Evaluation of Early Renal Involvement in Essential Hypertension by Measuring Urinary Biomarkers

Hypertensive kidney damage results in glomerular as well as tubular dysfunction. Albuminuria is a well-known marker of glomerular damage. On the other hand, urinary uromodulin is increasingly considered as a potential biomarker of early tubular dysfunction. The aim of the study was to assess glomerular and tubular function of the kidney by measuring urinary albumin and uromodulin excretion in hypertensive subjects. This cross-sectional study was conducted from July 2018 to June 2019 in Hypertension Clinic of Dhaka Medical College Hospital, Dhaka and Kidney Care and Research Centre, Sonargaon, Narayanganj, Bangladesh. In this study 122 hypertensive subjects with age >30 years, duration of hypertension <5 years, without accelerated or malignant BP, absence of dipstick proteinuria and eGFR >60ml/min were included. There were also 33 normotensive individuals included as healthy controls. Albumin-creatinine ratio (uACR mg/g), urine uromodulin-creatinine ratio (uUMODμg/g), urinary sodium-creatinine ratio (mEq/g) and potassium-creatinine ratio (mEq/g) were measured from single morning spot urine sample. Urinary uromodulin levels were measured by ELISA method. The hypertensive and normotensive subjects were age matched 49.0±12.0 vs. 48.0±11.0, years (p=NS). The mean uACR was 29.0±65.0 versus 5.6±2.7mg/g, (p<0.001) respectively. The median uUMOD in hypertensive subjects was 3.38 (1.73-9.06) and in normotensives 3.85(2.28-5.69) μg/g (p=non significant). Multivariate analysis showed significant inverse association between diastolic blood pressure and urinary uromodulin excretion. A uUMOD cut-off of 2.9 (25th percentile) showed eGFR, urinary sodium and potassium excretions were significantly lower at low uromodulin group. The glomerular involvement was found in 21.0% of hypertensive subjects as evidenced by albuminuria. No difference was observed in urinary uromodulin level between hypertensive and normotensive subjects. Low urinary uromodulin level was associated with lower eGFR, Na+ and K+ excretion which indicate simultaneous tubular and glomerular involvement.

Cytotoxic activity of guaiane-type sesquiterpene lactone (deoxycynaropicrin) isolated from the leaves of Centaurothamnus maximus

Guaianolide is a type of naturally occurring sesquiterpene lactone compounds that have attracted attention due to their diverse biological properties. In this work, a guaiane-type sesquiterpene lactone identified as deoxycynaropicrin (compound 1) was isolated and reported for the first time from the leaves of Centaurothamnus maximus with two known flavonoid derivatives namely luteolin 6-O-methyl ether (compound 2) and quercetin 3-methyl ether 5-O-glucopyranoside (compound 3). The cytotoxic activity of all the three compounds was evaluated against the THP-1 human leukemia cell lines. Moreover, flow cytometry was employed to explore the cell cycle arrest and apoptosis induction for the active compound. We found that compound 1 (deoxycynaropicrin) exerted the highest cytotoxicity while compounds 2 and 3 showed no activity. Cell cycle analysis showed that compound 1 arrested the cells’ population at the G2/M phase. Furthermore, THP-1 cells treated with compound 1 exhibited a marked increase in the apoptotic cells compared to the control. Overall, this study showed that deoxycynaropicrin induces cytotoxicity against human leukemia cell lines and provided an important insight into its potential therapeutic effects against leukemia cells.

A Dig Deep to Scout the Pharmacological and Clinical Facet of Garlic (Allium sativum)

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Garlic, Allium sativum L., is a culinary herb that has been employed medicinally since ancient times. Garlic has been regarded as the oldest of all cultivated plants. Various experimental as well as human studies have demonstrated that garlic is used in preventing the initiation and evolution of several ailments such as hypertension, atherosclerosis, diabetes mellitus, cancer, microbial infections, arthritis, thrombosis, and Alzheimer’s disease. It can also act as an anti-oxidant. The preclinical toxicity study gives an impression that garlic is safe, although allergic reactions may occur. Recently, there has been systematic research regarding garlic, and positive results have been attained in healing many diseases. For centuries many countries of different civilizations and continents protected their populations and healed themselves using garlic. Therefore, there is an augmented necessity of investigation on the history of garlic for the sake of strengthening the ability of physicians and pharmacists to deal with the challenges arising in the provision of specialized facilities to serve mankind. The present review provides morphological, pharmacological, and toxicological insight regarding garlic. Further studies are required to explicate the therapeutic mode of action of garlic along with its potency, effectiveness, and clinical wellbeing in the management of different ailments.

Diabetes Mellitus during the Pandemic Covid-19: Prevalence, Pathophysiology, Mechanism, and Management: An updated overview

BACKGROUND

Diabetes mellitus (DM) is among the most frequently reported comorbidities in patients tainted with the pandemic coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). With a high pervasiveness of diabetes mellitus, there is an urgency to understand the special aspects of COVID-19 in hyperglycemic patients. Diabetic patients are at higher risk than the general population of viral or bacterial infections, thus require special attention since diabetes is linked with severe, critical, and lethal modes of COVID-19.

OBJECTIVE

The objective of this study was to focus on epidemiology, pathophysiology, mechanism, and management of DM with COVID-19.

METHODS

The search was carried out on databases portals such as Pubmed, EMBASE, Google Scholar, and CINAHL with the keywords, i.e., COVID-19, coronavirus, SARS-CoV-2, diabetes, covid-19, etc. Result: DM and COVID-19 disease conditions can impact each other in terms of clinical progression and outcome. Available laboratory/clinical observations suggest that hyperglycemia-induced immune dysfunction, inflated lactate grades, and cytokines storm may play critical roles in the seriousness of COVID-19 in patients with diabetes; however, the exact mechanisms linking diabetes and COVID-19 remain to be further clarified.

CONCLUSION

Standards to constrain the disease spread at the individual and community level are the key to extenuate the speedily rising pandemic, while definitive treatment, like plasma therapy, chemoprophylaxis, or vaccine for COVID-19, has yet to be discovered.

Cytotoxicity and molecular docking analysis of racemolactone I, a new sesquiterpene lactone isolated from Inula racemosa

CONTEXT

Traditionally, Inula racemosa Hook. f. (Asteraceae) has been reported to be effective in cancer treatment which motivated the authors to explore the plant for novel anticancer compounds.

OBJECTIVE

To isolate and characterize new cytotoxic phytoconstituents from I. racemosa roots.

MATERIALS AND METHODS

The column chromatography of I. racemosa ethyl acetate extract furnished a novel sesquiterpene lactone whose structure was established by NMR (1D/2D), ES-MS and its cytotoxic properties were assessed on HeLa, MDAMB-231, and A549 cell lines using MTT and LDH (lactate dehydrogenase) assays. Further, morphological changes were analyzed by flow cytometry, mitochondrial membrane potential, AO-EtBr dual staining, and comet assay. Molecular docking and simulation were performed using Glide and Desmond softwares, respectively, to validate the mechanism of action.

RESULTS

The isolated compound was identified as racemolactone I (compound 1). Amongst the cell lines tested, considerable changes were observed in HeLa cells. Compound 1 (IC50 = 0.9 µg/mL) significantly decreased cell viability (82%) concomitantly with high LDH release (76%) at 15 µg/mL. Diverse morphological alterations along with significant increase (9.23%) in apoptotic cells and decrease in viable cells were observed. AO-EtBr dual staining also confirmed the presence of 20% apoptotic cells. A gradual decrease in mitochondrial membrane potential was observed. HeLa cells showed significantly increased comet tail length (48.4 µm), indicating broken DNA strands. In silico studies exhibited that compound 1 binds to the active site of Polo-like kinase-1 and forms a stable complex.

CONCLUSIONS

Racemolactone I was identified as potential anticancer agent, which can further be confirmed by in vivo investigations.

COVID-19 pandemic in Uttarakhand, India: Environmental recovery or degradation?

The human coronavirus disease-2019 (COVID-19) caused by SARS-CoV-2 is now a global pandemic. Personal hygiene such as hand-washing, the use of personal protective equipment, and social distancing via local and national lockdowns are used to reduce the risk of transmission of SARS-CoV-2. COVID-19 and the associated lockdowns may have significant impacts on environmental quality and ergonomics. However, limited studies exists on the impacts of COVID-19 and the associated lockdowns on environmental quality and ergonomics in low-income settings. Therefore, the present study investigated the impacts of the COVID-19 outbreak on socioeconomics, ergonomics and environment (water quality, air quality and noise) in Uttarakhand, India. Approximately 55% of respondents experienced headaches, and the other common health-related issue was back pain, with 45% of respondents having problems with their backs. Water and air quality significantly improved during the lockdown relative to the pre-lockdown period, but was observed to return to their previous characteristics afterwards. Lockdowns significant increased the concentration of indoor air pollutants while noise pollution levels significantly declined. In summary, lockdowns have adverse impacts on ergonomics, resulting in work-related human health risks. The impacts of lockdowns on environmental quality are mixed: temporary improvements on water and air quality, and noise reduction were observed, but indoor air quality deteriorated. Therefore, during lockdowns there is a need to minimize the adverse environmental and ergonomic impacts of lockdowns while simultaneously enhancing the beneficial impacts.

Recent Advances Towards Treatment of HIV: Synthesis and SAR Studies

In the present study, authors want to encourage the research exertions through structureactivity relationship for the identification of effective molecules for the treatment of Human immunodeficiency virus because nowadays AIDS is considered as one of the main causes of death in human beings. A diversity of biological resources has been searched and developed for the treatment of HIV but unfortunately, until now, no medicine is found to be fully effective and safe for the cure of patients. Human immunodeficiency virus is a type of lentivirus which causes the infection of HIV and once it enters the human body, it stays for a longer period of time triggering immunodeficiency syndrome. For searching and developing new potent and effective anti-HIV molecules, medicinal chemists have engaged in countless targets with the structure-activity relationship (SAR) of molecules and on this basis, many antiretroviral therapies have been developed to cure HIV infection. Most of these new searched molecules have been found to be clinically active against various types of AIDS patient and auxiliary research in this area may lead to better treatment in the near future. This article encompasses and highlights the recent advancement of innumerable inhibitors laterally through synthetic, semi-synthetic and structure-activity relationship approaches.

Design, Synthesis, Molecular Modelling, and Biological Evaluation of Oleanolic Acid-Arylidene Derivatives as Potential Anti-Inflammatory Agents

INTRODUCTION

Oleanolic acid, a pentacyclic triterpenic acid, is widely distributed in medicinal plants and is the most commonly studied triterpene for various biological activities, including anti-allergic, anti-cancer, and anti-inflammatory.

METHODS

The present study was carried out to synthesize arylidene derivatives of oleanolic acid at the C-2 position by Claisen Schmidt condensation to develop more effective anti-inflammatory agents. The derivatives were screened for anti-inflammatory activity by scrutinizing NO production inhibition in RAW 264.7 cells induced by LPS and their cytotoxicity. The potential candidates were further screened for inhibition of LPS-induced interleukin (IL-6) and tumour necrosis factor-alpha (TNF-α) production in RAW 264.7 cells.

RESULTS

The results of in vitro studies revealed that derivatives 3d, 3e, 3L, and 3o are comparable to that of the oleanolic acid on the inhibition of TNF-α and IL-6 release. However, derivative 3L was identified as the most potent inhibitor of IL-6 (77.2%) and TNF-α (75.4%) when compared to parent compound, and compounds 3a (77.18%), 3d (71.5%), and 3e (68.8%) showed potent inhibition of NO than oleanolic acid (65.22%) at 10µM. Besides, from docking score and Cyscore analysis analogs (3e, 3L, 3n) showed greater affinity towards TNF-α and IL-1β than dexamethasone.

CONCLUSION

Herein, we report a series of 15 new arylidene derivatives of oleanolic acid by Claisen Schmidt condensation reaction. All the compounds synthesized were screened for their anti-inflammatory activity against NO, TNF-α and IL-6. From the data, it was evident that most of the compounds exhibited better anti-inflammatory activity.

Synthetic lethality on drug discovery: an update on cancer therapy

INTRODUCTION

A novel anticancer therapy is the need of the hour due to growing incidences of resistance to first line cancer chemotherapy. Synthetic lethality (SL) is one of the new age treatment methods being explored for combating the resistance to anticancer agents. In this method, cell mutations are exploited for the development of new therapeutic agents, where, if there is loss of function of one gene, the cell mutations can still be fixed by alternative machinery but if two genes involved in DNA repair undergo loss of function, it causes lethality to the cell.

AREAS COVERED

The authors condense findings of SL-based novel anticancer regimen. The review emphasizes some of the SL based clinical and preclinical studies of novel targets and therapy.

EXPERT OPINION

SL conceptualizes a resolution against treatment resistance to anticancer regimen by recognition of therapeutic vulnerabilities in particular cancer cells. A multitude of clinical trials associated with SL and DNA repair are being conducted that will be useful in obtaining a clearer picture pertaining to the use of cancer biomarkers and effectiveness of drugs acting via target-based molecular changes. Furthermore, new anticancer regimen focused on personalized medicines will emerge basing their development upon SL.

Stability issues and approaches to stabilised nanoparticles based drug delivery system

Nanoparticles form the fundamental building blocks for many exciting applications in various scientific disciplines due to its unique features such as large surface to mass ratio, targeting potential, ability to adsorbed and carry other compound which makes them suitable for biomedical applications. However, the problem of the large-scale synthesis of nanoparticles remains challenging due to physical instability associated with nanoparticles which lead to generation of aggregates particles with high polydispersity index (PDI) indicating low particle homogeneity and eventually loss of their special nanoscale properties. The stabilisation concept can be generated by repulsive electrostatic force, which nanoparticles experience, when they are surrounded by a double layer of electric charges. Selection of proper stabiliser will govern the stability of NPs and ultimately development of optimised drug delivery system. This review summarises mechanism of physical instability issues likely to be encountered during the development of nanoformulations. It also discusses potential stabilising agents used so far and their mechanism in achieving stable nanosystems.

Magnitude of unreported kala-azar cases in a highly endemic district of Bihar, India: A positive impact of Indian elimination programme

BACKGROUND & OBJECTIVES

In India, kala-azar surveillance is weak and no public-private partnership exists for disease containment. Estimate of disease burden is not reliably available and still cases are going to private providers for the treatment. The present study aimed to assess the magnitude of kala-azar cases actually detected and managed at private set-up and unreported to existing health management information system.

METHODS

Institution based cross-sectional prospective pilot study was conducted. List of facilities was created with the help of key informants. The information about incidence of kala-azar cases were captured on monthly basis from July 2010 to June 2011. Rapid diagnostic strip test (rk-39) or bone marrow/splenic puncture were applied as laboratory methods for the diagnosis of kala-azar. Descriptive statistics as well as chi-square test for comparison between proportions was conducted.

RESULTS

Overall availability of private practitioners (PPs) was 4.59/1,00,000 population and maximum PPs (46; 93.9%) were from qualified category. The median years of medical practice was 25 yr (inter quartile-range [18, 28]). Interestingly, only a small proportion (240; 19%) of cases was managed by PPs. Amongst the PPs, only low proportion (32; 18.2%) managed >2 cases per month. The mean number of kala-azar suspects and cases identified varied significantly between different PPs' professions with p <0.048 and p <0.032, respectively. A highly significant difference (p <0.0001) was observed for kala-azar case load between qualified and unqualified practitioners. A small proportion (38; 15.8%) of kala-azar cases was not present in the public health system record.

INTERPRETATION & CONCLUSION

Still sizeable proportions of cases are going to PPs and unrecorded into government surveillance system. A mechanism need to be devised to involve at least qualified PPs in order to reduce treatment delay and increase case detection in the region.

Assessment of environmental and ergonomic hazard associated to printing and photocopying: a review

"Knowledge is power" and distribution of knowledge is fueled by printing and photocopying industry. Even as printing and photocopying industry have revolutionized the availability of documents and perceptible image quickly at extremely inexpensive and affordable cost, the boon of its revolution has turned into a bane by irresponsible, uncontrolled and extensive use, causing irreversible degradation to not only ecosystem by continuous release of ozone and other volatile organic compounds (VOCs) but also the health of workers occupationally exposed to it. Indoor ozone level due to emission from different photocopying equipment's increases drastically and the condition of other air quality parameters are not different. This situation is particularly sedate in extremely sensitive educational and research industry where sharing of knowledge is extremely important to meet the demands. This work is an attempt to catalogue all the environmental as well as health impacts of printing or photocopying. It has been observed that printing/photocopying operation is a significant factor contributing to indoor air quality degradation, which includes increase in concentration of ozone, VOCs, semi-volatile organic compounds (SVOCs) and heavy metals such as cadmium, selenium, arsenic, zinc, nickel, and other pollutants from photocopy machines. The outcome of this study will empower the manufactures with information regarding ozone and other significant emission, so that their impact can be reduced.

Pharmacological Evaluation of Secondary Metabolites and Their Simultaneous Determination in the Arabian Medicinal Plant Plicosepalus curviflorus Using HPTLC Validated Method

Plicosepalus is an important genus of the Loranthaceae family, and it is a semiparasitic plant grown in Saudi Arabia, traditionally used as a cure for diabetes and cancer in human and for increasing lactation in cattle. A flavonoid quercetin (P1), (-)-catechin (P2), and a flavane gallate 2S,3R-3,3',4',5,7-pentahydroxyflavane-5-O-gallate (P3) were isolated from the methanol extract of the aerial parts of P. curviflorus (PCME). The PCME and the isolated compounds were subjected to pharmacological assays to estimate peroxisome proliferator-activated receptors PPARα and PPARγ agonistic, anti-inflammatory, cytotoxic, and antimicrobial activities. Results proved for the first time the dual PPAR activation effect of the PCME and catechin (P2), in addition to the promising anti-inflammatory activity of the flavonoid quercetin (P1). Interestingly, both PCME and isolated compounds showed potent antioxidant activities while no antimicrobial effect against certain microbial strains had been reported from the extract and the isolated compounds. Based on the pharmacological importance of these compounds, an HPTLC validated method was developed for the simultaneous estimation of these compounds in PCME. It was found to furnish a compact and sharp band of compounds P1, P2, and P3 at R _f = 0.34, 0.47, and 0.65, respectively, using dichloromethane, methanol, and formic acid (90 : 9.5 : 0.5, (v/v/v)) as the mobile phase. Compounds P1, P2, and P3 were found to be 11.06, 10.9, 6.96 μg/mg, respectively, in PCME. The proposed HPTLC method offers a sensitive, precise, and specific analytical tool for the quantification of quercetin, catechin, and flavane gallates in P. curviflorus.

Interspecies Anticancer and Antimicrobial Activities of Genus Solanum and Estimation of Rutin by Validated UPLC-PDA Method

Solanaceae is one of the highly diverse plant families of which Solanum is the largest genera (1700 species) containing several pharmacological properties like anticancer and antimicrobial. This motivated us to explore the anticancer (against HepG2, HEK-293, and MCF-7 cells) and antimicrobial (against S. aureus, E. coli, P. aeruginosa, and C. albicans) properties of S. schimperianum, S. villosum, S. coagulans, S. glabratum, S. incanum, and S. nigrum along with rutin estimation by UPLC-PDA method. Of the studied Solanum extracts, S. nigrum exhibited significant cytotoxic property against HepG2 (IC50: 20.4 μg/mL) and MCF-7 (IC50: 30.1 μg/mL); S. coagulans showed toxicity against HepG2 (IC50: 28.4 μg/mL) and HEK-293 cells (IC50: 25.7 μg/mL) compared to 5-Fluorouracil (standard). Compared to these, extracts of S. coagulans and S. glabratum exhibited relatively high antimicrobial potency (MIC: 0.4-1.6 mg/mL). Nonetheless, all Solanum extracts significantly reduced the biofilm against PAO1-strain. Rutin was detected in all extracts with the highest content (53.79 μg/mg) in S. coagulans that supported its strong antimicrobial and anticancer properties. Molecular docking analysis showing strong binding of rutin with human DNA and proteins (DNA Topoisomerase IIα and E. coli DNA gyrase B) supported the anticancer and antimicrobial activities of Solanum species.

Flavonoid glycosides from leaves and straw of Oryza sativa and their effects of cytotoxicity on a macrophage cell line and allelopathic on weed germination

Five new flavonoids namely, 5-hydroxy-6-isoprenyl-7,4'-dimethoxyflavonol-3-O-β-d-arabinofuranoside (1), 5,7-dihydroxy-4'-methoxyflavone-7-O-β-d-arabinopyranosyl-2''-n-decan-1'''-oate (2), 3-butanoyl-5,6,8-trihydroxy-7,4'-dimethoxyflavonol--5-O-β-d-glucopyranoside (3), 7, 4'-dimethoxy-5-hydroxyflavone-5-O-α-d-arabinopyranosyl-(2'' → 1''')-O-α-d-arabinopyranoside (4), and 5,6-dihydroxy-7, 4'-dimethoxyflavone-5-O-α-d-glucopyranoside (5), together with two known compounds, were isolated from the methanol extract of Oryza sativa leaves and straw. Their structures of new compounds were elucidated by 1D and 2D NMR spectral methods, viz: COSY, HMBC and HSQC aided by mass techniques and IR spectroscopy. The cytotoxicity of these compounds (1-7) were assessed by using (RAW 264.7) mouse macrophages cell line, and allelopathic effects of compounds (1-7) on the germination characteristics of barnyardgrass (Echinochloa oryzicola) and pigweed (Chenopodium album L.) were also evaluated. The compounds 1, 6 and 7 showed cytotoxicity and compounds 1-7 exhibited significant inhibitory activity on the seed germination of two weed species.

Comparative anticancer and antimicrobial activity of aerial parts of Acacia salicina, Acacia laeta, Acacia hamulosa and Acacia tortilis grown in Saudi Arabia

The standardized ethanol extract (EE) of aerial parts of four Acacia species [A. salicina (ASEE), A. laeta (ALEE), A. hamulosa (AHEE), and A. tortilis (ATEE)] were examined in order to compare their cytotoxic and antimicrobial activities. All the extracts were standardized by UPLC- PDA method using rutin as standard compound. The extracts ALEE, AHEE and ATEE were found to contain rutin along with several other phytoconstituents while rutin was absent in ASEE. All the extracts showed varying level of antimicrobial activity with zone of inhibition ranged from 11 to 21 mm against Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa and Candida albicans. The ALEE and ATEE showed relatively high antimicrobial potency (MIC = 0.2 to 1.6 mg mL⁻¹) in comparison to other extracts. All the extracts were found to reduce the biofilm of P. aeruginosa PAO1 strain significantly in comparison to the untreated control. The cytotoxic property of ASEE, ALEE, AHEE, ATEE were evaluated against HepG2 (Liver), HEK-293 (Kidney), MCF-7 (Breast) and MDA-MB 231 (Breast) cancer cells. Of these, ALEE, AHEE and ATEE exhibited moderate cytotoxic property against human liver carcinoma cells (HepG2; IC50 = 46.2, 39.2 and 42.3 μg mL⁻¹, respectively) and breast cancer cell lines (MCF-7; IC50 = 57.2, 55.3 and 65.7 μg mL⁻¹, respectively). The ATEE and ALEE showed moderate cytotoxicity against HEK-293 (kidney) cells with IC50 = 49.1 and 53.5 μg mL⁻¹, respectively. Since, Acacia species (A. laeta and A. hamulosa) contains numerous polyphenols which might prove to be highly cytotoxic and antimicrobial agents, we suggest that these species can be further subjected to the isolation of more cytotoxic and antimicrobial compounds.

Simultaneous separation of antihyperlipidemic drugs by green ultrahigh-performance liquid chromatography–diode array detector method: Improving the health of liquid chromatography

Statins in combination with fibrates show beneficial effects on the lipoprotein profile of patients because they have positive complimentary effects on lipid profile. A new green ultrahigh-performance liquid chromatography–diode array detector method for simultaneous analysis of simvastatin (SMV) and fenofibrate (FNF) in standard form, marketed formulations, and self-emulsifying drug delivery system formulations was developed and validated in the present investigation. The method utilized C₁₈ as stationary phase and a combination of methanol:water (8:2) as an eluent. It was found that selected eluent provided short run time (2.5 minutes), better peak symmetry and satisfactory values of other chromatographic parameters such as resolution (Rs = 2.325), capacity factor (k, 3.0 and 4.2 for SMV and FNF, respectively), selectivity (α = 1.4), and number of theoretical plates (N, 4265 and 5285 for SMV and FNF, respectively). An excellent linear relationship (r² 0.998 and 0.997 for SMV and FNF, respectively) was observed for linear regression data for the calibration plots. The developed system was validated for accuracy, precision, robustness (^> 2% for both drugs) and recovery (98–102% for both drugs). Results obtained from the statistical treatment of the values obtained for different parameters proved that the method is suitable, reproducible, and selective for the simultaneous analysis of SMV and FNF in bulk, marketed, and self-emulsifying drug delivery system formulations. The replacement of commonly applied toxic solvents with innocuous and environmentally benign solvents provides a better option than the more toxic processes in drug analysis.

Inter-species comparative antioxidant assay and HPTLC analysis of sakuranetin in the chloroform and ethanol extracts of aerial parts of Rhus retinorrhoea and Rhus tripartita

Context: Extensive research on Rhus (Anacardiaceae) shows their antioxidant potential, which warrants further evaluation of its other species.

Objective: To perform a comparative antioxidant assay on extracts of R. retinorrhoea and R. tripartita, including sakuranetin quantification by a validated HPTLC method.

Materials and methods:In vitro antioxidant assay was performed on chloroform and ethanol extracts of R. retinorrhoea Steud. ex Oliv. (RRCE and RREE) and R. tripartita (Ucria) Grande (RTCE and RTEE) by DPPH radical scavenging (at 31.25, 62.5, 125, 250 and 500 μg/mL concentrations) and β-carotene-linoleic acid bleaching methods at 500 μg/mL concentration. Densitometric HPTLC method was developed and validated using toluene: ethyl acetate: methanol (8:2:0.2; v/v/v) as mobile phase, executed on glass-backed silica gel F₂₅₄ plate and scanned at 292 nm.

Results: Antioxidant activity of Rhus extracts tested by the two methods (DPPH/BCB) was found in order of RTEE > RREE > RTCE > RRCE with IC₅₀ 118.67/256.26, 315.75/82.35, 827.92/380.0 and 443.69/292.75, respectively. Scanning of the HPTLC plate provided an intense peak of sakuranetin at R_f = 0.59. The estimated sakuranetin content in the dry weight of the extracts was highest in RREE (27.95 μg/mg) followed by RRCE (25.22 μg/mg), RTEE (0.487 μg/mg) and RTCE (0.0 μg/mg). Presence of sakuranetin in RREE, RRCE and RTEE supported the highest antioxidant property of the two Rhus species. Nonetheless, low sakuratenin in R. tripartita indicated the presence of other bioactive constituents responsible for synergistic antioxidant activity.

Conclusion: The developed HPTLC method therefore guarantees its application in quality control of commercialized herbal drugs and formulations containing sakuranetin.

New constituents triterpene ester and sugar derivatives from Panax ginseng Meyer and their evaluation of antioxidant activities

Panax ginseng C. A. Meyer (Araliaceae), is a well-known herb and used in the old established system of Oriental remedy, especially in Japan, China and Korea. Four new compounds characterized as (cis)- 7β,11α,19,21-tetra-O-decanoyl-18, 22β-dihydroxy-dammar-1-en-3-one (1), 3β,4α,12β-trihydroxystigmast-5-en-21-yl octadecan-9',12'-dienoate (2), dammar-12, 24-dien-3α, 6β, 15α-triol-3α-D-arabinopyranosyl-6β-L-arabinopyranoside (3) and dammar-24-en-3α, 6β, 16α, 20β-tetraol-3α-D-arabinopyranosyl-6β-D-arabinopyranoside (4) were isolated and established from the ethyl acetate and butanol extracts of the roots of P. ginseng. Their structures were established on the basis of spectral data and chemical reactions. Natural compounds indicative a great reservoir of materials and compounds with evolved biological activity, including antioxidant. Compounds 1-4 were investigated in vitro for antioxidant potential using ferric reducing antioxidant power (FRAP), the Nitric oxide (NO) scavenging activity, reducing power, phosphomolybdenum and 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging actions, and the decision showed the compounds 3and 4 have probablyessential antioxidant properties than the compounds 1and 2 presented weak activity.

Quantitative analysis of biomarker rutin in different species of genus Ficus by validated NP and RP-HPTLC methods

Biomarker rutin was analyzed in methanol extracts of leaves of five different species of genus Ficus (Ficus carica, Ficus nitida, Ficus ingens, Ficus palmata and Ficus vasta) by NP-HPTLC (Method I) and RP- HPTLC methods (Method II). The development and validation for method I was carried out with silica gel 60F254 plates using EA: GAA: FA: H2O (10:1:1:2.5, v/v/v/v) as developing system. Method II was carried out on silica gel 60F254 RP-18 plates using mobile phase ACN: H2O (4:6 v/v). Both analyses were scanned at 305 nm and were found to give well resolved peak of rutin at Rf0.28±0.01 and 0.68±0.03 for Method I and Method II, respectively. The percentage of rutin was found to be 0.51% & 0.66% in F. ingens, 0.24% & 0.54% in F. palmata and 0.14% & 0.17% in F. vasta by Method I &amp; Method II, respectively. Method II (RP-HPTLC) was found to be more accurate, precise and sensitive than Method I. Method II can be used as an important tool for standardization and quality control of bulk drugs and in-process formulations of rutin.

Ameliorative effect of methanol extract of Rumex vesicarius on CCl4-induced liver damage in Wistar albino rats

CONTEXT

Rumex vesicarius L. (Polygonaceae), an edible plant, is reported to have many bioactive phytochemicals, especially flavonoids and anthraquinones with antioxidant and detoxifying properties.

OBJECTIVE

This study evaluated the methanolic extract of R. vasicarius (MERV) for hepatoprotective activity in rats against CCl4-induced liver damage.

MATERIALS AND METHODS

The whole plant extract was prepared and investigated for its hepatoprotective activity. Rats were pretreated with MERV (100 and 200 mg/kg, p.o.) for 7 d prior to the induction of liver damage by CCl4. Animals were then sacrificed 24 h after CCl4 administration for the biochemical (AST, ALT, and ALP activity in serum; lipid peroxidation (LPO) and glutathione (GSH) levels in liver tissue) and histological analyses.

RESULTS

CCl4-induced hepatotoxicity was confirmed by an increase (p < 0.05) in serum AST (4.55-fold), ALT (3.51-fold), and ALP (1.82-fold) activities. CCl4-induced hepatotoxicity was also manifested by an increase (p < 0.05) in LPO (3.88-fold) and depletion of reduced glutathione (3.14-fold) activity in liver tissue. The multiple dose MERV administration at 200 mg/kg showed promising hepatoprotective activity as evident from significant decrease levels of serum AST (230.01 ± 13.21), serum ALT (82.15 ± 5.01), serum ALP (504.75 ± 19.72), hepatic LPO (3.38 ± 0.33), and increased levels of hepatic glutathione (0.34 ± 0.04) towards near normal. Further, biochemical results were confirmed by histopathological changes as compared with CCl4-intoxicated rats.

DISCUSSION AND CONCLUSION

The results obtained from this study indicate hepatoprotective activity of Rumex plant against CCl4-induced liver toxicity; hence, it can be used as a hepatoprotective agent.

Densitometric validation and analysis of biomarker β-amyrin in different Acacia species (leaves) grown in Kingdom of Saudi Arabia by high performance thin-layer chromatography

Biomarker β-amyrin was analyzed in the leaves of four different Acacia species (A. salicina, A. loreta, A. hamulosa and A. tortilis) grown in Kingdom of Saudi Arabia by a validated HPTLC method. The chromatography was performed on glass-backed silica gel 60 F254 HPTLC plates using solvents toluene: methanol (9:1, v/v) as mobile phase. The developed TLC plate was derivatized with anisaldehyde and scanned at 520 nm. A sharp peak of β-amyrin was found at Rf=0.58±0.01. The r2 and the linear regression equation for β-amyrin was found to be 0.991 and 19.913X+107.803, respectively in the concentration range of 100-800 ng. The percentage of β-amyrin was found to be maximum 2.70% w/w in A. tortilis, 1.85% w/w in A. loreta and 1.80% w/w in A. hamulosa while it was totally absent in A. salicina. This study conceives maiden reporting of quantification of β-amyrin in four different species of Acacia by validated HPTLC method. The developed method for the analysis of β-amyrin was proved to be reproducible by statistical analysis hence it can be employed for further analysis of β-amyrin in plasma, other biological fluids and in finished products available in the market.

Isolation and characterization of a new oxygenated homoditerpenoid from leaves of Centaurothamnus maximus with antimicrobial potential

A new bioactive oxygenated homoditerpenic compound along with one known compound from the antimicrobial active ethanol extract of leaves of an endemic plant Centaurothamnus maximus was isolated. The n -hexane, dichloromethane, ethyl acetate and ethanol fractions of C. maximus leaves were evaluated for their antimicrobial potential by using standard agar well diffusion method against various microorganisms viz. B. subtilis, S. aureus, E. coli, P. aeruginosa, C. albicans and M. smegmatis. The results revealed that only ethanol extract was active against all microbes except the fungus C. albicans. A new compound 2α, 3α-dihydroxy-8α-methoxy-15-hydroxy-methylene- pimar-5,9 (11)-diene (CM-1) was isolated along with a known compound α-D-xylose (CM-2) from ethanol extract by reverse phase (RP-18) column chromatography and 1D and 2D NMR (DEPT, COSY, HMBC and HSQC) aided by EIMS mass and IR spectra were used to establish the structure. CM-1 was found to be active against B. subtilis, S. aureus and M. smegmatis (P>0.005) at MIC 20 μg/ml. Findings of this study may provide a lead for synthesis of more potent antimicrobial agents to serve the humanity against multidrug-resistant bacterial infections.

Evaluation of thermo sensitivity of curcumin and quantification of ferulic acid and vanillin as degradation products by a validated HPTLC method

Charismatic therapeutic potential of curcumin in biological research have triggered an interest to explore the thermal degradation pattern of curcumin, formation of ferulic acid and vanillin as degraded metabolites at different temperatures in methanol and corn oil. The results revealed 47% w/w loss of curcumin along with formation of 17% w/w vanillin and 9% w/w ferulic acid at boiling temperature of methanol while oil samples show 38.9% w/w loss of curcumin but not confirming the formation of ferulic acid and vanillin. Findings of this study revealed that formation of vanillin in methanol starts around 50°C and its concentration goes on increasing up to 70°C and then further degraded at boiling temperature of methanol. Formation of ferulic acid begins around 60°C and initially increases with rise of temperature and then decreases approaching boiling point of methanol. Vanillin as well as ferulic acid was absent in corn oil samples though degradation of curcumin was observed by reduction in peak area of curcumin. The present study was done by applying a validated high-performance thin-layer chromatography method. The method involved glass-backed HPTLC plates precoated with silica gel 60F254 as the stationary phase and toluene: ethyl acetate: methanol (8:1:1, v/v/v) as mobile phase.

Effect of some plants' extracts used in Sudanese folkloric medicines on carrageenan-induced inflammation

Investigations for anti-inflammatory potential and categorization of Sudanese medicinal plants according to their potency. Anti-inflammatory effect of plants' extracts of 17 genera were studied using the carrageenan induced inflammation in rats' paws. The plant extracts were obtained using methanol and dichloromethane as solvent and administered intra peritoneally at the concentration of 2g/kg body weight. The results obtained in this experiment strongly support and validate the traditional uses of these Sudanese medicinal plants to treat various inflammatory diseases. 63.9% of plants extracts showed marked inhibition of inflammation induced by carrageenan (78.3% out of this percentage represented by methanolic extract), 27.8% showed no activity and 8.3% enhanced the carrageenan induced inflammation. The anti-inflammatory effect of many of these plants has not been reported previously, yet they have been extensively used in Sudanese folkloric medicine. The result of this study justify the traditional medicinal use of the evaluated plants species in treating inflammatory disorders and helped in categorizing the investigated plants into most useful, moderately useful and least useful category for inflammatory diseases. Out of the 17 investigated plant species 05 belongs to most useful and 06 belongs to moderately useful category. However, toxicity studies are required to prove the safety of these plant materials.

Quantification of glycyrrhizin in anti-stress herbal formulations by validate HPTLC method: a rational paradigm towards quality control of herbals

In the present study an analytical method of high-performance thin-layer chromatography (HPTLC) has been developed for quantification of glycyrrhizin for marketed antistressliquorice root capsules (LRC) and herbal tea (HT). Chromatography was performed by using mobile phase ethyl acetate (EA): glacial acetic acid (GAA): Methanol (MeOH): water (H(2)O) in proportion of 6:2:2:1, v/v/v/v. The developed plate was scanned and quantified densitometrically at absorption maxima 254nm. The method was validated for various analytical parameters viz. precision, accuracy, recovery, robustness, specificity, detection and quantification limits. The developed system was found to give compact spot for glycyrrhizin (R(f)= 0.33± 0.001). The linearity relationship was described by the equation Y=6.841X+ 70.428. The limit of detection (34 ng band(-1)), limit of quantification (101 ng band(-1)), recovery (99.4-99.8%), and precision (<1.84% and <1.62%; intraday and interday, respectively) were found satisfactory for glycyrrhizin. Linearity range for glycyrrhizin was 100-600ng (r(2)=0.998). The amount of glycyrrhizin was estimated by comparing the peak area of standard and the same was present in crude extract. The content of glycyrrhizin was estimated as 11.4% and 4.7% w/w in sample LRC and HT, respectively. The proposed method will be useful to quantify the therapeutic dose of glycyrrhizin in herbal formulations as well as in bulk drug.

Antioxidant potential of Rumex vesicarius L.: in vitro approach

OBJECTIVE

To assess in-vitro antioxidant activity of different fraction and perform high performance thin layer chromatography fingerprint analysis of most active fraction of Rumex vesicarius L. (R. vesicarius).

METHODS

In the present study, acetone, ethyl acetate, n-butanol, and methanol extracts of R. vesicarius were evaluated for radical scavenging activity by studying the inhibition of the level of lipid peroxidation induced by Fe(++)/ascorbate, DNA sugar damage, scavenging of hydrogen peroxide, diphenylphosphine DPPH radical scavenging activity, total phenolic content, total flavonoids content and total proanthocyanidin. High performance thin layer chromatography finger print profiling of R. vesicarius L. was also done.

RESULTS

Lipid peroxidation induced by the iron/ascorbate system, hydrogen peroxide, diphenylphosphine and DNA sugar damage were inhibited by the addition of different extract of R. vesicarius. Among them, methanolic extract showed maximum efficacy. The methanolic extract showed the highest total phenolic, total flavonoids and total proanthocyanidin contents.

CONCLUSIONS

The results suggest that the extracts can be a vital source of phytochemical antioxidants.

Physicochemical and phytochemical standardization with HPTLC fingerprinting of Nigella sativa L. seeds

This study was designed to perform the physicochemical and phytochemical standardization with HPTLC fingerprinting of Nigella sativa seeds in order to establish the standard pharmacognostical parameters of this miracle herb. Different parameters like extractive values; total ash value, acid insoluble ash value and water soluble ash value, moisture content, loss on drying, pH values of Nigella sativa seeds were performed. Preliminary phytochemical screening was done to detect different phytoconstituents by using the Harborne's phytochemical methods. Quantification of phenolic and flavonoid contents, determination of pesticides residues, aflatoxin and heavy metals were also carried out. HPTLC fingerprinting of methanolic extract was performed using CAMAG-HPTLC system connected with win CAT software. Preliminary phytochemical screening of the extracts in different solvent revealed the presence of carbohydrates, phenolic compounds, flavonoids, alkaloids, proteins, saponins, lipids, sterols and tannins. Total flavonoid and phenolic contents in methanolic extract was found to be 1.4 mg/gm and 9.8 mg/gm extract respectively. Concentrations of heavy metals were found within acceptable limits. Pesticides residues and aflatoxins were not detected. The physicochemical and phytochemical standards along with HPTLC fingerprint profile established as an outcome of this research may be utilized as substantial data for identification, purification and standardization of Nigella sativa seeds.

Pacemaker placement and shoulder surgery: is there a risk?

INTRODUCTION

Surgery to the anterior aspect of the shoulder is performed by many surgical specialties but the techniques used by our cardiology colleagues for insertion of cardiac pacemaker wires are often not appreciated by the surgical community. The deltopectoral approach has been used for open pacemaker wire insertion for many years by cardiologists.

METHODS

We surveyed a group of subspecialty shoulder surgeons as well as orthopaedic trainees to see if this approach for pacemakers is well recognised. We tried to assess what level of knowledge exists regarding pacemaker placement in general as well as specific risks.

RESULTS

There appears to be a paucity of knowledge regarding pacemaker placement and related patient safety issues in both surveyed groups. There was no difference between the two groups, suggesting that the level of knowledge does not increase with experience and specialisation.

CONCLUSIONS

There is the potential to cause harm to patients if the insertion site and type of device is not identified before commencing surgery in this region and steps must be taken to minimise any intra-operative risk. There is a risk from direct injury to the pacemaker and/or leads as well as the hazards of using diathermy in close proximity to a pacemaker. There must be more widespread dissemination of this information in order to minimise risks to patients with pacemakers in situ.

Asymptomatic infection of visceral leishmaniasis in hyperendemic areas of Vaishali district, Bihar, India: a challenge to kala-azar elimination programmes

A cohort of 91 asymptomatic individuals with visceral leishmaniasis (VL) were identified during base line screening using recombinant 39-aminoacid antigen (rk-39) and polymerase chain reaction (PCR) conducted from December 2005 to June 2006 involving 997 individuals of two highly endemic villages of Vaishali district, Bihar. The point prevalence of asymptomatic infection was 98 per 1000 persons at baseline. There was no statistically significant difference between rk-39 and PCR positivity rate (P>0.05), even though PCR positivity alone was found significantly higher (4.2%) than rk-39 positivity alone (2.6%). The monthly follow-up of the asymptomatic cohort revealed a disease conversion rate of 23.1 per 100 persons within a year. There was a statistically significant difference in conversion of disease when individuals were positive by both tests as compared to single tests by rk-39 and PCR (P<0.01). Disease conversion rate in the subjects residing in households with a history of VL (62%, 13/21) was higher than those residing in the households without a history of VL (38%, 8/21). Most of the identified asymptomatic individuals were from low socio-economic strata similar to that of VL cases in general. Apart from rk-39, PCR may be considered for screening of asymptomatic Leishmania donovani infection in large-scale epidemiological studies. Screening of asymptomatic cases and their close follow-up to ascertain early detection and treatment of VL may be considered in addition to the existing VL control strategies.

Imaging characteristics of primary laryngeal lymphoma

BACKGROUND AND PURPOSE

The larynx is a rare site for primary NHL. Fewer than 100 cases have been reported in the literature, with the largest imaging review involving only 4 patients. We describe the findings of laryngeal lymphoma on CT, PET, and MR imaging and identify features that may distinguish laryngeal lymphoma from the far more common laryngeal squamous cell carcinoma.

MATERIALS AND METHODS

Multi-institutional retrospective chart review revealed 20 patients with histopathologically proved laryngeal lymphoma. Pretreatment CT, PET, and MR images were reviewed by a head and neck radiologist, focusing on extent of tumor, cervical lymph node involvement, and enhancement patterns.

RESULTS

Patients ranged from 30 to 90 years of age with a mean of 63 years at the time of initial diagnosis and a 2:1 female predominance. The average tumor size was 37 +/- 19 mm. In all patients, laryngeal lymphoma involved the supraglottis but also extended into the glottis (65%) and hypopharynx (60%). The subglottis was less frequently involved (35%). Laryngeal cartilage invasion and cervical lymphadenopathy were each seen in 20% of patients. Lymphoma was consistently FDG-avid (100%) and usually enhanced uniformly with iodinated contrast (73%). Necrosis and calcification were not seen in any cases.

CONCLUSIONS

Although laryngeal lymphoma is rare, particular imaging features suggest this diagnosis. A large uniformly enhancing supraglottic tumor without central necrosis and without cervical lymphadenopathy is a characteristic finding of lymphoma. Similar to squamous cell carcinoma, lymphoma may extend into the subglottis, pharynx, and laryngeal cartilages.

Awareness about kala-azar disease and related preventive attitudes and practices in a highly endemic rural area of India

This study was undertaken to assess the extent of community awareness and related practices about kala-azar undertaken by them to control the disease, in an highly endemic focus of Bihar, India. A household-based cross-sectional knowledge, attitude, and practices (KAP) survey consisting of quantitative components on knowledge, attitude, and practices concerning kala-azar was administered to heads-of-household through a semi-structured questionnaire. Data indicated that 61% respondents were illiterate, 4% had correct knowledge that sandfly bites caused kala-azar, 26% do not know any specific transmission agents for kala-azar. A majority (72%) of respondents were not able to recognize sandfly, 33% had no specific knowledge about the symptoms. All of them (100%) believed that this disease could affect his or her family income. Nearly all (95%) were positive that the kala-azar cases could be reduced with implementation of proper health measures. A few (11%) suggested isolation of patients to avoid contacting kala-azar while a high proportion (93%) of respondents favored specific allopathic medicine, and a majority (72%) favored the utilization of the services offered by primary health centers or government hospitals. Just over half (66%) of the respondents were not using any prevention measures to avoid contacting disease. These results could prove to be useful for health planners in developing suitable control strategies.

Stem cells for tendon and ligament tissue engineering and regeneration

Tendons and ligaments are frequently injured. Due to their relatively avascular nature, repair is slow and often incomplete. Stem cells offer a new approach to augment healing of native tissues, as well as providing materials to surgically replace injured structures that are beyond repair. Here we discuss the various roles of stem cells in natural repair processes compared to engineered tissues to assist healing or replace tissues.

Knowledge about sandflies in relation to public and domestic control activities of kala-azar in rural endemic areas of Bihar

Visceral Leishmaniasis (VL) control is a global cause of concern. To identify the gaps in People's knowledge/awareness about sand flies and control activities of kala-azar in rural endemic areas of Bihar, this study consisting of 450 respondents with 288 male and 162 female was carried out. The result showed that 95% respondents had heard about the disease up to some extent, but majority respondents were neither aware about the vector of kala-azar, nor they had any idea about transmission of the disease. About 61% had wrong impression that mosquitoes were causing kala-azar. Regarding knowledge about breeding and resting sites of vectors, 20% reported cattle shed, 16% crevices in the household followed by 15% damp dark places. The attitude of respondents towards vector control programme was poor, as 99% lost faith in the DDT spraying because of ineffectiveness, like no reduction in mosquito nuisance. Bed net was considered the best protection method against sand fly or mosquito nuisance but the cost was considered the major constraint in its use. Proper health education programme in Simple and local language along with visual demonstration should be promoted to enhance the awareness and co-operation at community level.

A pilot study on the status of lymphatic filariasis in a rural community of Bihar

A pilot study of lymphatic filariasis was conducted in two contiguous villages of Patna district in Bihar situated at the side of the river Ganges, known to be endemic for lymphatic filariasis, to study present status of transmission parameters of filariasis. Of the 1872 persons examined, 8.4% were found asymptomatic but microfilaraemic. Morbidity pattern due to filarial infection showed an increase with advancement of age and significantly high in males as compared to female (p < 0.001). Acute and chronic filarial disease was observed as 0.5% and 9% respectively. Microfilaria was found in 10% of acute and 11.2% of chronic filarial cases. The Mf rate was found to be 9.9% in males and 9.0% in females respectively. The parasite species was identified as W. bancrofti. The vector fauna surveyed show highest prevalence of vector species of Cx. quinquefasciatus (43%) in both domestic as well as predomestic area in the community. Other species like Cx. vishnui and Ma. uniformis were also seen. Each household and predomestic area was searched for mosquito fauna at night. The infection rate in vectors was found to be 14% and infectivity rate (L3) was 8%. The filariasis cases detected in the study were treated with 12 days course of DEC 6 mg/kg body weight.

Visceral leishmaniasis and tuberculosis in patients with HIV co-infection

We describe here two cases, one male and one female, both age 40 years, with visceral leishmaniasis and HIV-1 co-infection. The female patient had features of Koch's abdomen. The male patient had features of tuberculous lymphadenitis and bilateral pleural effusion more marked on the right side. Both were treated with highly active antiretroviral therapy, antituberculous drugs, antibiotics, antifungal medicine (fluconazole) and miltefosine. Both patients showed marked improvement with therapy.

Prevalence of exercise-induced bronchospasm in national hockey players of Pakistan

OBJECTIVE

To determine prevalence of Exercise-induced Bronchospasm (EIB) in hockey players, who had represented or were aspiring to represent Pakistan at international level.

METHOD

An observational, cross-sectional study was done on the prevalence of EIB in national hockey players of Pakistan. All participants of the training camp (n = 27) players were included in this study, after obtaining permission from the Pakistan Hockey Federation. An acquaintance session was conducted to introduce the study, and for the correct recording of Peak Expiratory Flow (PEF) rate. On field-testing day, pulse and PEF rates were measured first without any exercise and warm up (pre-exercise PEF rate). After competitive 6 minute (6-min) field free running, pulse rate was measured to ensure that players heart rate has reached 70% of the predicted maximum heart rate. PEF and pulse rates were measured at 5-min, 15-min and 30-min post exercise. A player was considered EIB positive based on a post exercise decrement in PEF rate > or = 15% at any defined point of time.

RESULTS

Twenty-seven players participated in our study out of which 5 players (19%) had EIB.

CONCLUSION

Our findings indicate that a significant number of cases of EIB exist among national field hockey players. We suggest that active screening for EIB should be made part of training sessions, so that performance of players could be enhanced. Diagnosed cases should be treated as per the guidelines laid down by International Olympic Committee Medical Commission.

Staging quality is related to the survival of women with endometrial cancer: a Scottish population based study. Deficient surgical staging and omission of adjuvant radiotherapy is associated with poorer survival of women diagnosed with endometrial cancer in Scotland during 1996 and 1997

The association between treatment variation and survival of women with endometrial cancer was investigated. A retrospective cohort based upon the complete Scottish population registered on in-patient and day-case hospital discharge data (Scottish Morbidity Record-1) and cancer registration (Scottish Morbidity Record-6) coded C54 and C55 in ICD10, between 1st January 1996 to 31st December 1997 were analysed. Seven hundred and three patients who underwent surgical treatment out of 781 patients that were diagnosed with endometrial cancer in Scotland during 1996 and 1997. The overall quality of surgical staging was poor. The quality of staging was related to both the year that the surgeon passed the Member of the Royal College of Obstetricians and Gynaecologists examination and also to 'specialist' status but was not related to surgeon caseload. Two clinically important prognostic factors were found to be associated with survival; whether the International Federation of Obstetrics and Gynaecology stage was documented, RHR=2.0 (95% CI=1.3 to 3.1) and also to the use of adjuvant radiotherapy, RHR=2.2 (95% CI=1.5 to 3.5). The associations with survival were strongest in patients with advanced disease, International Federation of Obstetrics and Gynaecology stages 1C through to stage 3. Deficiencies in staging and variations in the use of adjuvant radiotherapy represent a possible source of avoidable mortality in patients with endometrial cancer. Consequently, there should be a greater emphasis on improving the overall quality of surgical staging in endometrial cancer.

A randomized clinical trial of low dosage combination of pentamidine and allopurinol in the treatment of antimony unresponsive cases of visceral leishmaniasis

OBJECTIVES

A randomized clinical trial of low dosage combination of pentamidine and allopurinol was carried out with objectives to assess the efficacy and toxicity as compared to full dosage of pentamidine in antimony unresponsive visceral leishmaniasis (VL) patients.

METHODS

Using a randomized control clinical trial, a total of 158 antimony unresponsive patients of VL were randomly allocated into two treatment groups. Patients in one group (n=80) received half the dosage of pentamidine i.e. 2 mg/kg body weight by IM route on alternate day and allopurinol in dose of 15 mg/kg body weight in three divided dosages for 30 days; patients in the second group (n=78) received pentamidine in dose of 4 mg/kg body weight by IM route on alternate day for 15 injections in 30 days. The efficacy and safety of the two regimens were compared.

RESULTS

Apparent cure i.e. clinical and pathological cure at the end of therapy, in 78 (97.5%) and 67 (86%), and ultimate cure i.e. clinical and parasitological cure at the end of follow-up of six months, in 73 (91.25%) and 58 (74.35%) patients was observed in the combination regimen and single regimen group respectively. The difference of the ultimate cure between two groups of the patients was statistically significant (p < 0.01). In single regimen group, 11 (14%) patients showed primary unresponsiveness (with no response during treatment) and nine (13%) relapse (after six months of follow-up) respectively, where as in combination regimen group, two (2.5%) patients showed primary unresponsiveness and five (6.4%) relapse respectively. By the end of the treatment, the incidence of injection-related toxicity, such as rigor and fever, was same in both groups. No hyperglycemia was observed in combination therapy probably due to reduced dose of pentamidine and three patients in single regimen developed hyperglycemia and one of them developed irreversible hyperglycemia.

CONCLUSIONS

The study showed that the combination of pentamidine (half dose) and allopurinol is more effective in achieving ultimate cure with an added advantage of reduced toxicity in unresponsive cases as compared to full pentamidine dose.

An integrated curriculum for MBBS

OBJECTIVE

To report the formulation and implementation of an organ system based integrated curriculum for MBBS students at Ziauddin Medical University (ZMU) Karachi.

STEPS OF INTEGRATION

The Basic Medical Science Faculty (Anatomy, Physiology and Biochemistry) along with representatives from Medicine, Surgery and Community Health Sciences held joint meetings spread over weeks to design a system based integrated curriculum for the first two years of the MBBS class. Objectives of an integrated course were devised and the duties of term coordinator determined.

CONCLUSION

Horizontal integration of Basic Science subjects can be achieved, with the subject specialists coordinating the teaching of a system based as opposed to subject based curriculum. The basic sciences can also be integrated with Community Health Sciences to achieve partial vertical integration.

Osteoporosis in older men: discovering when and how to treat it

Nearly 1.5 million American men age 65 and older have osteoporosis, and another 3.5 million are at risk. Hip fractures in older men have a higher mortality than in women and represent a growing medical problem. Glucocorticoid treatment, hypogonadism, and excessive alcohol consumption are important secondary etiologies for loss of bone mass in men. Detection of hypogonadism may be difficult, and testosterone replacement is indicated for only a well-defined subset of patients. Because of a lack of data on pathogenesis, risk factors, and therapeutic interventions in men, treatment decisions are usually based on extrapolation from studies in women. None of the medications approved by the FDA for the treatment of osteoporosis in postmenopausal women has been approved for use in older men, but physicians are prescribing bisphosphonates and calcitonin.

Retinoic acid receptors and retinoid binding proteins in endometrial adenocarcinoma: differential expression of cellular retinoid binding proteins in endometrioid tumours

Retinoic acid is apparently required for the normal differentiation of reproductive epithelium. Cellular abnormalities in retinoid homeostasis could be a factor in the development of endometrial malignancy. We have thus investigated the expression of nuclear retinoic acid receptors (RARs and RXRs) and cellular binding proteins for retinol (CRBP) and retinoic acid (CRABP) in endometrial adenocarcinoma of the endometrioid histological subtype. Ten grade I, II grade 2 and 10 grade 3 tumour samples, as well as 4 samples of severe atypical precancerous endometrial hyperplasia, were studied. No significant difference in expression of RAR-beta was detected in tumour samples compared with normal epithelial cells. RAR-gamma was significantly elevated in grade 1 and 2 carcinomas, but this may be due to greater stromal cell involvement in these lower grade tumours. There was significant elevation of CRBP I mRNA in tumour samples. Furthermore, although undetectable in normal endometrial epithelium, CRABP I was expressed in 3/II grade 2 and 9/10 grade 3 carcinomas, with expression being significantly higher where the primary tumour had invaded more than 50% of the total myometrial thickness. Analysis of 2 epithelial-like endometrial adenocarcinoma cell lines supported the idea that CRABP I expression is characteristic of poorly differentiated endometrial adenocarcinoma. Our data suggest that alterations in mechanisms of retinoid homeostasis are a feature of endometrial adenocarcinoma and may contribute to the severity of disease.

Cellular retinoid binding proteins and nuclear retinoic acid receptors in endometrial epithelial cells

Retinoic acid, one of the most potent of the naturally occurring retinoids (retinol and derivatives), is required in vivo for the maintenance of epithelial cell growth. This study describes the pattern of expression of nuclear retinoic acid receptors (RARs and RXRs), and cellular binding proteins for retinol and retinoic acid (CRBP I, CRABP I and II), in endometrial epithelial cells. The effects of retinoic acid on the expression of these receptors in endometrial epithelial cells have also been studied and compared with its effects in endometrial stromal cells. Messenger RNA for RAR-alpha, RAR-beta, RAR-gamma, RXR-alpha, CRBP I and CRABP II was detected by Northern blotting of total RNA extracted from cultured epithelial cells. In comparison with stromal cell RNA that was used as an internal standard, CRBP I appeared to be more abundant in epithelial cells, whereas CRABP II appeared to be more abundant in the stromal cells. This implies that the intracellular concentration of retinoic acid may be maintained at higher levels in epithelial cells compared to stromal cells. In addition, the response of the two cell types to retinoic acid differs: RAR-beta is induced in stromal cells treated with all-trans retinoic acid but not in epithelial cells. From these data we suggest that retinoid physiology differs between endometrial epithelial and stromal cells. Furthermore, by analogy with other studies, we propose that retinoic acid may be maintained at a higher intracellular concentration in endometrial epithelial cells to facilitate differentiation to a glandular phenotype.(ABSTRACT TRUNCATED AT 250 WORDS)

Estimation of nor-adrenaline content of human penile tissue in diabeticmen with/without neuropathy

Penile tissue consisting of corps cavernosum (cc) and tunica albuginea (TA) was obtained from 35 impotent patients undergoing surgery for implantation of penile prostheses and was examined for nor adrenaline content. 10 patients were classified as a non diabetic non neuropathic group, on the basis of their clinical history and differential diagnostic symptoms which included Peyronie's disease, vascular disease, hypertension and psychogenic impotence. The nor adrenaline content was found to be significantly lower in tunica albuginea than the corpus cavernosum (P<0.02) in this group. The nor adrenaline content of corpus cavernosum from insulin dependent (IDDM) and non insulin dependent (NIDDM) diabetic neuropathic patients was also found to be significantly lower (P <0.02) than that of non diabetic non neuropathic patients. The nor adrenaline content of tunica albuginea however, was similar in both groups. A non significant association in the content of nor adrenaline in corpus cavernosum and tunica albuginea among IDDM and NIDDM diabetic neuropathics was also observed. These results provide evidence that an underlying neuropathic factor itself causes vascular as well as metabolic changes in the adrenergic nerves of the penis in diabetics due to neuropathy in addition to the effect of the disease and thus may contribute to the development of impotence in these patients irrespective of their type of diabetes.

Anaemia in pregnancy--a report of two trials

In two separate trials, 140 cases of Pregnancy Anaemia were investigated in the University Teaching Hospital, Lusaka. The distribution of anaemia was as follows: Iron deficiency 118 (84.2%); dual deficiency 15 (19.7%); haemolytic five (35%); and megaloblastic 2 (1.4%). Anaemia with megaloblastic change was more common in the second study.