Isolation of quinic acid from dropped Citrus reticulata Blanco fruits: its derivatization, antibacterial potential, docking studies, and ADMET profiling

Citrus reticulata dropped fruits are generally discarded as waste, causing environmental pollution and losses to farmers. In the present study, column chromatography has been used to isolate quinic acid (1,3,4,5-tetrahydroxycyclohexane-1-carboxylic acid) from the ethyl acetate fraction of a methanol extract of citrus fruits dropped in April. Quinic acid is a ubiquitous plant metabolite found in various plants and microorganisms. It is an important precursor in the biosynthesis of aromatic natural compounds. It was further derivatized into 3,4-o-isopropylidenequinic acid 1,5-lactone (QA1), 1,3,4,5-tetraacetoxycyclohexylaceticanhydride (QA2), and cyclohexane-1,2,3,5-tetraone (QA3). These compounds were further tested for their antibacterial potential against the foodborne pathogens Staphylococcus aureus, Bacillus spp., Yersinia enterocolitica, and Escherichia coli. QA1 exhibited maximum antibacterial potential (minimum inhibitory concentration; 80-120 μg/mL). QA1 revealed synergistic behavior with streptomycin against all the tested bacterial strains having a fractional inhibitory concentration index ranging from 0.29 to 0.37. It also caused a significant increase in cell constituent release in all the tested bacteria compared to the control, along with prominent biofilm reduction. The results obtained were further checked with computational studies that revealed the best docking score of QA1 (-6.30 kcal/mol, -5.8 kcal/mol, and -4.70 kcal/mol) against β-lactamase, DNA gyrase, and transpeptidase, respectively. The absorption, distribution, metabolism, excretion, and toxicity (ADMET) analysis revealed that the drug-like properties of QA1 had an ideal toxicity profile, making it a suitable candidate for the development of antimicrobial drugs.

Efficacy of a Longitudinal Project-Based Quality Improvement Curriculum in Pediatric Cardiology Fellowship

Quality improvement knowledge is a requirement of fellowship training. Our goal was to evaluate the efficacy of a 3-year quality improvement and patient safety (QI/PS) curriculum that gives fellows both didactic knowledge and first-hand experience with improvement science, and meets Clinical Learning Environment Review (CLER) requirements. Knowledge assessment is obtained through pre- and post-surveys. A secondary measure of success is academic products resulting from fellows' QI/PS work, and future participation in QI/PS efforts. Since 2019, 51 pre-tests and 36 post-tests were completed, showing improvement across all competencies. Fellows have produced one published manuscript, two poster presentations, and two oral presentations describing their improvement work. Additionally, mentoring faculty members have gone on to lead other QI work throughout the division. This longitudinal QI/PS curriculum provides both knowledge and experience in QI/PS work. It also creates opportunities for academic publications and presentations, builds faculty expertise, and most importantly, works to improve multiple aspects of patient care. This curriculum can serve as a model for other cardiology fellowships working to meet CLER requirements.

Occurrence, Isolation, Pharmacological Potential, Metabolism, and Toxicity of Myristicin: A Naturally Occurring Alkoxy-Substituted Allylbenzene

Background:

Natural products are secondary metabolites obtained from plants, animals, and microorganisms with diverse chemical structures resulting in diverse biological functions and drug-like properties.

Objective:

This review article summarizes in detail the occurrence, detection, isolation, various pharmacological properties, metabolism, and toxicity of a natural compound i.e., 5-Allyl-1-methoxy-2,3-methylenedioxybenzene commonly known as Myristicin.

Methods:

A relevant literature search was made using the keywords essential oil, mace, myristicin, nutmeg, and pharmacological activities from different databases such as Pub Med, Sci finder, Science Direct, and Google Scholar. The literature search results presented articles from 1963 to 2022. Thereafter, the articles were carefully screened and selected for review.

Results:

Myristicin, an alkoxy-substituted allylbenzene is present in major to minor amounts in the essential oils obtained from different plant parts and exhibits various pharmacological properties such as antimicrobial, antioxidant, antiproliferative, anti-inflammatory, insecticidal, and hepatoprotective. It forms 10 metabolites by reduction, demethylation, hydroxylation, ring formation, ring-opening, and conjugate formation. In the liver, myristicin has been metabolized by Cytochrome P450 complex enzymes to generate active metabolite (1ˈ hyroxymyristicin) responsible for cytotoxic, genotoxic and apoptotic effects (150 µM). But, myristicin at 600 µM does not produce enough 1ʼ-hydroxymyristicin to give the final toxicant.

Conclusion:

Myristicin poses no major risk to human health through the consumption of herbs and spices due to its presence in low amounts. It has great potential to be used in the traditional system of medicine. We hope that this review will provide complete knowledge about myristicin on a single platform.

Assessment of prescribing pattern of drugs and completeness of prescriptions as per the World Health Organization prescribing indicators in various Indian tertiary care centers: A multicentric study by Rational Use of Medicines Centers-Indian Council of Medical Research network under National Virtual Centre Clinical Pharmacology activity

OBJECTIVE

The rational use of medicines as per the World Health Organization (WHO) should be practiced globally. However, data regarding the completeness of the prescriptions and their rational use is lacking from developing countries like India. Thus, the aim of this study was to assess the prescribing patterns of drugs and completeness of prescriptions as per WHO core drug use and complementary indicators to provide real-life examples for the Indian Council of Medical Research (ICMR) online prescribing skill course for medical graduates.

METHODS

Prescriptions of the patients, fulfilling inclusion criteria, attending Outpatient Departments of various specialties of tertiary care hospitals, were collected by thirteen ICMR Rational use of medicines centers located in tertiary care hospitals, throughout India. Prescriptions were evaluated for rational use of medicines according to the WHO guidelines and for appropriateness as per standard treatment guidelines using a common protocol approved by local Ethics committees.

RESULTS

Among 4838 prescriptions, an average of about three drugs (3.34) was prescribed to the patients per prescription. Polypharmacy was noted in 83.05% of prescriptions. Generic drugs were prescribed in 47.58% of the prescriptions. Further, antimicrobials were prescribed in 17.63% of the prescriptions and only 4.98% of prescriptions were with injectables. During the prescription evaluation, 38.65% of the prescriptions were incomplete due to multiple omissions such as dose, duration, and formulation.

CONCLUSION

Most of the parameters in the present study were out of the range of WHO-recommended prescribing indicators. Therefore, effective intervention program, like training, for the promotion of rational drug use practice was recommended to improve the prescribing pattern of drugs and the quality of prescriptions all over the country.

Echocardiographic Clues in Diagnosis of Takayasu Arteritis in a Child with Severe Acute Respiratory Syndrome Coronavirus 2-Related Multisystem Inflammatory Syndrome

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Echocardiography of the abdominal aorta is key in children with severe hypertension.

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Takayasu arteritis may present with hypertension and depressed ventricular function.

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Takayasu arteritis can present with severe aorta thrombosis in the setting of MIS-C.

The impact of impulsivity on weight loss after bariatric surgery: a systematic review

BACKGROUND

Impulsivity has been shown to be associated with obesity through links to pathological eating behavior such as binge eating. The recent literature suggests that impulsivity is linked to poorer outcomes post-bariatric surgery. Impulsivity can be measured in various ways and comprises of three broad domains: impulsive choice, impulsive action, and impulsive personality traits. The aim of this systematic review is to synthesize the current evidence on the impact of impulsivity on post-bariatric surgery weight loss.

METHODS

A literature review was performed in February 2020. Original studies investigating the relationship between impulsivity and weight loss post-bariatric surgery were evaluated.

RESULTS

Ten studies with a total of 1246 patients were analyzed. There were four case-control, four prospective observational and two retrospective observational studies. The postoperative follow-up ranged from 0.5 to 12 years. Eight studies measuring trait impulsivity did not show any association with weight loss post-bariatric surgery, although two studies reported an indirect effect of impulsivity on weight loss mediated via pathological eating behavior. Assessment of impulsive action by two studies showed that post-bariatric surgery weight loss is affected by impulsive action.

CONCLUSION

Impulsivity may adversely affect postoperative outcomes after bariatric surgery. However, this may be specific to state impulsivity or impulsive action rather than trait impulsivity. Patients with a higher state impulsivity may benefit from closer follow-up post-bariatric surgery, as well as cognitive behavioral therapies targeting cognitive control over food.

LEVEL OF EVIDENCE

Level I, systematic review.

Intranasal Fentanyl Use in Neonates

Background: The recent addition of intranasal medication options for procedural sedation and analgesia has decreased the need for additional painful procedures such as intravenous lines for medication administration. Intranasal fentanyl (INF) has been used in the prehospital setting, as well as in the emergency department for several years, and is increasingly utilized in other locations such as the neonatal intensive care unit (NICU). A paucity of data exists in these smallest children, so we sought to explore trends in INF use in our NICU. Objective: The objective of the study was to describe INF use in the NICU from December 2014 to December 2017. Design/Methods: A retrospective cohort study was conducted of patients receiving INF in the NICU of a large free-standing quaternary inner-city children's hospital from December 2014 to 2017. Demographic data were abstracted from the medical record including gestational age on administration, post-menstrual age, day of life on administration, sex, medication initial and total dose, reported indication, and documented adverse events. This study was approved by our local institutional review board. Results: A total of 54 patients received a total of 67 INF administrations: 32 women (59%), median day of life on administration = 57.1 (interquartile range [IQR] = 33.7-110.4), median weeks gestation = 26.0 (IQR = 24.1-36.1), post-menstrual age = 38.1 weeks (IQR = 33.1-45.4). Initial doses of medications were 1.49 µg/kg/dose INF (range = 0.5-2 µg/kg). Conclusions: Intranasal adjuncts are increasingly used in the NICU. Starting dose of INF is 1.5 µg/kg/dose, and typically, one dose is given.

Parkinson's Disease in Intensive Care Unit: An Observational Study of Frequencies, Causes, and Outcomes

Objective:

To analyze the frequency, causes, and outcomes of admission to the Intensive Care Unit (ICU) among Parkinson's disease (PD) population so that preventive measures can be developed.

Methods:

We prospectively observed patients with diagnosis of PD admitted to ICU from January 2014 to December 2016. Based on etiology for hospital admission, they were divided into two groups – related to PD (further divided into direct or indirect) or not associated with PD at all. Etiology for hospitalization was determined from history and investigational data. The primary outcome was death or discharge from the hospital. Factors contributing to ICU admission were analyzed by comparing these patients with a cohort of 50 PD patients admitted to the neurology ward during the same study period. All values were expressed as mean (standard deviation) and percentages using SPSS version 16.0.

Results:

Fifty-three (36%) out of a total of 146 patients required ICU admission. Most common causes leading to admission in decreasing order of frequency were fever (34%), delirium (16%), falls (12%), encephalopathy (8%), gastrointestinal emergencies (6%); while direct disease-related severe dyskinesias were seen only in two patients (4%). 13.7% needed mechanical ventilation and mean duration of ventilation was 5.94 days with mortality rate of 20%. Significant factors predicting ICU admission, and thus, poor outcomes were age >65 years, history of previous admission within the last 12 months, delirium, and hypoalbuminemia. There was no significant association between the incidence of ICU admission and duration of disease or severity of the disease.

Conclusions:

Poor outcome in PD patients is due to systemic causes, hence multidisciplinary teamwork may improve outcome in these patients.

Performance, carcass characteristics and economics of broiler chickens fed dietary enzymes and probiotic

BACKGROUND

Researchers are challenged with identification of possible feed additives with the ability to increase the efficiency of feed utilization.

AIMS

The present work aimed at studying growth pattern and carcass traits in broiler fed on dietary enzymes (Enzymex) and probiotic (Yeamark) over a period of six weeks.

METHODS

A completely randomized design, including 8 treatments, 3 replications and 15 birds in each experimental unit was applied. Results: The results showed that feed intake decreased significantly (P<0.05) which might be due to the birds fulfilling their nutrient requirements by taking less amount of feed with improved digestibility of energy sources and amino acids. The results of present study also demonstrate the beneficial effects on performance and dressed yield in the treated groups in broiler.

CONCLUSION

Enzymes and probiotic are, therefore, suggested to be used as feed additives in broiler rations for higher profitability.

Birth preparedness and determinants of birth place among migrants living in slums and slum-like pockets in Delhi, India

OBJECTIVE

The objective of this paper is to report birth preparedness and place of birth and its determinants among recent- and settled- migrant households living in slums of Delhi.

METHODS

In a cross-sectional survey, 458 migrant mothers with a child aged below one year of age were identified. Socio-demographic details, data on the place of childbirth, antenatal care (ANC) and birth preparedness in terms of planning for home birth or hospital birth, transport, saving money, knowledge of danger signs were collected through interviewer-administered pretested questionnaire. Logistic regression was carried out for the determinants of hospital birth.

RESULTS

The present study migrants are characterised by younger ages, low educational attainment, low incomes and represented by socioeconomically disadvantaged communities. They mainly relied on government healthcare services for maternal care. ANC seeking was not satisfactory with 16% of women with no ANC; 46% receiving 1-3 visits; and only 23% of women reported health worker visited them at home. 59% of the births took place at hospitals. Having ANC visits (Adjusted Odds Ratio (AOR) for having 4 or more ANC visits = 5.252), planning for hospital birth (AOR = 6.114), plan for transport (AOR = 1.989), mass media exposure (listening to radio; AOR = 2.871) and knowledge of danger signs (AOR = 3.872) resulted in significant chances of hospital birth.

CONCLUSION

Migrant women are at the risk of utilizing the services to a less extent. The health systems need to take measures to mitigate the disadvantage due to migration through specific strategies to make them inclusive and outreach to the poor migrants.

Visual Factors in the Avoidance of Front-To-Rear-End Highway Collisions

Two visual factors in the avoidance of front-to-rear-end collisions are (a) judging time to collision so as to control braking optimally on a moment-to-moment basis, and/or (b) judging one's heading relative to the lead car so as to steer appropriately. It is known that time to contact equals θ/(dθ/dt) and it is also known that the eye is sensitive to θ and, separately, (dθ/dt) (θ is the angular size and (dθ/dt) is the rate of increase of angular size). But whether the eye is sensitive to the ratio (θ/(dθ/dt) and, if so, whether drivers use this information are further questions. We report here that the human visual system does contain neurons sensitive to the ratio θ/(dθ/dt) rather independently of θ and (dθ/dt). It is important that the driver looks directly at the lead vehicle: sensitivity to (dθ/dt) falls off steeply in peripheral view. But, over a wide range, sensitivity to (dθ/dt) is independent of contrast. In addition to the classical disparity-driven system for binocular depth perception, there is a separate binocular system for motion in depth. Precise judgements (0.2 deg) of heading are supported by this stereomotion system, but on the other hand about 20% of the population have stereomotion “blind spots” (i.e. field defects). Monocularly-available informations can also support precise judgements of heading, and field defects seem to be rare. Field studies on flight simulators and telemetry-tracked jet aircraft showed that laboratory measures of sensitivity to (dθ/dt) and to the rate of expansion of the optical flow field predicted intersubject differences in performance on flying tasks that were closely related to the rear-end collision situation.

Application and interpretation of genome-wide association (GWA) studies for informing pharmacogenomic research - examples from the field of age-related macular degeneration

Genome-wide association (GWA) studies apply broad DNA scans on hundreds-of-thousands of common sequence variants in thousands of people for the purpose of mapping trait- or disease-related loci. We provide examples of ligand- and target-based studies from the field of age-related macular degeneration (AMD) to demonstrate the value of the GWA approach in confirmatory and exploratory pharmacogenomics research. Complementing this genomic analysis, we used a simple biochemical retinal pigment epithelium (RPE) oxidative, apoptotic high throughput screening (HTS) assay to identify compounds. This ligand-to-targetto DNA sequence variant-to disease approach provided guidance on rational design of preclinical studies and identified associations between: 1) valproic acid and advanced AMD-associated genes with the capacity to alter GABA-succinate signaling (ALDH5A1, CACNA1C, SUCLA2, and GABBR2) and chromatin remodeling (HDAC9); and 2) Ropinirole and a geographic atrophy-associated gene (DRD3) with the capacity to alter systems involved in cAMP-PKA signaling. In both applications of our method, the breadth of GWA findings allowed efficient expansion of results to identify enriched pathways and additional ligands capable of targeting pathway constituents. A disease associated SNP-to gene-to target-to ligand approach provided guidance to inform preventive and therapeutic preclinical studies investigating roles of targets in: 1) PPAR-RXR transcription complex constituents for neovascular AMD; and 2) the stress activated MAPK signaling cascade constituents for advanced AMD. Our conclusion is that publically available data from GWA studies can be used successfully with open-access genomics, proteomics, structural chemistry, and pharmacogenomics databases in an efficient, rational approach to streamline the processes of planning and implementation for confirmatory and exploratory pre-clinical studies of preventive or therapeutic pharmacologic treatments for complex diseases.

Spinal Tuberculosis with Paraplegia in Pregnancy

Spinal tuberculosis leading to paraplegia is uncommon in pregnancy and is a diagnostic and therapeutic challenge. We report a case of tubercular paraplegia presenting at 35 weeks of gestation. She was managed with Anti-tubercular drugs and did not require surgical intervention. Her neurological status improved and she was allowed to go in labour. She delivered a healthy term infant by cesarean. At three months follow-up, both mother and child are doing well.

A multicenter study of primary graft failure after infant heart transplantation: impact of extracorporeal membrane oxygenation on outcomes

Primary graft failure is the major cause of mortality in infant HTx. The aim of this study was to characterize the indication and outcomes of infants requiring ECMO support due to primary graft failure after HTx. We performed a retrospective review of all infants (<1 yr) who underwent Htx from three institutions. From 1999 to 2008, 92 infants (<1 yr) received Htx. Sixteen children (17%) required ECMO after Htx due to low cardiac output syndrome. Eleven (69%) infants were successfully weaned off ECMO, and 9 (56%) infants were discharged with a mean follow-up of 2.3 ± 2.5 yr. Mean duration of ECMO in survivors was 5.4 days (2-7 days) compared with eight days (2-10 days) in non-survivors (p = NS). The five-yr survival rate for all patients was 75%; however, the five-yr survival rate was 40% in the ECMO cohort vs. 80% in the non-ECMO cohort (p = 0.0001). Graft function within one month post-Htx was similar and normal between ECMO and non-ECMO groups (shortening fraction = 42 ± 3 vs. 40 ± 2, p = NS). For infants, ECMO support for primary graft failure had a lower short-term and long-term survival rate vs. non-ECMO patients. Duration of ECMO did not adversely impact graft function and is an acceptable therapy for infants after HTx for low cardiac output syndrome.

Migration and access to maternal healthcare: determinants of adequate antenatal care and institutional delivery among socio-economically disadvantaged migrants in Delhi, India

OBJECTIVE

To identify the determinants of adequate antenatal care (ANC) utilisation and institutional deliveries among socio-economically disadvantaged migrants living in Delhi, India.

METHODS

In a cross-sectional survey, 809 rural-urban migrant mothers with a child aged below 2 years were interviewed with a pretested questionnaire. Data on receiving antenatal, delivery and post-natal services, migration history and other social, demographic and income were collected.

RESULTS

Recent migrants used the services significantly less than settled migrants. ANC was adequate only among 37% (35% of recent migrant women and 39% of settled migrants). Multinomial regression revealed that being a recent migrant, multiparous, illiterate and married to an unskilled worker were significant risk factors for receiving inadequate ANC. Around 53% of deliveries took place at home. ANC seeking has a strong influence on place of delivery: 70% of births to women who received inadequate ANC were at home. Women who are educated, had their first delivery after the age of 20 years and received adequate ANC were more likely to deliver their child in hospital. Post-natal care is grossly neglected among these groups.

CONCLUSION

Migrant women, particularly recent migrants, are at the risk of not receiving adequate maternal healthcare. Because migration is a continuing phenomenon, measures to mitigate disadvantage due to migration need to be taken in the healthcare system.

An unusual cause of reversible axonal neuropathy and hypertension in a 10-year-old girl

A 10-year-old girl, who was referred with refractory epilepsy, had 1.5 years of episodic abnormal behavior. On examination, she also had hypertension and peripheral neuropathy. Hypoglycemia with correspondingly high insulin levels was documented during a confusional episode. MRI of the abdomen revealed an islet cell tumor in the body of the pancreas. One year after tumor excision, both the neuropathy and hypertension showed remarkable improvement. A final diagnosis of insulinoma with hypoglycemic axonal neuropathy and hypertension (reversed with tumor excision) was made. Insulinoma is the commonest cause of hyperinsulinemic hypoglycemia in adults, but is rare in childhood. To our knowledge, distal symmetrical motor-sensory axonal neuropathy has been described in only 40 patients, and hypertension has not been reported with insulinoma.

Recurrent floods and prevalence of diarrhea among under five children: observations from Bahraich district, Uttar Pradesh, India

Background

Diarrhea is an important problem among the under-five children in India.

Objective

The paper examines long-term impacts of recurrent floods on diarrhea among under-five children in Uttar Pradesh, India.

Design

A two stage stratified cluster survey was conducted in flood affected (exposed) and non-flood affected areas (unexposed).

Results

The long-term impact of the floods was not clearly marked in the overall prevalence of diarrhea with the exposed group having prevalence of 55.1% as against 56.2% in the unexposed group of children under five. Economic condition of the household is associated with the prevalence of diarrhea in both exposed and unexposed strata. Anemia was found to be a significant risk factor for diarrhea among children in both the flood exposed and non-flood exposed populations. The recurrent floods did not have any significant effect on the prevalence of diarrhea in relation to gender, religion, caste, and household size.

Conclusions

The study indicates that the long-term impacts of floods are very differently manifested than the immediate impacts.

Detection of aberrant drainage after sentinel lymph node mapping and its impact on staging and change of operation in colon cancer

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Background: Sentinel lymph node mapping in colon cancer leads to the detection of micrometastasis in 15- 20% of patients leading to upstaging to stage III disease.

Methods: Between 1996-2010, patients diagnosed with colon cancer were enrolled in our study and underwent SLNM at the tim of surgery plus standard oncological resection including regional LN resection. After initial years of experience, exact locations of the SLNs were mapped in relation to the primary tumor. Aberrant drainage was observed when a SLN was detected outside the standard lymph node basin. The primary objective of this analysis is to identify the frequency of detection of such aberrant drainage and the rates of positive aberrant SLNs leading to change of operation and staging.

Results: Between 1996-2010, 304 patients were included in the study. The overall success rates of SLNM was 99.7%. The average number of resected LNs was 15.4. SLNM had a sensitivity, negative predictive value, accuracy and false negative rates of 85.3%, 91.7%, 94.4% and 14.6% respectively. Micrometastatic disease was detected in 15.1% of patients with node positive disease. Since 2001, 150 patients were evaluated for the presence of aberrant drainage and potential change of planned surgery. In 27 patients (18%), extended surgery was performed due to aberrant drainage. The nodal positivity in these 27 patients was 59.5%, compared to 46% in the whole group. The average number of lymph nodes in this group was 16 and the average number of SLNs was 4.3. The most common location of the primary tumor was the right colon in 55.6% of patients with aberrant drainage. In 13 patients (8.7% of case), change of operation led to the detection of positive SLNs leading to upstaging to stage IIIA/B diseases. All of these 13 patients had T3 or T4 disease. All node positive patients underwent adjuvant chemotherapy.

Conclusions: SLNM in colon cancer is highly successful, sensitive and overall accurate staging procedure. It leads to detection of SLNs outside the regional lymphatic basin and change of surgery in 18% of patients. This results in higher nodal positivity and significant change of planned surgery in 8.7% of cases.

No significant financial relationships to disclose.

Study of relationship between facial index and gestational age in normal newborns

Anthropometric dimensions are the basis of evaluation of health of newborns. Results of cephalometric studies can be used in forensic medicine, plastic surgery, pediatrics, oral surgery, dentistry, otolaryngology and syndromology. Three hundred sixty appropriate for gestational age newborns belonging to the region in and around Patiala were the subjects of the present study. The gestational age varied from 29 to 41 weeks. Face length and face width were measured and facial index was calculated. The overall mean face length and mean face width were 5.17 cm and 6.42 cm respectively. Facial index ranged from 79.3 - 81.4% with mean facial index being 80.5%. Facial index increased with increasing gestational age. Gestational age has negative correlation with face length and face width but positively significant correlation was observed between gestational age and facial index. Facial length and facial width were jointly determined. All inter-relationships improved remarkably when determined for gestational age groups. These findings have significant implication as gestational age linearly influenced facial index. In addition they provide database from 29th to 41st week of gestation and can be used as baseline for further anthropometric studies to specify the role of heredity and environment.

Therapeutic potential of valproic acid for retinitis pigmentosa

BACKGROUND/AIM

To examine the efficacy and safety of valproic acid (VPA) in patients with retinitis pigmentosa (RP).

METHODS

Thirteen eyes were examined before and after brief treatment (average 4 months) with VPA. Visual fields (VF) for each eye were defined using digitised Goldmann Kinetic Perimetry tracings. VF areas were log-transformed and VF loss/gain relative to baseline was calculated. Visual acuity was measured using a Snellen chart at a distance of 20&emsp14;feet (6.1 m). Values were converted to the logarithm of the minimum angle of resolution (logMAR) score.

RESULTS

Nine eyes had improved VF with treatment, two eyes had decreased VF and two eyes experienced no change, with an overall average increase of 11%. Assuming typical loss in VF area without treatment, this increase in VF was statistically significant (p<0.02). An average decrease (0.172) in the logMAR scores was seen in these 13 eyes, which translates to a positive change in Snellen score of approximately 20/47 to 20/32, which was significant (p<0.02) assuming no loss in acuity without treatment. Side effects were mild and well tolerated.

CONCLUSION

Treatment with VPA is suggestive of a therapeutic benefit to patients with RP. A placebo-controlled clinical trial will be necessary to assess the efficacy and safety of VPA for RP rigorously.