 patients with PDD + D, only eighteen (3.9%) were diagnosed with syndromal depression. There were no significant differences in sociodemographic profile including sex, marital and socioeconomic status (all P > 0.05). PDD + D group had a significantly younger age at onset ([PDD + D: 30.6 9.2 years vs. PDD: 33.5 11.1 years]; t = 2.9, P < 0.05). There was no significant difference between the clinical presentation including mode of onset, the main theme of their delusion and secondary delusions (all P > 0.3). However, comorbid substance dependence was significantly higher in patients with PDD only. (χ2 = 5.3, P = 0.02). In terms of treatment, response to antipsychotics was also comparable ([> 75% response: PDD + D = 77/142 vs. PDD = 106/179); χ2 = 1.9, P = 0.3). There was a significant difference between the two groups in terms of antidepressant treatment ([PDD + D = 32/187; 17% vs PDD: 17/268; 6%), χ2 = 12.9, P = 0.001).DiscussionPatients with PDD + D had significantly earlier onset of illness. These patients may require antidepressants for treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Sanjay N, Basavaraju R, Biradar S, Mehta U, Kesavan M, Thirthalli J, Ganesan V. Cortical Inhibition in Symptomatic and Remitted Mania Compared to Healthy Subjects: A Paired-pulse TMS Study. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.244] [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: 10/19/2022] Open
Abstract
IntroductionCortical inhibition (CI) is a neurophysiological outcome of the interaction between GABA inhibitory interneurons and other excitatory neurons. Transcranial magnetic stimulation (TMS) measures of CI deficits have been documented in both symptomatic and remitted bipolar disorder (BD) suggesting it could be a trait marker. The effects of medications and duration of illness may contribute to these findings.ObjectiveTo study CI in BD.AimsTo compare CI across early-course medication-naive BD-mania, remitted first episode mania (FEM) and healthy subjects (HS).MethodsSymptomatic BD subjects having < 3 episodes, currently in mania and medication-naive (n = 27), remitted FEM (n = 27; YMRS < 12 and HDRS < 8) and 45 HS, matched for age and gender, were investigated. Resting motor threshold (RMT) and 1-millivolt motor threshold (MT1) were estimated from the right first dorsal interosseous muscle. Paired-pulse TMS measures of short (SICI; 3ms) and long interval intracortical inhibition (LICI; 100ms) were acquired. Group differences in measures of CI were examined using ANOVA.ResultsTable 1.ConclusionsSymptomatic mania patients had the highest motor thresholds and the maximum LICI indicating a state of an excessive GABA-B neurotransmitter tone. Remitted mania patients had deficits in SICI indicating reduced GABA-A neurotransmitter tone. Putative changes in GABA-A neurotransmitter system activity with treatment may be investigated in future studies. CI has received less attention in BD as compared to schizophrenia and is a potential avenue for future research in this area.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Abstract
AIM This review of the literature, and the authors' own decade of experience with lutetium-177-octreotate-capecitabine±temozolomide peptide receptor radionuclide therapy (PRRT)-chemotherapy of GEPNETs, analyses the risk of both short- and long-term hematotoxicity. BACKGROUND Myelodysplastic syndrome (MDS) and acute leukemia (AL) have been associated with PRRT in heavily pretreated patients with a history of exposure to alkylating agents. Commenced 15 years ago, PRRT is now becoming established as first- and second-line therapy for gastroentero pancreatic neuroendocrine tumors (GEPNETs), and early treatment minimizes myelotoxicity, which is the most significant potential adverse event following PRRT. RESULTS Sixteen key articles involving primary research were identified. A total of 2225 patients were treated (2104 treated with PRRT monotherapy and 121 with PRRT combined with chemotherapy). The average age of patients in these studies ranged from 53 to 64 years with median duration of follow-up ranging from 6 to 62 months. Short-term myelotoxicity was observed in 221 patients (10%), occurring in 213 of 2104 patients treated with PRRT monotherapy and 8 of 121 patients treated with PRRT combined with chemotherapy. Acute toxicity manifested as modest self-limited grade 3/4 toxicity (CTCAE or WHO), most often affecting platelets during the first cycle of treatment. Toxicity manifesting early was easily managed with dose modification or therapy cessation and was ameliorated by appropriate patient selection. MDS/AL was a rare stochastic event occurring in 32 (1.4%) patients. Where bone marrow biopsy was performed, cases of MDS displayed cytogenetic abnormalities, consistent with secondary MDS. Factors associated with myelotoxicity included age >70 years, impaired renal function, baseline cytopenias, prior number of therapies, prior chemotherapy (alkylating agents), and prior radiotherapy. CONCLUSION Early therapy with PRRT-containing regimens improves outcomes, minimizes myelotoxicity, and renders the risk of MDS and AL negligible.
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Affiliation(s)
- Murali Kesavan
- School of Medicine and Pharmacology, The University of Western Australia , Crawley, Australia
| | - J Harvey Turner
- School of Medicine and Pharmacology, The University of Western Australia , Crawley, Australia
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Kesavan M, Chuah H, Murray M, Dixon T. A case of acquired high molecular weight kininogen deficiency. Pathology 2016. [DOI: 10.1016/j.pathol.2015.12.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bindu M, Kumar AA, Kesavan M, Suresh V. Effect of preoperative pregabalin on postoperative pain relief in thyroidectomy patients: A prospective observational study. Anesth Essays Res 2015; 9:161-6. [PMID: 26417121 PMCID: PMC4563951 DOI: 10.4103/0259-1162.156292] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 11/18/2022] Open
Abstract
Background: Effective management of postoperative pain leads to increased patient satisfaction, earlier mobilization, reduced hospital stay and costs. One of the methods used for management of postoperative pain is preemptive analgesia-blockade of afferent nerve fibers before a painful stimulus. It modifies peripheral and central nervous system processing of noxious stimuli and reduces postoperative opioid consumption. In this study, we sought to determine whether the preoperative use of pregabalin reduced postoperative pain and morphine consumption in thyroidectomy. Materials and Methods: The observation was conducted on patients undergoing thyroidectomy surgery in two groups of 30 each. Of the two groups, one received a single oral dose of pregabalin 1 h preoperatively. Both the group of patients undergoes anesthesia in a similar manner. Following surgery the efficacy of the preoperative dose of pregabalin is observed by measuring the total opioid consumption 6 h postoperatively and assessing verbal numeric pain scales. Results: The mean time to request of rescue analgesia in pregabalin group was 322.07 ± 69.106 min when compared to morphine group 256.33 ± 111.978 min (P < 0.05). The mean pain scores in the postoperative period were also significantly lower in patients receiving pregabalin. Conclusion: Single oral dose of pregabalin was effective in reducing acute postoperative pain in thyroidectomy patients. It prolongs the time to the request of rescue analgesia and also results in lower postoperative pain scores in the immediate postoperative period. However a statistically significant low opioid consumption could not be proved.
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Affiliation(s)
- M Bindu
- Department of Anaesthesia and Critical Care, Medical College, Thrissur, Kerala, India
| | - A Arun Kumar
- Department of Anaesthesia and Critical Care, Medical College, Thrissur, Kerala, India
| | - M Kesavan
- Department of Anaesthesia and Critical Care, Medical College, Thrissur, Kerala, India
| | - Varun Suresh
- Department of Anaesthesia and Critical Care, Medical College, Thrissur, Kerala, India
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Dhama K, Kesavan M, Karthik K, . A, Tiwari R, Sunkara LT, Singh R. Neuroimmunomodulation Countering Various Diseases, Disorders, Infections, Stress and Aging. INT J PHARMACOL 2015. [DOI: 10.3923/ijp.2015.76.94] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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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Sethu Raman M, Kesavan M, Senthilkumar K, Ponnuswamy V. Ultrasonic, DFT and FT-IR studies on hydrogen bonding interactions in aqueous solutions of diethylene glycol. J Mol Liq 2015. [DOI: 10.1016/j.molliq.2014.12.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Kesavan M, Claringbold PG, Turner JH. Hematological toxicity of combined 177Lu-octreotate radiopeptide chemotherapy of gastroenteropancreatic neuroendocrine tumors in long-term follow-up. Neuroendocrinology 2014; 99:108-17. [PMID: 24714208 DOI: 10.1159/000362558] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 03/28/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The combination of radiopeptide therapy [peptide receptor radionuclide therapy (PRRT)] with radiosensitizing chemotherapy of gastroenteropancreatic neuroendocrine tumors (GEP NETs) may improve efficacy, but has the potential to increase myelotoxicity. In a prospective clinical study of GEP NET patients treated with (177)Lu-octreotate PRRT in combination with capecitabine and temozolomide, as a prelude to a planned Australasian Gastro-Intestinal Trials Group (AGITG) international randomized controlled trial, we characterized the incidence and degree of hematological toxicity. MATERIALS AND METHODS Well-differentiated progressive metastatic GEP NETs in 65 patients were treated with 4 cycles of 7.8 GBq (177)Lu-octreotate, 1,650 mg/m(2) capecitabine (n = 28) and 1,500 mg/m(2) capecitabine with 200 mg/m(2) temozolomide (n = 37), and monitored for hematological toxicity over a 5-year period. RESULTS Short-term, self-limited hematological toxicity grade 3/4 comprised anemia in 1 patient (3.5%) in the 28 patient-cohort of patients treated with (177)Lu-octreotate and capecitabine. One of these patients (3.5%) later developed significant anemia and one developed thrombocytopenia (3.5%) over a median follow-up of 60 months (SD 20). The incidence of short-term grade 3/4 reversible myelosuppression in 37 patients after (177)Lu-octreotate/capecitabine/temozolomide was zero. Long- term follow-up for a median of 36 months (SD 11) showed significant thrombocytopenia in 2.7% and neutropenia in 2.7% of the patients and anemia in 10.8% of the patients (n = 4). The 3-year median hemoglobin and platelet and neutrophil counts trended downwards, but remained within normal ranges. Two patients in this cohort developed myelodysplastic syndrome. CONCLUSION The modest reversible hematological toxicity of PRRT of GEP NETs is not significantly increased by the addition of radiosensitizing chemotherapy with capecitabine and temozolomide in combination with (177)Lu-octreotate, which has the potential to enhance the efficacy of radiopeptide therapy.
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Affiliation(s)
- Murali Kesavan
- Department of Hematology, Fremantle Hospital, The University of Western Australia, Fremantle, W.A., Australia
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Karthik K, Kesavan M, Tamilmahan P, Saravanan M, Dashprakash M. Neutrophils in Tuberculosis: will the code be unlocked. Vet World 2013. [DOI: 10.5455/vetworld.2013.118-121] [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: 11/03/2022] Open
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Tharakan ST, Kuttan G, Kuttan R, Kesavan M, Rajagopalan K. Immunostimulatory action of AC II--an ayurvedic formulation useful in HIV. Indian J Exp Biol 2008; 46:47-51. [PMID: 18697571] [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: 05/26/2023]
Abstract
Immunostimulatory activity of AC II, a registered ayurvedic preparation prepared at Amala Ayurvedic Research Centre for treating HIV and AIDS is reported. AC II administration could significantly enhance the mitogen-induced proliferation of lymphocytes of spleen cells. It was also found to increase cell-mediated immune responses in normal and tumor-bearing control animals. Oral administration of AC II significantly enhanced Natural Killer cell activity in normal and tumor-bearing animals on the 7th day, which was observed earlier than the tumor-bearing control animals and normal animals. Antibody dependent cellular cytotoxicity (ADCC) was also increased in AC II treated normal and tumor-bearing animals. An early enhancement of antibody-dependent complement-mediated cytotoxicity was also observed by the administration of AC II in normal as well as tumor-bearing animals. Treatment with AC II elevated the levels of IL-2, TNF-alpha and IFN-gamma in normal mice. Administration of AC II was also found to increase the cytotoxic T lymphocyte production in EL4 treated mice. These studies support the use of this immune stimulatory preparation in HIV patients.
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Tharakan ST, Kuttan G, Kuttan R, Kesavan M, Austin S, Rajagopalan K. Effect of AC II, an herbal formulation in cyclophosphamide-induced immunosuppression in BALB/c mice--Implication in HIV treatment. Immunol Invest 2007; 36:147-57. [PMID: 17365016 DOI: 10.1080/08820130600941153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Effect of AC II, herbal drug formulation in reducing immunosuppression caused by administration of cyclophosphamide was studied. Mice were injected cyclophosphamide (CTX) 50 mg/kg b.wt. for 14 days with or without the drug and total WBC, bone marrow cellularity and alpha-esterase positive cells were determined. On day 15, total WBC count in cyclophosphamide treated mice was 1500 +/- 420 cells/mm3, while in AC II-treated mice it was 7658 +/- 376 cells/mm3. On day 16, administration of cyclophosphamide reduced bone marrow cellularity to 3.42 +/- 0.38 x 10(6) cells/femur from the normal value of 13.83 +/- 0.96 x 10(6) cells/femur. In AC II treated group bone marrow cellularity was increased to 8.05 +/- 0.7 x 10(6) cells/femur. The number of alpha-esterase positive cells was found to be reduced to 177 +/- 25 cells per 4000 cells in CTX treated groups. But in AC II-treated group the number of alpha-esterase positive cells were raised to 843 +/- 86 cells per 4000 cells, which was closer to that of normal (710 +/- 49 cells per 4000 cells). Results indicate the usefulness of AC II to combat immunosuppression induced by chemical and biological agents.
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Donata, Kesavan M, Austin, Mohan K, Rajagopalan K, Kuttan R. Clinical trial of certain ayurvedic medicines indicated in vitiligo. Anc Sci Life 1990; 9:202-6. [PMID: 22557698 PMCID: PMC3331338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/1990] [Accepted: 02/20/1990] [Indexed: 11/08/2022] Open
Abstract
An Ayurvedic preparation consisting of dried ginger, black pepper, pippali and leadwort root fermented in cow's urine was given internally and a paste made of several meical herbs including Psoralea corylifolia for external application was tried in patients with vitiligo. 4 out of 10 patients had relief within six months of treatment. Three patients had relief with adverse reaction on the skin and other did not respond. The preparations did not have any adverse effect in the body as seen from haematological parameters and biochemical tests.
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Affiliation(s)
- Donata
- Ayurvedic Research Section
| | | | - Austin
- Ayurvedic Research Section
| | | | | | - Ramadasan Kuttan
- Amala Cancer Hospital and Research Centre, Amala Nagar, Trichur-680 553, Kerala, India
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Salomi M, Panikkar K, Kesavan M, Donata K, Rajagopalan K. Anti-cancer activity of nigella sativa. Anc Sci Life 1989; 8:262-6. [PMID: 22557660 PMCID: PMC3336718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/1988] [Accepted: 08/16/1988] [Indexed: 11/16/2022] Open
Abstract
An extract of Smilax china, Hemidesmus indicus and Nigella Sativa on the ratio 3:2:1, prepared by boiling in water and concentrated could completely cure cases of oral canger diagnosed by modern methods. Cytotoxic studies with the three components showed activity in Nigella sativa at a concentration of 25 microgram equivalent of the dry powder against Dalton's lymphoma ascites cells. Animal experiments indicated the retarded growth of ascites as compared to the controls with a longivity of 90%.
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Affiliation(s)
- M.J. Salomi
- Amala Cancer Research Centre, Trichur 680 553, India
| | - K.R. Panikkar
- Amala Cancer Research Centre, Trichur 680 553, India
| | - M. Kesavan
- Ayurveda Hospital & Reserch Centre, Amala Cancer Hospital , Trichur, 680 553, India
| | - K. Donata
- Ayurveda Hospital & Reserch Centre, Amala Cancer Hospital , Trichur, 680 553, India
| | - K. Rajagopalan
- Ayurveda Hospital & Reserch Centre, Amala Cancer Hospital , Trichur, 680 553, India
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Jayavardhanan K, Pannikar K, Kesavan M, Donata, Rajagopalan K. Antipoisonous property of canavalia virosa. Anc Sci Life 1988; 8:103-5. [PMID: 22557638 PMCID: PMC3331357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/1988] [Accepted: 07/29/1988] [Indexed: 10/25/2022] Open
Abstract
Canavalia virosa seed is applied on the wound after removing the seed coat. This sticks to the skin till the poison is completely removed and falls off which takes five to seven hours. There is complete relief of the poisoning in the case of Scorpion, Centipede., and the seeds which have been detected and studied here.
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Affiliation(s)
| | - K.R. Pannikar
- Amala Cancer Research Centre. Trichur 680 533, India
| | - M. Kesavan
- Ayurveda Hospital & Research Centre, Amala Cancer Hospital, 580 533, India
| | - Donata
- Ayurveda Hospital & Research Centre, Amala Cancer Hospital, 580 533, India
| | - K. Rajagopalan
- Ayurveda Hospital & Research Centre, Amala Cancer Hospital, 580 533, India
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Suresh K, Nirmala K, Donata, Kesavan M, Vasudevan DM. Preliminary studies on the immunopotentiating action of some ayurvedic preparations. Anc Sci Life 1988; 8:41-3. [PMID: 22557628 PMCID: PMC3331351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/1986] [Accepted: 07/28/1987] [Indexed: 11/29/2022] Open
Abstract
Ten healthy controls, 9 Rheumatoid Arthritis patients and 5 cancer patients were studied for T and B cells in peripheral circulation. T cell count in cancer patients showed a slight enhancement after receiving Ayurvedic Treatment; but the B cell count remained the same. In Rheumatoid Arthritis patients no significant change was noticed either in T cell or cell count.
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Affiliation(s)
- K. Suresh
- Amala Cancer Research Centre, Trichur-680 553, Kerala, India
| | - K. Nirmala
- Amala Cancer Research Centre, Trichur-680 553, Kerala, India
| | - Donata
- Amala Cancer Research Centre, Trichur-680 553, Kerala, India
| | - M. Kesavan
- Amala Cancer Research Centre, Trichur-680 553, Kerala, India
| | - D. M. Vasudevan
- Amala Cancer Research Centre, Trichur-680 553, Kerala, India
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