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Khanal P, Khanal P, Paudel S, Pokhrel A, Chapagain S. Paraneoplastic movement disorder due to suspected metastatic Leiomyosarcoma of tongue: A case report. Clin Case Rep 2024; 12:e8648. [PMID: 38464567 PMCID: PMC10920308 DOI: 10.1002/ccr3.8648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 03/12/2024] Open
Abstract
Paraneoplastic movement disorders, though rare, can be the initial symptoms of malignancies like leiomyosarcoma, as in our case. Clinicians should keep malignancies in their differential diagnosis in cases of unexplained movement abnormalities.
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Affiliation(s)
- Pradeep Khanal
- Department of Internal MedicineTrinity Health Ann Arbor HospitalYpsilantiMichiganUSA
| | | | - Sandip Paudel
- Institute of MedicineTribhuvan UniversityKathmanduNepal
| | - Ashbita Pokhrel
- Department of Anatomic and Clinical PathologyWilliam Beaumont HospitalRoyal OakMichiganUSA
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Shah S, Yadav R, Bhattarai A, Tharu S, Sharma P, Subedi P, Kharel A, Khanal P, Pradeep Khanal Mbbs Md PK, Kollepara S, Gundabolu K. Danazol for the Treatment of Myelodysplastic Syndromes: A Systematic Review. Oncology (Williston Park) 2023; 37:480-487. [PMID: 38133562 DOI: 10.46883/2023.25921009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Purpose To study the potential utility of danazol for treating patients with myelodysplastic syndromes, with a focus on efficacy and adverse effects (AEs). Methods MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus were searched for relevant publications from inception June 1, 1950, until June 28, 2022. The studies were screened by title and abstract, followed by full-text screening. The quality of the included studies was assessed via a prespecified set of questionnaires. Data on the efficacy measures and adverse outcomes were extracted and included in a descriptive summary. Results Nine studies consisting of 246 participants were included in our review. The overall quality of the included studies was fair. The age of the participants ranged from 61 to 78 years. In all 9 studies, more male patients had been enrolled than female patients. Overall, a proportion of patients in all the studies reported a desired major response to a danazol dose of 400 to 800 mg/day. Few studies did not observe any improvement in the platelet count. Elevated liver enzyme levels, weight gain, headache, dermatitis, and weakness were the most common AEs observed. One study reported a fatal intracerebral hemorrhage in 1 participant. Conclusions Danazol has been effective in increasing platelet count and hemoglobin level. Despite a few AEs, danazol is a safe drug for the treatment of patients with myelodysplastic syndromes.
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Gautam S, Bhattarai A, Shah S, Thapa S, Gyawali P, Khanal P, Kharel A, Sharma P, Subedi P, Chand S, Mirmosayyeb O. The association of multiple sclerosis with thyroid disease: A meta-analysis. Mult Scler Relat Disord 2023; 80:105103. [PMID: 37925961 DOI: 10.1016/j.msard.2023.105103] [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: 05/17/2023] [Revised: 08/22/2023] [Accepted: 10/22/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Multiple Sclerosis (MS) is an autoimmune disease with T-cell-mediated inflammation showing different clinical and pathological phenotypes. The relationship between MS and thyroid diseases has been debated, with varying research outcomes. This meta-analysis aims to clarify the association between different thyroid diseases and MS. METHODS Databases PubMed, Google Scholar, ScienceDirect, and Web of Science were searched electronically for the studies investigating the association of thyroid disorders in MS. Studies were selected based on the eligibility criteria and meta-analysis was performed on Review Manager Version 5.4 using a random-effects model. Subgroup analyses were performed based on the clinical subtypes of thyroid disorders and forest plots were generated to interpret the findings. Publication bias was assessed using Egger's and Begg's tests and interpreted into funnel plots. Sensitivity analysis was performed to investigate the effect of the exclusion of each study on the pooled odds ratio. RESULTS Inclusive of thirteen studies comprising 13,012 MS cases and 56,850 controls, our analysis unveiled notable findings. pwMS displayed a significantly elevated prevalence of both hypothyroidism (Odds Ratio [OR]: 2.29, 95 % Confidence Interval [CI]: 1.16-4.49, pvalue: 0.02, I2 = 27 %) and autoimmune thyroid disorder (OR: 1.70, 95 % CI: 1.02-2.85, pvalue: 0.04, I2 = 79 %). The collective prevalence of all thyroid diseases among pwMS was markedly higher (OR: 1.60, 95 % CI: 1.20-2.11, p-value: 0.001, I2 = 61 %). Furthermore, gender-specific analyses revealed that females with MS experienced a significantly increased prevalence of thyroid disorders compared to their male counterparts. (pooled odds ratio 2.38,95 % CI 1.11-5.10, p-value: 0.03, I2 = 28 %) CONCLUSION: This comprehensive meta-analysis establishes a significant association between thyroid diseases and MS, substantiating the increased risk of thyroid disorders in pwMS. Moreover, the gender-based analysis implicates a potentially significant interaction between gender and the observed association. These findings collectively contribute to a better understanding of the complex interplay between MS and thyroid diseases, offering crucial insights for both clinical management and future research endeavors.
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Affiliation(s)
- Sushan Gautam
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | | | - Sangam Shah
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Sangharsha Thapa
- Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
| | | | - Pitambar Khanal
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Arun Kharel
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Prakash Sharma
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Prativa Subedi
- KIST Medical College and Teaching Hospital, Kathmandu, Nepal
| | - Swati Chand
- Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Omid Mirmosayyeb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Paudel N, Shrestha S, Marasine NR, Khanal P, Aryal S, Erku D, Poudel A. Impact of hospital pharmacist-delivered individualised pharmaceutical service intervention on clinical and patient-reported outcomes in patients with hypertension: a randomised controlled trial. Eur J Hosp Pharm 2023; 30:316-321. [PMID: 34980596 PMCID: PMC10647875 DOI: 10.1136/ejhpharm-2020-002512] [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: 09/03/2020] [Accepted: 12/14/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Patients with hypertension in Nepal are often known to have poor medication adherence and quality of life. This randomised controlled trial aimed to evaluate the impact of a hospital pharmacist-delivered individualised pharmaceutical service (P-DIPS) intervention on blood pressure, medication adherence and health-related quality of life (HRQoL) among patients with hypertension in a hospital setting in Nepal. METHODS In an open trial, 56 adult patients with hypertension who had been receiving antihypertensive medication for ≥6 months were randomly allocated to a control group (n=28) which received the usual care and an intervention group (n=28) which received a P-DIPS along with the usual care. The difference in blood pressure, medication adherence and HRQoL between the two groups at baseline, 2 and 4 months was compared using the Mann-Whitney U test, independent t-test or χ2 tests. RESULTS Participants were mostly ≥40 years (86%) and female (57%). There were no significant differences in the baseline characteristics between the control (C) and intervention (I) groups. At 2 months, the two groups had a significant improvement in the median (IQR) Morisky-Green-Levine (MGL) Medication Adherence Score (I=1 (2) vs C=2 (2); p<0.001) and the median (IQR) mental component of HRQoL (I=43.6 (9.5) vs C=37.5 (8.6); p=0.013). At 4 months, there were significant differences in the median (IQR) values of all the outcome measures between the groups (systolic blood pressure: I=125 (10) mmHg vs C=130 (15) mmHg, p=0.008; diastolic blood pressure: 80 (14) mmHg vs 90 (10) mmHg, p=0.012; MGL score: I=1 (1) vs C=2 (1), p<0.001; physical component of HRQoL: 45.0 (9.0) vs 40.3 (8.2), p=0.046; and mental component of HRQoL: 47.1 (11.1) vs 38.8 (8.5), p=0.003). CONCLUSIONS The findings suggest that a P-DIPS intervention in the hospital setting of Nepal has a significant potential to improve blood pressure, medication adherence and HRQoL in patients with hypertension.
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Affiliation(s)
- Nabina Paudel
- School of Pharmacy, Kathmandu University, Dhulikhel, Nepal
| | - Shakti Shrestha
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
- Quality Use of Medicine Research Network Nepal, Chitwan, Nepal
| | - Nirmal Raj Marasine
- Department of Pharmacy, Karnali College of Health Sciences, Kathmandu, Nepal
| | - Pitambar Khanal
- Department of Pharmacy, Nepalgunj Medical College, Nepalgunj, Nepal
| | - Sushant Aryal
- School of Physical and Chemical Sciences, University of Canterbury, Christchurch, New Zealand
| | - Daniel Erku
- Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Goldcoast, Queensland, Australia
| | - Arjun Poudel
- Quality Use of Medicine Research Network Nepal, Chitwan, Nepal
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
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Khanal P, Johnson J, Gouveia G, Ross P, Deeb N. Genomic evaluation of feed efficiency in US Holstein heifers. J Dairy Sci 2023; 106:6986-6994. [PMID: 37210367 DOI: 10.3168/jds.2023-23258] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 01/12/2023] [Accepted: 04/12/2023] [Indexed: 05/22/2023]
Abstract
There is growing interest in improving feed efficiency traits in dairy cattle. The objectives of this study were to estimate the genetic parameters of residual feed intake (RFI) and its component traits [dry matter intake (DMI), metabolic body weight (MBW), and average daily gain (ADG)] in Holstein heifers, and to develop a system for genomic evaluation for RFI in Holstein dairy calves. The RFI data were collected from 6,563 growing Holstein heifers (initial body weight = 261 ± 52 kg; initial age = 266 ± 42 d) for 70 d, across 182 trials conducted between 2014 and 2022 at the STgenetics Ohio Heifer Center (South Charleston, OH) as part of the EcoFeed program, which aims to improve feed efficiency by genetic selection. The RFI was estimated as the difference between a heifer's actual feed intake and expected feed intake, which was determined by regression of DMI against midpoint MBW, age, and ADG across each trial. A total of 61,283 SNPs were used in genomic analyses. Animals with phenotypes and genotypes were used as training population, and 4 groups of prediction population, each with 2,000 animals, were selected from a pool of Holstein animals with genotypes, based on their relationship with the training population. All traits were analyzed using univariate animal model in DMU version 6 software. Pedigree information and genomic information were used to specify genetic relationships to estimate the variance components and genomic estimated breeding values (GEBV), respectively. Breeding values of the prediction population were estimated by using the 2-step approach: deriving the prediction equation of GEBV from the training population for estimation of GEBV of prediction population with only genotypes. Reliability of breeding values was obtained by approximation based on partitioning a function of the accuracy of training population GEBV and magnitudes of genomic relationships between individuals in the training and prediction population. Heifers had DMI (mean ± SD) of 8.11 ± 1.59 kg over the trial period, with growth rate of 1.08 ± 0.25 kg/d. The heritability estimates (mean ± SE) of RFI, MBW, DMI, and growth rate were 0.24 ± 0.02, 0.23 ± 0.02, 0.27 ± 0.02, and 0.19 ± 0.02, respectively. The range of genomic predicted transmitted abilities (gPTA) of the training population (-0.94 to 0.75) was higher compared with the range of gPTA (-0.82 to 0.73) of different groups of prediction population. Average reliability of breeding values from the training population was 58%, and that of prediction population was 39%. The genomic prediction of RFI provides new tools to select for feed efficiency of heifers. Future research should be directed to find the relationship between RFI of heifers and cows, to select individuals based on their lifetime production efficiencies.
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Affiliation(s)
| | | | | | - P Ross
- STgenetics, Navasota, TX 77868
| | - N Deeb
- STgenetics, Navasota, TX 77868
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Khanal P, Paudel S, Chapagain S, Thapa S, Gyawali M. Hypokalemic Paralysis Revealing Primary Sjogren's Syndrome: A Case Report. JNMA J Nepal Med Assoc 2023; 61:735-737. [PMID: 38289796 PMCID: PMC10579740 DOI: 10.31729/jnma.8266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Indexed: 02/01/2024] Open
Abstract
Sjogren's syndrome is a rare chronic autoimmune disease characterised by dry eyes and dry mouth due to autoimmune destruction of the lacrimal and salivary glands, which can occur concurrently with other autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus, or thyroiditis. It can lead to renal complications such as interstitial nephritis and glomerulonephritis, with distal/ type 1 renal tubular acidosis which may result in life-threatening electrolyte imbalance. We present a case of a 35-year-old female who presented with complaints of multiple episodes of muscle weakness. Type 1 renal tubular acidosis was discovered to be the cause of her symptoms which lead to the subsequent diagnosis of Sjogren's syndrome. This is rare presentation of Sjogren's syndrome, and it poses a challenge to diagnosis. Early detection and diagnosis of Sjogren's syndrome might be difficult due to existing diagnostic criteria, which contributes to a higher likelihood of missed diagnosis. Keywords case reports; hypokalemia; renal tubular acidosis; Sjogren's syndrome.
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Affiliation(s)
| | - Sandip Paudel
- Maharajgunj Medical Campus, Maharajgunj, Kathmandu, Nepal
| | | | - Saurav Thapa
- National Academy of Health Sciences, Mahaboudha, Kathmandu, Nepal
| | - Madan Gyawali
- Department of Internal Medicine, Bakulahar Ratnanagar Hospital, Tandi, Chitwan, Nepal
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Dahal K, Chaudhary A, Rawal L, Ray U, Paudel S, Khanal P, Gyawali P, Sah SK, Shrestha KK, Pandey S. Antisynthetase syndrome and interstitial lung disease: A case report. Ann Med Surg (Lond) 2022; 82:104571. [PMID: 36268301 PMCID: PMC9577423 DOI: 10.1016/j.amsu.2022.104571] [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: 07/16/2022] [Revised: 08/30/2022] [Accepted: 09/04/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Myositis, Raynaud's phenomenon, fever, interstitial lung disease, mechanic's hands, and arthropathy are symptoms of Antisynthetase Syndrome (ASS), which is defined by the development of antibodies against t-ribonucleic acid (RNA) synthetase, particularly anti-Jo-1. Case presentation The case is about 29 years female with 1 month history of non-productive cough and dyspnea on exertion which was later diagnosed as ASS. Discussion The diagnosis of an inflammatory myopathy is based on clinical findings such as subacute development of symmetrical muscle weakness and signs such as laboratory investigations revealing skeletal muscle inflammation. Creatinine phosphokinase (CPK) is mainly used to demonstrate skeletal muscle involvement. Conclusion Interstitial lung disease is a frequent occurrence and is associated with a bad prognosis during the course of antisynthetase syndrome.
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Affiliation(s)
- Krishna Dahal
- Tribhuvan University, Institute of Medicine, Maharajgunj, 44600, Nepal
| | - Anand Chaudhary
- Tribhuvan University, Institute of Medicine, Maharajgunj, 44600, Nepal
| | - Laba Rawal
- Tribhuvan University, Institute of Medicine, Maharajgunj, 44600, Nepal
| | - Umesh Ray
- Tribhuvan University, Institute of Medicine, Maharajgunj, 44600, Nepal
| | - Sandip Paudel
- Tribhuvan University, Institute of Medicine, Maharajgunj, 44600, Nepal
| | - Pitambar Khanal
- Tribhuvan University, Institute of Medicine, Maharajgunj, 44600, Nepal
| | - Pawan Gyawali
- Tribhuvan University, Institute of Medicine, Maharajgunj, 44600, Nepal
| | - Sanjit Kumar Sah
- Tribhuvan University, Institute of Medicine, Maharajgunj, 44600, Nepal
| | | | - Shailendra Pandey
- Tribhuvan University, Institute of Medicine, Maharajgunj, 44600, Nepal
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8
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Thapa S, Shah S, Chand S, Sah SK, Gyawali P, Paudel S, Khanal P. Ataxia due to vitamin E deficiency: A case report and updated review. Clin Case Rep 2022; 10:e6303. [PMID: 36093469 PMCID: PMC9448968 DOI: 10.1002/ccr3.6303] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 05/21/2022] [Revised: 08/03/2022] [Accepted: 08/20/2022] [Indexed: 11/10/2022] Open
Abstract
Ataxia with vitamin E deficiency (AVED) is a rare cause of hereditary ataxia in developing countries with unknown prevalence. AVED is an autosomal‐recessive disorder, which is characterized by ataxia, areflexia, and proprioceptive and vibratory sensory loss. The disease is characterized clinically by symptoms with often resembling to those of Friedreich ataxia (FRDA). Vitamin E supplementation improves symptoms and prevents the progression of the disease. In this case report, we reviewed the recently updated findings in AVED in regard to the management and present a case of AVED in a 16‐year‐old boy, who was initially misdiagnosed as FRDA, prior to the genetic test.
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Affiliation(s)
- Sangharsha Thapa
- University of Minnesota Medical School Twin Cities Minneapolis Minnesota USA
| | - Sangam Shah
- Institute of Medicine Tribhuvan University Kirtipur Nepal
| | - Swati Chand
- Rochester General Hospital Rochester New York USA
| | | | - Pawan Gyawali
- Institute of Medicine Tribhuvan University Kirtipur Nepal
| | - Sandip Paudel
- Institute of Medicine Tribhuvan University Kirtipur Nepal
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9
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Khanal P, Ståhlberg T, Luntamo T, Gyllenberg D, Kronström K, Suominen A, Sourander A. Time trends in treated incidence, sociodemographic risk factors and comorbidities: a Finnish nationwide study on anxiety disorders. Eur Psychiatry 2022. [PMCID: PMC9565546 DOI: 10.1192/j.eurpsy.2022.209] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction Anxiety disorders (ADs) are common in childhood and adolescence and global estimates suggest they affect 6.5% of individuals under 19 years of age.Yet, there has been a lack of research on time trends and socio-demographic risks for children and adolescents who receive treatment for ADs. Objectives We aim to fill gaps in our knowledge by examining a nationwide sample of Finnish children and adolescents diagnosed in specialized healthcare settings. Methods We used register data of all singleton children born in Finland from 1992-2006 and diagnosed with ADs from 1998-2012. Changes in time trends in incidence were studied by dividing the study sample into three cohorts by birth years: 1992-1996, 1997-2001 and 2002-2006. The 22,388 individuals with ADs were matched with 76,139 controls. Nested case-control design was used to study the socio-demographic risk factors. Results Comparing the 1992-1996 and 2002-2006 cohorts showed the cumulative incidence of treated ADs at the age of 10 increased from 0.3% to 1.2% (females) and 0.46% to 1.9% (males). Subjects had higher odds of being diagnosed with an AD if mothers had low SES (OR 1.49, 95% CI 1.42-1.58) and were single parents (OR 1.99, 95% CI 1.84-2.15) at birth. Unipolar depression was the most common psychiatric comorbidity (31.2%). Conclusions
ADs diagnosed by specialized services increased from 1998-2012 in both genders. This could indicate real increase in overall ADs, an increase in seeking treatment or both phenomena. The findings on maternal socioeconomic status and single parenting help improve understanding of environmental risk for anxiety disorders among children and adolescents. Disclosure No significant relationships.
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Khanal P, Parker Gaddis K, Vandehaar M, Weigel K, White H, Peñagaricano F, Koltes J, Santos J, Baldwin R, Burchard J, Dürr J, Tempelman R. Multiple-trait random regression modeling of feed efficiency in US Holsteins. J Dairy Sci 2022; 105:5954-5971. [DOI: 10.3168/jds.2021-21739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/22/2022] [Indexed: 11/19/2022]
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Bhattarai A, Shah S, Bagherieh S, Mirmosayyeb O, Thapa S, Paudel S, Gyawali P, Khanal P. Endothelium, Platelets, and Coagulation Factors as the Three Vital Components for Diagnosing Bleeding Disorders: A Simplified Perspective with Clinical Relevance. Int J Clin Pract 2022; 2022:5369001. [PMID: 36101812 PMCID: PMC9440837 DOI: 10.1155/2022/5369001] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/31/2022] [Accepted: 08/12/2022] [Indexed: 12/02/2022] Open
Abstract
Bleeding disorders are a major group of hematological disorders, which are highly prevalent in the world. Excessive bleeding can result in serious consequences including hypoperfusion and cardiac arrest. The body has its selfmechanism to control excessive bleeding which is termed hemostasis. Hemostasis is achieved in two major steps, the formation of the primary and secondary hemostatic plugs. Endothelium, platelets, and coagulation factors are three components involved in hemostasis. Endothelium and platelets have a major role in forming the primary hemostatic plug. Consequently, the first step in investigating a bleeding disorder is platelet count. Despite normal platelet count, abnormality in the primary hemostatic plug may arise due to functional defects of the platelets including adhesion, activation, and aggregation. Von Willebrand disease (VWD) is an endothelial defect and the most prevalent inherited defect in coagulation. Abnormalities in the secondary hemostatic plug are largely due to coagulation factor deficiencies, and, to a lesser extent, the presence of inhibitors. Techniques involving viscoelastics have been aiding in rapid diagnosis and are useful in point-of-care testing. This article discusses the investigation of bleeding disorders from the perspective of the endothelium, platelet, and coagulation factor physiology. These three components should be properly investigated to achieve the definitive diagnosis of bleeding disorders.
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Affiliation(s)
- Abhinav Bhattarai
- Institute of Medicine, Tribhuvan University, Maharajgunj 44600, Nepal
| | - Sangam Shah
- Institute of Medicine, Tribhuvan University, Maharajgunj 44600, Nepal
| | | | | | - Sangharsha Thapa
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, University, Buffalo, State University of NY, Buffalo, NY, USA
| | - Sandip Paudel
- Institute of Medicine, Tribhuvan University, Maharajgunj 44600, Nepal
| | - Pawan Gyawali
- Institute of Medicine, Tribhuvan University, Maharajgunj 44600, Nepal
| | - Pitambar Khanal
- Institute of Medicine, Tribhuvan University, Maharajgunj 44600, Nepal
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Srivastava A, Khanal P, Zargaran D, Zoller F, Zargaran A, Mosahebi A. 980 Technological Innovations in The Management of Pressure Ulcers: A Systematic Review and Discussion. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
Pressure ulcers (PUs) affect over 700,000 patients per annum and are associated with an up to fourfold increase in mortality rate in older populations with complex pathologies. NICE guidelines for PU management involve a combination of low-grade technological interventions, including dressings and foam mattresses, while technology-centric therapies are not offered. The aim of this systematic review is to evaluate the effectiveness of any novel and high-grade technological PU interventions.
Method
The PubMed, Embase (via Ovid), Web of Science and CINAHL databases were electronically searched using free-text and MeSH search strings. Results evaluating the type of technological intervention, outcome measures and wound healing rates, duration of hospital stay, requirement for surgical debridement, infection and mortality rates were methodically assessed.
Results
An initial search identified 900 articles. Using the PRISMA guidance, 25 studies were included, encompassing 845 patients. 28 novel modalities of high-grade innovations were identified, with distinguished technologies including smart wireless bandages and 3D-printed wound repair scaffolds. Overall, 92.8% of devices demonstrated an improvement in wound healing (P < 0.05). A novel framework was created from the different innovations identified to approach adopting innovation in PU management.
Conclusions
The majority of high-technology innovations identified in this systematic review significantly improve PU healing, thus offering an additional pathway to standard care. Given the annual cost of PUs (£531 million), it is vital innovative technologies are considered as the NHS transitions into a digital age. Therefore, further studies are essential and recommended to evaluate the potential benefit of the promising, innovative technologies identified.
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Affiliation(s)
- A Srivastava
- School of Medicine, University College London (UCL), London, United Kingdom
| | - P Khanal
- School of Medicine, University College London (UCL), London, United Kingdom
| | - D Zargaran
- Department of Plastic and Reconstructive Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - F Zoller
- Department of Plastic and Reconstructive Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - A Zargaran
- Department of Medical Education, St Thomas’ Hospital, London, United Kingdom
| | - A Mosahebi
- Department of Plastic and Reconstructive Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom
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13
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Zargaran A, Zargaran D, Ashraf M, Khanal P, Srivastava A, Mosahebi A. 1376 Latex Allergies: Seeking an Alternative to Minimise Risk in The Operating Theatre. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
Natural Rubber Latex (NRL) gloves have been ubiquitously used in surgical practice. Over the past few decades, there have been many reports of NRL allergies associated with their use presenting a safety hazard to both patients and healthcare workers. Powder-free and latex-free gloves have been shown to offer reductions in incidence of allergic reactions, as well as cost savings.
Method
We performed a literature search to identify the rates of reaction to latex across the population in addition to the associated costs including litigation costs, costs of admission, and lost work time associated. We further looked at the rates of perforation of alternatives and the costs associated with such a transition.
Results
The UK prevalence of sensitisation amongst healthcare workers has been estimated to be 10%. The average cost of litigation to the employer was found to be $21,402 per claim. The mean cost of inpatient care for anaphylaxis has been cited as £469.88, with additional costs such as follow-up representing approximately £400. A 14-month study found cost savings of $10,000pa with a switch to non-latex gloves. Furthermore, an overall perforation rate of 80% in a latex-free glove compared to 34.4% in a latex glove.
Conclusions
From a business perspective, there is evidence of cost-savings arising from a switch to latex-free gloves, however, formal cost-effectiveness analyses would inform future decisions. Furthermore, comfort and reducing the chances of allergic reactions through removing the offending allergen all represent benefits of switching to latex-free gloves, however, non-inferiority analyses will inform future strategies both locally and nationally.
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Affiliation(s)
- A Zargaran
- Department of Medical Education, St. Thomas' Hospital, London, United Kingdom
| | - D Zargaran
- Department of Plastic and Reconstructive Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - M Ashraf
- Harefield Hospital, London, United Kingdom
| | - P Khanal
- School of Medicine, University College London (UCL), London, United Kingdom
| | - A Srivastava
- School of Medicine, University College London (UCL), London, United Kingdom
| | - A Mosahebi
- Department of Plastic and Reconstructive Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom
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Khanal P, Srivastava A, Zargaran D, Zargaran A, Nikkhah D, Mosahebi A. 1070 A Systematic Review of Seymour Fracture Management. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
Seymour fractures are distal phalanx fractures of the finger in children with a juxta-epiphyseal or Salter-Harris Type I/II pattern associated with a nail-bed injury. There remains a paucity in literature regarding the development of complications between Seymour fracture management options, with early studies encouraging non-operative management due to the increased rates of post-operative infection. This systematic review aims to identify present-day, optimal management strategies for Seymour fractures, with further analysis of infection rates and secondary outcomes during post-operative recovery.
Method
Free-text search, MeSH terms and expanded keywords/phrases were employed to search the PubMed, Embase (via Ovid), Web of Science and CINAHL databases. Studies that described the management of Seymour fractures in paediatric patients were included, subject to inclusion/exclusion criteria. The data extracted included the sample size, intervention, infection rates and secondary outcomes.
Results
An initial search identified 305 articles, following the PRISMA guidance, 8 studies were eligible for full-text analysis. Across all studies, 307 Seymour fractures were identified (mean age, 10±1.2 years). A cross-study analysis showed a lower rate of adverse outcomes (including malunion/non-union and unplanned operative intervention) for K-wire fixation when compared to external splinting, 8.3% and 20.7% (P ≤ 0.001), respectively.
Conclusions
There was no statistically significant difference between non-operative and operative management in rates of infection and adverse outcomes. However, further analysis revealed a significantly lower risk of complications in patients who received K-wire fixation when compared to external splinting. Nonetheless, further studies with greater levels of evidence need to be carried out to consolidate this.
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Affiliation(s)
- P Khanal
- School of Medicine, University College London (UCL), London, United Kingdom
| | - A Srivastava
- School of Medicine, University College London (UCL), London, United Kingdom
| | - D Zargaran
- Department of Plastic and Reconstructive Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - A Zargaran
- Department of Medical Education, St. Thomas' Hospital, London, United Kingdom
| | - D Nikkhah
- Department of Plastic and Reconstructive Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - A Mosahebi
- Department of Plastic and Reconstructive Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom
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Khanal P, Chawla U, Praveen S, Malik Z, Malik S, Yusuf M, Khan SA, Sharma M. Study of Naturally-derived Biomolecules as Therapeutics against SARS-CoV-2 Viral Spike Protein. JPRI 2021. [DOI: 10.9734/jpri/2021/v33i28a31524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The SARS-CoV2 virus, the causative agent for COVID-19 disease has to lead to more than 3.1 million deaths and crossed 146 million infections worldwide so far. Although vaccines development and emergency authorization has been approved by several governments, there has been great concern about its side effects for the long term and its effectiveness against new mutated strains. A resurgence of COVID-19 or related disease can be catastrophic. There is an urgent need to look for effective antiviral agents for many coronavirus strains with minimum side-effects, and maximum efficacy globally. Several, naturally-derived biomolecules have proved their excellent effect on several infectious diseases in a multi-mode fashion by targeting several pathways as well as increasing efficacy with high safety profile. Integrate computational prediction design was used in the study to examine the pharmacology of bioactive compounds of natural origin against SARS-CoV2 spike protein. Keeping these facts we have computationally examined 16 naturally occurring compounds using to evaluate their effectiveness against the SARS-CoV2 virus using the molecular docking technique. Hesperidin derivatives are known to ameliorate diabetes, co-morbidity for coronavirus, as well as help in preventing post coronavirus complications. We found the binding free energy of Hesperidin with spike protein to be -7.57 kcal/mol, the aglycone derivative to be -6.93 kcal/mol, hesperidin monoacetyl derivative to be -7.82 kcal/mol, and hesperidin pentaacetyl derivative to be -8.39 kcal/mol. Our findings revealed that acetylated derivatives of hesperidin showed significant improved remarked binding affinity while aglycone derivative hesperetin showed a decrease in binding affinity. Our studies give a new direction where natural bioactive compounds and their derivatives can be modulated and used after clinical trials to effectively inhibit coronavirus infection as well as diabetes simultaneously with a high safety profile.
Graphical Abstract
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16
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Khanal P. Antimalarial and anticancer properties of artesunate and other artemisinins: current development. Monatsh Chem 2021; 152:387-400. [PMID: 33814617 PMCID: PMC8008344 DOI: 10.1007/s00706-021-02759-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/22/2021] [Indexed: 02/06/2023]
Abstract
This review provides a recent perspective of artesunate and other artemisinins as antimalarial drugs and their uses in cancer therapy. Artesunate is an artemisinin derivative. Artemisinin is extracted from the plant Artemisia annua. Artemisinin and its derivatives have been the most useful drug for malarial treatment in human history. The artesunate has an advantage of a hydrophilic group over other artemisinins which makes it a more potent drug. On the industrial scale, artemisinins are synthesized in semisynthetic ways. The 1,2,4-endoperoxide bridge of artemisinins is responsible for the drug's antimalarial activity. There is the emergence of artemisinin resistance on Plasmodium falciparum and pieces of evidence suggest that it is mainly due to the mutation at Kelch13 protein of P. falciparum. Clinical trial data show that the artesunate is more favorable than quinine and other artemisinins to treat patients with severe malaria. Pieces of evidence indicate that artemisinins can be developed as anticancer drugs. The mechanism of actions on how artemisinins act as an anticancer drug involves oxidative stress, DNA damage and repair, and various types of cell deaths.
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Affiliation(s)
- Pitambar Khanal
- Nagarik College, Tribhuvan University, Gaidakot-2, Nawalparasi Purva, Gandaki, Nepal
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17
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Khanal P, Browning R. Effect of doeling traits at weaning on subsequent replacement doe fitness traits in a multi-breed meat goat herd. Small Rumin Res 2019. [DOI: 10.1016/j.smallrumres.2019.01.002] [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: 11/16/2022]
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18
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Khanal P, Mandar BK, Magadum P, Patil BM, Hullatti KK. In silico docking study of Limonoids from Azadirachta indica with pfpk5: A Novel Target for Plasmodium falciparum. Indian J Pharm Sci 2019. [DOI: 10.36468/pharmaceutical-sciences.514] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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20
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Bandara N, Li Y, Diebolder P, Mpoy C, Gu X, Khanal P, Deng S, Rogers BE, Savage PB. Translation of ceragenin affinity for bacteria to an imaging reagent for infection. RSC Adv 2019; 9:14472-14476. [PMID: 32864109 PMCID: PMC7451630 DOI: 10.1039/c9ra02226k] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/29/2022] Open
Abstract
Responses to bacterial infections may be manifest systemically without evidence of the location of the infection site. A rapid means of pinpointing infection sites would be useful in providing effective and possibly localized treatment. Successful means of identifying infection sites would require two components: (1) a molecule capable of recognizing bacteria and (2) a means of communicating recognition. For the recognition element, we used a ceragenin, a small molecule with affinity for bacterial membranes that was designed as a mimic of endogenous antimicrobial peptides. For the communication element, we used 64Cu, which is a positron emitter. By conjugating a copper chelating group to the ceragenin, the two elements were combined. Chelation of 64Cu by the conjugate was effective and provided a stable complex that allowed in vivo imaging. When administered to mice in a thigh infection model, the 64Cu-labeled conjugate accumulated at the site of infection (right thigh) without accumulation at the complementary site (left thigh). This conjugate may provide a means of identifying infection sites in patients presenting general signs of infection without localized symptoms. Infection imaged via autoradiography with ceragenin conjugated to a copper radiolabel.![]()
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Affiliation(s)
- Nilantha Bandara
- Department of Radiation Oncology
- Washington University School of Medicine
- St. Louis
- USA
| | - Yubo Li
- Brigham Young University
- Department of Chemistry and Biochemistry
- Provo
- USA
| | - Philipp Diebolder
- Department of Radiation Oncology
- Washington University School of Medicine
- St. Louis
- USA
| | - Cedric Mpoy
- Department of Radiation Oncology
- Washington University School of Medicine
- St. Louis
- USA
| | - Xiaobo Gu
- Brigham Young University
- Department of Chemistry and Biochemistry
- Provo
- USA
| | - Pitambar Khanal
- Brigham Young University
- Department of Chemistry and Biochemistry
- Provo
- USA
| | - Shenglou Deng
- Brigham Young University
- Department of Chemistry and Biochemistry
- Provo
- USA
| | - Buck E. Rogers
- Department of Radiation Oncology
- Washington University School of Medicine
- St. Louis
- USA
| | - Paul B. Savage
- Brigham Young University
- Department of Chemistry and Biochemistry
- Provo
- USA
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21
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Khanal P, Maltecca C, Schwab C, Gray K, Tiezzi F. 305 Genetic parameters of meat quality and carcass composition traits in crossbred swine. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.254] [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: 11/12/2022] Open
Affiliation(s)
- P Khanal
- North Carolina State University,Raleigh, NC, United States
| | - C Maltecca
- North Carolina State University,Raleigh, NC, United States
| | - C Schwab
- The Maschhoffs LLC,Carlyle, IL, United States
| | - K Gray
- Smithfield Premium Genetics,Roanoke Rapids, NC, United States
| | - F Tiezzi
- North Carolina State University,Raleigh, NC, United States
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22
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Johnsen L, Lyckegaard NB, Khanal P, Quistorff B, Raun K, Nielsen MO. Fetal over- and undernutrition differentially program thyroid axis adaptability in adult sheep. Endocr Connect 2018; 7:777-790. [PMID: 29794141 PMCID: PMC5970278 DOI: 10.1530/ec-18-0014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 04/10/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We aimed to test, whether fetal under- or overnutrition differentially program the thyroid axis with lasting effects on energy metabolism, and if early-life postnatal overnutrition modulates implications of prenatal programming. DESIGN Twin-pregnant sheep (n = 36) were either adequately (NORM), under- (LOW; 50% of NORM) or overnourished (HIGH; 150% of energy and 110% of protein requirements) in the last-trimester of gestation. From 3 days-of-age to 6 months-of-age, twin lambs received a conventional (CONV) or an obesogenic, high-carbohydrate high-fat (HCHF) diet. Subgroups were slaughtered at 6-months-of-age. Remaining lambs were fed a low-fat diet until 2½ years-of-age (adulthood). METHODS Serum hormone levels were determined at 6 months- and 2½ years-of-age. At 2½ years-of-age, feed intake capacity (intake over 4-h following 72-h fasting) was determined, and an intravenous thyroxine tolerance test (iTTT) was performed, including measurements of heart rate, rectal temperature and energy expenditure (EE). RESULTS In the iTTT, the LOW and nutritionally mismatched NORM:HCHF and HIGH:CONV sheep increased serum T3, T3:T4 and T3:TSH less than NORM:CONV, whereas TSH was decreased less in HIGH, NORM:HCHF and LOW:HCHF. Early postnatal exposure to the HCHF diet decreased basal adult EE in NORM and HIGH, but not LOW, and increased adult feed intake capacity in NORM and LOW, but not HIGH.Conclusions: The iTTT revealed a differential programming of central and peripheral HPT axis function in response to late fetal malnutrition and an early postnatal obesogenic diet, with long-term implications for adult HPT axis adaptability and associated consequences for adiposity risk.
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Affiliation(s)
- L Johnsen
- Department of Large Animal SciencesFaculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - N B Lyckegaard
- Department of Large Animal SciencesFaculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - P Khanal
- Department of Large Animal SciencesFaculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - B Quistorff
- Department of Biomedical SciencesFaculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - K Raun
- Diabetes and Obesity PharmacologyNovo Nordisk A/S, Måløv, Denmark
| | - M O Nielsen
- Department of Large Animal SciencesFaculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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23
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Mayberry K, Khanal P, Poore MH, Serão NVL, Poole DH. 110 Evaluation of Angus Calf Performance Based on Dams Tolerance or Susceptibility to Fescue Toxicosis. J Anim Sci 2018. [DOI: 10.1093/jas/sky027.103] [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: 11/13/2022] Open
Affiliation(s)
- K Mayberry
- North Carolina State University, Raleigh, NC
| | - P Khanal
- North Carolina State University, Raleigh, NC
| | - M H Poore
- North Carolina State University, Raleigh, NC
| | | | - D H Poole
- North Carolina State University, Raleigh, NC
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24
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Nicklaus KM, Teo I, Reece GP, Huang SC, Mahajan K, Andon J, Khanal P, Sun CS, Merchant FA, Markey MK, Fingeret MC. Abstract P5-18-03: Relationships among breast symmetry, appearance investment, and body image dissatisfaction in breast cancer patients undergoing reconstruction. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-18-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: Reconstruction as part of treatment for breast cancer is aimed at mitigating body image concerns post-mastectomy. Although algorithms are increasingly being developed to objectively assess breast reconstruction outcomes, previous research has not evaluated associations between objectively quantified breast aesthetic appearance and patient-reported body image outcomes. Further, the role appearance investment plays in a patient's body image is not well understood. We examined the extent to which objectively quantified breast symmetry and appearance investment were associated with body image dissatisfaction in patients undergoing cancer-related breast reconstruction. Method: Breast cancer patients in different stages of reconstruction (n=190) completed self-report measures of appearance investment and body image dissatisfaction. Vertical extent and horizontal extent symmetry values, which are indicators of breast symmetry across the vertical axis, were calculated from clinical photographs. Associations among symmetry, appearance investment, body image dissatisfaction, and patient clinical factors were examined. Multiple regression was used to evaluate the association of symmetry and appearance investment with body image dissatisfaction. Results: Vertical extent symmetry, but not horizontal extent symmetry, was associated with body image dissatisfaction. Multiple regression results indicated that decreased vertical extent symmetry (β = -0.24, p <0.01) and increased appearance investment (β = 0.37, p <0.001) were significantly associated with greater body image dissatisfaction while controlling for clinical factors.Conclusions: Our findings suggest that quantitatively measured reconstruction outcomes and appearance investment both significantly contribute to an understanding of patient-reported body image satisfaction during breast reconstruction treatment. Future studies are encouraged to utilize algorithms assessing breast aesthetic appearance and to consider patient values as predictors of body image outcomes.
Symmetry Predicting Body Image Dissatisfaction Controlling for Clinical Factors Body Image Dissatisfaction (β)VE Symmetry-0.24**Appearance investment (ASI-R)0.37*** Clinial factors controlled for BMI-0.01Prior chemotherapy0.19Prior radiation therapy0.08Prior complications0.06Reconstruction timing (ref: Immediate) Delayed0.06Reconstruction type (ref: Implant) Autologous-0.01Mixed type0.09Reconstruction Stage (ref: Pre-surgery) Intermediate-0.06Final-0.15*p<.05, **p<.01, ***p<.001; ref = reference group; Note ASI-R = Appearance Schemas Inventory-Revised
Citation Format: Nicklaus KM, Teo I, Reece GP, Huang S-C, Mahajan K, Andon J, Khanal P, Sun CS, Merchant FA, Markey MK, Fingeret MC. Relationships among breast symmetry, appearance investment, and body image dissatisfaction in breast cancer patients undergoing reconstruction [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-18-03.
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Affiliation(s)
- KM Nicklaus
- The University of Texas at Austin, Austin, TX; Duke-NUS Medical School, Singapore, Singapore; The University of Texas MD Anderson Cancer Center, Houston, TX; OpenText, Austin, TX; Icahn School of Medicine at Mount Sinai, New York, NY; University of Houston, Houston, TX; University of Hawaii Residency Programs, Honolulu, HI
| | - I Teo
- The University of Texas at Austin, Austin, TX; Duke-NUS Medical School, Singapore, Singapore; The University of Texas MD Anderson Cancer Center, Houston, TX; OpenText, Austin, TX; Icahn School of Medicine at Mount Sinai, New York, NY; University of Houston, Houston, TX; University of Hawaii Residency Programs, Honolulu, HI
| | - GP Reece
- The University of Texas at Austin, Austin, TX; Duke-NUS Medical School, Singapore, Singapore; The University of Texas MD Anderson Cancer Center, Houston, TX; OpenText, Austin, TX; Icahn School of Medicine at Mount Sinai, New York, NY; University of Houston, Houston, TX; University of Hawaii Residency Programs, Honolulu, HI
| | - S-C Huang
- The University of Texas at Austin, Austin, TX; Duke-NUS Medical School, Singapore, Singapore; The University of Texas MD Anderson Cancer Center, Houston, TX; OpenText, Austin, TX; Icahn School of Medicine at Mount Sinai, New York, NY; University of Houston, Houston, TX; University of Hawaii Residency Programs, Honolulu, HI
| | - K Mahajan
- The University of Texas at Austin, Austin, TX; Duke-NUS Medical School, Singapore, Singapore; The University of Texas MD Anderson Cancer Center, Houston, TX; OpenText, Austin, TX; Icahn School of Medicine at Mount Sinai, New York, NY; University of Houston, Houston, TX; University of Hawaii Residency Programs, Honolulu, HI
| | - J Andon
- The University of Texas at Austin, Austin, TX; Duke-NUS Medical School, Singapore, Singapore; The University of Texas MD Anderson Cancer Center, Houston, TX; OpenText, Austin, TX; Icahn School of Medicine at Mount Sinai, New York, NY; University of Houston, Houston, TX; University of Hawaii Residency Programs, Honolulu, HI
| | - P Khanal
- The University of Texas at Austin, Austin, TX; Duke-NUS Medical School, Singapore, Singapore; The University of Texas MD Anderson Cancer Center, Houston, TX; OpenText, Austin, TX; Icahn School of Medicine at Mount Sinai, New York, NY; University of Houston, Houston, TX; University of Hawaii Residency Programs, Honolulu, HI
| | - CS Sun
- The University of Texas at Austin, Austin, TX; Duke-NUS Medical School, Singapore, Singapore; The University of Texas MD Anderson Cancer Center, Houston, TX; OpenText, Austin, TX; Icahn School of Medicine at Mount Sinai, New York, NY; University of Houston, Houston, TX; University of Hawaii Residency Programs, Honolulu, HI
| | - FA Merchant
- The University of Texas at Austin, Austin, TX; Duke-NUS Medical School, Singapore, Singapore; The University of Texas MD Anderson Cancer Center, Houston, TX; OpenText, Austin, TX; Icahn School of Medicine at Mount Sinai, New York, NY; University of Houston, Houston, TX; University of Hawaii Residency Programs, Honolulu, HI
| | - MK Markey
- The University of Texas at Austin, Austin, TX; Duke-NUS Medical School, Singapore, Singapore; The University of Texas MD Anderson Cancer Center, Houston, TX; OpenText, Austin, TX; Icahn School of Medicine at Mount Sinai, New York, NY; University of Houston, Houston, TX; University of Hawaii Residency Programs, Honolulu, HI
| | - MC Fingeret
- The University of Texas at Austin, Austin, TX; Duke-NUS Medical School, Singapore, Singapore; The University of Texas MD Anderson Cancer Center, Houston, TX; OpenText, Austin, TX; Icahn School of Medicine at Mount Sinai, New York, NY; University of Houston, Houston, TX; University of Hawaii Residency Programs, Honolulu, HI
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Haddawy P, Khanal P, Suebnukarn S, Dailey MN, Rhienmora P. A Virtual Reality Simulator for Teaching and Evaluating Dental Procedures. Methods Inf Med 2018; 49:396-405. [DOI: 10.3414/me9310] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Summary
Objectives: We present a dental training system with a haptic interface that allows dental students or experts to practice dental procedures in a virtual environment. The simulator is able to monitor and classify the performance of an operator into novice or expert categories. The intelligent training module allows a student to simultaneously and proactively follow the correct dental procedures demonstrated by an intelligent tutor.
Methods: The virtual reality (VR) simulator simulates the tooth preparation procedure both graphically and haptically, using a video display and haptic device. We evaluated the performance of users using hidden Markov models (HMMs) incorporating various data collected by the simulator. We implemented an intelligent training module which is able to record and replay the procedure that was performed by an expert and allows students to follow the correct steps and apply force proactively by themselves while reproducing the procedure.
Results: We find that the level of graphics and haptics fidelity is acceptable as evaluated by dentists. The accuracy of the objective performance assessment using HMMs is encouraging with 100 percent accuracy.
Conclusions: The simulator can simulate realistic tooth surface exploration and cutting. The accuracy of automatic performance assessment system using HMMs is also acceptable on relatively small data sets. The intelligent training allows skill transfer in a proactive manner which is an advantage over the passive method in a traditional training. We will soon conduct experiments with more participants and implement a variety of training strategies.
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Galliou JM, Khanal P, Mayberry K, Poore MH, Poole DH, Serão NV. 113 Evaluating the Accuracy of a New Commercial Genetic Test for Response to Fescue Toxicosis in Cattle. J Anim Sci 2016. [DOI: 10.2527/ssasas2017.0113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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27
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Khanal P, Mayberry K, Poore MH, Poole DH, Serão NV. 038 Effect of Genetic Response to Fescue Toxicity on Body Weight, Body Temperature, Hair Coat, Hair Shed and Body Condition Score in Angus Cows. J Anim Sci 2016. [DOI: 10.2527/ssasas2017.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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McFall M, Hayes EG, Khanal P, Leite-Browning ML, Browning R. 117 Effect of Internal Parasites on Meat Goat Reproductive Traits. J Anim Sci 2016. [DOI: 10.2527/ssasas2017.0117] [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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30
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Khanal P, Browning ML, Byars M, Browning R. 026 Effect of doeling traits at weaning on doe survival and reproductive rates through their first production year in the southeastern United States. J Anim Sci 2016. [DOI: 10.2527/ssasas2015-026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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31
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Hayes EG, Khanal P, Louren_on RV, Browning R. 041 Evaluations of Savanna Sires Compared with Kiko and Spanish Sires for Birth to Weaning Meat Goat Kid Traits. J Anim Sci 2016. [DOI: 10.2527/ssasas2015-041] [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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Khanal P, Axel AMD, Kongsted AH, Husted SV, Johnsen L, Pandey D, Pedersen KL, Birtwistle M, Markussen B, Kadarmideen HN, Nielsen MO. Late gestation under- and overnutrition have differential impacts when combined with a post-natal obesogenic diet on glucose-lactate-insulin adaptations during metabolic challenges in adolescent sheep. Acta Physiol (Oxf) 2015; 213:519-36. [PMID: 25204637 DOI: 10.1111/apha.12391] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 05/21/2014] [Accepted: 09/03/2014] [Indexed: 01/04/2023]
Abstract
AIM To determine whether late gestation under- and overnutrition programme metabolic plasticity in a similar way, and whether metabolic responses to an obesogenic diet in early post-natal life depend on the foetal nutrition history. METHODS In a 3 × 2 factorial design, twin-pregnant ewes were for the last 6 weeks of gestation (term = 147 days) assigned to HIGH (N = 13; 150 and 110% of energy and protein requirements, respectively), NORM (N = 9; 100% of requirements) or LOW (N = 14; 50% of requirements) diets. The twin offspring were raised on high-carbohydrate-high-fat (HCHF; N = 35) or conventional (CONV; N = 35) diets from 3 days to 6 months of age (around puberty). Then intravenous glucose (GTT; overnight fasted), insulin (ITT; fed) and propionate (gluconeogenetic precursor; PTT; both fed and fasted) tolerance tests were conducted to evaluate (hepatic) metabolic plasticity. RESULTS Prenatal malnutrition differentially impacted adaptations of particularly plasma lactate followed by glucose, cholesterol and insulin. This was most clearly expressed during PTT in fasted lambs and much less during ITT and GTT. In fasted lambs, propionate induced more dramatic increases in lactate than glucose, and HIGH lambs became more hyperglycaemic, hyperlactataemic and secreted less insulin compared to the hypercholesterolaemic LOW lambs. Propionate-induced insulin secretion was virtually abolished in fasted HCHF lambs, but upregulated in fasted compared to fed CONV lambs. HCHF lambs had the greatest glucose-induced insulin secretory responses. CONCLUSION Prenatal malnutrition differentially programmed glucose-lactate metabolic pathways and cholesterol homeostasis. Prenatal overnutrition predisposed for hyperglycaemia and hyperlactataemia, whereas undernutrition predisposed for hypercholesterolaemia upon exposure to an obesogenic diet. Prenatal overnutrition (not undernutrition) interfered with pancreatic insulin secretion by non-glucose-dependent mechanisms.
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Affiliation(s)
- P. Khanal
- Department of Veterinary Clinical and Animal Sciences; Faculty of Health and Medical Sciences; University of Copenhagen; Frederiksberg C Denmark
| | - A. M. D. Axel
- Department of Veterinary Clinical and Animal Sciences; Faculty of Health and Medical Sciences; University of Copenhagen; Frederiksberg C Denmark
| | - A. H. Kongsted
- Department of Veterinary Clinical and Animal Sciences; Faculty of Health and Medical Sciences; University of Copenhagen; Frederiksberg C Denmark
| | - S. V. Husted
- Department of Veterinary Clinical and Animal Sciences; Faculty of Health and Medical Sciences; University of Copenhagen; Frederiksberg C Denmark
| | - L. Johnsen
- Department of Veterinary Clinical and Animal Sciences; Faculty of Health and Medical Sciences; University of Copenhagen; Frederiksberg C Denmark
| | - D. Pandey
- Department of Veterinary Clinical and Animal Sciences; Faculty of Health and Medical Sciences; University of Copenhagen; Frederiksberg C Denmark
- School of Science and Technology; Örebro University; Örebro Sweden
| | - K. L. Pedersen
- Department of Veterinary Clinical and Animal Sciences; Faculty of Health and Medical Sciences; University of Copenhagen; Frederiksberg C Denmark
| | - M. Birtwistle
- Early Life Research Unit; Academic Division of Child Health; School of Medicine; Nottingham University; Nottingham UK
| | - B. Markussen
- Department of Mathematical Sciences; Faculty of Science; Laboratory of Applied Statistics; University of Copenhagen; Copenhagen Denmark
| | - H. N. Kadarmideen
- Department of Veterinary Clinical and Animal Sciences; Faculty of Health and Medical Sciences; University of Copenhagen; Frederiksberg C Denmark
| | - M. O. Nielsen
- Department of Veterinary Clinical and Animal Sciences; Faculty of Health and Medical Sciences; University of Copenhagen; Frederiksberg C Denmark
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Haque M, Roggenbuck M, Khanal P, Nielsen M, Madsen J. Development of methane emission from lambs fed milk replacer and cream for a prolonged period. Anim Feed Sci Technol 2014. [DOI: 10.1016/j.anifeedsci.2014.09.002] [Citation(s) in RCA: 6] [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: 11/24/2022]
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Khanal P, Husted SV, Axel AMD, Johnsen L, Pedersen KL, Mortensen MS, Kongsted AH, Nielsen MO. Late gestation over- and undernutrition predispose for visceral adiposity in response to a post-natal obesogenic diet, but with differential impacts on glucose-insulin adaptations during fasting in lambs. Acta Physiol (Oxf) 2014; 210:110-26. [PMID: 23746217 DOI: 10.1111/apha.12129] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 02/15/2013] [Accepted: 06/03/2013] [Indexed: 11/26/2022]
Abstract
AIM To investigate if late gestation under- or overnutrition has similar adverse impacts on visceral adiposity, metabolic and endocrine function in sheep, and if subsequent exposure to a high-fat diet in early post-natal life exaggerates the prenatal programming outcomes later in life. METHODS Thirty-six twin-pregnant ewes were fed a NORM (fulfilling 100% of daily requirements for energy and protein), LOW (50% of NORM) or HIGH diet (150% of energy and 110% of protein requirements) during the last 6 weeks of gestation (term = 147 days). Post-natally, the twin lambs were subjected to a high-fat or a moderate diet until 6 months of age (around puberty), where metabolic and endocrine adaptability to fasting was examined, and subgroups of animals were killed. RESULTS Animals exposed to either prenatal under- or overnutrition had reduced subcutaneous fat deposition when fed a high-fat diet, resulting in higher ratios of mesenteric and peri-renal fat relative to subcutaneous fat compared to controls. This was not related to prenatal influences on plasma glucose or insulin. Irrespective of the prenatal diet, high-fat-fed lambs underwent changes resembling the metabolic syndrome with higher plasma glucose, cholesterol, non-esterified fatty acids, triglyceride and lactate combined with abdominal obesity. Peri-renal fat appeared to be a particular target of a high-fat diet post-natally. CONCLUSION Both prenatal under- and overnutrition predisposed for abdominal adiposity, apparently by reducing the expandability of subcutaneous adipose tissue and induced differential physiological adaptations to fasting. This study does not suggest that exposure to gestational overnutrition will provide a protective effect against development of hyperglycaemia later in life.
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Affiliation(s)
- P. Khanal
- Department of Veterinary Clinical and Animal Sciences; Faculty of Health and Medical Sciences; University of Copenhagen; Frederiksberg Denmark
| | - S. V. Husted
- Department of Veterinary Clinical and Animal Sciences; Faculty of Health and Medical Sciences; University of Copenhagen; Frederiksberg Denmark
| | - A. M. D. Axel
- Department of Veterinary Clinical and Animal Sciences; Faculty of Health and Medical Sciences; University of Copenhagen; Frederiksberg Denmark
| | - L. Johnsen
- Department of Veterinary Clinical and Animal Sciences; Faculty of Health and Medical Sciences; University of Copenhagen; Frederiksberg Denmark
| | - K. L. Pedersen
- Department of Veterinary Clinical and Animal Sciences; Faculty of Health and Medical Sciences; University of Copenhagen; Frederiksberg Denmark
| | - M. S. Mortensen
- Department of Veterinary Clinical and Animal Sciences; Faculty of Health and Medical Sciences; University of Copenhagen; Frederiksberg Denmark
| | - A. H. Kongsted
- Department of Veterinary Clinical and Animal Sciences; Faculty of Health and Medical Sciences; University of Copenhagen; Frederiksberg Denmark
| | - M. O. Nielsen
- Department of Veterinary Clinical and Animal Sciences; Faculty of Health and Medical Sciences; University of Copenhagen; Frederiksberg Denmark
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Khanal P, Yun HJ, Lim SC, Ahn SG, Yoon HE, Kang KW, Hong R, Choi HS. Proyl isomerase Pin1 facilitates ubiquitin-mediated degradation of cyclin-dependent kinase 10 to induce tamoxifen resistance in breast cancer cells. Oncogene 2012; 31:3845-56. [PMID: 22158035 DOI: 10.1038/onc.2011.548] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Endocrine therapies that inhibit estrogen receptor (ER)-α signaling are the most common and effective treatment for ER-α-positive breast cancer. However, the use of these agents is limited by the frequent development of resistance. The aim of this study was to elucidate the mechanisms by which downregulation of CDK10 expression confers resistance to tamoxifen in breast cancer. Here, we show that peptidyl-prolyl isomerase Pin1 downregulates CDK10 protein as a result of its interaction with and ubiquitination of CDK10, thereby affecting CDK10-dependent Raf-1 phosphorylation (S338). Pin1(-/-) mouse embryonic fibroblasts (MEFs) show higher CDK10 expression than Pin1(+/+) MEFs, whereas CDK10 protein was downregulated in the rescued Pin1(-/-) MEFs after reexpression of Pin1. Pin1 silencing in SKBR-3 and MCF7 cells increased the CDK10 expression. In human tamoxifen-resistant breast cancer and tamoxifen-resistant MCF7 cells, immunohistochemical staining and immunoblotting analysis shows an inverse correlation between the expression of CDK10 and the degree of tamoxifen resistance. There was also a positive correlation between the high level of P-Raf-1 (Ser338) and Pin1 in human tamoxifen-resistant breast cancer and tamoxifen-resistant MCF7 (TAMR-MCF7) cells. Importantly, 4-OH tamoxifen (4-OHT), when used in combination with overexpressed CDK10 or Raf-1 inhibitor, increased cleaved PARP and DNA fragmentation to inhibit cologenic growth of MCF7 cells and Tamoxifen-resistant MCF7 cells, respectively. On the basis of these findings, we suggest that the Pin1-mediated CDK10 ubiquitination is a major regulator of tamoxifen-resistant breast cancer cell growth and survival.
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Affiliation(s)
- P Khanal
- BK21 Project Team, College of Pharmacy, Chosun University, Gwangju, Republic of Korea
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Barber-Meyer SM, Jnawali SR, Karki JB, Khanal P, Lohani S, Long B, MacKenzie DI, Pandav B, Pradhan NMB, Shrestha R, Subedi N, Thapa G, Thapa K, Wikramanayake E. Influence of prey depletion and human disturbance on tiger occupancy in Nepal. J Zool (1987) 2012. [DOI: 10.1111/j.1469-7998.2012.00956.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - S. R. Jnawali
- National Trust for Nature Conservation; Lalitpur; Nepal
| | - J. B. Karki
- Department of National Parks and Wildlife Conservation; Kathmandu; Nepal
| | | | | | | | | | - B. Pandav
- WWF International; Gland; Switzerland
| | | | | | - N. Subedi
- National Trust for Nature Conservation; Lalitpur; Nepal
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Aryal DR, Gurung R, Misra S, Khanal P, Pradhan A, Gurubacharya SM. Intrauterine growth curves for singleton live babies in Paropakar Maternity and Women's Hospital in Nepal. J Nepal Health Res Counc 2012; 10:160-166. [PMID: 23034381] [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: 06/01/2023]
Abstract
BACKGROUND To construct birth weight, crown heel length and head circumference centile chart referenced to gestational age for Nepalese infants. METHODS The study was conducted over a period of six months. It included consecutive live births from 28 to 42 weeks of gestation. Their birth weight, crown-heel length and head circumference were recorded. Smoothed percentile values along with curves were created using the Lambda Mu Sigma (LMS) method. The curves were compared with one of the Indian study. RESULTS A total of 9710 newborns were measured. The mean birth weight, crown-heel length, head circumference at 40 weeks were 3023g, 49.22cm and 33.61cm respectively. Smoothed percentile values calculated gave the cutoffs for defining small and large gestational age for Nepalese newborns. Comparison with Indian study showed significant difference (p<0.01) in weight. The Indian babies weighed less than Nepalese babies. CONCLUSIONS The referenced growth standards help in clinical assessment, defining and identifying high risk newborns, thus, leading to improved care and management of neonates. It should help public health policy makers to track population difference due to several factors, intervene and find response over time.
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Affiliation(s)
- D R Aryal
- Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu, Nepal
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Khan J, Shrestha SK, Pradhan NM, Acharya BKM, Khanal P. Percutaneous K wire fixation of fifth metacarpal neck fracture--new and simple technique. J Nepal Health Res Counc 2012; 10:61-65. [PMID: 22929640] [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: 06/01/2023]
Abstract
BACKGROUND Isolated fractures of metacarpals and phalanges are the commonest injuries affected upper extremity, which constitute about 10% of skeletal fractures in general. Fifth metacarpal (boxer's fractures) being the most common. The objective of this study was to investigate the outcome of treatment of the displaced neck and sub-capital fractures of the fifth metacarpal by percutaneous K wire fixation. METHODS An observational study was conducted in the department of orthopedics Patan hospital as an outpatient procedure from January 2010 to January 2012. All adult patients with unilateral fracture of neck of fifth metacarpal bone were included. Whose physis was open, having previous hand injury or diseases causing deformity or impaired hand function and when fracture was more than 7 days old, were excluded from the study. RESULTS Twenty eight of 35 patients obtained anatomic reduction, and 7 patients had 2/3 apposition of bone end and no rotational deformity. Follow-up was available for only 30 patients. The follow-up time was up to 12 weeks. The head/shaft angle of the fifth metacarpal was 60.60 degrees ±9.39 degrees preoperatively, and 14.20 degrees ±7.32 degrees postoperatively, and 15.60 degrees ±6.95 degrees in 12 weeks postoperatively. The difference between preoperative and postoperative angles was highly significant. The range of motion of the metacarpal joint was 86.73 degrees ±6.13 degrees postoperatively, which was not significantly different compared with that of uninjured side which was 90.93 degrees ±3.18. The difference between preoperative and postoperative angles was highly significant. The range of motion of the metacarpal joint was not significantly different compared with that of uninjured side. The average union time was 5.46 weeks ±1.22. CONCLUSIONS This method under consideration does not disturb the fracture site itself, the Kirschner wire being introduced in retrograde fashion makes it easier to correctly place the wire, which gives reasonably stable fixation, gives excellent results in a high proportion of selected cases. Local anesthesia is an added advantage.
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Affiliation(s)
- J Khan
- Department of Orthopedics and Trauma Surgery, Universal College of Medical Science, Bhairahawa, Nepal.
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Gurung CK, Dahal R, Khanal P, Nepal S, Jaiswal AK. Pattern of poisoning cases in a hospital in a Terai district of central Nepal. Nepal Med Coll J 2011; 13:160-163. [PMID: 22808805] [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: 06/01/2023]
Abstract
Poisoning is a major global health problem and is one of the major causes of hospitalization through emergency. The objective of this study is to evaluate the characteristics of poisoning cases admitted to emergency department over a one year period. A hospital based study was carried out in the emergency department, Mahendra Adarsha Chikitsalaya, Chitwan analyzing the data of the poisoning cases attended for one year duration by searching all the medical records. A total of 921 poisoning cases presented to emergency department in the year 2007. The female to male ratio was 1.17:1. Most of poisoning occurred in the age group 15-24 years. Snake bite was the commonest form of poisoning amongst all cases. By occupation, 46.0% cases were in farmers. Accidental poisoning prevailed over intentional poisoning. Seasonal trend revealed maximum cases being in summer (42.4%). Poisoning shows seasonal trend and hence proper intervention is required in community level.
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Affiliation(s)
- C K Gurung
- Department of Community Medicine and Family Health, Institute of Medicine, Kathmandu, Nepal
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Weinberg Z, Chen Y, Khanal P, Pinto R, Zakin V, Sela S. The effect of cattle manure cultivation on moisture content and survival of Escherichia coli12. J Anim Sci 2011; 89:874-81. [DOI: 10.2527/jas.2010-3272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Khanal P, Ghimire RH, Gautam B, Dhungana SK, Parajuli P, Jaiswal AK, Khanal B. Substance Use among Medical Students in Kathmandu Valley. JNMA J Nepal Med Assoc 2010. [DOI: 10.31729/jnma.26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Introduction: Substance use including tobacco and alcohol is the most important cause of preventable morbidity, disability, and premature mortality. The study aims to specify the prevalence and the pattern of use of different substance.
Methods: A cross sectional study was performed amongst first year and final year students in four medical colleges in Kathmandu using self administered anonymous questionnaire.Data collectedfrom 446 students were analyzed.
Results: Prevalence of substance use was found to be 60.3% among the medical students. Alcohol (57.6%) was the substance most prevalently used followed by tobacco (27.58%) and cannabis (12.8%). Mean age of first exposure was 17.94 (Confidence interval: 17.91-17.97). There was significant difference in the useof tobacco and cannabis amongst final year students than first year students. Male and female differed significantly in use of every substance except for benzodiazepine. Medical college, college and school were place of first exposure in 17.26%, 15.92% and 13.23% of the cases respectively. Family history was associated with substance use in medical students and was statistically significant (P<0.0001).Experimentation was the major reason for the use of most of the substances.
Conclusions: Substance use is prevalent in male medical students of both first and final year. Hence steps should be initiated early in school, college and medical college to prevent substance use.
Keywords: alcohol, medical students, substance use, tobacco.
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Khanal P, Ghimire RH, Gautam B, Dhungana SK, Parajuli P, Jaiswal AK, Khanal B. Substance use among medical students in Kathmandu valley. JNMA J Nepal Med Assoc 2010; 50:267-272. [PMID: 22049888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION Substance use including tobacco and alcohol is the most important cause of preventable morbidity, disability, and premature mortality. The study aims to specify the prevalence and the pattern of use of different substance. METHODS A cross sectional study was performed amongst first year and final year students in four medical colleges in Kathmandu using self administered anonymous questionnaire.Data collectedfrom 446 students were analyzed. RESULTS Prevalence of substance use was found to be 60.3% among the medical students. Alcohol (57.6%) was the substance most prevalently used followed by tobacco (27.58%) and cannabis (12.8%). Mean age of first exposure was 17.94 (Confidence interval: 17.91-17.97). There was significant difference in the useof tobacco and cannabis amongst final year students than first year students. Male and female differed significantly in use of every substance except for benzodiazepine. Medical college, college and school were place of first exposure in 17.26%, 15.92% and 13.23% of the cases respectively. Family history was associated with substance use in medical students and was statistically significant (P<0.0001).Experimentation was the major reason for the use of most of the substances. CONCLUSIONS Substance use is prevalent in male medical students of both first and final year. Hence steps should be initiated early in school, college and medical college to prevent substance use.
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Affiliation(s)
- P Khanal
- Institute of Medicine, Maharajgunj, Kathmandu, Nepal.
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Khanal P, Lee KY, Kang KW, Kang BS, Choi HS. Tpl-2 kinase downregulates the activity of p53 and enhances signaling pathways leading to activation of activator protein 1 induced by EGF. Carcinogenesis 2009; 30:682-9. [DOI: 10.1093/carcin/bgp040] [Citation(s) in RCA: 11] [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: 01/08/2023] Open
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Pepall J, Khanal P. Conservation reaches new heights. IDRC Rep 1992; 20:22-4. [PMID: 12285834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
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