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Mandavia R, Parmar D, Ahmed MN, Berber V, Sanz D, Paulucci B, D'Souza AR. An Overview of Rhinoplasty Practices: European Academy of Facial Plastic Surgery, Collaborative Cross-Sectional Study. Facial Plast Surg 2024; 40:31-35. [PMID: 36787791 DOI: 10.1055/a-2034-8397] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
This collaborative European Academy of Plastic Surgery (EAFPS) study aimed to provide an overview of rhinoplasty practices, informing clinician and patient decision making. It is a multicenter cross-sectional study, reported as per Strengthening the Reporting of Observational Studies in Epidemiology guidelines. All EAFPS members were contacted via email, inviting them to participate. Members expressing an interest to participate were asked to anonymously complete a questionnaire, related to rhinoplasties that they performed as first/supervising surgeon over a period from January 1, 2019 to January 1, 2022. A descriptive analysis was performed. One hundred and fifteen surgeons submitted data on 41,259 rhinoplasties from 33 countries. Eighty percent of rhinoplasties were primary, and 20% were secondary. Thirty five percent of primary rhinoplasties were closed and 65% were open. Thirty one percent of primary rhinoplasties were for cosmetic indications, 11% functional and 58% were for both. Of the 8147 secondary rhinoplasties, 44% were closed and 56% were open. Thirty percent were for cosmetic indications, 11% functional, and 59% for both cosmetic and functional. Ninety-one percent of rhinoplasties were performed by ENT surgeons, 3% by plastic surgeons, 5% by maxillofacial surgeons, and 1% were dual (maxillofacial and ENT) trained. One-thousand seven-hundred thirty primary rhinoplasties underwent revision surgery (5%) and 102 secondary rhinoplasties underwent revision surgery (1%). The most commonly reported indications for revision surgery were dorsal asymmetry, nasal blockage, and dissatisfaction with nasal tip. Three percent of rhinoplasties underwent preoperative psychological assessment. To the authors knowledge, this is the largest published rhinoplasty dataset. This study provides an overview of rhinoplasty practices that can be used for benchmarking and to guide clinician and patient decision making. Psychological assessment of prerhinoplasty appears insufficient with higher levels recommended to minimize unsuccessful outcomes. This study showcases the power of collaborative research and may serve as a catalyst for future collaborative facial plastic surgery research.
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Affiliation(s)
- R Mandavia
- Department of ENT, Head and Neck Surgery, University College London Hospitals, NHS Trust, London, United Kingdom
| | - D Parmar
- Bedfordshire Hospitals NHS Foundation Trust, Luton, United Kingdom
| | - M N Ahmed
- Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - V Berber
- Department of Otolaryngology, Ege University, Izmir, Turkey
| | - D Sanz
- Miguel Servet University Hospital, Zaragoza, Spain
| | - B Paulucci
- Royal Free NHS Trust, London, United Kingdom
| | - A R D'Souza
- Department of Otolaryngology, Lewisham and Greenwich NHS Trust UK, London, United Kingdom
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Srivastava S, Bertone MP, Parmar D, Walsh C, De Allegri M. The genesis of the PM-JAY health insurance scheme in India: technical and political elements influencing a national reform towards universal health coverage. Health Policy Plan 2023:czad045. [PMID: 37436821 DOI: 10.1093/heapol/czad045] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 04/18/2023] [Accepted: 06/30/2023] [Indexed: 07/13/2023] Open
Abstract
Many countries are using health insurance to advance progress towards universal health coverage (UHC). India launched the Pradhan Mantri Jan Arogya Yojana (PM-JAY) health insurance scheme in 2018. We examine the political economy context around PM-JAY policy formulation, by examining the perspectives of policy stakeholders shaping decisions around the reform. More specifically, we focus on early policy design at the central (national) level. We use a framework on the politics of UHC reform proposed by Fox and Reich (The politics of universal health coverage in low- and middle-income countries: A framework for evaluation and action. J. Health Polit. Policy Law 2015;40:1023-1060), to categorize the reform into phases and examine the interactions between actors, institutions, interests, ideas and ideology which shaped reform decisions. We interviewed 15 respondents in Delhi between February and April 2019, who were either closely associated with the reform process or subject experts. The ruling centre-right government introduced PM-JAY shortly before national elections, drawing upon policy legacies from prior and state insurance schemes. Empowered policy entrepreneurs within the government focused discourse around ideas of UHC and strategic purchasing, and engaged in institution building leading to the creation of the National Health Authority and State Health Agencies through policy directives, thereby expanding state infrastructural and institutional power for insurance implementation. Indian state inputs were incorporated in scheme design features like mode of implementation, benefit package and provider network, while features like the coverage amount, portability of benefits and branding strategy were more centrally driven. These balanced negotiations opened up political space for a cohesive, central narrative of the reform and facilitated adoption. Our analysis shows that the PM-JAY reform focused on bureaucratic rather than ideological elements and that technical compromises and adjustments accommodating the interests of states enabled the political success of policy formulation. Appreciating these politics, power and structural issues shaping PM-JAY institutional design will be important to understand how PM-JAY is implemented and how it advances UHC in India.
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Affiliation(s)
- S Srivastava
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, Baden-Württemberg 69120, Germany
| | - M P Bertone
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland EH21 6UU, UK
| | - D Parmar
- King's Centre for Global Health and Health Partnerships, School of Life Course and Population Sciences, King's College London, Strand, London WC2R 2LS, UK
| | - C Walsh
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, Baden-Württemberg 69120, Germany
| | - M De Allegri
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, Baden-Württemberg 69120, Germany
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Parmar D, Rodriguez-Gutierrez R, González-González J, Shaikh F, Cruz-López J. Efficacy and safety of saroglitazar 4 mg compared to fenofibrate 160 mg in latino adults with moderate to severe hypertriglyceridemia-a randomized clinical trial. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kumar S, Pramudya Y, Müller K, Chandresh A, Dehm S, Heidrich S, Fediai A, Parmar D, Perera D, Rommel M, Heinke L, Wenzel W, Wöll C, Krupke R. Sensing Molecules with Metal-Organic Framework Functionalized Graphene Transistors. Adv Mater 2021; 33:e2103316. [PMID: 34496451 DOI: 10.1002/adma.202103316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/13/2021] [Indexed: 06/13/2023]
Abstract
Graphene is inherently sensitive to vicinal dielectrics and local charge distributions, a property that can be probed by the position of the Dirac point in graphene field-effect transistors. Exploiting this as a useful sensing principle requires selectivity; however, graphene itself exhibits no molecule-specific interaction. Complementarily, metal-organic frameworks can be tailored to selective adsorption of specific molecular species. Here, a selective ethanol sensor is demonstrated by growing a surface-mounted metal-organic framework (SURMOF) directly onto graphene field-effect transistors (GFETs). Unprecedented shifts of the Dirac point, as large as 15 V, are observed when the SURMOF/GFET is exposed to ethanol, while a vanishingly small response is observed for isopropanol, methanol, and other constituents of the air, including water. The synthesis and conditioning of the hybrid materials sensor with its functional characteristics are described and a model is proposed to explain the origin, magnitude, and direction of the Dirac point voltage shift. Tailoring multiple SURMOFs to adsorb specific gases on an array of such devices thus generates a versatile, selective, and highly sensitive platform for sensing applications.
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Affiliation(s)
- Sandeep Kumar
- Institute of Nanotechnology, Karlsruhe Institute of Technology, 76021, Karlsruhe, Germany
- Institute of Materials Science, Technische Universität Darmstadt, 64287, Darmstadt, Germany
| | - Yohanes Pramudya
- Institute of Nanotechnology, Karlsruhe Institute of Technology, 76021, Karlsruhe, Germany
| | - Kai Müller
- Institute of Functional Interfaces, Karlsruhe Institute of Technology, 76021, Karlsruhe, Germany
| | - Abhinav Chandresh
- Institute of Functional Interfaces, Karlsruhe Institute of Technology, 76021, Karlsruhe, Germany
| | - Simone Dehm
- Institute of Nanotechnology, Karlsruhe Institute of Technology, 76021, Karlsruhe, Germany
| | - Shahriar Heidrich
- Institute of Nanotechnology, Karlsruhe Institute of Technology, 76021, Karlsruhe, Germany
| | - Artem Fediai
- Institute of Nanotechnology, Karlsruhe Institute of Technology, 76021, Karlsruhe, Germany
| | - Devang Parmar
- Institute of Quantum Materials and Technologies, Karlsruhe Institute of Technology, 76021, Karlsruhe, Germany
| | - Delwin Perera
- Institute of Materials Science, Technische Universität Darmstadt, 64287, Darmstadt, Germany
| | - Manuel Rommel
- Institute of Nanotechnology, Karlsruhe Institute of Technology, 76021, Karlsruhe, Germany
| | - Lars Heinke
- Institute of Functional Interfaces, Karlsruhe Institute of Technology, 76021, Karlsruhe, Germany
| | - Wolfgang Wenzel
- Institute of Nanotechnology, Karlsruhe Institute of Technology, 76021, Karlsruhe, Germany
| | - Christof Wöll
- Institute of Functional Interfaces, Karlsruhe Institute of Technology, 76021, Karlsruhe, Germany
| | - Ralph Krupke
- Institute of Nanotechnology, Karlsruhe Institute of Technology, 76021, Karlsruhe, Germany
- Institute of Materials Science, Technische Universität Darmstadt, 64287, Darmstadt, Germany
- Institute of Quantum Materials and Technologies, Karlsruhe Institute of Technology, 76021, Karlsruhe, Germany
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Sharma AC, Srivastava RN, Srivastava SR, Agrahari A, Singh A, Parmar D. Evaluation of the association between a single-nucleotide polymorphism of bone morphogenetic proteins 5 gene and risk of knee osteoarthritis. J Postgrad Med 2019; 63:151-156. [PMID: 28695869 PMCID: PMC5525478 DOI: 10.4103/jpgm.jpgm_450_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Osteoarthritis (OA) is a chronic degenerative disorder probably affected by both genetic and environmental causes. Bone morphogenetic proteins (BMPs) are bone-derived factors that can induce new bone formation. Single-nucleotide polymorphisms (SNPs) of BMP5 gene alters the transcriptional activity of the BMP5 promoter that has been involved in OA susceptibility. This case–control study investigated the association of rs1470527 and rs9382564 SNP of BMP5 gene with susceptibility to knee OA (KOA). Materials and Methods: A total of 499 cases with radiographic KOA and 458 age- and sex-matched healthy controls were enrolled. Venous blood samples were obtained from all the cases as well as controls for polymerase chain reaction-restriction fragment length polymorphism. Results: The genotype distribution for rs1470527 and rs9382564 SNP was significantly different in cases and controls (P < 0.0001). Within both the SNPs of BMP5 gene, genotype CT and TT were significantly (P < 0.0001) associated with KOA as compared to the CC genotype. T allele of both the studied SNP was significantly associated with KOA (P < 0.0001). The allele frequencies of rs1470527 were 0.56(T) and 0.44(C) in cases and 0.33(T) and 0.67(C) in controls and in rs9382564 were 0.57(C) and 0.43(T) in cases and 0.71(C) and 0.29(T) in controls. Further in relation with clinical severity of OA, we observed signification association of TT genotype with both visual analog scale (P < 0.0001) and Western Ontario and McMaster Universities score (P < 0.05). Conclusion: Our results indicate significant association of rs1470527 and rs9382564 polymorphism of BMP5 gene with KOA.
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Affiliation(s)
- A C Sharma
- Department of Orthopaedic Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - R N Srivastava
- Department of Orthopaedic Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - S R Srivastava
- Department of Orthopaedic Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - A Agrahari
- Department of Orthopaedic Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - A Singh
- Department of Orthopaedic Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - D Parmar
- Developmental Toxicology Division, IITR, Lucknow, Uttar Pradesh, India
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Mudawal A, Srivastava A, Singh A, Shankar J, Yadav S, Mishra M, Singh PK, Khanna VK, Parmar D. Corrigendum to 'Proteomic approaches to investigate age related vulnerability to lindane induced neurodegenerative effects in rats' [Food Chem. Toxicol.] 115 (2018) 499-510. Food Chem Toxicol 2019; 133:110752. [PMID: 31431304 DOI: 10.1016/j.fct.2019.110752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- A Mudawal
- Developmental Toxicology Laboratory, Systems Toxicology & Health Risk Assessment Group, CSIR-Indian Institute of Toxicology Research (IITR), Vishvigyan Bhavan, 31, M.G. Marg, Lucknow, 226 001, U.P., India; Academy of Scientific & Innovative Research (AcSIR), New Delhi, India
| | - A Srivastava
- Developmental Toxicology Laboratory, Systems Toxicology & Health Risk Assessment Group, CSIR-Indian Institute of Toxicology Research (IITR), Vishvigyan Bhavan, 31, M.G. Marg, Lucknow, 226 001, U.P., India
| | - A Singh
- Developmental Toxicology Laboratory, Systems Toxicology & Health Risk Assessment Group, CSIR-Indian Institute of Toxicology Research (IITR), Vishvigyan Bhavan, 31, M.G. Marg, Lucknow, 226 001, U.P., India
| | - J Shankar
- Microscopy Laboratory, CSIR-Indian Institute of Toxicology Research, Vishvigyan Bhavan, 31, M.G. Marg, Lucknow, 226 001, U.P., India
| | - S Yadav
- Developmental Toxicology Laboratory, Systems Toxicology & Health Risk Assessment Group, CSIR-Indian Institute of Toxicology Research (IITR), Vishvigyan Bhavan, 31, M.G. Marg, Lucknow, 226 001, U.P., India
| | - M Mishra
- Plant Molecular Biology Laboratory, CSIR-National Botanical Research Institute, Rana Pratap Marg, Lucknow, 226 001, India
| | - P K Singh
- Plant Molecular Biology Laboratory, CSIR-National Botanical Research Institute, Rana Pratap Marg, Lucknow, 226 001, India
| | - V K Khanna
- Developmental Toxicology Laboratory, Systems Toxicology & Health Risk Assessment Group, CSIR-Indian Institute of Toxicology Research (IITR), Vishvigyan Bhavan, 31, M.G. Marg, Lucknow, 226 001, U.P., India
| | - D Parmar
- Developmental Toxicology Laboratory, Systems Toxicology & Health Risk Assessment Group, CSIR-Indian Institute of Toxicology Research (IITR), Vishvigyan Bhavan, 31, M.G. Marg, Lucknow, 226 001, U.P., India.
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Parmar D, Krishnappa M, Arifahmed F, Mali N, Patel J, Shah M, Parmar K, Shah C, Faldu K. A Clinical Trial To Evaluate The Safety And Efficacy Of Saroglitazar Compared To Fenofibrate In Patients With Dyslipidemia. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.105] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Parmar D, Kansagra K. MON-318 A PHASE II TRIAL TO ASSESS SAFETY, TOLERABILITY AND EFFICACY OF PHD-2 INHIBITOR (DESIDUSTAT-ZYAN1) IN THE TREATMENT OF ANEMIA IN PRE-DIALYSIS CHRONIC KIDNEY DISEASE PATIENTS. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.1131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abstract
Aims The increasing infection burden after total hip arthroplasty (THA) has seen a rise in the use of two-stage exchange arthroplasty and the use of increasingly powerful antibiotics at the time of this procedure. As a result, there has been an increase in the number of failed two-stage revisions during the past decade. The aim of this study was to clarify the outcome of repeat two-stage revision THA following a failed two-stage exchange due to recurrent prosthetic joint infection (PJI). Patients and Methods We identified 42 patients who underwent a two-stage revision THA having already undergone at least one previous two stage procedure for infection, between 2000 and 2015. There were 23 women and 19 men. Their mean age was 69.3 years (48 to 81). The outcome was analyzed at a minimum follow-up of two years. Results A satisfactory control of infection and successful outcome was seen in 26 patients (57%). There therefore remained persistent symptoms that either required further surgery or chronic antibiotic suppression in 16 patients (38%). One-third of patients had died by the time of two years’ follow-up. Conclusion The rate of failure and complication rate of repeat two-stage exchange THA for PJI is high and new methods of treatment including host optimization, immunomodulation, longer periods between stages, and new and more powerful forms of antimicrobial treatment should be investigated. Cite this article: Bone Joint J 2019;101-B(6 Supple B):110–115.
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Affiliation(s)
- N. Khan
- Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - D. Parmar
- Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - M. S. Ibrahim
- Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - B. Kayani
- Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - F. S. Haddad
- University College London Hospitals NHS Foundation Trust, The Princess Grace Hospital, and the NIHR Biomedical Research Centre at UCLH, London, UK
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Yadav S, Parmar D. Cys144Arg & Tyr358Cys variants (alleles *2 & *3) of CYP2C9 gene: Effect on chemotherapeutic outcomes in HNSCC. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy438.030] [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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He J, Fuelscher I, Coxon J, Barhoun P, Parmar D, Enticott P, Hyde C. Impaired motor inhibition in developmental coordination disorder. Brain Cogn 2018; 127:23-33. [DOI: 10.1016/j.bandc.2018.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/09/2018] [Accepted: 09/11/2018] [Indexed: 01/30/2023]
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Bandyopadhyay M, Chakraborty A, Rotti C, Joshi J, Patel H, Yadav A, Shah S, Tyagi H, Parmar D, Sudhir D, Gahlaut A, Bansal G, Soni J, Pandya K, Pandey R, Yadav R, Nagaraju MV, Mahesh V, Pillai S, Sharma D, Singh D, Bhuyan M, Mistry H, Parmar K, Patel M, Patel K, Prajapati B, Shishangiya H, Vishnudev M, Bhagora J. Indian Test Facility (INTF) and its updates. ACTA ACUST UNITED AC 2017. [DOI: 10.1088/1742-6596/823/1/012001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bhatia S, Parmar D. 364PD Head & neck cancer pharmacogenetics: case control study on 5- fluorouracil and cisplatin adjuvant treatment outcome. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw587.006] [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: 11/13/2022] Open
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Yadav S, Parmar D, Chauhan V. 492P G681A & G636A variants (alleles *2 & *3) of CYP2C19 gene: Susceptibility to oral cancer and chemotherapeutic outcomes. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv533.11] [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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Bhaskar B, Mullany D, Parmar D, Ziengenfuss M, Shekar K. Successful conservative management of an iatrogenic ECMO cannula--related inferior vena cava injury. Anaesth Intensive Care 2015; 43:418-419. [PMID: 25943619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Yadav S, Chauhan V, Parmar D. Pharmacogenetics & Treatment Outcome in Cancer Patients Receiving Radio-Chemotherapy. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv045.11] [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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Sawke GK, Parmar D, Sawke N. Diagnostic application of computerised nuclear morphometric image analysis in fine needle aspirates of breast lesions. Saudi J Health Sci 2015. [DOI: 10.4103/2278-0521.151409] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Shankleman J, Massat NJ, Khagram L, Ariyanayagam S, Garner A, Khatoon S, Rainbow S, Rangrez S, Colorado Z, Hu W, Parmar D, Duffy SW. Evaluation of a service intervention to improve awareness and uptake of bowel cancer screening in ethnically-diverse areas. Br J Cancer 2014; 111:1440-7. [PMID: 24983374 PMCID: PMC4183836 DOI: 10.1038/bjc.2014.363] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 05/08/2014] [Accepted: 06/09/2014] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Uptake of bowel cancer screening is lowest in London, in populations of lower socio-economic status, and in particular ethnic or religious groups. METHODS We report on the evaluation of two interventions to improve uptake in an area including populations of low socio-economic status and considerable ethnic diversity. The interventions were face-to-face health promotion on bowel cancer screening at invitees' general practice and health promotion delivered by telephone only. Nine large general practices in East London were chosen at random to offer face-to-face health promotion, and nine other large practices to offer telephone health promotion, with 24 practices of similar size as comparators. Data at practice level were analysed by Mann-Whitney-Wilcoxon tests and grouped-logistic regression. RESULTS There were 2034 invitees in the telephone intervention practices, 1852 in the face-to-face intervention practices and 5227 in the comparison practices. Median gFOBt kit uptake in the target population (aged 59-70) was 46.7% in the telephone practices, 43.8% in the face-to-face practices and 39.1% in the comparison practices. Significant improvements in the odds of uptake were observed following telephone intervention in both males (OR=1.39, 95% CI=1.20-1.61, P<0.001) and females (OR=1.49, 95% CI=1.29-1.73, P<0.001), while the face-to-face intervention mainly impacted uptake in males (OR=1.23, 95% CI=1.10-1.36), P<0.001) but did not lead to a significant increase in females (OR=1.12, 95% CI=0.96-1.29, P=0.2). CONCLUSIONS Personally delivered health promotion improved uptake of bowel cancer screening in areas of low socio-economic status and high ethnic diversity. The intervention by telephone appears to be the most effective method.
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Affiliation(s)
- J Shankleman
- Public Health, London Borough of Tower Hamlets, 4th Floor Mulberry Place, 5 Clove Crescent, London E14 1BY, UK
| | - N J Massat
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK
| | - L Khagram
- NHS Bowel Cancer Screening Programme Newham, Tower Hamlets and City & Hackney Strategic Commissioning and Community Public Health Partnerships, 4th Floor Westside, Newham Dockside, 1000 Dockside Road, London E16 2QU, UK
| | - S Ariyanayagam
- NHS England, London Region, Southside, 105 Victoria Street, London SW1E 6QT, UK
| | - A Garner
- NHS City & Hackney Clinical Commissioning Group, Lawson practice, Nuttal Street, London N1 5HZ, UK
| | - S Khatoon
- NHS Newham Clinical Commissioning Group, Warehouse K, 2 Western Gateway, London E16 1DR, UK
| | - S Rainbow
- Bowel Cancer Screening Programme London Hub, North West London Hospitals NHS Trust, Watford Road, Harrow HA1 3UJ, UK
| | - S Rangrez
- North East London Bowel Cancer Screening Programme, Homerton University Hospital Trust, Homerton Row, London E9 6SR, UK
| | - Z Colorado
- Community Links Trust, 105 Barking Road, London E16 4HQ, UK
| | - W Hu
- Community Links Trust, 105 Barking Road, London E16 4HQ, UK
| | - D Parmar
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK
| | - S W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK
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Yadav S, Pant M, Parmar D. Association of Cytochrome P450 2D6 (Cyp2D6) Polymorphisms with Susceptibility to Head & Neck Squamous Cell Carcinoma & Treatment Response. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu340.31] [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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Massat N, Tataru D, Parmar D, Sasieni P, Duffy S. Case Fatality in Breast Cancer: Relative Effect of Attendance at Breast Screening and Cancer Treatment. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu438.52] [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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Paul S, Chaudhuri T, Pant MC, Parmar D, Srivastava K. Association of cytochrome P450 2C9 polymorphism with locally advanced head and neck squamous cell carcinoma and response to concurrent cisplatin-based radical chemoradiation. South Asian J Cancer 2014; 3:154-8. [PMID: 25136521 PMCID: PMC4134605 DOI: 10.4103/2278-330x.136771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aims: The aim of the present study is to investigate the association between polymorphism of cytochrome P450 2C9 (CYP2C9) enzyme with head and neck squamous cell carcinoma (HNSCC) and response in patients receiving cisplatin-based radical chemoradiation (CT-RT). Materials and Methods: Four hundred and sixty patients suffering from locally advanced HNSCC and an equal number of healthy controls were genotyped for CYP2C9*2 and CYP2C9*013, leading to poor metabolizers (PMs) by polymerase chain reaction (PCR)-based restriction fragment length polymorphism (RFLP). Each case was assessed thoroughly for treatment response as per the World Health Organization (WHO) criteria. Results and Analysis: The frequency of heterozygous genotypes of both CYP2C9*2 (27.8%) and CYP2C9*3 (25%) were found to be significantly higher in the HNSCC cases as compared to the healthy controls. Tobacco intake in the form of chewing or smoking and alcohol intake resulted in several folds increase in the risk to HNSCC in the cases carrying variant genotypes of CYP2C9*2 or CYP2C9*013. Further, majority of the cases assessed for response (n = 436) carrying variant alleles of CYP2C9*2 (69.6%) or CYP2C9*3 (65.2%) were found to respond poorly to cisplatin-based radical CT-RT. Conclusion: The data suggests a significant association of the CYP2C9 polymorphism with HNSCC and treatment outcome underlining the importance of pretherapeutic genotyping in determining the treatment protocol.
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Affiliation(s)
- Sayan Paul
- Department of Radiotherapy, Chhatrapati Shahuji Maharaj Medical University, Formerly, King George's Medical University, Lucknow, India
| | - Tamojit Chaudhuri
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - M C Pant
- Department of Radiotherapy, Chhatrapati Shahuji Maharaj Medical University, Formerly, King George's Medical University, Lucknow, India
| | - D Parmar
- Department of Developmental Toxicology and Environmental Epidemiology, Indian Institute of Toxicology and Research, Lucknow, Uttar Pradesh, India
| | - Kirti Srivastava
- Department of Radiotherapy, Chhatrapati Shahuji Maharaj Medical University, Formerly, King George's Medical University, Lucknow, India
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Shukla A, Mohapatra TM, Parmar D, Seth K. Neuroprotective potentials of neurotrophin rich olfactory ensheathing cell's conditioned media against 6OHDA-induced oxidative damage. Free Radic Res 2014; 48:560-71. [PMID: 24528157 DOI: 10.3109/10715762.2014.894636] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
On the basis of recent reports, we propose that impaired neurotrophin signaling (PI3k/Akt), low antioxidant levels, and generation of reactive oxygen species (ROS) conjointly participate in the progressive events responsible for the dopaminergic cell loss in Parkinson's disease (PD). In the present study we tried to target these deficits collectively through multiple neurotrophic factors (NTFs) support in the form of Olfactory Ensheathing Cell's Conditioned Media (OEC CM) using human SH-SY5Y neuroblastoma cell line exposed to 6 hydroxydopamine (6OHDA). 6OHDA exposure induced, oxidative stress-mediated apoptotic cell death viz. enhanced ROS generation, diffused cytosolic cytochrome c (cyt c), impaired Bcl-2: Bax levels along with decrease in GSH content. These changes were accompanied by loss in Akt phosphorylation and TH levels in SH-SY5Y cells. OEC CM significantly checked apoptotic cell death by preserving pAkt levels which coincided with enhanced GSH and suppressed oxidative injury. Functional integrity of OEC CM supported cells was evident by maintained tyrosine hydroxylase (TH) expression. Intercepting Akt signaling by specific inhibitor LY294002 blocked the protective effect. Taken together our findings provide important evidence that the key to protective effect of multiple NTF support via OEC CM is enhanced Akt survival signaling which promotes antioxidant defense leading to suppression of oxidative damage.
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Affiliation(s)
- A Shukla
- Indian Institute of Toxicology Research (CSIR), Developmental Toxicology Division , Lucknow , India
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Dibden A, Offman J, Parmar D, Jenkins J, Slater J, Binysh K, McSorley J, Scorfield S, Cumming P, Liao XH, Ryan M, Harker D, Stevens G, Rogers N, Blanks R, Sellars S, Patnick J, Duffy SW. Reduction in interval cancer rates following the introduction of two-view mammography in the UK breast screening programme. Br J Cancer 2014; 110:560-4. [PMID: 24366303 PMCID: PMC3915134 DOI: 10.1038/bjc.2013.778] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 11/13/2013] [Accepted: 11/17/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The introduction of two-view mammography at incident (subsequent) screens in the National Health Service Breast Screening Programme (NHSBSP) has led to an increased number of cancers detected at screen. However, the effect of two-view mammography on interval cancer rates has yet to be assessed. METHODS Routine screening and interval cancer data were collated from all screening programmes in the United Kingdom for women aged 50-64, screened between 1 April 2003 and 31 March 2005. Interval cancer rates were compared based on whether two-view mammography was in use at the last routine screen. RESULTS The reduction in interval cancers following screening using two-view mammography compared with one view was 0.68 per 1,000 women screened. Overall, this suggests the introduction of two-view mammography at incident screen was accompanied by a 15-20% reduction in interval cancer rates in the NHSBSP. CONCLUSION The introduction of two-view mammography at incident screens is associated with a reduction in incidence of interval cancers. This is consistent with previous publications on a contemporaneous increase in screen-detected cancers. The results provide further evidence of the benefit of the use of two-view mammography at incident screens.
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Affiliation(s)
- A Dibden
- Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, Queen Mary, University of London, Wolfson Institute of Preventive Medicine, Charterhouse Square, London EC1M 6BQ, UK
| | - J Offman
- Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, Queen Mary, University of London, Wolfson Institute of Preventive Medicine, Charterhouse Square, London EC1M 6BQ, UK
| | - D Parmar
- Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, Queen Mary, University of London, Wolfson Institute of Preventive Medicine, Charterhouse Square, London EC1M 6BQ, UK
| | - J Jenkins
- East Midlands Quality Assurance Reference Centre (QARC), Nottingham University Hospital City Campus, Hucknall Road, Nottingham NG5 1PB, UK
| | - J Slater
- East of England QARC, 2nd Floor, Compass House, Chivers Way, Vision Park, Histon, Cambridge CB24 9AD, UK
| | - K Binysh
- London QARC, 1st Floor, 51/53 Bartholomew Close, London EC1A 7BE, UK
| | - J McSorley
- Northern Ireland QARC, 18 Ormeau Avenue, Belfast BT2 8HS, UK
| | - S Scorfield
- North East, Yorkshire and the Humber QARC, Waterfront 4, Goldcrest Way, Newburn Riverside Newcastle upon Tyne, NE15 8NY, UK
| | - P Cumming
- North West QARC, Hollinwood Business Centre, Albert Street, Oldham OL8 3QL, UK
| | - X-H Liao
- South Central QARC, 4150 Chancellor Court, Oxford Business Park South, Oxford OX4 2GX, UK
| | - M Ryan
- South East Coast QARC, 77a High Street, Battle, East Sussex TN33 0AG, UK
| | - D Harker
- South West QARC, 1st Floor, Grosvenor House, 149 Whiteladies Road, Clifton, Bristol BS8 2RA, UK
| | - G Stevens
- Public Health Wales, 18 Cathedral Road, Cardiff CF11 9LJ, UK
| | - N Rogers
- West Midlands Breast Screening QARC, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK
| | - R Blanks
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - S Sellars
- NHS Cancer Screening Programmes, Fulwood House, Old Fulwood Road, Sheffield S10 3TH, UK
| | - J Patnick
- NHS Cancer Screening Programmes, Fulwood House, Old Fulwood Road, Sheffield S10 3TH, UK
| | - S W Duffy
- Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, Queen Mary, University of London, Wolfson Institute of Preventive Medicine, Charterhouse Square, London EC1M 6BQ, UK
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Umranikar A, Parmar D, Davies S, Fountain S. Multiple births following in vitro fertilization treatment: redefining success. Eur J Obstet Gynecol Reprod Biol 2013; 170:299-304. [DOI: 10.1016/j.ejogrb.2013.06.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 03/13/2013] [Accepted: 06/24/2013] [Indexed: 11/29/2022]
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Sturgess DJ, Parmar D, Dulhunty JM, Hedge R, Jarrett P, Udy A. A preliminary evaluation of plasma b-type natriuretic peptide as a screening test for left ventricular diastolic dysfunction in non-cardiac intensive care. Anaesth Intensive Care 2013; 41:591-5. [PMID: 23977909 DOI: 10.1177/0310057x1304100503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Left ventricular filling and thus diastolic function are frequently monitored and managed in critical care. However, scant data exist regarding possible screening tests for diastolic dysfunction in the intensive care unit (ICU). The present study aimed to evaluate plasma b-type natriuretic peptide (BNP) as a marker of diastolic dysfunction in a single-centre cohort of 'non-cardiac' ICU patients. The ICU is non-cardiac in that it provides mixed medical/surgical services with the exception of cardiology, cardiac surgery and solid organ transplantation. Clinical data were recorded over the first 24 hours of ICU stay for 32 consecutive patients. Transthoracic echocardiogram and blood collection for BNP assay were then performed. Diastolic dysfunction was demonstrated in 34% (n=11). Mean ± standard deviation BNP values were higher with diastolic dysfunction (238 ± 195 vs 72 ± 78 pg/ml; P=0.003). A BNP threshold of >43 pg/ml yielded a sensitivity of 80% and a specificity of 59%; area under the receiver operating characteristic curve was 0.82. BNP correlated independently with E/e' (R=0.425; P=0.015) (E/e': peak early transmitral velocity [E]/early diastolic mitral annular velocity [e']) but not left ventricular ejection fraction (P=0.8), illness severity (Acute Physiological and Chronic Health Evaluation II; P=0.3) or fluid balance (P=0.4). Diastolic dysfunction was common in this cohort of non-cardiac ICU patients and was independently associated with a significantly higher BNP. The potential application as a screening test for diastolic dysfunction is likely to require a threshold lower than previously proposed for heart failure.
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Affiliation(s)
- D J Sturgess
- Department of Intensive Care, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
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Offman J, Wilson M, Lamont M, Birke H, Kutt E, Marriage S, Loughrey Y, Hudson S, Hartley A, Smith J, Eckersley B, Dungey F, Parmar D, Patnick J, Duffy SW. A randomised trial of weekend and evening breast screening appointments. Br J Cancer 2013; 109:597-602. [PMID: 23867998 PMCID: PMC3738129 DOI: 10.1038/bjc.2013.377] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 06/19/2013] [Accepted: 06/22/2013] [Indexed: 12/04/2022] Open
Abstract
Background: There is a need to research interventions that improve access to and convenience of breast cancer screening services. Methods: We conducted a randomised trial comparing invitations to out-of-hours appointments with standard office hour appointments. Women who were to be invited for routine breast screening were randomised (3 : 1 : 1 : 1) to one of these screening invitations: standard office hour appointment, office hour appointment with the option to change to an out-of-hours appointment, weekday evening appointment, or weekend appointment. Results: A total of 9410 women were invited to an office hour, 3519 to an office hour with the option to change, 3271 to a weekday evening, and 3162 to a weekend appointment. The offer of an initial out-of-hours appointment was associated with a non-significant decrease in attendance rates (73.7% vs 74.1%). The highest attendance was observed in the group offered an initial office hour appointment with the option to change to out-of-hours (76.1% vs 73.3% for standard office hour, P=0.001), with 7% of invitees exercising the option to change. Conclusion: The optimum strategy for improving attendance at breast screening is to offer a traditional office hour appointment and including in the letter of invitation an option to change to an evening or weekend appointment if wished.
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Affiliation(s)
- J Offman
- Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London EC1M 6BQ, UK
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Shukla A, Mohapatra TM, Agrawal AK, Parmar D, Seth K. Salsolinol induced apoptotic changes in neural stem cells: amelioration by neurotrophin support. Neurotoxicology 2013; 35:50-61. [PMID: 23261589 DOI: 10.1016/j.neuro.2012.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Revised: 12/14/2012] [Accepted: 12/14/2012] [Indexed: 11/20/2022]
Abstract
Salsolinol (SAL), a catechol isoquinoline has invited considerable attention due to its structural similarity with dopaminergic neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Its high endogenous presence in Parkinsonian brain implicated its possible association with the disease process. SAL is also present in alcohol beverages and certain food materials and can get access to brain especially in conditions of immature or impaired BBB. Besides this, the effect of SAL on neural stem cells (NSCs) which are potential candidates for adult neurogenesis and transplantation mediated rejuvenating attempts for Parkinson's disease (PD) brain has not been known so far. NSCs in both the cases have to overcome suppressive cues of diseased brain for their survival and function. In this study we explored the toxicity of SAL toward NSCs focusing on apoptosis and status of PI3K survival signaling. NSCs cultured from embryonic day 11 rat fetal brain including those differentiated to TH(+ve) colonies, when challenged with SAL (1-100μM), elicited a concentration and time dependent cell death/loss of mitochondrial viability. 10μM SAL on which significant mitochondrial impairment initiated was further used to study mechanism of toxicity. Morphological impairment, enhanced TUNEL positivity, cleaved caspase-3 and decreased Bcl-2:Bax suggested apoptosis. Sal toxicity coincided with reduced pAkt level and its downstream effectors: pCREB, pGSK-3β, Bcl-2 and neurotrophins GDNF, BDNF suggesting repressed PI3K/Akt signaling. Multiple neurotrophic factor support in the form of Olfactory Ensheathing Cell's Conditioned Media (OEC CM) potentially protected NSCs against SAL through activating PI3K/Akt pathway. This was confirmed on adding LY294002 the PI3K inhibitor which abolished the protection. We inferred that SAL exerts substantial toxicity toward NSCs. These findings will lead to better understanding of endogenous threats that might affect the fate of transplanted NSCs and their probable antidotes.
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Affiliation(s)
- A Shukla
- Indian Institute of Toxicology Research (CSIR), Developmental Toxicology Division, Mahatma Gandhi Marg, Post Box 80, Lucknow 226 001, India; Department of Microbiology, IMS, Banaras Hindu University, Varanasi 221 005, India
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Parmar D, De Allegri M, Savadogo G, Sauerborn R. Do community-based health insurance schemes fulfil the promise of equity? A study from Burkina Faso. Health Policy Plan 2013; 29:76-84. [DOI: 10.1093/heapol/czs136] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Affiliation(s)
- J. Kumar
- National Agri‐Food Biotechnology InstituteMohali160071PunjabIndia
| | - A. Kumar
- School of BiochemistryDevi Ahilya VishwavidyalayaIndoreIndia
| | - S.P. Singh
- National Agri‐Food Biotechnology InstituteMohali160071PunjabIndia
| | - J.K. Roy
- National Agri‐Food Biotechnology InstituteMohali160071PunjabIndia
| | - A. Lalit
- Department of Biochemistry and GeneticsBarkatullah UniversityBhopalIndia
| | - D. Parmar
- Department of Biochemistry and GeneticsBarkatullah UniversityBhopalIndia
| | - N.C. Sharma
- Department of Biochemistry and GeneticsBarkatullah UniversityBhopalIndia
| | - R. Tuli
- National Agri‐Food Biotechnology InstituteMohali160071PunjabIndia
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Gassmann T, Arambhadiya B, Beaumont B, Baruah U, Bonicelli T, Darbos C, Purohit D, Decamps H, Albajar F, Gandini F, Henderson M, Kazarian F, Lamalle P, Omori T, Parmar D, Patel A, Rathi D, Singh N. High voltage power supplies for ITER RF heating and current drive systems. Fusion Engineering and Design 2011. [DOI: 10.1016/j.fusengdes.2011.02.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Parmar D, Hauman CHJ, Leichter JW, McNaughton A, Tompkins GR. Bacterial localization and viability assessment in human ex vivo dentinal tubules by fluorescence confocal laser scanning microscopy. Int Endod J 2011; 44:644-51. [PMID: 21352240 DOI: 10.1111/j.1365-2591.2011.01867.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To develop a convenient method for the localization and quantification of live and dead bacteria in human ex vivo mineralized dentinal tubules. METHODOLOGY The roots from human single-rooted teeth (n = 12) were infected with Enterococcus faecalis V583 and either treated with calcium hydroxide paste or left untreated; six control roots were uninoculated and untreated. Following further incubation, roots were stained with fluorescent DNA-binding reagents, washed thoroughly, sectioned and examined by confocal laser scanning microscopy. Computer-assisted determinations of fluorescence (bacterial viability) were compared statistically. RESULTS Bacteria were distributed in the tubules throughout the length of the roots but tubule penetration distance was slightly reduced in the apical sections. There was no significant difference in bacterial tubule penetration between roots from different teeth and small standard deviations indicated reproducibility appropriate for experimental application. Following treatment with calcium hydroxide paste, live and dead bacteria were readily distinguishable by contrasting green and red fluorescence. Bacterial viability determinations amongst roots treated in the same way were not significantly different, and the small standard deviation is commensurate with experimental application. CONCLUSIONS Fluorescent viability staining is a convenient, accurate and reproducible method for localizing and quantifying live and dead bacteria in human ex vivo mineralized dentinal tubules.
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Affiliation(s)
- D Parmar
- Sir John Walsh Research Institute, School of Dentistry, University of Otago, Dunedin, New Zealand
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Paul S, Parmar D, Pant MC, Verma J. Association and treatment response to capecitabine-based chemoradiotherapy with CYP2C9 polymorphism in head and neck cancer. Indian J Cancer 2011; 48:223-9. [DOI: 10.4103/0019-509x.82899] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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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Souares A, Savadogo G, Dong H, Parmar D, Sié A, Sauerborn R. Using community wealth ranking to identify the poor for subsidies: a case study of community-based health insurance in Nouna, Burkina Faso. Health Soc Care Community 2010; 18:363-368. [PMID: 20180867 DOI: 10.1111/j.1365-2524.2009.00905.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Access to health-care is low in developing countries. Poor people are less likely to seek care than those who are better off. Community-based health insurance (CBI) aims to improve healthcare utilisation by removing financial barriers, unfortunately CBI has been less effective in securing equity than expected. Poor people, who probably require greater protection from catastrophic health expenses, are less likely to enrol in such schemes. Therefore, it is important to implement targeted interventions so that the most in need are not left out. CBI has been offered to a district in Burkina Faso, comprising 7762 households in 41 villages and the district capital of Nouna since 2004. Community wealth ranking (CWR) was used in 2007 to identify the poorest quintile of households who were subsequently offered insurance at half the usual premium rate. The CWR is easy to implement and requires minimal resources such as interviews with local informants. As used in this study, the agreement between the key informants was more (37.5%) in the villages than in Nouna town (27.3%). CBI management unit only received nine complaints from villagers who considered that some households had been wrongly identified. Among the poorest, the annual enrolment increased from 18 households (1.1%) in 2006 to 186 (11.1%) in 2007 after subsidies. CWR is an alternative methodology to identify poor households and was found to be more cost and time efficient compared to other methods. It could be successfully replicated in low-income countries with similar contexts. Moreover, targeted subsidies had a positive impact on enrolment.
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Affiliation(s)
- A Souares
- Department of Tropical Hygiene and Public Health, Heidelberg University, Im Neuenheimer Feld 324, Heidelberg, Germany.
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Singh M, Shukla R, Khanna V, Parmar D. Genetic polymorphism in susceptibility genes for PD. Neurosci Res 2007. [DOI: 10.1016/j.neures.2007.06.556] [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: 10/23/2022]
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Pant MC, Hadi R, Prasad R, Dalela D, Pant R, Parmar D, Srivastava M, Parikh S. Role of immuno-therapy as a adjuvant treatment in advance head & neck cancer, patient receiving chemo radiotherapy. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.2598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M. C. Pant
- King George’s Medcl Univ, Lucknow, India; ITRC, Lucknow, India; Lucknow Cancer Institute, Lucknow, India; Lucknow Cancer Institute, Lucknow, India; Gujarat Cancer Rsrch Inst, Ahmedabad, India
| | - R. Hadi
- King George’s Medcl Univ, Lucknow, India; ITRC, Lucknow, India; Lucknow Cancer Institute, Lucknow, India; Lucknow Cancer Institute, Lucknow, India; Gujarat Cancer Rsrch Inst, Ahmedabad, India
| | - R. Prasad
- King George’s Medcl Univ, Lucknow, India; ITRC, Lucknow, India; Lucknow Cancer Institute, Lucknow, India; Lucknow Cancer Institute, Lucknow, India; Gujarat Cancer Rsrch Inst, Ahmedabad, India
| | - D. Dalela
- King George’s Medcl Univ, Lucknow, India; ITRC, Lucknow, India; Lucknow Cancer Institute, Lucknow, India; Lucknow Cancer Institute, Lucknow, India; Gujarat Cancer Rsrch Inst, Ahmedabad, India
| | - R. Pant
- King George’s Medcl Univ, Lucknow, India; ITRC, Lucknow, India; Lucknow Cancer Institute, Lucknow, India; Lucknow Cancer Institute, Lucknow, India; Gujarat Cancer Rsrch Inst, Ahmedabad, India
| | - D. Parmar
- King George’s Medcl Univ, Lucknow, India; ITRC, Lucknow, India; Lucknow Cancer Institute, Lucknow, India; Lucknow Cancer Institute, Lucknow, India; Gujarat Cancer Rsrch Inst, Ahmedabad, India
| | - M. Srivastava
- King George’s Medcl Univ, Lucknow, India; ITRC, Lucknow, India; Lucknow Cancer Institute, Lucknow, India; Lucknow Cancer Institute, Lucknow, India; Gujarat Cancer Rsrch Inst, Ahmedabad, India
| | - S. Parikh
- King George’s Medcl Univ, Lucknow, India; ITRC, Lucknow, India; Lucknow Cancer Institute, Lucknow, India; Lucknow Cancer Institute, Lucknow, India; Gujarat Cancer Rsrch Inst, Ahmedabad, India
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Singh MP, Patel S, Parmar D, Gupta YK. Contribution of genomics, proteomics, and single-nucleotide polymorphism in toxicology research and Indian scenario. Indian J Hum Genet 2005. [DOI: 10.4103/0971-6866.16804] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Parmar D, Yadav S, Dayal M, Johri A, Dhawan A, Seth PK. Effect of lindane on hepatic and brain cytochrome P450s and influence of P450 modulation in lindane induced neurotoxicity. Food Chem Toxicol 2003; 41:1077-87. [PMID: 12842176 DOI: 10.1016/s0278-6915(03)00045-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [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: 10/27/2022]
Abstract
Oral administration of lindane (2.5, 5, 10 and 15 mg/kg, body weight) for 5 days was found to produce a dose-dependent increase in the activity of P450 dependent 7-ethoxyresorufin-O-deethylase (EROD), 7-pentoxyresorufin-O-dealkylase (PROD) and N-nitrosodimethylamine demethylase (NDMA-d) in rat brain and liver. A significant increase in the hepatic and brain P450 monooxygenases was also observed when the duration of exposure of low dose (2.5 mg/kg) of lindane was increased from 5 days to 15 or 21 days. As observed with different doses, the magnitude of induction in the activity of P450 monooxygenases was several fold higher in liver microsomes when compared with the brain. Western blotting studies have indicated that the increase in the P450 enzymes could be due to the increase in the expression of P450 1A1/1A2, 2B1/2B2 and 2E1 isoenzymes. In vitro studies using organic inhibitors specific for individual P450 isoenzymes and antibody inhibition experiments have further demonstrated that the increase in the activity of PROD, EROD and NDMA-d are due to the increase in the levels of P450 2B1/2B2, 1A1/1A2 and 2E1 isoenzymes, respectively. Induction studies have further shown that while pretreatment of 3-methylcholanthrene (MC), an inducer of P4501A1/1A2, did not produce any significant effect in the incidence of lindane induced convulsions, pretreatment with phenobarbital (PB), an inducer of P450 2B1/2B2 or ethanol, an inducer of P450 2E1 catalysed reactions, significantly increased the incidence of lindane induced convulsions. Similarly, when the P450-mediated metabolism of lindane was blocked by cobalt chloride incidence of convulsions was increased in animals treated with lindane indicating that lindane per se or its metabolites formed by PB or ethanol inducible P450 isoenzymes are involved in its neurobehavioral toxicity.
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Affiliation(s)
- D Parmar
- Developmental Toxicology Division, Industrial Toxicology Research Centre, PO Box 80, M.G. Marg, -226 001, U.P, Lucknow, India.
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Gilleece Y, Mandalia S, Parmar D, Nelson M. The safety and tolerability of switching from a non-failing antiretroviral regimen to lopinavir. J Infect 2003; 46:204-5. [PMID: 12643876 DOI: 10.1053/jinf.2002.1114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Dayal M, Parmar D, Dhawan A, Ali M, Dwivedi UN, Seth PK. Effect of pretreatment of cytochrome P450 (P450) modifiers on neurobehavioral toxicity induced by deltamethrin. Food Chem Toxicol 2003; 41:431-7. [PMID: 12504175 DOI: 10.1016/s0278-6915(02)00249-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
To investigate the involvement of cytochrome P450 (P450) enzyme induction and the effect of different P450 modifiers in the neurobehavioral toxicity of deltamethrin, deltamethrin (10 mg/kg; orally for 1 day) was administered to young male albino Wistar rats, or in rats pretreated with phenobarbital (PB; 80 mg/kg, ip for 5 days), an inducer of P450 2B1/2B2 or 3-methylcholanthrene (MC; 30 mg/kg, ip for 5 days), an inducer of P450 1A1/1A2 or cobalt chloride (CoCl(2); sc for 2 days), a depletor of P450s. The administration of PB or MC or CoCl(2) alone did not produced any symptoms of neurobehavioral toxicity. While a single oral administration of deltamethrin produced tremors in two out of 10 rats and decreased the spontaneous locomotor activity, pretreatment with MC or PB potentiated the deltamethrin induced neurobehavioral toxicity with 50% of the treated rats exhibiting tremors. Half of the animals pretreated with MC prior to exposure to deltamethrin also exhibited choreoathetosis. The decrease in the spontaneous locomotor activity was found to be much more significant in PB- or MC-pretreated animals exposed to deltamethrin. In contrast to the pretreatment with inducers, rats pretreated with CoCl(2) exhibited no symptoms of tremors or choreoathetosis, indicating that a reactive metabolite of deltamethrin is formed by P450 catalysed reactions which is involved in the neurobehavioral toxicity of deltamethrin.
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Affiliation(s)
- M Dayal
- Developmental Toxicology Division, Industrial Toxicology Research Centre, Department of Biochemistry, Lucknow University, PO Box 80, M.G. Marg, Lucknow-226 001, India
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Abstract
To investigate the similarities in the catalytic activity of blood lymphocyte P450 2E1 in blood lymphocyte with the liver isoenzyme, NADPH dependent lipid peroxidation and activity of N-nitrosodimethyamine demethylase (NDMA-d) was studied in rat blood lymphocytes. Blood lymphocytes were found to catalyse NADPH dependent (basal) lipid peroxidation and demethylation of N-nitrosodimethylamine (NDMA). Pretreatment with ethanol or pyrazole or acetone resulted in significant increase in the NADPH dependent lipid peroxidation and the activity of NDMA-d in blood lymphocytes and liver microsomes. In vitro addition of CCl(4) to the blood lymphocytes isolated from control or ethanol pretreated rats resulted in an increase in the NADPH dependent lipid peroxidation. Significant inhibition of the basal and CCl(4) supported NADPH dependent lipid peroxidation and NDMA-d activity in blood lymphocytes isolated from control or ethanol pretreated rats by dimethyl formamide or dimethyl sulfoxide or hexane, solvents known to inhibit P450 2E1 catalysed reactions in liver and anti- P450 2E1, have indicated the role of P450 2E1 in the NADPH dependent lipid peroxidation in rat blood lymphocytes. The data indicating similarities in the NADPH dependent lipid peroxidation and NDMA-d activity in blood lymphocyte with the liver microsome have provided evidence that blood lymphocyte P450 2E1 could be used as a surrogate to monitor and predict hepatic levels of the enzyme.
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Affiliation(s)
- A Dey
- Developmental Toxicology Division, Industrial Toxicology Research Centre, Lucknow, India
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Chowdhuri DK, Parmar D, Kakkar P, Shukla R, Seth PK, Srimal RC. Antistress effects of bacosides of Bacopa monnieri: modulation of Hsp70 expression, superoxide dismutase and cytochrome P450 activity in rat brain. Phytother Res 2002; 16:639-45. [PMID: 12410544 DOI: 10.1002/ptr.1023] [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: 11/11/2022]
Abstract
The antistress effect of bacosides of Brahmi (Bacopa monnieri, BBM), dissolved in distilled water, was -studied in adult male Sprague Dawley rats by administering oral doses of 20 and 40 mg/kg for 7 consecutive days. In half of the animals treated with 20 or 40 mg/kg of BBM, stress was given 2 h after the last dose. Stress was also administered to the animals treated with distilled water alone. BBM, at both doses, did not induce a significant change in the expression of Hsp70 in any brain region studied while stress alone produced a significant increase in the Hsp70 expression in all the brain regions. A significant decrease in the activity of superoxide dismutase (SOD) was evident in the hippocampus with the lower dose of BBM and in animals given stress alone, while an increase in the activity of SOD was observed in the brain regions with the higher dose of BBM. An increase in the activity of cytochrome P450 (P450) dependent 7-pentoxyresorufin-o-dealkylase (PROD) and 7-ethoxyresorufin-o-deethylase (EROD) was observed in all the brain regions after exposure to stress alone and with both doses of BBM although the magnitude of induction of P450 expression was less with a higher dose of BBM. Interestingly, stress when given to the animals pretreated with BBM for 7 days resulted in a decrease in Hsp70 expression in all the brain regions with a significant decrease occurring only in the hippocampus. Likewise the activity of SOD was found to be further reduced in all the brain regions in the animals treated with the lower dose of BBM followed by stress. However, when stress was given to the animals pretreated with the higher dose of BBM, a significant increase in the enzyme activity was observed in the cerebral cortex and in the rest of the brain while the activity of SOD was reduced to a much greater extent in the cerebellum and in the hippocampus. Likewise, the activity of P450 enzymes was found to be restored to almost control levels in the animals given stress and pretreated with the higher dose of BBM, while a lesser degree of induction, compared with animals treated with BBM or stress alone, was observed in the animals pretreated with the lower dose of BBM and given stress. The data indicate that BBM has potential to modulate the activities of Hsp70, P450 and SOD thereby possibly allowing the brain to be prepared to act under adverse conditions such as stress.
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Affiliation(s)
- D Kar Chowdhuri
- Industrial Toxicology Research Center, PO Box 80, M.G. Marg, Lucknow - 226001, UP, India
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Abstract
BACKGROUND Few UK studies have systematically investigated which antiretroviral therapy (ART) combinations HIV-infected people are commenced on, when they start and reasons for stopping or changing their regimens. OBJECTIVE To describe when HIV-infected ART-naive patients started first-, second- or third-line triple ART, classes of drugs prescribed and whether stopping ART was associated with virological, immunological or clinical indicators of treatment failure. DESIGN A multicentre prospective open cohort study, employing the National Prospective Monitoring System on the use, cost and outcome of HIV service provision in UK hospitals-HIV Health-economics Collaboration (NPMS-HHC). SETTING Five hundred and eighty-five ART-naive patients seen in one London and two non-London HIV clinics between 1 January 1998 and 31 December 1999. RESULTS Of 4,044 HIV-infected individuals seen, 585 (15%) were ART naive. Median time interval (interquartile range, IQR) between HIV diagnosis and starting triple ART was 800 (63-2,094) days. Median CD4 count when first diagnosed with HIV infection was 278 (IQR 127-481) cells/ micro L which dropped to 190 (IQR 86-297) cells/ micro L when starting triple ART. Of these 585 patients, 162 started second-line and 46 third-line ART during the study period. Of those patients who stopped ART, 51% did not have evidence of virological, immunological or clinical indicators of therapy failure. CONCLUSIONS Reasons for the delay between diagnosis of HIV infection and starting ART are varied. The large proportion of individuals who stopped ART for reasons other than virological, immunological or clinical indicators of therapy failure, are most likely due to drug-associated toxicity. Both of these findings need to be elucidated in greater detail through prospective studies.
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Affiliation(s)
- S Mandalia
- NPMS-HHC CAC, Chelsea and Westminster Hospital, London, UK
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Abstract
PURPOSE To assess the effect of diagnostic mydriasis with 1% cyclopentolate on the intraocular pressure (IOP) of patients attending glaucoma, medical retina and cataract clinics. METHODS Levels of agreement for IOP assessment were determined and 95% of repeated readings found to be within +/-2 mmHg. The IOP of 83 cataract, 87 medical retinal and 100 glaucoma patients was measured with Goldmann applanation tonometry before and 45 min after dilatation with 1% cyclopentolate. Those showing a substantial (>10 mmHg) increase in IOP underwent gonioscopy to determine if their angles remained open and were medically treated to lower their IOP. RESULTS An approximately normal distribution of change in IOP following dilatation was seen in all three groups (mean change 0.4 mmHg (95% CI 0.1-0.8)). The proportion of patients with a rise of 5 mmHg or more in the right eye was 7% (95% CI 4-10%). Logistic regression using all right eyes, looking at age, sex, diagnosis, ethnicity, ocular medication, iris colour and lens status (phakic/pseudophakic/aphakic) as risk factors for a rise of IOP of 5 mmHg or more did not reveal any significant contribution. Correlation between results obtained for right and left eyes in the glaucoma group was lower (0.43) than for the other groups (0.66 and 0.72), but the extent to which the direction of change in one eye predicted that in the other was shown to be high. Two glaucoma patients with open angles developed a clinically important (>10 mmHg) sustained rise in IOP requiring treatment. CONCLUSIONS Individual variability in the effects of cyclopentolate on aqueous dynamics may account for the approximately normal distribution of IOP seen following dilatation in all three groups. This variation was in excess of that due to observation error alone. It is recommended that the IOP be rechecked after dilation in glaucoma patients with significantly damaged optic nerve heads. In medical retina and cataract patients, sustained clinically important rises in intraocular pressure following dilation seem rarer.
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Affiliation(s)
- J Hancox
- Moorfields Eye Hospital London, UK
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Abstract
PURPOSE To determine the clinical efficacy of frequency-doubled Nd:YAG (FD YAG) laser for the treatment of diabetic clinically significant macular oedema (CSMO). METHODS A prospective pilot study was carried out on 55 eyes with CSMO. FD YAG laser exposures were applied in a focal or grid pattern. The results were evaluated by Snellen visual acuity, slit-lamp biomicroscopy, colour photography and fundus fluorescein angiography. RESULTS At mean review of 5.3 months, macular oedema had resolved either completely or partly in 44 (80%) eyes, was unchanged in 10 (18%) eyes and progressed in 1 (2%) eye. Visual acuity improved in 11 (20%), stabilised in 40 (73%) and deteriorated in 4 (7%) eyes. CONCLUSION FD YAG laser therapy is effective in the treatment of CSMO. It combines the ergonomic advantages of a solid-state laser with the benefits of its wavelength. A comparison between the clinical results of FD YAG and other lasers used in the treatment of CSMO is, however, required.
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Affiliation(s)
- M Saeed
- Ophthalmology Department, King's College Hospital, London, UK.
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Dayal M, Parmar D, Ali M, Dhawan A, Dwivedi UN, Seth PK. Induction of rat brain cytochrome P450s (P450s) by deltamethrin: regional specificity and correlation with neurobehavioral toxicity. Neurotox Res 2001; 3:351-7. [PMID: 14715465 DOI: 10.1007/bf03033196] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Oral administration of 5 mg/kg body weight of deltamethrin, an alpha-cyano type II pyrethroid insecticide once a day for 1, 7, 15 and 21 consecutive days to young Druckerey rats (6- 8 weeks old) produced a time dependent increase in the activity of cytochrome P450 (P450) dependent 7-ethoxyresorufin-O-deethylase (EROD) and 7-pentoxyresorufin-O-dealkylase (PROD) in rat brain microsomes. A significant induction was observed on prolonged exposure of deltamethrin for 15 or 21 days. The induction in the activity of cerebral P450 enzymes was associated with the time dependent increase in the spontaneous locomotor activity indicating accumulation of deltamethrin or its metabolites in brain with the increase in the duration of exposure. Administration of deltamethrin (5 mg/kg) for 21 days produced region specific changes in the dealkylation of ethoxyresorufin and pentoxyresorufin in rat brain with significant induction occurring in the activity of P450 1A1/2 dependent EROD in cerebellum, hippocampus, hypothalamus and medulla-pons and that of P450 2B1/2 mediated PROD in hippocampus, hypothalamus, corpus striatum and mid brain. The data suggests that the differences in the induction of individual P450 isoenzymes in diverse brain regions could play a role in regulating the response of brain to pyrethroid insecticides by modulating their concentration per se or their active metabolites at the target site(s).
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Affiliation(s)
- M Dayal
- Developmental Toxicology Division, Industrial Toxicology Research Centre, P.O. Box 80, M.G. Marg, Lucknow-226 001, U.P., India
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Abstract
Studies initiated to characterise the catalytic activity and expression of CYP1A1 in rat blood lymphocytes revealed significant activity of 7-ethoxyresorufin-O-deethylase (EROD) in rat blood lymphocytes. Pretreatment with 3-methylcholanthrene (MC) and beta-naphthoflavone (NF) resulted in significant induction in the activity of lymphocyte EROD suggesting that like the liver enzyme, EROD activity in lymphocytes is inducible and is mediated by the MC inducible isoenzymes of P450. The increase in the activity of EROD was associated with a significant increase in the apparent Vmax and affinity of the substrate towards EROD. That this increase in the activity of EROD could be primarily due to the increase in the expression of CYP1A1 isoenzymes was demonstrated by RT-PCR and western immunoblotting studies indicating an increase in the expression of CYP1A1 in blood lymphocytes after MC pretreatment. Significant inhibition in the EROD activity of MC induced lymphocyte by anti-CYP1A1/1A2 and alpha-naphthoflavone further provided evidence that the CYP1A1/1A2 isoenzymes are involved in the activity of EROD in blood lymphocytes. The data indicating similarities in the regulation of CYP1A1 in blood lymphocytes with the liver isoenzyme suggests that factors which may affect expression of CYP1A1 in liver may also affect expression in blood lymphocytes and that blood lymphocytes could be used as a surrogates for studying hepatic expression of the xenobiotic metabolising enzymes.
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Affiliation(s)
- A Dey
- Industrial Toxicology Research Centre, Mahatma Gandhi Marg, Lucknow, UP, India
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Vuong T, Parker W, Patrocinio HJ, Fava P, Parmar D, Evans MD, Freeman CR. An alternative mantle irradiation technique using 3D CT- based treatment planning for female patients with Hodgkin's disease. Int J Radiat Oncol Biol Phys 2000; 47:739-48. [PMID: 10837959 DOI: 10.1016/s0360-3016(00)00438-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE For female patients, radiotherapy treatment for Hodgkin's disease invariably results in the irradiation of breast tissue that may lead to radiation induced secondary cancers. The risk for secondary breast cancer is correlated with dose. We have developed a technique in an attempt to increase breast sparing during mantle field irradiation for female patients. MATERIAL AND METHODS To minimize the irradiated breast volume, a virtual simulation technique making use of a Styrofoam breast immobilization board has been developed whereby the patient lies prone with the breasts positioned in grooves within the board. The breast position is adjusted using Styrofoam wedges, and breast placement is verified using an AP CT-pilot view. A CT scan of the neck and thoracic regions is taken, and the lymph nodes, breast volume and critical structures are outlined. Virtual simulation of the mantle fields (typically AP/PA isocentric beams) is performed, and beam blocks are drawn on the digitally reconstructed radiographs (DRR) generated by the virtual simulation package. The shielding is designed to allow adequate margins around the lymph nodes while maximizing shielding of the lung and breast tissues. The para-aortic fields are also easily determined through virtual simulation, where multi-planar reconstructions (MPR) and 3D renderings of the patient's CT data are used to determine the field limits and beam gaps. In addition to allowing for the geometric optimization of the positioning of the breasts under the lung shields, the virtual simulation technique provides the necessary information for a 3D dosimetric analysis, including dose-volume histograms (DVHs) of the irradiated breast volume. RESULTS The 3D breast sparing technique was qualitatively and quantitatively compared to non-CT-based techniques and other 3D techniques currently available to assess the protection of the breasts. In a preliminary analysis, virtual simulation images (DRRs, 3D rendering and multi-planar reconstruction) demonstrated the advantage of using the breast sparing technique. A further analysis of DVHs showed a reduction of at least 50% in the volume of breast tissue irradiated when using the breast positioning board and virtual simulation as compared to the conventional simulation techniques where a breast immobilization board was not used. CONCLUSIONS The use of a breast immobilization board and of a virtual simulation technique is recommended for the planning and treatment of female patients with Hodgkin's disease. DVH analysis has shown that this leads to a decrease in the volume of breast irradiated. It is hoped that this approach will reduce the risk of secondary breast malignancies in female patients with Hodgkin's disease.
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Affiliation(s)
- T Vuong
- Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada.
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Abstract
Characterization of xenobiotic metabolizing cytochrome P450s (P450s) was carried out in rat brain microsomes using the specific substrates, 7-pentoxy- and 7-ethoxyresorufin (PR and ER), metabolized in the liver by P450 2B1/2B2 and 1A1/1A2 respectively and 7-benzyloxyresorufin (BR), a substrate for both the isoenzymes. Brain microsomes catalysed the O-dealkylation of PR, BR and ER in the presence of NADPH. The ability to dealkylate alkoxyresorufins varied in different regions of the brain. Microsomes from the olfactory lobes exhibited maximum pentoxyresorufin-O-dealkylase (PROD), benzyloxyresorufin-O-dealkylase (BROD) and ethoxyresorufin-O-dealkylase (EROD) activities. The dealkylation was found to be inducer selective. While pretreatment with phenobarbital (PB; 80 mg/kg; i.p. x 5 days) resulted in significant induction in PROD (3-4 fold) and BROD (4-5 fold) activities, 3-methylcholanthrene (MC; 30 mg/kg; i.p. x 5 days) had no effect on the activity of PROD and only a slight effect on that of BROD (1.4 fold). MC pretreatment significantly induced the activity of EROD (3 fold) while PB had no effect on it. Kinetic studies have shown that this increase in the activities following pretreatment with P450 inducers was associated with a significant increase in the velocity of the reaction (Vmax) of O-dealkylation. In vitro studies using organic inhibitors and antibodies have further provided evidence that the O-dealkylation of alkoxyresorufins is isoenzyme specific. While in vitro addition of alpha-naphthoflavone (ANF), an inhibitor of P450 1A1/1A2 catalysed reactions and antibody for hepatic P450 1A1/1A2 isoenzymes produced a concentration-dependent inhibition of EROD activity, metyrapone, an inhibitor of P450 2B1/2B2 and antibody for hepatic P450 2B1/2B2 significantly inhibited the activity of PROD and BROD in vitro. The data suggest that, as in the case of liver, dealkylation of alkoxyresorufins can be used as a biochemical tool to characterise the xenobiotic metabolising P450s and substrate selectivity of P450 isoenzymes in rat brain microsomes.
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Affiliation(s)
- A Dhawan
- Industrial Toxicology Research Centre, M.G. Marg, Lucknow, India
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