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Churiwala JJ, Rege SA, Salvi V, Shah SK. P-152 COMPARISON OF ENHANCED-VIEW TOTALLY EXTRAPERITONEAL (ETEP) AND TRANSABDOMINAL (TARM) MINIMAL ACCESS TECHNIQUES FOR RETROMUSCULAR PLACEMENT OF PROSTHESIS IN THE TREATMENT OF IRREDUCIBLE MIDLINE VENTRAL HERNIA. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.249] [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: 11/13/2022]
Abstract
Abstract
Aim
Retromuscular or sublay meshplasty has been advocated to reinstate abdominal wall strength following ventral hernia repair while avoiding complications like visceral adhesions, fistula formation and mesh infection. We aim to compare two minimally invasive approaches of sublay hernioplasty for irreducible ventral midline hernia with respect to their efficacy and safety.
Material & Methods
We performed a retrospective study of 73 patients operated for primary and recurrent irreducible ventral midline hernia by eTEP or TARM repair with sublay meshplasty. We compared the intraoperative and post-operative complications, post-operative pain score, subjective technical ease of procedure, patient satisfaction and recurrence after 3 months and 12 months of surgery.
Results & Conclusion
There was no significant difference in the outcome of surgery and complications by the two techniques. However, there was a significant subjective technical ease in the TARM group (n=35) due to ergonomic port placement and adhesiolysis and reduction of hernia contents done under vision. The number of ports used and post-operative pain score were higher in the TARM group as compared to that of the eTEP group. 96% of the patients belonging to both groups were satisfied with their surgery after a year on telephonic follow-up. However, a multicentric study with a larger sample size would be required to establish the advantage of one technique over the other.
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Affiliation(s)
- J J Churiwala
- Assistant Professor Department of General Surgery, Seth GS Medical College & KEM Hospital , Mumbai , India
| | - S A Rege
- Professor & Head of Unit Department of General Surgery, Seth GS Medical College & KEM Hospital , Mumbai , India
| | - V Salvi
- Assistant Professor Department of General Surgery, Seth GS Medical College & KEM Hospital , Mumbai , India
| | - S K Shah
- Junior Resident Department of General Surgery, Seth GS Medical College & KEM Hospital , Mumbai , India
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Karn RR, Acharya R, Rajbanshi AK, Singh SK, Thakur SK, Shah SK, Singh AK, Shah R, Upadhya Kafle S, Bhattachan M, Abrahamyan A, Shewade HD, Zachariah R. Antibiotic resistance in patients with chronic ear discharge awaiting surgery in Nepal. Public Health Action 2021; 11:1-5. [PMID: 34778008 PMCID: PMC8575382 DOI: 10.5588/pha.21.0029] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/26/2021] [Indexed: 11/16/2022] Open
Abstract
SETTING Biratnagar Eye Hospital, Biratnagar, Nepal, which offers ear surgery for chronic suppurative otitis media (CSOM). OBJECTIVE In patients with CSOM awaiting surgery, to determine the 1) sociodemographic characteristics 2) bacterial isolates and their antibiotic resistance patterns and 3) characteristics of those refused surgery, including antibiotic resistance. DESIGN A cohort study using hospital data, January 2018-January 2020. RESULTS Of 117 patients with CSOM and awaiting surgery, 64% were in the 18-35 years age group, and 79% were cross-border from India. Of 118 bacterial isolates, 80% had Pseudomonas aeruginosa and 16% had Staphylococcus aureus. All isolates showed multidrug resistance to nine of the 12 antibiotics tested. The lowest antibiotic resistance in P. aeruginosa was for vancomycin (29%) and moxifloxacin (36%), and for S. aureus, this was vancomycin (9%) and amikacin (17%). Fourteen (12%) patients underwent surgery: myringoplasty (n = 7, 50%), cortical mastoidectomy with tympanostomy (n = 4, 29%) and modified radical mastoidectomy (n = 3, 21%). Those infected with P. aeruginosa and with resistance to over six antibiotics were significantly more likely to be refused for surgery. CONCLUSION Patients awaiting ear surgery were predominantly infected with multidrug-resistant P. aeruginosa and were consequently refused surgery. This study can help inform efforts for improving surgical uptake and introducing cross-border antimicrobial resistance surveillance.
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Affiliation(s)
- R R Karn
- Nepal Netra Jyoti Sangh/Eastern Regional Eye Care - Programme/Biratnagar Eye Hospital, Biratnagar, Nepal
| | - R Acharya
- Nepal Netra Jyoti Sangh/Eastern Regional Eye Care - Programme/Biratnagar Eye Hospital, Biratnagar, Nepal
| | - A K Rajbanshi
- Nepal Netra Jyoti Sangh/Eastern Regional Eye Care - Programme/Biratnagar Eye Hospital, Biratnagar, Nepal
| | - S K Singh
- Nepal Netra Jyoti Sangh/Eastern Regional Eye Care - Programme/Biratnagar Eye Hospital, Biratnagar, Nepal
| | - S K Thakur
- Nepal Netra Jyoti Sangh/Eastern Regional Eye Care - Programme/Biratnagar Eye Hospital, Biratnagar, Nepal
| | - S K Shah
- Nepal Netra Jyoti Sangh/Eastern Regional Eye Care - Programme/Biratnagar Eye Hospital, Biratnagar, Nepal
| | - A K Singh
- Nepal Netra Jyoti Sangh/Eastern Regional Eye Care - Programme/Biratnagar Eye Hospital, Biratnagar, Nepal
| | - R Shah
- Nepal Netra Jyoti Sangh/Eastern Regional Eye Care - Programme/Biratnagar Eye Hospital, Biratnagar, Nepal
| | - S Upadhya Kafle
- Nepal Netra Jyoti Sangh/Eastern Regional Eye Care - Programme/Biratnagar Eye Hospital, Biratnagar, Nepal
| | - M Bhattachan
- World Health Organization, Country Office, Kathmandu, Nepal
| | - A Abrahamyan
- Tuberculosis Research and Prevention Center, Yerevan, Armenia
| | - H D Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- The Union, South East Asia, New Delhi, India
| | - R Zachariah
- United Nations Children's Fund/United Nations Development Programme/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
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Abstract
Abstract
In this work, we fabricated bulk heterojunction (BHJ) organic solar cells (OSCs) using electrospray deposition (ESD) with two different device configurations. ITO/PEDOT:PSS/P3HT: PCBM/Ca/Al and ITO/ZnO and TiO2/P3HT: PCBM/MoO3/Ag, termed as direct and inverted OSCs, respectively. In ZnO/ TiO2 -based inverted solar cells, ZnO/ TiO2 films were synthesized by sol-gel process and deposited on ITO deposited glass substrates using the spin-coating technique. P3HT/PCBM blend layers were deposited by using electrospray deposition (ESD). To observe the thermal effects on the device efficiencies, the devices were annealed at different temperatures (up to 140 °C). The cell’s performance parameters were compared at an annealing temperature of 120 °C. Comparing the performance parameters of both types of OSCs at an annealing temperature of 120 °C, the power conversion efficiency (PCE) the 1.62% is found for direct-structured OSC while 1.57% and 1.0% for ZnO/ TiO2-based inverted structures, respectively. Interestingly, the enhanced device performance parameters were obtained with oxides-based OSCs. Compared to ZnO-based inverted OSC, the TiO2-based inverted OSC has lower efficiency which might be due to the highly resistive surface of TiO2 with deep-level traps. These traps can be reduced by light soaking to achieve the optimal power conversion efficiency.
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Abstract
Provisions for post-trial access (PTA) of the experimental intervention are required before the start of a clinical trial. Although there has been ample attention for PTA in the context of preventive vaccine research, discussions on PTA barely include maternal vaccine trials in which mother-infant pairs are exposed to the intervention. In maternal vaccination trials, specific PTA arrangements are required because pregnancy is transient and PTA may apply to the next pregnancy or the child. In this article, we examine the application and adherence to PTA in the context of maternal vaccine trials. We focused on differences between publications before and after 2000 when international ethical guidance documents formalized PTA requirements. Randomized maternal vaccine trials were included after a systematic search for clinical trials in phases II and III with a maternal vaccine as intervention. We used PTA as defined at the time of publication in the World Medical Association's Declaration of Helsinki (DoH) or in the ethical guidelines of the Council for International Organizations of Medical Sciences (CIOMS). In addition, we investigated whether PTA was included in the trial design. Therefore, we contacted principal investigators (PI's) of the publications found in the review to fill out a questionnaire regarding provisions for PTA. Before and after 2000, no trial articles examined in the systematic review described PTA in their trial publication (0/7, 0% and 0/17, 0%, respectively). In addition, more than half of the PI's of the trials found were not familiar with PTA recommendations in international ethical guidelines. Most cases of PTA included making knowledge available by publishing the results of the trial. The revision of the DoH in 2002 and the CIOMS ethical guidelines in 2002 has not resulted in increased PTA provisions for maternal vaccination trials. PTA is a shared responsibility of various stakeholders including sponsors, Institutional Review Boards, regulators, political entities, and researchers. Inclusion of PTA provisions in trial protocols and publications on maternal vaccination trials is essential to increase transparency on the form and content of these provisions.
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Affiliation(s)
- I M A A Van Roessel
- Division of Paediatric Immunology and Infectious Diseases, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - N I Mazur
- Division of Paediatric Immunology and Infectious Diseases, University Medical Centre Utrecht, Utrecht, The Netherlands.,Lurie Children's Hospital, Smith Child Health Research and Advocacy Center, Chicago, United States.,Department of Pediatrics, Northwestern University Medical School, Chicago, United States
| | - S K Shah
- Lurie Children's Hospital, Smith Child Health Research and Advocacy Center, Chicago, United States.,Department of Pediatrics, Northwestern University Medical School, Chicago, United States
| | - L Bont
- Division of Paediatric Immunology and Infectious Diseases, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - R Van Der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
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Shah SK, Kimmelman J, Lyerly AD, Lynch HF, Miller FG, Palacios R, Pardo CA, Zorrilla C. Response-Evaluating human trials: FDA's role. Science 2018; 360:1308-1309. [PMID: 29930129 DOI: 10.1126/science.aau0865] [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: 11/02/2022]
Affiliation(s)
- S K Shah
- Treuman Katz Center for Pediatric Bioethics, University of Washington and Seattle Children's Research Institute, Seattle, WA 98101, USA.
| | - J Kimmelman
- Biomedical Ethics Unit, McGill University, Montreal, QC H3A 1X1, Canada
| | - A D Lyerly
- Center for Bioethics and Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - H F Lynch
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - F G Miller
- Weil Cornell Medical College, New York, NY 10065, USA
| | | | - C A Pardo
- Department of Neurology, Neurovirus Emerging in the Americas Study (NEAS), Johns Hopkins University, Baltimore, MD 21205, USA
| | - C Zorrilla
- University of Puerto Rico School of Medicine, San Juan, PR 00921, USA
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Shah SK, Kimmelman J, Lyerly AD, Lynch HF, Miller FG, Palacios R, Pardo CA, Zorrilla C. Bystander risk, social value, and ethics of human research. Science 2018; 360:158-159. [PMID: 29650663 DOI: 10.1126/science.aaq0917] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- S K Shah
- University of Washington and Seattle Children's Research Institute, Seattle, WA, USA.
| | | | - A D Lyerly
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - H F Lynch
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - F G Miller
- Weil Cornell Medical College, New York, NY, USA
| | | | - C A Pardo
- Johns Hopkins University, Baltimore, MD, USA
| | - C Zorrilla
- University of Puerto Rico School of Medicine, San Juan, Puerto Rico, USA
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Shah SK, Acharya M, Alam SI, Hossain MA, Aftabuddin M. Right Atrial Myxoma: An Uncommon Presentation. Mymensingh Med J 2017; 26:694-697. [PMID: 28919631] [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: 06/07/2023]
Abstract
There are two types of tumors found in the cardiac chamber. These are divided into primary intra-cardiac tumors and secondary intra-cardiac tumors. Primary intra cardiac tumors are rare and among them 29% are myxomas. Majority of them are found in the left atrium. Here, we report a case of a myxoma in the right atrium with hepatomegaly and Hepatitis B virus infection. The coexistence of all these conditions is very rare. A 52 years old patient presented with history of shortness of breath on exertion along with fever and generalized weakness for 6 months which aggravated lately for last 2 months. He was then taken for better medical care and hospitalization. On cardiac evaluation he had soft S1 and S2 over the tricuspid region on the right lower parasternal region. He had bilateral mild pitting pedal edema. On further examination, it was revealed that he had mild tender hepatomegaly with jaundice. His blood analysis for HBsAg was positive. Echocardiogram showed right atrial myxoma of 14.3cm² almost completely occupying the right atrium and even protruding into the Inferior Venacava however not fully obstructing it. The inferior vena cava size was mildly dilated (22mm). Abdominal ultrasound report showed hepatomegaly (17.6cm) with coarse hepatic parenchyma. In this report, we emphasize the rarity of myxoma in the Right Atrium, its difficult diagnosis because of the location and the atypical presentation in the echocardiograph.
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Affiliation(s)
- S K Shah
- Dr Sanjeet Kumar Shah, MS Resident (Phase-B), Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
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Vasavada V, Shah SK, Vasavada VA, Vasavada AR, Trivedi RH, Srivastava S, Vasavada SA. Comparison of IOL power calculation formulae for pediatric eyes. Eye (Lond) 2016; 30:1242-50. [PMID: 27494083 DOI: 10.1038/eye.2016.171] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 07/05/2016] [Indexed: 11/09/2022] Open
Abstract
PurposeTo evaluate and compare the accuracy of modern intraocular lens (IOL) power calculation formulae in pediatric eyes and compare prediction error (PE) obtained with manufacturer's vs personalized lens constant.Patients and methodsAn observational case study was conducted in 117 eyes (117 patients) undergoing pediatric cataract surgery with IOL implantation. PE was calculated as predicted refraction minus actual postoperative refraction, and absolute PE as absolute difference independent of the sign, (APE)=predicted refraction minus actual postoperative refraction. This was done for each formula using manufacturer's and personalized lens constant. Further, PE and APE were evaluated according to axial length (AL).ResultsMean age of children was 2.97 years. About 66/117 eyes (56.4%) were below 2 years of age. Using Holladay 2, Holladay 1, Hoffer Q, and SRK/T formulae with manufacturer's lens constant, mean PE was 0.36, 0.41, 0.69, and 0.28 diopter (D), respectively. With personalized lens constant, it was 0.16, 0.15, 0.50, and -0.12 D, respectively. Difference in mean PE between the formulae was statistically significant (P<0.0001). SRK/T and Holladay 2 formulae had the least PE, both with manufacturer's and personalized constant. For eyes with AL<20 mm, SRK/T and Holladay 2 formulae gave the least PE. Personalizing the lens constant led to a decrease in mean PE in all formulae, except the Hoffer Q formula. However, personalizing the lens constant did not significantly improve the APE. At least 21% eyes had an APE of >2 D with all formulae, even with personalized lens constants.ConclusionIn pediatric eyes, SRK/T and the Holladay 2 formulae had the least PE. Personalizing the lens formula constant did reduce the PE significantly for all formulae except Hoffer Q. In extremely short eyes (AL<20 mm), SRK/T and Holladay 2 formulae gave the best PE.
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Affiliation(s)
- V Vasavada
- Iladevi Cataract & IOL Research Centre, Raghudeep Eye Clinic, Ahmedabad, India
| | - S K Shah
- Iladevi Cataract & IOL Research Centre, Raghudeep Eye Clinic, Ahmedabad, India
| | - V A Vasavada
- Iladevi Cataract & IOL Research Centre, Raghudeep Eye Clinic, Ahmedabad, India
| | - A R Vasavada
- Iladevi Cataract & IOL Research Centre, Raghudeep Eye Clinic, Ahmedabad, India
| | - R H Trivedi
- Storm Eye Institute, Medical University of South Carolina, Charleston, SC, USA
| | - S Srivastava
- Iladevi Cataract & IOL Research Centre, Raghudeep Eye Clinic, Ahmedabad, India
| | - S A Vasavada
- Iladevi Cataract & IOL Research Centre, Raghudeep Eye Clinic, Ahmedabad, India
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Shah SK, McAnally KJ, Seoane L, Lombard GA, LaPlace SG, Lick S, Dhillon GS, Valentine VG. Analysis of pulmonary non-tuberculous mycobacterial infections after lung transplantation. Transpl Infect Dis 2016; 18:585-91. [PMID: 27368989 DOI: 10.1111/tid.12546] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [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: 12/22/2013] [Revised: 09/07/2014] [Accepted: 02/14/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE Non-tuberculous mycobacteria (NTM) are important pathogens in lung transplant recipients. This study describes the spectrum of NTM respiratory tract infections and examines the association of NTM infections with lung transplant complications. METHODS Data from 208 recipients transplanted from November 1990 to November 2005 were analyzed. Follow-up data were available to November 2010. Lung infection was defined by bronchoalveolar lavage, sputum, or blood cultures in the appropriate clinical setting. All identified NTM respiratory tract infections were tabulated. The cohort of patients with NTM lung infections (NTM+) were compared to the cohort without infection (NTM-). Univariate and multivariate analysis was performed to determine characteristics associated with NTM infection. Survival analyses for overall survival and development of bronchiolitis obliterans syndrome (BOS) were also performed. RESULTS In total, 52 isolates of NTM lung infection were identified in 30 patients. The isolates included Mycobacterium abscessus (46%), Mycobacterium avium complex (MAC) (36%), Mycobacterium gordonae (9%), Mycobacterium chelonae (7%), and Mycobacterium fortuitum (2%), with multiple NTM isolates seen on 3 different occasions. The overall incidence was 14%, whereas cumulative incidences at 1, 3, and 5 years after lung transplantation were 11%, 15%, and 20%, respectively. Comparisons between the NTM+ and NTM- cohorts revealed that NTM+ patients were more likely to be African-American and have cytomegalovirus mismatch. Although no difference was seen in survival, the NTM+ cohort was more likely to develop BOS (80% vs. 58%, P = 0.02). NTM+ infection, however, was not independently associated with development of BOS by multivariate analysis. CONCLUSION With nearly 20 years of follow-up, 14% of lung recipients develop NTM respiratory tract infections, with M. abscessus and MAC more commonly identified. M. gordonae was considered responsible for nearly 10% of NTM infections. Although survival of patients with NTM infections is similar, a striking difference in BOS rates is present in the NTM+ and NTM- groups.
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Affiliation(s)
- S K Shah
- Texas Transplant Center, University of Texas Medical Branch, Galveston, Texas, USA
| | - K J McAnally
- Ochsner Health System, New Orleans, Louisiana, USA
| | - L Seoane
- Ochsner Health System, New Orleans, Louisiana, USA
| | - G A Lombard
- Texas Transplant Center, University of Texas Medical Branch, Galveston, Texas, USA
| | - S G LaPlace
- Ochsner Health System, New Orleans, Louisiana, USA
| | - S Lick
- Texas Transplant Center, University of Texas Medical Branch, Galveston, Texas, USA
| | - G S Dhillon
- Stanford University Medical Center, Stanford, California, USA
| | - V G Valentine
- Texas Transplant Center, University of Texas Medical Branch, Galveston, Texas, USA
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Shah SK, Kumar AMV, Dogar OF, Khan MA, Qadeer E, Tahseen S, Masood F, Chandio AK, Edginton ME. Xpert(®) MTB/RIF under routine conditions in diagnosing pulmonary tuberculosis: a study in two hospitals in Pakistan. Public Health Action 2015; 3:20-2. [PMID: 26392990 DOI: 10.5588/pha.12.0081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/05/2012] [Accepted: 01/18/2013] [Indexed: 11/10/2022] Open
Abstract
Xpert(®) MTB/RIF testing was offered to consecutive patients with presumptive tuberculosis (TB) attending two hospitals in Pakistan during April-May 2012, in addition to routine diagnostic protocol (smear microscopy, chest radiography and clinical judgement). We assessed the relative contribution of each tool in detecting pulmonary TB under routine conditions. Of 606 participants, 121 (20%) were detected as pulmonary TB: 46 (38%) by microscopy, 38 (31%) by Xpert alone and 37 (31%) on clinical and radiological grounds; 41 (65%) were detected by both Xpert and microscopy. One patient had rifampicin resistance. Although Xpert detected approximately twice as many TB cases as microscopy (n = 79, 65%), clinical judgement remained favoured by clinicians even when smear and Xpert were negative.
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Affiliation(s)
- S K Shah
- Department of Health Sciences, University of York, York, UK
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
| | - O F Dogar
- Department of Health Sciences, University of York, York, UK
| | - M A Khan
- Association for Social Development, Islamabad, Pakistan
| | - E Qadeer
- National Tuberculosis Programme, Islamabad, Pakistan
| | - S Tahseen
- National Tuberculosis Programme, Islamabad, Pakistan
| | - F Masood
- National Tuberculosis Programme, Islamabad, Pakistan
| | - A K Chandio
- Health Services Academy, Islamabad, Pakistan
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Shah SK, He S, Guo L, Truong Q, Qi H, Du W, Lai Z, Liu J, Jian T, Hong Q, Dobbelaar P, Ye Z, Sherer E, Feng Z, Yu Y, Wong F, Samuel K, Madiera M, Karanam BV, Reddy VB, Mitelman S, Tong SX, Chicchi GG, Tsao KL, Trusca D, Feng Y, Wu M, Shao Q, Trujillo ME, Eiermann GJ, Li C, Pachanski M, Fernandez G, Nelson D, Bunting P, Morissette P, Volksdorf S, Kerr J, Zhang BB, Howard AD, Zhou YP, Pasternak A, Nargund RP, Hagmann WK. Discovery of MK-1421, a Potent, Selective sstr3 Antagonist, as a Development Candidate for Type 2 Diabetes. ACS Med Chem Lett 2015; 6:513-7. [PMID: 26005524 PMCID: PMC4434471 DOI: 10.1021/ml500514w] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/18/2015] [Indexed: 01/25/2023] Open
Abstract
![]()
The imidazolyl-tetrahydro-β-carboline
class of sstr3 antagonists
have demonstrated efficacy in a murine model of glucose excursion
and may have potential as a treatment for type 2 diabetes. The first
candidate in this class caused unacceptable QTc interval prolongation
in oral, telemetrized cardiovascular (CV) dogs. Herein, we describe
our efforts to identify an acceptable candidate without CV effects.
These efforts resulted in the identification of (1R,3R)-3-(4-(5-fluoropyridin-2-yl)-1H-imidazol-2-yl)-1-(1-ethyl-pyrazol-4-yl)-1-(3-methyl-1,3,4-oxadiazol-3H-2-one-5-yl)-2,3,4,9-tetrahydro-1H-β-carboline
(17e, MK-1421).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Guillermo Fernandez
- Department
of Safety Assessment, Merck Research Laboratories, 770 Sumneytown Pike, West Point, Pennsylvania 19486, United States
| | - Donald Nelson
- Department
of Safety Assessment, Merck Research Laboratories, 770 Sumneytown Pike, West Point, Pennsylvania 19486, United States
| | - Patricia Bunting
- Department
of Safety Assessment, Merck Research Laboratories, 770 Sumneytown Pike, West Point, Pennsylvania 19486, United States
| | - Pierre Morissette
- Department
of Safety Assessment, Merck Research Laboratories, 770 Sumneytown Pike, West Point, Pennsylvania 19486, United States
| | - Sylvia Volksdorf
- Department
of Safety Assessment, Merck Research Laboratories, 770 Sumneytown Pike, West Point, Pennsylvania 19486, United States
| | - Janet Kerr
- Department
of Safety Assessment, Merck Research Laboratories, 770 Sumneytown Pike, West Point, Pennsylvania 19486, United States
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Shah SK, Shah L, Bhattarai S, Giri M. Rhabdomyolysis Due to Severe Hypophosphatemia in Diabetic Ketoacidosis. JNMA J Nepal Med Assoc 2015; 53:137-140. [PMID: 26994037] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Rhabdomyolysis is a syndrome characterized by injury to skeletal muscle fibers with disruption and release of toxic metabolites into circulation. It is characterized by triad of muscle weakness, myalgia and dark urine and is associated with increased creatine kinase and lactate dehydrogenase. A severely malnourished 10 year old girl with severe diabetic ketoacidosis as hemr initial presentation of type 1 diabetes mellitus developed rhabdomyolysis (CK- 12,000 U/L) with non-oliguric renal failure during her initial course of hospital stay. The possible cause of her RM was attributed to severe hypophosphatemia (minimum serum phosphate, 0.8 mg/dL). Management of diabetic ketoacidosis phosphate supplementation and urinary alkalinization with diuresis improved her clinical course. She was discharged on Day 9 with Insulin. We recommend frequent monitoring of serum phosphate during early period of DKA, particularly in malnourished children, and its normalization in case of severe hypophosphatemia.
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Affiliation(s)
- S K Shah
- B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - L Shah
- B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - S Bhattarai
- B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - M Giri
- B.P. Koirala Institute of Health Sciences, Dharan, Nepal
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He S, Lai Z, Ye Z, Dobbelaar P, Shah SK, Truong Q, Du W, Guo L, Liu J, Jian T, Qi H, Bakshi R, Hong Q, Dellureficio J, Reibarkh M, Samuel K, Reddy V, Mitelman S, Tong SX, Chicchi GG, Tsao KL, Trusca D, Wu M, Shao Q, Trujillo M, Fernandez G, Nelson D, Bunting P, Kerr J, Fitzgerald P, Morissette P, Volksdorf S, Eiermann GJ, Li C, Zhang B, Howard A, Zhou YP, Nargund RP, Hagmann WK. Investigation of Cardiovascular Effects of Tetrahydro-β-carboline sstr3 antagonists. ACS Med Chem Lett 2014; 5:748-53. [PMID: 25050159 PMCID: PMC4094257 DOI: 10.1021/ml500028c] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 04/21/2014] [Indexed: 11/30/2022] Open
Abstract
Antagonism of somatostatin subtype receptor 3 (sstr3) has emerged as a potential treatment of Type 2 diabetes. Unfortunately, the development of our first preclinical candidate, MK-4256, was discontinued due to a dose-dependent QTc (QT interval corrected for heart rate) prolongation observed in a conscious cardiovascular (CV) dog model. As the fate of the entire program rested on resolving this issue, it was imperative to determine whether the observed QTc prolongation was associated with hERG channel (the protein encoded by the human Ether-à-go-go-Related Gene) binding or was mechanism-based as a result of antagonizing sstr3. We investigated a structural series containing carboxylic acids to reduce the putative hERG off-target activity. A key tool compound, 3A, was identified from this SAR effort. As a potent sstr3 antagonist, 3A was shown to reduce glucose excursion in a mouse oGTT assay. Consistent with its minimal hERG activity from in vitro assays, 3A elicited little to no effect in an anesthetized, vagus-intact CV dog model at high plasma drug levels. These results afforded the critical conclusion that sstr3 antagonism is not responsible for the QTc effects and therefore cleared a path for the program to progress.
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Affiliation(s)
- Shuwen He
- Merck Research Laboratories, Departments of Medicinal
Chemistry, Drug Metabolism and Pharmacokinetics, and Diabetes Research, 2000 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - Zhong Lai
- Merck Research Laboratories, Departments of Medicinal
Chemistry, Drug Metabolism and Pharmacokinetics, and Diabetes Research, 2000 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - Zhixiong Ye
- Merck Research Laboratories, Departments of Medicinal
Chemistry, Drug Metabolism and Pharmacokinetics, and Diabetes Research, 2000 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - Peter
H. Dobbelaar
- Merck Research Laboratories, Departments of Medicinal
Chemistry, Drug Metabolism and Pharmacokinetics, and Diabetes Research, 2000 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - Shrenik K. Shah
- Merck Research Laboratories, Departments of Medicinal
Chemistry, Drug Metabolism and Pharmacokinetics, and Diabetes Research, 2000 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - Quang Truong
- Merck Research Laboratories, Departments of Medicinal
Chemistry, Drug Metabolism and Pharmacokinetics, and Diabetes Research, 2000 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - Wu Du
- Merck Research Laboratories, Departments of Medicinal
Chemistry, Drug Metabolism and Pharmacokinetics, and Diabetes Research, 2000 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - Liangqin Guo
- Merck Research Laboratories, Departments of Medicinal
Chemistry, Drug Metabolism and Pharmacokinetics, and Diabetes Research, 2000 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - Jian Liu
- Merck Research Laboratories, Departments of Medicinal
Chemistry, Drug Metabolism and Pharmacokinetics, and Diabetes Research, 2000 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - Tianying Jian
- Merck Research Laboratories, Departments of Medicinal
Chemistry, Drug Metabolism and Pharmacokinetics, and Diabetes Research, 2000 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - Hongbo Qi
- Merck Research Laboratories, Departments of Medicinal
Chemistry, Drug Metabolism and Pharmacokinetics, and Diabetes Research, 2000 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - Raman
K. Bakshi
- Merck Research Laboratories, Departments of Medicinal
Chemistry, Drug Metabolism and Pharmacokinetics, and Diabetes Research, 2000 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - Qingmei Hong
- Merck Research Laboratories, Departments of Medicinal
Chemistry, Drug Metabolism and Pharmacokinetics, and Diabetes Research, 2000 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - James Dellureficio
- Merck Research Laboratories, Departments of Medicinal
Chemistry, Drug Metabolism and Pharmacokinetics, and Diabetes Research, 2000 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - Mikhail Reibarkh
- Merck Research Laboratories, Departments of Medicinal
Chemistry, Drug Metabolism and Pharmacokinetics, and Diabetes Research, 2000 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - Koppara Samuel
- Merck Research Laboratories, Departments of Medicinal
Chemistry, Drug Metabolism and Pharmacokinetics, and Diabetes Research, 2000 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - Vijay
B. Reddy
- Merck Research Laboratories, Departments of Medicinal
Chemistry, Drug Metabolism and Pharmacokinetics, and Diabetes Research, 2000 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - Stan Mitelman
- Merck Research Laboratories, Departments of Medicinal
Chemistry, Drug Metabolism and Pharmacokinetics, and Diabetes Research, 2000 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - Sharon X. Tong
- Merck Research Laboratories, Departments of Medicinal
Chemistry, Drug Metabolism and Pharmacokinetics, and Diabetes Research, 2000 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - Gary G. Chicchi
- Merck Research Laboratories, Departments of Medicinal
Chemistry, Drug Metabolism and Pharmacokinetics, and Diabetes Research, 2000 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - Kwei-Lan Tsao
- Merck Research Laboratories, Departments of Medicinal
Chemistry, Drug Metabolism and Pharmacokinetics, and Diabetes Research, 2000 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - Dorina Trusca
- Merck Research Laboratories, Departments of Medicinal
Chemistry, Drug Metabolism and Pharmacokinetics, and Diabetes Research, 2000 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - Margaret Wu
- Merck Research Laboratories, Departments of Medicinal
Chemistry, Drug Metabolism and Pharmacokinetics, and Diabetes Research, 2000 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - Qing Shao
- Merck Research Laboratories, Departments of Medicinal
Chemistry, Drug Metabolism and Pharmacokinetics, and Diabetes Research, 2000 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - Maria
E. Trujillo
- Merck Research Laboratories, Departments of Medicinal
Chemistry, Drug Metabolism and Pharmacokinetics, and Diabetes Research, 2000 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - Guillermo Fernandez
- Department
of Safety Assessment, 770 Sumneytown Pike, West Point, Pennsylvania 19486, United States
| | - Donald Nelson
- Department
of Safety Assessment, 770 Sumneytown Pike, West Point, Pennsylvania 19486, United States
| | - Patricia Bunting
- Department
of Safety Assessment, 770 Sumneytown Pike, West Point, Pennsylvania 19486, United States
| | - Janet Kerr
- Department
of Safety Assessment, 770 Sumneytown Pike, West Point, Pennsylvania 19486, United States
| | - Patrick Fitzgerald
- Department
of Safety Assessment, 770 Sumneytown Pike, West Point, Pennsylvania 19486, United States
| | - Pierre Morissette
- Department
of Safety Assessment, 770 Sumneytown Pike, West Point, Pennsylvania 19486, United States
| | - Sylvia Volksdorf
- Department
of Safety Assessment, 770 Sumneytown Pike, West Point, Pennsylvania 19486, United States
| | - George J. Eiermann
- Merck Research Laboratories, Departments of Medicinal
Chemistry, Drug Metabolism and Pharmacokinetics, and Diabetes Research, 2000 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - Cai Li
- Merck Research Laboratories, Departments of Medicinal
Chemistry, Drug Metabolism and Pharmacokinetics, and Diabetes Research, 2000 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - Bei Zhang
- Merck Research Laboratories, Departments of Medicinal
Chemistry, Drug Metabolism and Pharmacokinetics, and Diabetes Research, 2000 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - Andrew
D. Howard
- Merck Research Laboratories, Departments of Medicinal
Chemistry, Drug Metabolism and Pharmacokinetics, and Diabetes Research, 2000 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - Yun-Ping Zhou
- Merck Research Laboratories, Departments of Medicinal
Chemistry, Drug Metabolism and Pharmacokinetics, and Diabetes Research, 2000 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - Ravi P. Nargund
- Merck Research Laboratories, Departments of Medicinal
Chemistry, Drug Metabolism and Pharmacokinetics, and Diabetes Research, 2000 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - William K. Hagmann
- Merck Research Laboratories, Departments of Medicinal
Chemistry, Drug Metabolism and Pharmacokinetics, and Diabetes Research, 2000 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
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Abstract
BACKGROUND Sexual dysfunction due to antipsychotics is a significant problem encountered with first-generation antipsychotics. Even the second-generation antipsychotics like risperidone are not free of sexual dysfunction due to its D2 blocking properties leading to hyperprolactinaemia. Newer antipsychotic aripiprazole, partial dopamine agonist, with neutral effect on prolactin level or even decreasing it, is associated with avoidance of sexual dysfunction. OBJECTIVES To assess the effect of risperidone and aripiprazole on sexual function of schizophrenic patients. METHODS This was an open-label, cross-sectional, observational study conducted at College of Medical Sciences, Bharatpur. Schizophrenic patients attending OPD and inpatient, taking risperidone or aripiprazole for at least two months were included in this study. Forty one patients, without chronic medical illness and sexual dysfunction before starting drugs, with informed consent were studied during Jan 2012 and Aug 2012. RESULTS Changes in sexual activity was found in 11(55%) of those taking risperidone while, only 3(14.3%) had any kind of sexual difficulty. This was statistically significant (p=0.006). Majority, 92.7% of the patients did not report about changes in sexual activity spontaneously. CONCLUSION Sexual dysfunction was statistically significantly higher in those taking risperidone. Prevalence of sexual dysfunction was low with aripiprazole. Except those having poor sexual functions due to the drugs, the majority had to be specifically inquired about the effects of drug on sex life.
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Affiliation(s)
- S K Shah
- Department of Psychiatry, College of Medical Sciences, Bharatpur
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15
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Abstract
Objectives To study the clinical and socio demographic profile of patients with dissociative disorder and their comorbid mental illness. Materials and methods Fifty-one patients of dissociative disorder presenting to emergency and outpatient department of Psychiatry at College of Medical Sciences Teaching Hospital during the period from Jan to March 2012 were included. International statistical classification of diseases and related health problems tenth edition, diagnostic criteria for research (ICD-10, DCR) was used. Results Out of 51 patients, the majority 24 (47.1%), were in the age group 15-29. However the age of presentation ranged from 9-45 years. The females were more, 44 (86.3%) as compared to males 7 (13.7%). The majority of patients had low level of education with none of the patients having education above intermediate level. The majority of patients, 27(52.9%) belonged to lower middle class. 49% of the patients presented with dissociative convulsions, 15.7% with dissociative motor disorders, 15.7% with dissociative stupor, 11.8% with dissociative anesthesia and sensory loss and 7.8% with trance and possession disorder. Depressive illness was found co-morbid with dissociative disorder in 33.3%, borderline personality disorder in 9.8% and histrionic personality disorder in 7.8%. There was history of immediate stressful events that supposedly precipitated the event in 76.5%. Conclusion Dissociative disorder mainly affects young female of lower socio-economic and educational status with history of immediate stressful life events precipitating the illness. Journal of College of Medical Sciences-Nepal, 2012, Vol-8, No-3, 30-35 DOI: http://dx.doi.org/10.3126/jcmsn.v8i3.8683
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16
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Lindsey JC, Shah SK, Siberry GK, Jean-Philippe P, Levin MJ. Ethical tradeoffs in trial design: case study of an HPV vaccine trial in HIV-infected adolescent girls in lower income settings. Dev World Bioeth 2013; 13:95-104. [PMID: 23725055 PMCID: PMC3716837 DOI: 10.1111/dewb.12028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The Declaration of Helsinki and the Council of the International Organization of Medical Sciences provide guidance on standards of care and prevention in clinical trials. In the current and increasingly challenging research environment, the ethical status of a trial design depends not only on protection of participants, but also on social value, feasibility, and scientific validity. Using the example of a study assessing efficacy of a vaccine to prevent human papilloma virus in HIV-1 infected adolescent girls in low resource countries without access to the vaccine, we compare several trial designs which rank lower on some criteria and higher on others, giving rise to difficult trade-offs. This case demonstrates the need for developing more nuanced guidance documents to help researchers balance these often conflicting criteria.
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Affiliation(s)
- J C Lindsey
- Harvard School of Public Health – Center for Biostatistics in AIDS Research, 651 Huntington Avenue, Boston, MA 02115, USA.
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17
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Shah SK, Parto P, Lombard GA, James MA, Beckles DL, Lick S, Valentine VG. Probable Phaeoacremonium parasiticum as a cause of cavitary native lung nodules after single lung transplantation. Transpl Infect Dis 2012; 15:E9-13. [PMID: 23279754 DOI: 10.1111/tid.12040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 08/13/2012] [Accepted: 09/05/2012] [Indexed: 11/30/2022]
Abstract
Lung nodules after lung transplantation most often represent infection or post-transplant lymphoproliferative disorder in the allograft. Conversely, native lung nodules in single lung transplant recipients are more likely to be bronchogenic carcinoma. We present a patient who developed native lung cavitary nodules. Although malignancy was anticipated, evaluation revealed probable Phaeoacremonium parasiticum infection. Phaeoacremonium parasiticum is a dematiaceous fungus first described as a cause of soft tissue infection in a renal transplant patient. Lung nodules have not been previously described and this is the first case, to our knowledge, of P. parasiticum identified after lung transplantation.
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Affiliation(s)
- S K Shah
- Division of Pulmonary and Critical Care Medicine, University of Texas Medical Branch, Galveston, Texas 77555-0561, USA.
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18
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Acharya SR, Acharya NS, Bhangale JO, Shah SK, Pandya SS. Antioxidant and hepatoprotective action of Asparagus racemosus Willd. root extracts. Indian J Exp Biol 2012; 50:795-801. [PMID: 23305030] [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
The antioxidant activities of the crude hydro-alcoholic extract (CE) and its four fractions viz. methanol (MF), ethyl acetate (EF), n-Butanol (BF), and precipitated aqueous (PAF) of A.racemosus roots tested decreased in the order of EF > MF > CE > BF > PAF when investigated by DPPH free radical scavenging assay. Under iron induced lipid peroxidation almost similar results were observed except that the activity was more in PAF than BF. Hepatoprotective activity of the extracts was also demonstrable in vivo by the inhibition of-CCl4 induced formation of lipid peroxides in the liver of rats by pretreatment with the extracts. CCl4-induced hepatotoxicity in rats, as judged by the raised serum enzymes viz. glutamate oxaloacetate transaminase, glutamate pyruvate transaminase, alkaline phosphatase and total and direct bilirubin as well as oxidant enzyme viz. malon dialdehyde were prevented, while antioxidant enzymes viz. superoxide dismutase, reduced glutathione and catalase were elevated by pretreatment with the extracts, demonstrating the potent hepatoprotective action of the roots of A. racemosus.
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Affiliation(s)
- S R Acharya
- Department of Pharmacognosy, Institute of Pharmacy, Nirma University, Ahmedabad, 382 481, India.
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19
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Yengkokpam B, Shah SK, Bhantana GR. Study of psychiatric disorders among nepalese patients working abroad and their family members. J Coll Med Sci-Nepal 2012. [DOI: 10.3126/jcmsn.v6i4.6718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This study was carried out among the patients working abroad and their family members, having various psychiatric disorders. 80 patients attending psychiatry OPD between the age of 15 to 65 years both male and female in the period of July 2009 to July 2010 were included. The results were tabulated as per the diagnostic criteria of International Classification of Diseases (ICD-10). Out of total 80 patients, 41 were males and 39 were females, whose husbands were working abroad. 30 cases were of depression,out of which 16 were males and 14 were females.18 cases were having anxiety disorders out of which 5 were males and 13 were females. 12 cases were suffering from psychotic disorders out of which 10 were males and 2 were females.7 cases were having dissociative disorders with 1 male and 6 females.4 cases were having somatoform disorders with 2 males and 2 females.1 male and 1 female were suffering from mania.1 male and 1 female were suffering from bipolar affective disorder. 2 males were alcohol dependent and 2 males were having obsessive compulsive disorder. 1 male was having organic psychosis. Journal of College of Medical Sciences-Nepal,2011,Vol-6,No-4, 1-6 DOI: http://dx.doi.org/10.3126/jcmsn.v6i4.6718
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20
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Shah SK, Ojha SP, Koirala NR, Sharma VD, Yengkokpam B. A comparision of efficacy of risperidone and olanzapine in schizophrenia patients. J Coll Med Sci-Nepal 2012. [DOI: 10.3126/jcmsn.v7i3.6706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Schizophrenia is a leading worldwide mental health problem. It is also one of the common and challenging problems in Nepal. Risperidone and olanzapine is one of the major antipsychotic drug used for schizophrenia patients, however their efficacy is not compared in Nepal.To assess the efficacy of risperidone and olanzapine in schizophrenia patients in Nepalese context. An open-label, randomized, comparative, prospective study was done for 6 weeks. Total of 63 patients attending Psychiatry OPD in Jan to July 2008 at TUTH who could be available for close follow up were enrolled with consent. Risperidone was given in dose of 3-6 mg and Olanzapine in the dose of 15-20 mg per day. Efficacy and tolerability was assessed using PANSS, CGI, and UKU side-effect checklist. Both groups showed improvement in the entire positive, negative and general psychopathology subscales without significant difference in the two groups. Regarding tolerability, olanzapine was found to have significant sedation, weight gain while with risperidone extrapyramidal side-effects, palpitations, sexual side-effects were significant. Risperidone and olanzapine both are efficacious in the treatment of schizophrenia. Both the drugs have their own side-effects. Long-term efficacy and tolerability needs to be studied. As it has been seen in the ongoing studies, long-term use and side-effect profile, drop-out rates and the increase in metabolic syndromes need more consideration.DOI: http://dx.doi.org/10.3126/jcmsn.v7i3.6706 Journal of College of Medical Sciences-Nepal, 2011, Vol-7, No-3, 29-35
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21
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Shah SK, Walker PA, Khalil KG, Irani AD. Solitary fibrous tumour presenting as a pedunculated lung mass with associated lung atresia: report of a case. Curr Oncol 2012; 19:e219-21. [PMID: 22670113 DOI: 10.3747/co.19.903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This case report describes a solitary fibrous tumour presenting as a pedunculated mass arising from an almost completely atretic right middle lobe of lung. The intraoperative findings and pathologic diagnostic criteria used are described. To our knowledge, this is the first case report of a solitary fibrous tumour associated with partial lung atresia.
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Affiliation(s)
- S K Shah
- Department of Surgery, University of Texas Medical School at Houston, Houston, TX, USA.
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22
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Abstract
Over the past decade, there have been significant developments in the mechanisms for examination of biological and material samples. These developments exploit techniques in light microscopy to elucidate specific parts of cells and tissues, as well as inorganic particles. In recent years, spectral microscopy has become more prevalent for characterization of samples. Simultaneously, sensor technology has progressed as well and modern charge-coupled devices (CCD) cameras are now capable of achieving high spatial resolution and high sensitivity measurements of signals in the optical microscope. One major impediment in obtaining absolute quantitative information of imaged samples is the lack of automated photometric calibration mechanisms for spectral microscopes. In this paper, we present a methodology for achieving photometric calibration of an automated spectral imaging system targeted towards examination of biological samples. By acquiring spatial and spectral data simultaneously, spectral imaging allows one to exploit physical connections between a particle's morphology and its characteristic response to the optical spectrum. In composite biological material, the interpretation of the spectra is a complicated problem. This is because any light source and charge-coupled device camera used for data acquisition does not have a uniform illumination spectra and quantum efficiency, respectively, across the emitted light spectra. To balance the spectral response across individual wavelengths, our method modulates the exposure duration for the charge-coupled device camera during image acquisition. We present an image similarity based method to calibrate the system. Experiments to test the effectiveness of the calibration method under the various image similarity metrics are presented along with results to show the calibrated system's ability to accurately measure spectra based on the measured transmission profiles of optical filters.
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Affiliation(s)
- J Thigpen
- Quantitative Imaging Laboratory, Department of Computer Science, University of Houston, 4800 Calhoun, 501 Philip G. Hoffman, Houston, TX 77204-3010, USA
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23
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Shah SK, Khan AM, Cox CS. Pulmonary hypertensive crisis requiring ECMO associated with re-warming from whole body hypothermia for hypoxic ischemic encephalopathy: clinical observations from a case series. Eur J Pediatr Surg 2010; 20:205-6. [PMID: 19866416 DOI: 10.1055/s-0029-1241872] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- S K Shah
- University of Texas Medical School at Houston, Pediatric Surgery, Houston, TX 77030, USA
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24
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Walker PA, Harting MT, Shah SK, Cox CS. Current trends in cell therapy for pediatric acquired brain injury. Minerva Pediatr 2010; 62:91-106. [PMID: 20212402] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Pediatric traumatic brain injury (TBI) represents a major burden on healthcare worldwide. In the United States, TBI accounts for 435000 Emergency Department visits, 37000 hospital admissions, and approximately 2500 deaths each year. While aggressive early rehabilitation has shown some functional improvement, the acute care of TBI with focus on controlling intracranial pressure while maintaining adequate cerebral perfusion has not shown the ability to reverse neuronal injury on either a cellular or subcellular level. Preliminary investigation into the use of cell therapeutics has shown promise for the treatment of TBI in animal models. While progenitor cells may potentially act via altering the intracerebral milieu (modulation of inflammatory response and trophic factor secretion), the exact mechanism remains controversial. In addition, traditional delivery vehicles (intravenous, intra-arterial, intrathecal injections, and direct implantation) have shown significant barriers to translation coupled with inconsistent results. Therefore, investigation into novel delivery vehicles such as nanofiber scaffolds and hydrogels could enhance transplant cell viability, engraftment, and efficacy. Overall, a large amount of preclinical work remains to clearly define optimal progenitor cell type, dosage, and delivery vehicle. The optimal therapeutic benefit may be seen using a combination of therapies (controlled hypothermia, hypertonic therapy, and/or cellular therapeutics) to attack the complex pathophysiology of TBI at multiple points.
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Affiliation(s)
- P A Walker
- Department of Pediatric Surgery, University of Texas Medical School at Houston and Children's Memorial Hermann Hospital, Houston, TX, USA
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25
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Lapeer RJ, Shah SK, Rowland RS. An optimised radial basis function algorithm for fast non-rigid registration of medical images. Comput Biol Med 2009; 40:1-7. [PMID: 19913220 DOI: 10.1016/j.compbiomed.2009.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Accepted: 10/05/2009] [Indexed: 11/26/2022]
Abstract
The registration of multi-modal medical image data is important in the fields of image guided surgery and computer aided medical diagnosis. Registration accuracy is of utmost importance in both fields, however in the former, the speed of registration is equally important. In this paper, we present a point-based 'fast' non-rigid registration algorithm which exhibits significant speedups as compared to the non-optimised equivalent algorithm. Additionally, we make use of the parallel nature of the graphics processing unit (GPU) of the video adapter card of a standard PC to gain further speedups. The algorithm achieved sub-second performance when tested on the registration of MR with CT image data of size 256(3).
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Affiliation(s)
- R J Lapeer
- School of Computing Sciences, University of East Anglia, Norwich, UK.
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26
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Affiliation(s)
- S K Shah
- Department of Surgery, University of Texas Medical School at Houston, Houston, TX 77030, USA
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27
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Nicoletti JN, Shah SK, McCloskey DP, Goodman JH, Elkady A, Atassi H, Hylton D, Rudge JS, Scharfman HE, Croll SD. Vascular endothelial growth factor is up-regulated after status epilepticus and protects against seizure-induced neuronal loss in hippocampus. Neuroscience 2007; 151:232-41. [PMID: 18065154 DOI: 10.1016/j.neuroscience.2007.09.083] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Revised: 09/23/2007] [Accepted: 10/04/2007] [Indexed: 12/20/2022]
Abstract
Vascular endothelial growth factor (VEGF) is a protein factor which has been found to play a significant role in both normal and pathological states. Its role as an angiogenic factor is well-established. More recently, VEGF has been shown to protect neurons from cell death both in vivo and in vitro. While VEGF's potential as a protective factor has been demonstrated in hypoxia-ischemia, in vitro excitotoxicity, and motor neuron degeneration, its role in seizure-induced cell loss has received little attention. A potential role in seizures is suggested by Newton et al.'s [Newton SS, Collier EF, Hunsberger J, Adams D, Terwilliger R, Selvanayagam E, Duman RS (2003) Gene profile of electroconvulsive seizures: Induction of neurotrophic and angiogenic factors. J Neurosci 23:10841-10851] finding that VEGF mRNA increases in areas of the brain that are susceptible to cell loss after electroconvulsive-shock induced seizures. Because a linear relationship does not always exist between expression of mRNA and protein, we investigated whether VEGF protein expression increased after pilocarpine-induced status epilepticus. In addition, we administered exogenous VEGF in one experiment and blocked endogenous VEGF in another to determine whether VEGF exerts a neuroprotective effect against status epilepticus-induced cell loss in one vulnerable brain region, the rat hippocampus. Our data revealed that VEGF is dramatically up-regulated in neurons and glia in hippocampus, thalamus, amygdala, and neocortex 24 h after status epilepticus. VEGF induced significant preservation of hippocampal neurons, suggesting that VEGF may play a neuroprotective role following status epilepticus.
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Affiliation(s)
- J N Nicoletti
- City University of New York, New York, NY 10016, USA
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28
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Shearman LP, Stribling DS, Camacho RE, Rosko KM, Wang J, Tong S, Feng Y, Marsh DJ, Yu H, Guan X, Spann SK, Macneil DJ, Fong TM, Metzger JM, Goulet MT, Hagmann WK, Plummer CW, Finke PE, Mills SG, Shah SK, Truong Q, Van der Ploeg LHT, Macintyre DE, Strack AM. Characterization of a novel and selective cannabinoid CB1 receptor inverse agonist, Imidazole 24b, in rodents. Eur J Pharmacol 2007; 579:215-24. [PMID: 18021763 DOI: 10.1016/j.ejphar.2007.10.033] [Citation(s) in RCA: 12] [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: 01/03/2007] [Revised: 09/11/2007] [Accepted: 10/16/2007] [Indexed: 11/18/2022]
Abstract
We document in vitro and in vivo effects of a novel, selective cannabinoid CB(1) receptor inverse agonist, Imidazole 24b (5-(4-chlorophenyl)-N-cyclohexyl-4-(2,4-dichlorophenyl)-1-methyl-imidazole-2-carboxamide). The in vitro binding affinity of Imidazole 24b for recombinant human and rat CB(1) receptor is 4 and 10 nM, respectively. Imidazole 24b binds to human cannabinoid CB(2) receptor with an affinity of 297 nM; in vitro, it is a receptor inverse agonist at both cannabinoid CB(1) and CB(2) receptors as it causes a further increase of forskolin-induced cAMP increase. Oral administration of Imidazole 24b blocked CP-55940-induced hypothermia, demonstrating cannabinoid CB(1) receptor antagonist efficacy in vivo. Using ex vivo autoradiography, Imidazole 24b resulted in dose-dependent increases in brain cannabinoid CB(1) receptor occupancy (RO) at 2h post-dosing in rats, indicating that approximately 50% receptor occupancy is sufficient for attenuation of receptor agonist-induced hypothermia. Imidazole 24b administered to C57Bl/6 mice and to dietary-induced obese (DIO) Sprague-Dawley rats attenuated overnight food intake with a minimal effective dose of 10 mg/kg, p.o. Administration had no effect in cannabinoid CB(1) receptor-deficient mice. DIO rats were dosed orally with vehicle, Imidazole 24b (1, 3 or 10 mg/kg), or dexfenfluramine (3 mg/kg) for 2 weeks. At 3 mg/kg, Imidazole 24b reduced cumulative food intake, leading to a non-significant decrease in weight gain. Imidazole 24b at 10 mg/kg and dexfenfluramine treatment inhibited food intake and attenuated weight gain. These findings suggest that selective cannabinoid CB(1) receptor inverse agonists such as Imidazole 24b have potential for the treatment of obesity.
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MESH Headings
- Administration, Oral
- Animals
- Anti-Obesity Agents/pharmacology
- Autoradiography
- Brain/drug effects
- Brain/metabolism
- Dexfenfluramine/pharmacology
- Disease Models, Animal
- Dose-Response Relationship, Drug
- Drug Inverse Agonism
- Eating/drug effects
- Humans
- Imidazoles/administration & dosage
- Imidazoles/pharmacology
- In Vitro Techniques
- Male
- Mice
- Mice, Knockout
- Obesity/drug therapy
- Protein Binding
- Rats
- Rats, Sprague-Dawley
- Receptor, Cannabinoid, CB1/agonists
- Receptor, Cannabinoid, CB1/antagonists & inhibitors
- Receptor, Cannabinoid, CB1/genetics
- Receptor, Cannabinoid, CB2/agonists
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Affiliation(s)
- Lauren P Shearman
- Department of Pharmacology, Merck Research Laboratories, Rahway, NJ 07065, United States
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29
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Armstrong HE, Galka A, Lin LS, Lanza TJ, Jewell JP, Shah SK, Guthikonda R, Truong Q, Chang LL, Quaker G, Colandrea VJ, Tong X, Wang J, Xu S, Fong TM, Shen CP, Lao J, Chen J, Shearman LP, Stribling DS, Rosko K, Strack A, Ha S, Van der Ploeg L, Goulet MT, Hagmann WK. Substituted acyclic sulfonamides as human cannabinoid-1 receptor inverse agonists. Bioorg Med Chem Lett 2007; 17:2184-7. [PMID: 17293109 DOI: 10.1016/j.bmcl.2007.01.087] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Revised: 01/23/2007] [Accepted: 01/24/2007] [Indexed: 11/23/2022]
Abstract
Sulfonamide analogues of the potent CB1R inverse agonist taranabant were prepared and optimized for potency and selectivity for CB1R. They were variably more potent than the corresponding amide analogues. The most potent representative 22 had good pharmacokinetic and brain levels, but was modestly active in blocking CB1R agonist-mediated hypothermia.
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Affiliation(s)
- Helen E Armstrong
- Department of Medicinal Chemistry, Merck Research Laboratories, Rahway, NJ 07065, USA
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30
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Fong TM, Guan XM, Marsh DJ, Shen CP, Stribling DS, Rosko KM, Lao J, Yu H, Feng Y, Xiao JC, Van der Ploeg LHT, Goulet MT, Hagmann WK, Lin LS, Lanza TJ, Jewell JP, Liu P, Shah SK, Qi H, Tong X, Wang J, Xu SS, Francis B, Strack AM, MacIntyre DE, Shearman LP. Antiobesity efficacy of a novel cannabinoid-1 receptor inverse agonist, N-[(1S,2S)-3-(4-chlorophenyl)-2-(3-cyanophenyl)-1-methylpropyl]-2-methyl-2-[[5-(trifluoromethyl)pyridin-2-yl]oxy]propanamide (MK-0364), in rodents. J Pharmacol Exp Ther 2007; 321:1013-22. [PMID: 17327489 DOI: 10.1124/jpet.106.118737] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The cannabinoid-1 receptor (CB1R) has been implicated in the control of energy balance. To explore the pharmacological utility of CB1R inhibition for the treatment of obesity, we evaluated the efficacy of N-[(1S,2S)-3-(4-chlorophenyl)-2-(3-cyanophenyl)-1-methylpropyl]-2-methyl-2-[[5-(trifluoromethyl)pyridin-2-yl]oxy]propanamide (MK-0364) and determined the relationship between efficacy and brain CB1R occupancy in rodents. MK-0364 was shown to be a highly potent CB1R inverse agonist that inhibited the binding and functional activity of various agonists with a binding K(i) of 0.13 nM for the human CB1R in vitro. MK-0364 dose-dependently inhibited food intake and weight gain, with an acute minimum effective dose of 1 mg/kg in diet-induced obese (DIO) rats. CB1R mechanism-based effect was demonstrated for MK-0364 by its lack of efficacy in CB1R-deficient mice. Chronic treatment of DIO rats with MK-0364 dose-dependently led to significant weight loss with a minimum effective dose of 0.3 mg/kg (p.o.), or a plasma C(max) of 87 nM. Weight loss was accompanied by the loss of fat mass. Partial occupancy (30-40%) of brain CB1R by MK-0364 was sufficient to reduce body weight. The magnitude of weight loss was correlated with brain CB1R occupancy. The partial receptor occupancy requirement for efficacy was also consistent with the reduced food intake of the heterozygous mice carrying one disrupted allele of CB1R gene compared with the wild-type mice. These studies demonstrated that MK-0364 is a highly potent and selective CB1R inverse agonist and that it is orally active in rodent models of obesity.
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MESH Headings
- Amides/chemistry
- Amides/metabolism
- Amides/pharmacology
- Animals
- Anti-Obesity Agents/chemistry
- Anti-Obesity Agents/metabolism
- Anti-Obesity Agents/pharmacology
- Binding, Competitive/drug effects
- Body Temperature/drug effects
- Body Weight/drug effects
- CHO Cells
- Colforsin/pharmacology
- Cricetinae
- Cricetulus
- Cyclic AMP/metabolism
- Cyclohexanols/pharmacology
- Dose-Response Relationship, Drug
- Eating/drug effects
- Humans
- Indoles/metabolism
- Male
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Molecular Structure
- Obesity/drug therapy
- Obesity/metabolism
- Obesity/physiopathology
- Piperidines/metabolism
- Pyridines/chemistry
- Pyridines/metabolism
- Pyridines/pharmacology
- Rats
- Rats, Sprague-Dawley
- Receptor, Cannabinoid, CB1/genetics
- Receptor, Cannabinoid, CB1/metabolism
- Receptor, Cannabinoid, CB1/physiology
- Transfection
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Affiliation(s)
- Tung M Fong
- Department of Metabolic Disorders, Merck Research Laboratories, R80M-213, P.O. Box 2000, Rahway, NJ 07065, USA.
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31
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Lin LS, Lanza TJ, Jewell JP, Liu P, Shah SK, Qi H, Tong X, Wang J, Xu SS, Fong TM, Shen CP, Lao J, Xiao JC, Shearman LP, Stribling DS, Rosko K, Strack A, Marsh DJ, Feng Y, Kumar S, Samuel K, Yin W, Van der Ploeg LHT, Goulet MT, Hagmann WK. Discovery of N-[(1S,2S)-3-(4-Chlorophenyl)-2- (3-cyanophenyl)-1-methylpropyl]-2-methyl-2- {[5-(trifluoromethyl)pyridin-2-yl]oxy}propanamide (MK-0364), a novel, acyclic cannabinoid-1 receptor inverse agonist for the treatment of obesity. J Med Chem 2007; 49:7584-7. [PMID: 17181138 DOI: 10.1021/jm060996+] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The discovery of novel acyclic amide cannabinoid-1 receptor inverse agonists is described. They are potent, selective, orally bioavailable, and active in rodent models of food intake and body weight reduction. A major focus of the optimization process was to increase in vivo efficacy and to reduce the potential for formation of reactive metabolites. These efforts led to the identification of compound 48 for development as a clinical candidate for the treatment of obesity.
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MESH Headings
- Animals
- Anti-Obesity Agents/chemical synthesis
- Anti-Obesity Agents/chemistry
- Anti-Obesity Agents/pharmacology
- Body Weight/drug effects
- Cannabinoids/chemical synthesis
- Cannabinoids/chemistry
- Cannabinoids/pharmacology
- Cyclic AMP/metabolism
- Eating/drug effects
- Humans
- Liver/drug effects
- Liver/metabolism
- Microsomes/drug effects
- Microsomes/metabolism
- Obesity/drug therapy
- Rats
- Receptor, Cannabinoid, CB1/agonists
- Receptor, Cannabinoid, CB1/antagonists & inhibitors
- Receptor, Cannabinoid, CB1/metabolism
- Receptor, Cannabinoid, CB2/agonists
- Receptor, Cannabinoid, CB2/antagonists & inhibitors
- Receptor, Cannabinoid, CB2/metabolism
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Affiliation(s)
- Linus S Lin
- Department of Medicinal Chemistry, Merck Research Laboratories, Rahway, NJ 07065, USA.
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32
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Shah NJ, Shah SK, Patel VF, Patel NM. Development and validation of a HPTLC method for the estimation of cefuroxime axetil. Indian J Pharm Sci 2007. [DOI: 10.4103/0250-474x.32131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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33
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Khan MA, Walley JD, Witter SN, Shah SK, Javeed S. Tuberculosis patient adherence to direct observation: results of a social study in Pakistan. Health Policy Plan 2005; 20:354-65. [PMID: 16183735 DOI: 10.1093/heapol/czi047] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [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: 11/13/2022] Open
Abstract
A randomized controlled trial was carried out in Pakistan in 1999 to establish the effectiveness of the direct observation component of DOTS programmes. It found no significant differences in cure rates for patients directly observed by health facility workers, community health workers or by family members, as compared with the control group who had self-administered treatment. This paper reports on the social studies which were carried out during and after this trial, to explain these results. They consisted of a survey of all patients (64% response rate); in-depth interviews with a smaller sample of different types of patients; and focus group discussions with patients and providers. One finding was that of the 32 in-depth interview patients, 13 (mainly from the health facility observation group) failed to comply with their allocated DOT approach during the trial, citing the inconvenience of the method of observation. Another finding was that while patients found the overall TB care approach efficient and economical in general, they faced numerous barriers to regular attendance for the direct observation of drug-taking (most especially, time, travel costs, ill health and need to pursue their occupation). This may be one of the reasons why there was no overall benefit from direct observation in the trial. Provider attitudes were also poor: health facility workers expressed cynical and uncaring views; community health workers were more positive, but still arranged direct observation to suit their, rather than patients', schedules. The article concludes that direct observation, if used, should be flexible and convenient, whether at a health facility close to the patient's home or in the community. The emphasis should shift in practice from tablet watching towards treatment support, together with education and other adherence measures.
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Affiliation(s)
- M A Khan
- IMMPACT, University of Aberdeen, Aberdeen AB24 3FX, Scotland, UK
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34
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Shah SK, Chen N, Guthikonda RN, Mills SG, Malkowitz L, Springer MS, Gould SL, Demartino JA, Carella A, Carver G, Holmes K, Schleif WA, Danzeisen R, Hazuda D, Kessler J, Lineberger J, Miller M, Emini EA, MacCoss M. Synthesis and evaluation of CCR5 antagonists containing modified 4-piperidinyl-2-phenyl-1-(phenylsulfonylamino)-butane. Bioorg Med Chem Lett 2005; 15:977-82. [PMID: 15686896 DOI: 10.1016/j.bmcl.2004.12.044] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2004] [Revised: 12/14/2004] [Accepted: 12/15/2004] [Indexed: 11/21/2022]
Abstract
Synthesis of analogs containing more rigid bicyclic piperidine replacements for the 4-benzyloxycarbonyl-(ethyl)amino-piperidine moiety of the CCR5 antagonist structure, 1, is described. Although similar binding affinity to the lead was achieved with some analogs they were overall less potent anti-HIV agents suggesting that other features besides CCR5 binding are required for good anti-viral activity.
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Affiliation(s)
- Shrenik K Shah
- Department of Medicinal Chemistry, Merck Research Laboratories, PO Box 2000, Rahway, NJ 07065, USA.
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35
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Guthikonda RN, Shah SK, Pacholok SG, Humes JL, Mumford RA, Grant SK, Chabin RM, Green BG, Tsou N, Ball R, Fletcher DS, Luell S, Euan MacIntyre D, Maccoss M. Bicyclic amidine inhibitors of nitric oxide synthase: discovery of perhydro-iminopyrindine and perhydro-iminoquinoline as potent, orally active inhibitors of inducible nitric oxide synthase. Bioorg Med Chem Lett 2005; 15:1997-2001. [PMID: 15808455 DOI: 10.1016/j.bmcl.2005.02.067] [Citation(s) in RCA: 14] [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: 01/20/2005] [Revised: 02/18/2005] [Accepted: 02/22/2005] [Indexed: 10/25/2022]
Abstract
Syntheses and nitric oxide synthase inhibitory activity of cyclic amidines containing 5,6- 6,6- and 7,6-fused systems are described. X-ray structure determination facilitated the assignment of the stereochemistry of the most active compounds perhydro-2-iminoisoquinoline (8a) and perhydro-2-iminopyrindine (10a). Both 8a and 10a are very potent inhibitors of iNOS, with excellent selectivity over eNOS and they are orally active in rats with long duration suitable for once or twice a day dosing.
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Affiliation(s)
- Ravindra N Guthikonda
- Department of Medicinal Chemistry, Merck Research Laboratories, Rahway, NJ 07065, USA
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36
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Shankaran K, Donnelly KL, Shah SK, Caldwell CG, Chen P, Hagmann WK, Maccoss M, Humes JL, Pacholok SG, Kelly TM, Grant SK, Wong KK. Synthesis of analogs of (1,4)-3- and 5-imino oxazepane, thiazepane, and diazepane as inhibitors of nitric oxide synthases. Bioorg Med Chem Lett 2004; 14:5907-11. [PMID: 15501067 DOI: 10.1016/j.bmcl.2004.09.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2004] [Revised: 09/08/2004] [Accepted: 09/08/2004] [Indexed: 12/26/2022]
Abstract
A series of 3- and 5-imino analogs from oxazepane, thiazepane, and diazepane was prepared and evaluated as inhibitors of human nitric oxide synthesis (NOS). The most potent iNOS inhibitor was the thiazepane analog 25 (IC(50) = 0.19 microM).
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Affiliation(s)
- K Shankaran
- Department of Medicinal Chemistry, Merck Research Laboratories, PO Box 2000, Rahway, NJ 07065, USA.
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37
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Shankaran K, Donnelly KL, Shah SK, Guthikonda RN, MacCoss M, Humes JL, Pacholok SG, Grant SK, Kelly TM, Wong KK. Evaluation of pyrrolidin-2-imines and 1,3-thiazolidin-2-imines as inhibitors of nitric oxide synthase. Bioorg Med Chem Lett 2004; 14:4539-44. [PMID: 15357988 DOI: 10.1016/j.bmcl.2004.06.033] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2004] [Revised: 06/10/2004] [Accepted: 06/10/2004] [Indexed: 01/02/2023]
Abstract
Syntheses and evaluation of pyrrolidin-2-imines and 1,3-thiazolidin-2-imines as inhibitors of nitric oxide synthase (NOS) are discussed. An extensive SAR was established for pyrrolidin-2-imines class of compounds. The amidines came out as the most potent inhibitors in addition to displaying selectivity.
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Affiliation(s)
- K Shankaran
- Department of Medicinal Chemistry, Merck Research Laboratory, PO Box 2000, Rahway, NJ 07065, USA.
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38
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Shankaran K, Donnelly KL, Shah SK, Guthikonda RN, MacCoss M, Mills SG, Gould SL, Malkowitz L, Siciliano SJ, Springer MS, Carella A, Carver G, Hazuda D, Holmes K, Kessler J, Lineberger J, Miller MD, Emini EA, Schleif WA. Syntheses and SAR studies of 4-(heteroarylpiperdin-1-yl-methyl)-pyrrolidin-1-yl-acetic acid antagonists of the human CCR5 chemokine receptor. Bioorg Med Chem Lett 2004; 14:3419-24. [PMID: 15177445 DOI: 10.1016/j.bmcl.2004.04.078] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2004] [Revised: 04/20/2004] [Accepted: 04/26/2004] [Indexed: 11/28/2022]
Abstract
Efforts toward the exploration of the title compounds as CCR5 antagonists are disclosed. The basis for such work stems from the fact that cellular proliferation of HIV-1 requires the cooperative assistance of both CCR5 and CD4 receptors. The synthesis and SAR of pyrrolidineacetic acid derivatives as CCR5 antagonists displaying potent binding and antiviral properties in a HeLa cell-based HIV-1 infectivity assay are discussed.
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Affiliation(s)
- K Shankaran
- Department of Medicinal Chemistry, Merck Research Laboratories, PO Box 2000, Rahway, NJ 07065, USA.
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39
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Shankaran K, Donnelly KL, Shah SK, Caldwell CG, Chen P, Finke PE, Oates B, MacCoss M, Mills SG, DeMartino JA, Gould SL, Malkowitz L, Siciliano SJ, Springer MS, Kwei G, Carella A, Carver G, Danzeisen R, Hazuda D, Holmes K, Kessler J, Lineberger J, Miller MD, Emini EA, Schleif WA. Syntheses and biological evaluation of 5-(piperidin-1-yl)-3-phenyl-pentylsulfones as CCR5 antagonists. Bioorg Med Chem Lett 2004; 14:3589-93. [PMID: 15177481 DOI: 10.1016/j.bmcl.2004.03.112] [Citation(s) in RCA: 10] [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] [Received: 02/11/2004] [Accepted: 03/29/2004] [Indexed: 11/30/2022]
Abstract
Cellular proliferation of HIV-1 requires the cooperative assistance of both the CCR5 and CD4 receptors. Our medicinal chemistry efforts in this area have resulted in the identification of N-alkyl piperidine sulfones as CCR5 antagonists. These compounds display potent binding and show antiviral properties in HIV-1 spread cell-based assays.
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Affiliation(s)
- K Shankaran
- Department of Medicinal Chemistry, Merck Research Laboratories, PO Box 2000, Rahway, NJ 07065, USA.
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40
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Shah SK, Sadiq H, Khalil M, Noor A, Rasheed G, Shah SM, Ahmad N. Do private doctors follow national guidelines for managing pulmonary tuberculosis in Pakistan? East Mediterr Health J 2003; 9:776-88. [PMID: 15748074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
As private medical practitioners play a major role of in providing care to pulmonary tuberculosis (TB) patients, a survey was made of knowledge and practice in 2 cities in Pakistan. Only 1 of the 245 physicians was aware that cough > 3 weeks alone is the main symptom suggesting pulmonary TB. The majority diagnosed (80%) and treated (83%) cases themselves without referral. Less than 1% relied on sputum microscopy alone for diagnosis. None of the practitioners were following National TB Control guidelines for prescribing drugs and none ensured compliance with anti-TB treatment under supervision of a doctor/health worker. Only 3% kept records of pulmonary TB patients. None of the physicians assessed the effectiveness of treatment with sputum microscopy alone; the majority (76%) used only clinical assessment.
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Affiliation(s)
- S K Shah
- National Tuberculosis Control Programme, Rawalpindi, Pakistan
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41
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Agboatwalla M, Kazi GN, Shah SK, Tariq M. Gender perspectives on knowledge and practices regarding tuberculosis in urban and rural areas in Pakistan. East Mediterr Health J 2003; 9:732-40. [PMID: 15748070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
We investigated gender differences in knowledge of and attitude towards tuberculosis (TB) in urban and rural communities in Sindh province, Pakistan. Knowledge of symptoms was generally deficient, particularly in rural females. Regarding TB prevention, 22.4% of rural and 14.4% of urban males said completing treatment was important; only 9.8% of rural and 7.1% of urban females agreed. Doctors were an important source of information in rural areas and 60.9% of rural males said they would only stop treatment on a doctor's advice. In contrast, > 65% of respondents in urban areas said they would stop treatment when symptoms ended. Our study highlights the need to increase population awareness about TB in Sindh.
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Affiliation(s)
- M Agboatwalla
- Health Oriented Preventive Education (HOPE), Karachi, Pakistan
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42
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Costamagna G, Shah SK, Tringali A, Mutignani M, Perri V, Riccioni ME. Prospective evaluation of a new self-expanding plastic stent for inoperable esophageal strictures. Surg Endosc 2003; 17:891-5. [PMID: 12618935 DOI: 10.1007/s00464-002-9098-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2002] [Accepted: 02/10/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND High stent cost is considered the major drawback of self-expanding metal stents for dysphagia palliation in patients with inoperable esophageal strictures. We report our experience with a self-expanding plastic (Polyflex) stent, the cost of which is half that of the metal stents. METHODS Between September 1999 and April 2001, 16 dysphagic patients (15 men; mean age, 69.4 +/- 14.5 years; range, 49-100 years; mean dysphagia score, 3.31 +/- 0.6) with esophageal strictures who underwent Polyflex stent placement (insertion device diameter, 12-14 mm; postexpansion inner stent diameter, 16-21 mm; stent length, 9, 12, and 15 cm) were studied prospectively. The strictures were caused by postsurgical recurrence of gastric/esophageal cancer at the anastomotic site in five patients, primary esophageal cancer in four patients, esophagocardia junction cancer in four patients, metastatic mediastinal lymph nodes from a primary lung cancer invading the esophagus in 1 patient, and benign peptic stricture in two elderly patients. All the patients were prospectively followed until death. RESULTS Stent insertion was technically successful in 12 patients (75%). Stent placement failed in four patients (25%) because of failure to pass the delivery catheter across the stricture in three patients and failure of the stent to open in one patient. Early and late stent migration occurred in two patients and 1 patient, respectively. Tumor overgrowth occurred in 1 patient. The mean dysphagia score 7 days after stent placement was 1.1 +/- 0.9. Mean survival was 100.6 +/- 71.2 days (range, 8-225 days). CONCLUSION Self-expanding Polyflex stents are safe and effective for inoperable esophageal strictures and have an acceptable technical success rate. Further experience, better selection criteria, and design improvements should improve results.
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Affiliation(s)
- G Costamagna
- Digestive Endoscopy Unit, Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy.
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Mutignani M, Shah SK, Bruni A, Perri V, Costamagna G. Endoscopic treatment of extrahepatic bile duct strictures in patients with portal biliopathy carries a high risk of haemobilia: report of 3 cases. Dig Liver Dis 2002; 34:587-91. [PMID: 12502216 DOI: 10.1016/s1590-8658(02)80093-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Extrahepatic portal venous obstruction can be associated with bile duct abnormalities, the entity being called portal biliopathy. Three cases are reported of extrahepatic bile duct strictures in patients with portal biliopathy who developed haemobilia during endotherapy. Although endoscopic therapy with stent placement can be successful in patients with portal biliopathy and could also lead to permanent stricture resolution, procedure-related haemobilia is not as uncommon as previously held. Shunt surgery could be a better option in fit patients, since it could provide definitive treatment in a young patient with an otherwise normal life expectancy.
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Affiliation(s)
- M Mutignani
- Digestive Endoscopy Unit, Catholic University Sacro Cuore, A. Gemelli University Hospital, Rome, Italy
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Mutignani M, Shah SK, Morganti AG, Perri V, Macchia G, Costamagna G. Treatment of unresectable pancreatic carcinoma by intraluminal brachytherapy in the duct of Wirsung. Endoscopy 2002; 34:555-9. [PMID: 12170409 DOI: 10.1055/s-2002-33214] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND STUDY AIMS Our aim was to evaluate the feasibility and clinical outcome of intraluminal brachytherapy (ILBT) in the duct of Wirsung in patients with unresectable pancreatic adenocarcinoma. PATIENTS AND METHODS Nine patients (eight men, one woman; mean age 72.4 +/- 9.1, range 52 - 80) with unresectable pancreatic adenocarcinoma of the head or body underwent ERCP for biliary and/or pancreatic stent placement and placement of a nasopancreatic drain with/without nasobiliary drain. The ILBT dose administered was 30 - 50 Gy calculated at 1 cm from the iridium-192 wire axis. Seven patients received ILBT from the duct of Wirsung whereas two patients received dual-duct ILBT (duct of Wirsung and the common bile duct). Three patients received combined-modality treatment (ILBT with external beam radiotherapy and 5-fluorouracil). The patients were prospectively followed up. RESULTS No endoscopy-related complications occurred. No radiation-related toxicity occurred in patients treated with ILBT alone. One patient undergoing combined-modality treatment developed gastric bleeding. Intraluminal source dislodgement occurred in three patients. Obvious tumor mass reduction of greater than 50 % was seen in three patients at 8 weeks after brachytherapy. Median survival was 11 months (range 6 - 37 months) and the 1-year and 3-year actuarial survival rates were 44 % and 15 %, respectively. CONCLUSION Intraluminal brachytherapy in the duct of Wirsung in patients with unresectable pancreatic carcinoma is safe and feasible. Further clinical trials are warranted.
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Affiliation(s)
- M Mutignani
- Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Rome, Italy
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Coates RM, Shah SK, Mason RW. Stereoselective total synthesis of (.+-.)-gymnomitrol via reduction-alkylation of .alpha.-cyano ketones. J Am Chem Soc 2002. [DOI: 10.1021/ja00372a016] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Riccioni ME, Shah SK, Tringali A, Ciletti S, Mutignani M, Perri V, Zuccalà G, Coppola R, Costamagna G. Endoscopic palliation of unresectable malignant oesophageal strictures with self-expanding metal stents: comparing Ultraflex and Esophacoil stents. Dig Liver Dis 2002; 34:356-63. [PMID: 12118954 DOI: 10.1016/s1590-8658(02)80130-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Two types of self-expanding metal stents to palliate dysphagia in patients with unresectable malignant oesophageal strictures have been compared. METHODS From February 1996 to October 2000, 50 metal stents (23 covered Ultraflex and 27 Esophacoil) were placed in 50 patients (40 males, mean age: 67+/-12 years, range: 33-100, mean dysphagia score: 3.18+/-0.66) with unresectable malignant oesophageal strictures. Patients were followed until death. A retrospective review has been made of a prospectively collected database. RESULTS The two groups were comparable as far as concerns degree of dysphagia, location and stricture length. Stent placement was successful in all cases. Covered Ultraflex stent was placed in 2 patients with oesophagobronchial fistula. No procedure-related deaths were seen. Early severe complications occurred in 2 patients (perforation in 1 and tumour bleeding in 1, in the Esophacoil group). Nine patients and 1 patient complained of pain following Esophacoil and Ultraflex stent placement, respectively. Late complications were asymptomatic rupture of distal Esophacoil rings in 2 patients, symptomatic Ultraflex stent migration in 2 and tumour overgrowth in 3 (Esophacoil 1, Ultraflex 2). Mean dysphagia score at 4 weeks after stent placement was 1.9+/-0.77. Mean survival was 177+/-109 days (range: 35-603 days). There were no significant differences in technical success, dysphagia palliation, complications (except chest pain) and survival using the two types of stent. CONCLUSIONS Self-expanding metal stents are safe with high technical success and achieve satisfactory long-term palliation for dysphagia. The covered Ultraflex and Esophacoil stents are equally effective.
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Affiliation(s)
- M E Riccioni
- Department of Surgery, Catholic University Sacro Cuore, Rome, Italy
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Reich HJ, Shah SK, Gold PM, Olson RE. Selenium-stabilized anions. Preparation of .alpha.,.beta.-unsaturated carbonyl compounds using propargyl selenides. Synthesis of (.+-.)-7-hydroxymyoporone. J Am Chem Soc 2002. [DOI: 10.1021/ja00401a032] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Reich HJ, Shah SK. Selenium stabilized anions. Selenoxide syn elimination and sila-Pummerer rearrangement of .alpha.-silyl selenoxides. J Org Chem 2002. [DOI: 10.1021/jo00430a021] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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