Pankaj Mathur

Tocopherols in the Prevention and Treatment of Atherosclerosis and Related Cardiovascular Disease

Oxidants/antioxidants play an important role in cellular homeostasis. The human body has endogenous molecules that work as antioxidants, such as glutathione, superoxide dismutase, peroxidases, and catalase. Exogenous substances in the diet, such as β‐carotene, ascorbate, and vitamin E, are vital antioxidants. Of these, vitamin E is likely the most important antioxidant in the human diet, and many studies have been performed to elucidate its role in health and disease. Vitamin E is a family of several compounds, of which α‐tocopherol is the most widely known analog. α‐Tocopherol exhibits antioxidative property in vitro and inhibits oxidation of low‐density lipoprotein cholesterol. In addition, α‐tocopherol shows anti‐inflammatory activity and modulates expression of proteins involved in the uptake, transport, and degradation of atherogenic lipids. Though α‐tocopherol exhibits important antioxidant, anti‐inflammatory, and antiatherogenic features in vitro, α‐tocopherol supplements have failed to consistently reduce atherosclerosis‐related events in human trials. The conflicting results have led to reconsideration of the importance previously given to α‐tocopherol and led to interest in other members of vitamin E family, especially γ‐tocopherol, which exerts a much more potent antioxidant, anti‐inflammatory, and cardioprotective effect than α‐tocopherol. This reconsideration has been backed by solid laboratory and clinical research. We suggest that the absence of γ‐tocopherol in traditional preparations may be one reason for the lack of consistent salutary effects of vitamin E preparations in clinical trials. This review summarizes our current understanding of tocopherols as antioxidant molecules and emerging evidence of an important role of γ‐tocopherol in the pathophysiology of atherosclerosis‐related cardiovascular disease.

The level of deletion 17p and bi-allelic inactivation of TP53 has a significant impact on clinical outcome in multiple myeloma

Multiple myeloma (MM) is a malignant disorder of plasma cells with a heterogeneous clinical outcome that is affected by both numerical and structural chromosomal abnormalities, baseline characteristics (age, lactate dehydrogenase concentration, International Staging System score) and treatment

Atrial Fibrillation in Hematologic Malignancies, Especially After Autologous Hematopoietic Stem Cell Transplantation: Review of Risk Factors, Current Management, and Future Directions

Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with significant morbidity and mortality worldwide. In addition to well-established risk factors, cancer has been increasingly associated with the development of AF. Its increased occurrence in those with hematologic malignancies has been attributed to chemotherapeutic agents and autologous hematopoietic stem cell transplantation (AHSCT). Recently, a few studies have attempted to define the etiopathogenesis of AF in hematologic malignancies. The management of AF in these patients is challenging because of the concurrent complicating factors, such as thrombocytopenia, orthostatic hypotension, and cardiac amyloidosis. More studies are needed to define the management of AF, especially rate versus rhythm control and anticoagulation. Arrhythmias, in particular, AF, have been associated with an increased length of stay, increased intensive care unit admissions, and greater cardiovascular mortality. In the present review, we describe AF in patients with hematologic malignancies, the risk factors, especially after AHSCT, and the current management of AF.

Biochemical basis and therapeutic implications of angiogenesis

Biochemical basis and therapeutic implications of angiogenesis / , Biochemical basis and therapeutic implications of angiogenesis / , کتابخانه دیجیتال جندی شاپور اهواز

Myelosuppression-sparing treatment of central nervous system nocardiosis in a multiple myeloma patient utilizing a tedizolid-based regimen: a case report

Central nervous system (CNS) nocardiosis is a recognised opportunistic infection in immunocompromised patients. Treatment involves prolonged institution of antibiotics, making oral agents a convenient and desired option. Unfortunately, devising an effective, well-tolerated antimicrobial for the duration required to treat CNS nocardiosis is challenging owing to treatment intolerance and toxicities. This report highlights myelosuppression-sparing treatment with an oral tedizolid-based regimen following a complicated course with standard agents. A 68-year-old female from Florida (USA) with low-risk lambda light chain multiple myeloma complicated by persistently low CD4 counts, absolute neutrophil counts and IgG levels presented 18 months after diagnosis with fever, pneumonia, new-onset atrial fibrillation, right-sided hemiparesis, encephalopathy and slurred speech. Magnetic resonance imaging (MRI) showed numerous ring-enhancing lesions, and blood cultures were positive for Nocardia farcinica. The patient failed initial therapy with trimethoprim/sulfamethoxazole (SXT), linezolid and imipenem plus surgical debridement of the frontal lobe abscess. Intraoperative cultures were positive for N. farcinica. The treatment course was also complicated by steadily declining white blood cell and platelet counts despite receiving filgrastim. She was therefore placed on SXT and tedizolid for 6 months. Subsequent brain MRI showed complete resolution of the lesions and thus chemotherapy for multiple myeloma was re-initiated. In conclusion, tedizolid-based regimens may be an option for patients with myelosuppression requiring prolonged antibiotic therapy for CNS nocardiosis.

The prognostic value of the depth of response in multiple myeloma depends on the time of assessment, risk status and molecular subtype

Complete remission (CR) rates for multiple myeloma (MM) have increased to 60% with current treatment approaches, including high dose melphalan-based autologous stem cell transplant (ASCT) and novel agents, and are associated with improved survival.[1][1]–[3][2] Despite this improvement, highly

Metastatic prostate cancer with bone marrow infiltration mimicking multiple myeloma

Concomitant diagnosis of metastatic prostate cancer and a multiple myeloma in older male patients is challenging as both malignancies are usually associated with bone lesions. Exact knowledge, experience, and an interdisciplinary approach are required in order to differentiate between both malignancies and determine the exact treatment strategy.

Electrocardiogram helmet sign: an adverse clinical prognosis.

A 90-year-old male with a history of hypertension, diabetes mellitus type II and coronary artery disease status-post coronary artery bypass graft surgery in 2001 presented with a new onset seizure. On examination he was stuporous, afebrile, had a heart rate 85 beats per minute and blood pressure 148/70 mm of Hg. His pupils were reactive to light, had a supple neck and no focal neurological deficits. Had elevated jugular venous pressure 14 cm of H2O, diffuse bilateral rales on lung auscultation and …

Atherosclerosis and Gender-Related Differences

Coronary artery disease (CAD) remains the leading cause of mortality and morbidity world wide. Despite significant advances in our understanding of the atherogenesis, gender related differences in CAD remain unclear. It is generally assumed that the estrogens play a protective role in women in the premenopausal age group; however, hormone replacement therapy in postmenopausal women has not led to a significant decrease in cardiovascular events. Nonetheless, subtle differences at cellular level and in the plaque morphology have been identified in women as compared with men. Recent studies have shown a different pattern of atherosclerotic changes in the distribution of vessels, morphology of lesions and microvasculature between men and women. New markers of atherosclerosis such as G protein coupled estrogen receptors, Toll-like receptors and lipoprotein(a) also exhibit different patterns in men and women. Other studies have shown that women as compared to men have poorer prognosis after STEMI and CABG. An improved understanding the gender related pathophysiology will help in improved management of CAD in women.

Evolving Role of Telemedicine in Health Care Delivery in India

Introduction: India is the world’s largest democratic country, and second most populous country in the world. Despite recent successes in the economic front, India still faces many social challenges like poverty, illiteracy, sanitation, gender inequality, and lack of healthcare for all. The healthcare disparity is mainly due to shortage of trained health care professionals and lack of necessary infrastructure in remote areas of the country. Telemedicine as a tool for health care delivery, particularly in the rural areas where 68% of the population lives, has been addressed by the Government of India since the turn of the century using telemedicine. Telemedicine as a method of healthcare delivery has been successfully tested all over the country, and the results have been very promising. Methods: Literature search was done on Medline, Web of science and Google search engines using keywordstelemedicine, India model of health care delivery. Results: We found that telemedicine as a healthcare delivery system has been effectively used in several underserved areas of India, through the initiatives taken by the federal, state governments as well as private sector. Conclusion: Although not a substitute for traditional healthcare system, telemedicine can be used to overcome healthcare disparities in the underserved areas. This approach for healthcare delivery can be replicated around the world, especially in the developing countries