Morphometric and gut microbial evaluation of Tilapia (Oreochromis niloticus) fed on different levels of Moringa oleifera

Abstract In current study, different feeding levels of Moringa oleifera formulated diet was compared to analyze the growth performance, feed conversion ratio, feed conversion efficiency and gut microbiology of Oreochromis niloticus. The study was comprised of four treatment groups including 4%, 8% and 12% Moringa oleifera and one control group which was devoid of Moringa leaves. The experimental trial was conducted at the Zoology laboratory of Pakistan Institute of Applied and Social Sciences, (PIASS) Kasur. The physicochemical parameters of water such as temperature, dissolve oxygen, pH, total dissolved solids and salinity in all aquaria were found non-significantly different from each other. In control condition T1, the average weight gain was 14.89±16.90a grams, while average length gain was 11.52±7.444a cm. However, the total viable count on Eosin methylene blue was 7.4×107, 5.8×107 on Tryptic soy agar and 5.8×107on Nutrient agar. In T2, the average weight gain was 16.22±16.09b grams and average length gain was 12.97±7.79b cm. The total viable count on Eosin methylene blue was 7×107, 5.5×107 on Tryptic soy agar and 5.8×107on Nutrient agar. In T3, the average weight gain was 37.88±27.43c grams, while the average length gain was recorded as 16.48±12.56c cm. However, the total viable count for treatment 3 was 6.4×10 on Eosin methylene blue, 4.8×107 on Tryptic soy agar and 5.2×107on Nutrient agar. In T4, the average weight gain was 44.22±31.67d grams, while the average length gain was 15.25±10.49d cm. The total viable count was 4.3×107on Eosin methylene blue, 3.1×107 on Tryptic soy agar and 3.8×107 on Nutrient agar. The effect of Moringa oleifera on the growth of Oreochromis niloticus was found to be significant and 12% Moringa extract showed maximum length and weight gain and minimum feed conversion ratio with the least microbial count in fish intestine.

Uterocutaneous Fistula and its Repair

A uterocutaneous fistula is a rare condition with a few reports in the literature. A 29-year female presented to our department with infected discharge at her previous Pfannenstiel incision. She was P3+1 with her last hysterotomy 16 months back due to previous two cesarean sections and missed miscarriage at 24 weeks of gestational amenorrhea. Over a period of time, she developed a fistulous tract between uterus and anterior abdominal wall and had pussy discharge from the same. MRI showed a fistulous tract extending from the endometrial cavity till the anterior abdominal wall. Her laparotomy was done. The fistulous tract was removed and uterus was repaired successfully. Key Words: Fistula, Uterus, Hysterotomy.

Methadone Blockade of Cardiac Inward Rectifier K+ Current Augments Membrane Instability and Amplifies U Waves on Surface ECGs: A Translational Study

Background Methadone is associated with a disproportionate risk of sudden death and ventricular tachyarrhythmia despite only modest inhibition of delayed rectifier K⁺ current (I_Kr)_, the principal mechanism of drug-associated arrhythmia. Congenital defects of inward rectifier K⁺ current (I_K1) have been linked to increased U-wave amplitude on ECG and fatal arrhythmia. We hypothesized that methadone may also be a potent inhibitor of I_K1, contributing to delayed repolarization and manifesting on surface ECGs as augmented U-wave integrals. Methods and Results Using a whole-cell voltage clamp, methadone inhibited both recombinant and native I_K1 with a half-maximal inhibitory concentration IC50) of 1.5 μmol/L, similar to that observed for I_Kr block (half-maximal inhibitory concentration of 2.9 μmol/L). Methadone modestly increased the action potential duration at 90% repolarization and slowed terminal repolarization at low concentrations. At higher concentrations, action potential duration at 90% repolarization lengthening was abolished, but its effect on terminal repolarization rose steadily and correlated with increased fluctuations of diastolic membrane potential. In parallel, patient ECGs were analyzed before and after methadone initiation, with 68% of patients having a markedly increased U-wave integral compared with premethadone (lead V3; mean +38%±15%, P=0.016), along with increased QT and T_Peak to T_End intervals, likely reflective of I_Kr block. Conclusions Methadone is a potent I_K1 inhibitor that causes augmentation of U waves on surface ECG. We propose that increased membrane instability resulting from I_K1 block may better explain methadone's arrhythmia risk beyond I_Kr inhibition alone. Drug-induced augmentation of U waves may represent evidence of blockade of multiple repolarizing ion channels, and evaluation of the effect of that agent on I_K1 may be warranted.

Physical performance among post-COVID and non-COVID individuals: a comparative study

In this comparative cross-sectional study, we compare the physical performance among post-COVID and non-COVID subjects. A sample of 64 subjects recovered from COVID-19 and 64 subjects who were not infected with COVID-19 were recruited for the study. Both groups were tested for physical performance by 30-s sit-to-stand test, 6-min walk test, and HUMAC balance system. The findings of the present study reveal that there was a significant difference in physical performance between both the groups. In conclusion, this study demonstrated that physical performance is impaired in the post-COVID subjects as compared to the matched non-COVID subjects. Therefore, physical therapy exercise program/regimen should be a part of recovery from COVID-19.

Phytochemical and biological attributes of Bauhinia variegata L. (Caesalpiniaceae)

Abstract Bauhinia variegata plant is a very popular and traditionally potent ethnomedicine. Therefore, it is need of hour to study ameliorative characteristics of B. variegata for novel secondary metabolites. The current study was designed to explore antiproliferative potential of B. variegata due to scant reports on this aspect. Extracts of various parts (flowers, leaves, bark, stem, and roots) were prepared by successive maceration using organic solvents in increasing order of polarity (n-hexane, ethyl acetate, methanol, and water). The determination of polyphenolic contents was done by using colorimetric methods while antioxidant potential was measured using reducing power assay. Brine shrimp lethality assay was performed for determining preliminary cytotoxicity and antiproliferative activity against breast cancer MCF-7 cell line using MTT protocols. Moreover, antimicrobial activities were detected by using disc diffusion assay. The alpha-amylase assay was performed to monitor the antidiabetic potential of the plant. In case of phytochemical analysis methanolic extract of leaves and bark showed highest phenolic and flavonoids contents. n-Hexane and ethyl acetate extracts of stem and roots exhibited more than 90% mortality with LD50 ranges between 1-25 µg/mL when studied by brine shrimp lethality assay. n-Hexane and ethyl acetate extracts of roots and stem also showed antiproliferative activity against human breast cancer MCF-7 cell line with IC50 values ranges between 12.10-14.20 µg/mL. Most of the extracts displayed moderately high antibacterial and antifungal activities. The n-hexane extract of roots showed antidiabetic activity with 60.80 ± 0.20% inhibition of alpha-amylase. In sum, these preliminary results will be useful for further compound isolation from selected plant parts for the discovery of antibacterial, antidiabetic, and anticancer lead candidates.

Impact of idiopathic pulmonary fibrosis on the clinical outcomes of patients admitted for acute decompensated heart failure: an analysis of U.S national inpatient sample

Background

The cardiovascular manifestations of idiopathic pulmonary fibrosis (IPF) include heart failure, pulmonary hypertension, coronary artery disease, cardiac arrhythmias and cardiac manifestations of drugs used to treat IPF. Cardiac disease can be worsened by hypoxia and pulmonary hypertension by IPF. The impact of IPF on the outcomes of acute decompensated heart failure (ADHF) is not well studied.

Purpose

We aim to determine the outcomes of patients admitted for ADHF with co-morbid IPF.

Methods

Data were extracted from the National Inpatient Sample (NIS) 2016 - 2018 Database. The NIS was searched for hospitalizations for adult patients with ADHF as principal discharge diagnosis with and without IPF as secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality. Secondary outcomes are detailed in table 1. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. A univariate screen was done to further confirm that these factors affected outcomes with variables having a p-value less than 0.2 included in the multivariate regression analysis. STATA software was used to for analysis.

Results

Of 1,007,824 patients admitted for ADHF, 1850 (0.2%) had IPF. Patients with IPF were significantly younger at the time of hospitalization for ADHF (71 years vs. 76 years, p<0.001). There were 46% females in IPF group compared to 48% in the non-IPF group, p=0.451. The adjusted odds ratio (aOR) for inpatient mortality for ADHF with IPF compared to those without IPF was 2.82 (95% CI 1.897–4.215, p<0.001). Patients with comorbid IPF had 1 day increase in mean length of stay (95% CI 0.475–1.525, p<0.001). Detailed outcomes are listed in table 1.

Conclusions

Co-morbid IPF leads to higher inpatient mortality and higher length of hospitalization in patients with acute decompensated heart failure. It is prudent to risk stratify these patients to improve overall morbidity and mortality.

Funding Acknowledgement

Type of funding sources: None.

Mortality among patients hospitalized with heart failure and type 2 diabetes mellitus: results from United States national inpatient sample 2008 to 2018

Background

Type 2 diabetes mellitus (T2DM) is an important risk factor for, and a frequent co-existing condition with heart failure (HF). With increasing prevalence of heart failure and type 2 diabetes, patients with concomitant HF and T2DM have worse clinical outcomes.

Purpose

We sought to determine the in-patient mortality for type 2 diabetics admitted for heart failure in the U.S hospitals from 2008 to 2018.

Methods

Data were extracted from the National Inpatient Sample (NIS) 2008 to 2018 Database. The NIS was searched for hospitalizations for adult patients with heart failure as principal discharge diagnosis with type 2 diabetes mellitus as a secondary diagnosis using ICD-9 and ICD-10 codes. The primary outcome was inpatient mortality. Multivariate logistic regression analysis was used determine the impact of evolving demographic characteristics (age, sex and race/ethnicity) on in-hospital mortality. STATA software was used to for analysis.

Results

Hospitalization with a primary discharge diagnosis of heart failure steadily decreased from 1,011,094 in 2008 to 807,764 in 2016 and 139,315 in 2018. The patient characteristics of hospitalizations for heart failure in type 2 diabetics are shown in table 1. Adjusted in-hospital mortality in HF with T2DM decreased significantly from 2008 to 2018 (3.6% in 2008 to 2.0% in 2018, P trend 0.003) as shown in graph 1.

Conclusion

Hospitalization for heart failure decreased steadily from 2008 to 2018 in the United States. In-hospital mortality rate for type 2 diabetics admitted for heart failure decreased significantly from 2008 to 2018.

Funding Acknowledgement

Type of funding sources: None.

Interaction of tacrolimus through hedgehog signaling pathway: An in vitro evaluation using rat hepatocytes

Tacrolimus (TAC) is the drug of choice in immunosuppressive therapy for organ transplantation; however, adverse effects are still a major concern. The current study aims to decipher the short-term exposure of TAC on rat hepatocytes in relation to activation of hedgehog (HH) signaling pathway. Time dependent study was conducted using primary rat hepatocytes treated with TAC (36 µM) for 6, 12, 24 and 48 h. Western blot analysis was performed using cell lysate in order to analyze the regulation of HH pathway proteins including HHIP, SMO, PTCH, IHH, SHH, and GLI transcription factors. The study revealed change in protein expression of HH signaling molecules with activation of HH pathway, due to downregulation of HHIP, and enrichment of HH ligands with activation of SMO and GLI transcription factors. It is therefore, concluded that short term TAC exposure leads to upregulation of HH pathway in liver, which may initially act to repair the liver damage but can worsen the condition in case of prolonged immunosuppressive therapy. This insight could lead to understand association of off target effects of immunosuppressive drugs and occurrence of other liver diseases in transplant patients when it comes to long term immunosuppressive therapy. These findings also illuminate a novel direction that use of HH inhibitor might provide a therapeutic strategy for immune suppression related liver disorders.

Impact of Chronic kidney disease on the outcomes of hospitalizations for implantable cardioverter defibrillator or cardiac resynchronization defibrillator placement: An analysis of Inpatient Sample

Funding Acknowledgements

Type of funding sources: None.

1. Background

Implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy defibrillator (CRT-D) are indicated in primary and secondary prevention of dysrhythmias among other indications. We sought to determine the impact of chronic kidney disease (CKD) on hospitalizations for ICD or CRT-D placement.

2. Purpose

Determine how CKD impacts in-patient mortality and cardiovascular outcomes in patients undergoing ICD or CRT-D placement while hospitalized.

3. Methods

Data were extracted from the National Inpatient Sample (NIS) 2016 - 2018 Database. The NIS was searched for patients who underwent ICD or CRT-D placement. The patients were divided into two groups based on presence or absence of CKD as secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders (A univariate screen was done to confirm the confounders affected outcomes with variables having a p less than 0.2 were included in the multivariate regression analysis). STATA software was used to for analysis.

4. Results

Of 145,550 patients admitted for ICD or CRT-D placement, 47740 (32.8%) had CKD. The adjusted odds ratio (aOR) for inpatient mortality for patients undergoing ICD or CRT-D placement with co-morbid CKD compared to those without CKD was 1.66 (95% CI 1.194 – 2.329, p = 0.003). Patients with comorbid CKD had lower odds of developing cardiogenic shock (aOR: 0.83, 95% CI 0.718 – 0.948, p = 0.007) and cardiac arrest (aOR: 0.88, 95% CI 0.766 – 0.999, p = 0.048) compared to patients without CKD. Detailed outcomes are listed in table 1.

5. Conclusion

Chronic kidney disease is a risk factor associated with increased in-patient mortality in patients admitted for ICD or CRT-D placement.

Outcome Without CKD, % With CKD, % aOR (95% CI) p-value* Primary outcome In hospital mortality 0.6 1.9 1.66 (1.194 - 2.329) 0.003* Secondary outcomes Length of stay (days), mean 7.0 9.2 -0.01 (-0.345 - 0.322) # 0.945 Total hospital charges (US$), mean 218,962 241,679 -13047 (-20924 - -5171) # 0.001* Cardiogenic shock 6.8 8.0 0.83 (0.718 - 0.948) 0.007* IABP placement 1.7 1.7 0.52 (0.399 - 0.671) <0.001* Cardiac arrest 12..1 8.5 0.88 (0.766 - 0.999) 0.048* Acute renal failure 17.9 48.1 2.89 (2.648 - 3.163) <0.001* Abbreviations: *; statistically significant, #; adjusted mean difference, aOR: adjusted odds ratio, CI: confidence interval, IABP: Intra-aortic balloon placement.Adjusting factors: Age, Charlson comorbidity index, patient’s insurance, location and teaching status of the admitting hospital, dyslipidemia, old myocardial infarction, cerebral infarction, hypertension, diabetes mellitus, liver disease, smoking status and obesity.

Impact of obesity on the clinical outcomes of patients undergoing pacemaker insertion during hospitalization: An analysis of the United States National Inpatient Sample

Funding Acknowledgements

Type of funding sources: None.

1. Introduction

Obesity causes significant cardiovascular morbidity. Nonetheless, there is also evidence supporting obesity paradox particularly in heart failure patients. The impact of obesity on the outcomes of patients undergoing pacemaker insertion is not well studied.

2. Purpose

The purpose of this study is to determine if obesity paradox exists for the patients who undergo pacemaker insertion.

3. Methods

Data were extracted from the National Inpatient Sample (NIS) 2016 - 2018 Database. The NIS was searched for patients who underwent pacemaker insertion while hospitalized. The patients were divided into two groups based on presence or absence of obesity as secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. STATA software was used to for analysis.

4. Results

Of 408,040 patients who underwent pacemaker insertion, 64185 (15.7%) were obese. The adjusted odds ratio for inpatient mortality for obese patient undergoing pacemaker insertion compared to non-obese patients was 0.65 (95% CI 0.516 – 0.821, p < 0.001). Secondary outcomes are listed in table 1.

5. Conclusion

Obese patients who underwent pacemaker insertion had lower inpatient mortality compared to non-obese patients. Also, obese patients undergoing pacemaker insertion were less likely to have cardiac arrest but they were more likely to develop decompensated heart failure and acute renal failure compared to non-obese patients.

Outcome Without Obesity, % With Obesity, % aOR (95% CI) p-value* Primary outcome In hospital mortality 10.8 7.0 0.65 (0.516 - 0.821) <0.001* Secondary outcomes Length of stay (days), mean 5.7 6.3 0.031 (-0.105 - 0.168) # 0.654 Total hospital charges (US$), mean 121250 134757 720 (-2307 - 3747) # 0.641 Decompensated heart failure 13.3 19.2 1.53 (1.451 - 1.629) <0.001* Cardiogenic shock 2.3 2.7 1.00 (0.883 - 1.141) 0.954 IABP placement 0.5 0.6 0.98 (0.746 - 1.294) 0.898 Cardiac arrest 4.27 4.30 0.83 (0.753 - 0.920) <0.001* Acute renal failure 20.7 25.4 1.17 (1.112 - 1.231) <0.001* Abbreviations: *; statistically significant, #; adjusted mean difference, aOR: adjusted odds ratio, CI: confidence interval, IABP: Intra-aortic balloon pump.Adjusting factors: Age, race, Charlson comorbidity index, primary insurance, median household income for patient’s zip code, location and teaching status of the admitting hospital, dyslipidemia, chronic obstructive pulmonary disease, hypertension, peripheral vascular disease, diabetes mellitus, chronic kidney disease, liver disease and smoking status. Table 1: Clinical outcomes of hospitalizations for pacemaker insertion based on presence or absence of obesity, analysis of United States National Inpatient Sample from 2016 through 2018.

Novel cholesterol-dependent regulation of cardiac KATP subunit expression revealed using histone deacetylase inhibitors

We recently discovered that the histone deacetylase inhibitor, trichostatin A (TSA), increases expression of the sulfonylurea receptor 2 (SUR2; Abcc9) subunit of the ATP-sensitive K+ (KATP ) channel in HL-1 cardiomyocytes. Interestingly, the increase in SUR2 was abolished with exogenous cholesterol, suggesting that cholesterol may regulate channel expression. In the present study, we tested the hypothesis that TSA increases SUR2 by depleting cholesterol and activating the sterol response element binding protein (SREBP) family of transcription factors. Treatment of HL-1 cardiomyocytes with TSA (30 ng/ml) caused a time-dependent increase in SUR2 mRNA expression that correlates with the time course of cholesterol depletion assessed by filipin staining. Consistent with the cholesterol-dependent regulation of SREBP increasing SUR2 mRNA expression, we observe a significant increase in SREBP cleavage and translocation to the nucleus following TSA treatment that is inhibited by exogenous cholesterol. Further supporting the role of SREBP in mediating the effect of TSA on KATP subunit expression, SREBP1 significantly increased luciferase reporter gene expression driven by the upstream SUR2 promoter. Lastly, HL-1 cardiomyocytes treated with the SREBP inhibitor PF429242 significantly suppresses the effect of TSA on SUR2 gene expression. These results demonstrate that SREBP is an important regulator of KATP channel expression and suggest a novel method by which hypercholesterolemia may exert negative effects on the cardiovascular system, namely, by suppressing expression of the KATP channel.

Synergic effects of cancer stem cells markers, CD44 and embryonic stem cell transcription factor Nanog, on bladder cancer prognosis

Background: Therapy that targets cancer stem cells has the potential to eradicate cancer and prevent tumour recurrence. Therefore, we hypothesized the combined prognostic significance of stem cell markers CD44 (prevalent in basal layer of urothelial carcinoma) and Nanog (embryonic stem cell transcription factor) in bladder cancer.Material and Methods: CD44 and Nanog expression were determined by immunohistochemistry in 112 bladder cancer cases of which 79 were non-muscle invasive and 33 muscle invasive.Results: A significant correlation was found between CD44 and Nanog expression (r = 0.41, p < 0.001). The bladder cancer patients with high CD44 and Nanog expression had poor recurrence-free survival and poor overall survival (all p < 0.01). Multivariate Cox regression analysis identified lymph node positivity (hazard ratio; HR 3.81, 95% confidence interval; CI 1.66-8.75), CD44 (HR/95%CI 7.03 [3.04-16.22]) and Nanog (HR/95%CI 2.89 [1.23-6.77]) as independent prognostic biomarkers for recurrence-free survival, whilst a combined index of CD44 and Nanog expression (high expression group; HR/95%CI 25.45 [6.71-96.50] for recurrence-free survival) and lymph node positivity (HR/95%CI 3.68 [1.63-8.33] for recurrence-free survival) were independent prognostic biomarkers for recurrence-free survival and overall survival (all p < 0.001).Conclusions: A combined index of CD44 and Nanog expression is a promising prognostic predictor of recurrence-free survival and overall survival in bladder cancer. It may help identification of patients who will benefit from intensive treatment.

Acute blood transfusion reactions in a tertiary care hospital in Pakistan - an initiative towards haemovigilance

OBJECTIVE

In this study, we report acute blood transfusion reactions at our hospital, compare our analysis with the reported data and identify areas for improvement.

BACKGROUND

Haemovigilance programmes have been implemented in many countries, and adverse events associated with blood transfusion are published in their annual reports. Pakistan has no current established programme.

MATERIAL AND METHODS

A cross-sectional study was conducted, and all adverse reactions reported to the blood bank from January 2014 to March 2016 were included. An adverse response in the patient, related to administration of blood (within 24 h), was considered an immediate transfusion reaction.

RESULTS

During the study period, 20 956 blood components were issued. A total of 32 (0·15%) adverse reactions were documented. Allergic reactions were the most common adverse event observed in 15 (46·8%) of the cases. Febrile non-haemolytic transfusion reaction (FNHTR) was the second most common reaction seen in nine (28%) followed by bacterial contamination in four (12·5%) and acute haemolytic reaction in two (6·2%) of the cases.

CONCLUSION

The low incidence indicates underreporting and the need for a formal haemovigilance system. International benchmarking between different medical systems is helpful to identify areas in the transfusion process that have to be changed to improve transfusion safety.

Potent Inhibition of hERG Channels by the Over-the-Counter Antidiarrheal Agent Loperamide

OBJECTIVES

The aim of this study was to determine the in vitro electrophysiological properties of loperamide. The authors' hypothesis was that loperamide is a potent blocker of the current carried by the human ether-à-go-go-related gene (hERG) potassium channel.

BACKGROUND

Loperamide is a peripherally-acting μ-opioid agonist available worldwide as an over-the-counter treatment for diarrhea. Like most opioids, it is not currently known to be proarrhythmic. Recent cases of torsade de pointes in association with high-dose loperamide raise concern given its structural similarity to methadone, another synthetic opioid with an established arrhythmia risk.

METHODS

Effects of loperamide on blockade of the hERG potassium channel ion current were assessed in Chinese Hamster Ovary (CHO) cells stably expressing hERG to elucidate current amplitude and kinetics. The concentration required to produce 50% inhibition of hERG current was assessed from the amplitude of tail currents and the impact on action potential duration was assessed in isolated swine ventricular cardiomyocytes.

RESULTS

The 50% inhibitory concentration for loperamide inhibition of hERG ionic tail currents was approximately 40 nmol/l. In current-voltage measurements, loperamide reduced steady and tail currents and shifted the current activation to more negative potentials. Loperamide (10 nmol/l) also increased the action potential duration, assessed at 90% of repolarization, in ventricular myocytes by 16.4 ± 1.7% (n = 6; p < 0.004). The maximum rate of rise of phase 0 of the action potential, however, was not significantly altered at any tested concentration of loperamide.

CONCLUSIONS

Loperamide is a potent hERG channel blocker. It significantly prolongs the action potential duration and suggests a causal association between loperamide and recent clinical cases of torsade de pointes.

Histone deacetylase inhibitors modulate KATP subunit transcription in HL-1 cardiomyocytes through effects on cholesterol homeostasis

Histone deacetylase inhibitors (HDIs) are under investigation for the treatment of a number of human health problems. HDIs have proven therapeutic value in refractory cases of cutaneous T-cell lymphoma. Electrocardiographic ST segment morphological changes associated with HDIs were observed during development. Because ST segment morphology is typically linked to changes in ATP sensitive potassium (K_ATP) channel activity, we tested the hypothesis that HDIs affect cardiac K_ATP channel subunit expression. Two different HDIs, romidepsin and trichostatin A, caused ~20-fold increase in SUR2 (Abcc9) subunit mRNA expression in HL-1 cardiomyocytes. The effect was specific for the SUR2 subunit as neither compound causes a marked change in SUR1 (Abcc8) expression. Moreover, the effect was cell specific as neither HDI markedly altered K_ATP subunit expression in MIN6 pancreatic β-cells. We observe significant enrichment of the H3K9Ac histone mark specifically at the SUR2 promoter consistent with the conclusion that chromatin remodeling at this locus plays a role in increasing SUR2 gene expression. Unexpectedly, however, we also discovered that HDI-dependent depletion of cellular cholesterol is required for the observed effects on SUR2 expression. Taken together, the data in the present study demonstrate that K_ATP subunit expression can be epigenetically regulated in cardiomyocytes, defines a role for cholesterol homeostasis in mediating epigenetic regulation and suggests a potential molecular basis for the cardiac effects of the HDIs.

Glanzmann thrombasthenia in Pakistan: molecular analysis and identification of novel mutations

Glanzmann thrombasthenia (GT) is an inherited genetic disorder affecting platelets, which is characterized by spontaneous mucocutaneous bleeding and abnormally prolonged bleeding in response to injury or trauma. The underlying defect is failure of platelet aggregation due to qualitative and/or quantitative deficiency of platelet integrin αIIbβ3 resulting from molecular genetic defects in either ITGA2B or ITGB3. Here, we examine a Pakistani cohort of 15 patients with clinical symptoms of GT who underwent laboratory and molecular genetic analysis. In patients with a broad range of disease severity and age of presentation, we identified pathogenic mutations in ITGA2B in 11 patients from 8 different families, including 2 novel homozygous mutations and 1 novel heterozygous mutation. Mutations in ITGB3 were identified in 4 patients from 3 families, two of which were novel homozygous truncating mutations. A molecular genetic diagnosis was established in 11 families with GT, including 5 novel mutations extending the spectrum of mutations in this disease within a region of the world where little is known about the incidence of GT. Mutational analysis is a key component of a complete diagnosis of GT and allows appropriate management and screening of other family members to be performed.

Endometrial stromal sarcoma: a rare entity

Endometrial Stromal Sarcoma (ESS) is a hormone sensitive tumor. It is a rare gynecological tumor and is considered to occur more often in pre-menopausal women. A proper pre-operative diagnosis is difficult and confirmed in most cases after hysterectomy for a presumed benign disease. Endometrial sampling, ultrasound, and magnetic resonance imaging can provide diagnostic clues. For early disease complete surgical cure is possible, however, adjuvant therapy is available for recurrence. This case of Low Grade Endometrial Stromal Sarcoma (LGESS) in a 21 years old woman was presented as irregular vaginal bleeding. Clinical diagnosis of fibroid was made but analysis of endometrium showed ESS confirmed on hysterectomy specimen. One should consider it in any case with rapid fibroid enlargement.

Phenolic Glycosides from Symplocos racemosa

The re-investigation of the chemical constituents of the bark of the stem of Symplocos racemosa Roxb. led to the isolation of two new phenolic glycosides, Symconoside A (1) and Symconoside B (2). The structures of the new compounds were determined by 1D and 2D-homonuclear and heteronuclear NMR spectroscopy, chemical evidences, and by comparison with the published data of the closely related compounds. The phenolic glycosides 1 and 2 displayed in vitro inhibitory activity against phosphodiesterase-I with the IC50 values of 158±0.02 and 900±0.08 μM, respectively.

Comparison between transcerebellar diameter with biparietal diameter of ultrasound for gestational age measurement in third trimester of pregnancy

OBJECTIVE

To determine the frequency of correct assessment by transcerebeller diameter (TCD) versus biparietal diameter (BPD) for gestational age measurement at 36 weeks of pregnancy using first day of last menstrual period (LMP) for actual period of gestation.

STUDY DESIGN

Quasi experimental.

PLACE AND DURATION OF STUDY

Department of Obstetrics and Gynaecology, Bahawal Victoria Hospital, Bahawalpur from May to November 2010.

METHODOLOGY

This study was performed on 228 patients at 36 weeks of pregnancy fulfilling the inclusion criteria. Ultrasound measurements of TCD and BPD was made and compared with LMP. Collected data was analyzed by SPSS version 10. Proportoin of correct diagnosis by each measurement was determined and compared using chi-square test with significance at p < 0.05.

RESULTS

Out of 228 patients, TCD was found to give correct assessment in 209 patients (91.7%; p = 0.001) corresponding to the gestational age by LMP i.e 36 weeks. BPD was found to give correct assessment corresponding to the gestational age by LMP in 176 patients (77.2%).

CONCLUSION

Although both BPD and TCD are accurate biometric parameters at 36 weeks of gestation, transcerebellar diameter is more reliable method of gestational age determination in third trimester of pregnancy than biparietal diameter. TCD can be used as a tool to assist in the assessment of gestational age in third trimester.

Promoter DNA methylation regulates murine SUR1 (Abcc8) and SUR2 (Abcc9) expression in HL-1 cardiomyocytes

Two mammalian genes encode the SURx (SUR1, Abcc8 and SUR2, Abcc9) subunits that combine with Kir6.2 (Kcnj11) subunits to form the ATP-sensitive potassium (KATP) channel in cardiac myocytes. Different isoform combinations endow the channel with distinct physiological and pharmacological properties, and we have recently reported that the molecular composition of sarcolemmal KATP channels is chamber specific in the mouse heart. KATP channel composition is determined by what subunits are expressed in a cell or tissue. In the present study, we explore the role of CpG methylation in regulating SUR1 and SUR2 expression. In HL-1 cardiomyocytes, as in atrial myocytes, SUR1 expression is markedly greater than SUR2. Consistent with CpG methylation-dependent silencing of SUR2 expression, bisulfite sequencing of genomic DNA isolated from HL-1 cells demonstrates that 57.6% of the CpGs in the promoter region of the SUR2 gene are methylated, compared with 0.14% of the the CpG residues in the SUR1 sequence. Moreover, treatment with 10 µM 5-aza-2'-deoxycytidine (Aza-dC) significantly increased both the unmethylated fraction of the SUR2 CpG island and mRNA expression. However, we cannot rule out additional mechanisms of Aza-dC action, as Aza-dC also causes a decrease in SUR1 expression and lower doses of Aza-dC do not alter the unmethylated DNA fraction but do elicit a small increase in SUR2 expression. The conclusion that DNA methylation alone is not the only regulator of SUR subunit expression is also consistent with observations in native myocytes, where the CpG islands of both SUR genes are essentially unmethylated in both atrial and ventricular myocytes. Collectively, these data demonstrate the potential for CpG methylation to regulate SURx subunit expression and raises the possibility that regulated or aberrant CpG methylation might play a role in controlling channel structure and function under different physiological conditions or different species.

Colles' fracture - is it a signal of osteoporosis?

Asymptomatic post-menopausal osteoporosis is common but some-times associated with pain and deformity. Symptomatic osteoporosis is usually associated with fracture. A 59 years old post-menopausal woman presented with a history of acute low-back-pain. She had menopause for 12 years. She gave history of colles' fracture at about two years back. Her mother died as consequences of femoral neck fracture. MRI of vertebral spine showed demineralization with partial collapse of D6,7,12 and L1 vertebra. Dual energy X-ray absorptiometry of vertebra showed BMD T-score of -4.5. Patient was managed with IV infusion of zoledronic acid, oral intake of vitamin D and calcium supplements and with regular non-weight-bearing exercises. Her condition improved gradually. During post-menopausal period, every women must be aware of osteoporosis and any fracture in that time must be evaluated to rule out osteoporosis.

Impact of methods for uterine incision closure on repeat caesarean section scar of lower uterine segment

OBJECTIVE

To compare the effect of different suturing techniques in repeat caesarean section in terms of scar thickness, blood loss, operative time and scar dehiscence at the time of next caesarean section.

STUDY DESIGN

A randomized double blinded trial.

PLACE AND DURATION OF STUDY

Obstetrics and Gynaecology Department of Bahawal Victoria Hospital, Bahawalpur, from June 2005 to June 2010.

METHODOLOGY

Ninety patients undergoing repeat caesarean section were included and randomly assigned to one of the three groups. Group A underwent one layer closure; Group B underwent two layer closure while Group C underwent modified two layer closure of the uterine incision. Ultrasonographic evaluation of the scar thickness was performed at 6 weeks post operatively and longer follow-up was done in next caesarean for scar dehiscence. Frequency percentages were obtained and compared using chi-square test with significance at p < 0.05.

RESULTS

In only 2 (6.6%) of modified two layer closure cases, it was necessary to use additional haemostatic sutures, compared with 16 (53%) of one layer closure group, and 10 (33%) of the two layer closure group. At 6 weeks, the mean car thickness in group C (17.08 +1.635 mm) was significantly greater (p < 0.001) as compared to group A (13.19 + 1.32 mm) and group B (14.58 +1.18 mm). At long-term follow-up, only 1 (6%) case from group C showed the "uterine window" at the time of repeat caesarean section as compared to 3 (23%) in group A and 2 (14%) in group B.

CONCLUSION

Scar thickness was significantly increased with modified two layer closure when compared with traditional one and two layer closure of lower transverse uterine incision at the time of repeat caesarean section.

Misoprostol for the purpose of mid-trimester termination of pregnancy: a comparative study with prostaglandin F2 alpha

OBJECTIVE

To compare the efficacy of misoprostol verses prostaglandin F2alpha (PGF2alpha) in the medical management of termination of mid-trimester pregnancy due to medical reasons.

METHODS

This experimental study was conducted in Obstetrics and Gynaecology Department, Bahawal Victoria Hospital, Bahawalpur for a period of 6 months from April 2005 to September 2005. Time interval between induction with misoprostol or PGF2alpha and expulsion of foetus, number of tablets of misoprostol used and total dose of injection PGF2alpha used for termination of pregnancy as well as the complications experienced with both drugs. Fifty patients of 18-35 years of age were randomly selected who presented to Gynaecology and Obstetrics outdoor with mid-trimester foetal loss or congenitally malformed foetus incompatible to life, confirmed on ultrasonography. These women were randomised to receive either intravaginal misoprostol or extra-amniotic PGF2alpha.

RESULTS

Ninety-six percent of cases were managed successfully with Misoprostol as compared to 92% where PGF2alpha was tried (p > 0.5). Mean induction to expulsion duration for misoprostol and PGF2alpha were 9.02 +/- 4.57 and 16.04 +/- 6.22 hours respectively (p < 0.5). Complications profile was low especially in cases of PGF2alpha and only one case experienced significant haemorrhage.

CONCLUSION

Misoprostol and PGF2alpha were found to be of same success rate but former was found to be more efficacious in terms of induction to expulsion duration.

Pattern and management of renal injuries at Pakistan Institute of Medical Sciences

OBJECTIVE

To determine the types and grade of various renal injuries and methods adopted for their management at the Department of Urology, Pakistan Institute of Medical Sciences, Islamabad.

STUDY DESIGN

An observational study.

PLACE AND DURATION OF STUDY

Department of Urology, Pakistan Institute of Medical Sciences, Islamabad, from January 2005 to December 2007.

METHODOLOGY

The study included 50 patients with both blunt and penetrating renal trauma of either gender and aged above 13 years. Injuries, grade management and outcome was recorded. The data was entered in structured proforma and analyzed for descriptive statistics using SPSS version 10.

RESULTS

Frequency was higher in males (82%). The mode of renal injury was blunt in 78% and penetrating in 22% cases. Blunt injuries were mostly due to road traffic accident (94.9%) and penetrating injuries due to firearm (63.6%). Hematuria was present in 86% and absent in 14% cases. Minor renal injury was seen in 74% and major injury in 26% cases. Seventy-two percent of cases were managed conservatively. All grade-V (14%) and one grade-1V injury (2%) patients underwent nephrectomy. Renorrhaphy was done in 6% cases. Urinary extravasation was seen in one case (2%). One patient developed renocolic fistula. No mortality was observed in non-operative group; however, 4% patients expired in operative group due to associated injuries.

CONCLUSION

Blunt trauma accounts for majority of the cases of renal injury and non-operative treatment is the suitable method of management for most cases of blunt as well as selected cases of penetrating renal trauma, who are stable hemodynamically and without peritonitis.

Abstract 663: The comparative efficacy of the PARP inhibitors AG14361, ABT888 and AZD2281 in the treatment of triple negative and BRCA1 breast cancer

Introduction: Most preclinical studies have used “in vitro” animal cell lines, “in vivo” allografts and/or gene knockdowns to predict the clinical efficacy of PARP1 and PARP1 & 2 inhibitors in the treatment of human breast cancer. It has been shown however that “in vitro” experiments with human breast cancer cell lines are more useful in predicting the clinical performance of cancer drugs than these other methods. In this study, the PARP1 inhibitor AG14361 and the PARP1 & 2 inhibitors AZD2281 and ABT888 were tested against a panel of 25 human breast cancer cell lines. Methods: The MTT assay was used to determine the IC50 inhibitory effect of the PARP inhibitors against the human breast cancer cell lines over a 72 hour period with each experiment being replicated at least 10 times. The MTT assay was validated for each cell line using direct counting via hemacytometer & trypan blue staining. Human to mouse xenografts were then challenged by PARP inhibitors. The IC50 results were then correlated with the PARP activity of each cell line. Results: The PARP1 inhibitor AG14361 was 5 and 8 fold more effective in inhibiting human breast cancer growth than ABT888 and AZD2281 respectively. The average IC50 values for AG14361, ABT888 and AZD2281 against BRCA1-/- human breast cancer cell lines were 20, 120, and 190 micromolar respectively. The average IC50 values for non-BRCA1 triple negative breast cancer were 24, 110 and 165 micromolar respectively. ANOVA analysis sustained the null hypothesis between BRCA1-/- breast cancer and non-BRCA1 triple negative breast cancer. Xenograft studies mirrored the “in vitro results”. These IC50 values are significantly higher than previously published preclinical data that utilized BRCA1 -/- animal cell lines and human BRCA1 gene knockdowns. This suggests that BRCA1 animal cell lines are more sensitive to PARP1 inhibitors and that human BRCA1 -/- gene knockdowns may be fundamentally different from naturally derived BRCA1-/- breast cancer cell lines. Conclusion: The PARP1 inhibitor was more effective than the PARP1 & 2 inhibitors in inhibiting breast cancer growth. Non-BRCA1 triple negative breast cancers were at least as sensitive to PARP inhibition as BRCA1 breast cancers.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 663.

Abstract A42: The treatment of sporadic breast cancer with Poly(ADP-ribose) polymerase (PARP1) inhibitors (AZD2281, ABT888, AG14361) as single agents and in combination with chemotherapy

Introduction: It has been shown that poly(ADP-ribose) polymerase (PARP1) inhibitors may be useful in the treatment of BRCA1 and 2 hereditary breast cancers due to their deficiency in homologous repair. Many sporadic breast cancers may also be deficient in homologous repair due to deficiency's in RAD51, RAD54, DSS1, RPA1, NBS1, ATR, ATM, CH1, CHK2, FANCD2, FANCA, FANC or a down regulation of BRCA.

Methods: Human breast cancer cell lines representative of basal, Her2/neu, luminal A and luminal B subtypes were treated with PARP1 inhibitors alone or in combination with standard chemotherapeutic agents (alkylating, topoisomerase inhibitors, anti-metabolites, anti-mitotics and/or DNA intercalators) for 72 hours. IC50 values were determined by standard dose response curves of the PARP1) inhibitors (AZD2281, ABT888, AG14361), standard chemotherapeutic agents alone and in combination with each other. PARP1 inhibitor pharmacodynamic, PARP1 activity assays and the quantification of molecular markers from the apoptotic, DNA repair and mitotic pathways were also performed and correlated with IC50 values.

Results: There was no statistical difference in the IC50 of PARP1 inhibitors for BRCA1, non-BRCA1 triple negative or luminal human breast cancer tissue. Significant enhancement of chemotherapeutic cytotoxicity by PARP1 inhibitors was observed in not only hereditary (BRCA1 & BRCA2) breast cancer but, in sporadic breast cancer also. The results suggest that many sporadic breast cancers are deficient in homologous recombination and their ability to preserve DNA and chromosomal fidelity.

Conclusion: PARP1 inhibitors in combination with chemotherapy may be effective in treating sporadic breast cancer.

Citation Information: Clin Cancer Res 2010;16(7 Suppl):A42

Caveolin-1 promotes resistance to chemotherapy-induced apoptosis in Ewing's sarcoma cells by modulating PKCalpha phosphorylation

Caveolin-1 (CAV1) has been implicated in the regulation of several signaling pathways and in oncogenesis. Previously, we identified CAV1 as a key determinant of the oncogenic phenotype and tumorigenic activity of cells from tumors of the Ewing's Sarcoma Family (ESFT). However, the possible CAV1 involvement in the chemotherapy resistance commonly presented by an ESFT subset has not been established to date. This report shows that CAV1 expression determines the sensitivity of ESFT cells to clinically relevant chemotherapeutic agents. Analyses of endogenous CAV1 levels in several ESFT cells and ectopic CAV1 expression into ESFT cells expressing low endogenous CAV1 showed that the higher the CAV1 levels, the greater their resistance to drug treatment. Moreover, results from antisense- and shRNA-mediated gene expression knockdown and protein re-expression experiments demonstrated that CAV1 increases the resistance of ESFT cells to doxorubicin (Dox)- and cisplatin (Cp)-induced apoptosis by a mechanism involving the activating phosphorylation of PKCalpha. CAV1 knockdown in ESFT cells led to decreased phospho(Thr(638))-PKCalpha levels and a concomitant sensitization to apoptosis, which were reversed by CAV1 re-expression. These results were recapitulated by PKCalpha knockdown and re-expression in ESFT cells in which CAV1 was previously knocked down, thus demonstrating that phospho(Thr(638))-PKCalpha acts downstream of CAV1 to determine the sensitivity of ESFT cells to chemotherapeutic drugs. These data, along with the finding that CAV1 and phospho(Thr(638))-PKCalpha are co-expressed in approximately 45% of ESFT specimens tested, imply that targeting CAV1 and/or PKCalpha may allow the development of new molecular therapeutic strategies to improve the treatment outcome for patients with ESFT.

Protective effect of liposomal formulation of tuftsin (a naturally occurring tetrapeptide) against cyclophosphamide-induced genotoxicity and oxidative stress in mice

Tuftsin, a naturally occurring tetrapeptide with a sequence Thr-Lys-Pro-Arg was evaluated for its in vivo protective effect against cyclophosphamide-induced genotoxicity and oxidative stress in Swiss albino mice. The anticancer drug cyclophosphamide (CP) was administered intra-peritonially to induce mutagenic effect. The drug treatment caused significant increase in chromosomal aberrations, formation of micronucleated polychromatic erythrocytes (MNPCE's), as well as oxidative stress and decrease in lipid peroxidation in liver of the animals. The pretreatment with tuftsin abolished such effects in dose-dependent manner and also increased mitotic index in the experimental animals. Results of the present study validated chemo-preventive properties of tuftsin against CP-induced chromosomal mutations and cellular injury of liver by oxidative stress.

Label-free global serum proteomic profiling reveals novel celecoxib-modulated proteins in familial adenomatous polyposis patients

Celecoxib, a selective inhibitor of cyclooxygenase-2 (Cox-2), was efficacious in clinical prevention trials of patients with familial adenomatous polyposis (FAP) and sporadic colorectal cancer. To identify as yet poorly defined molecular determinants of celecoxib efficacy, a multidimensional serum fractionation approach was used coupled with nanospray tandem mass spectrometry to perform label-free global proteomic profiling of serum samples from the FAP/celecoxib prevention trial. Subsequently, the application of an algorithm for large-scale biomarker discovery on comparative serum proteomic profiles of pre- and post-celecoxib treatment samples identified 83 potentially celecoxib-responsive proteins from various cellular compartments, biological processes and molecular functions. Celecoxib modulation of some of these proteins was confirmed in serum samples of FAP patients and colorectal cancer cell lines by Western blotting. Thus, using a shotgun procedure to rapidly identify important celecoxib-modulated proteins, this pilot study has uncovered novel systemic changes some of which are highly relevant for carcinogenesis and vascular biology. Validation of selected markers, especially those involved in key signaling networks and those considered molecular indicators of cardiovascular pathology, in larger celecoxib clinical trials is expected to provide insights into the molecular mechanisms of celecoxib and the efficacy/toxicity issues related to its use as a chemopreventive agent.

Comparison of the antidiabetic activity of Berberis lyceum root extract and berberine in alloxan-induced diabetic rats

Berberine has been shown to have hypoglycaemic activity in several in vitro and in vivo models, although the mechanism of action is not fully known. Berberis lyceum Royle root produces high concentrations of berberine, and in traditional medicine, the whole extract of this plant is used widely to treat diabetes. The antidiabetic activity of the ethanol root extract of Berberis lyceum was compared with pure berberine in normal and alloxan-diabetic rats using similar doses of each. The concentration of berberine in the extract was determined to be 80% dry weight with only trace amounts of other alkaloids present. The purpose of the study was to investigate the effects of berberine and a whole extract of Berberis lyceum on blood glucose and other parameters associated with diabetes, to compare the effects of the crude extract with those of pure berberine and thus validate its use as a therapeutic agent, and finally to identify any contribution of the other components of the extract to these effects. Oral administration of 50 mg/kg of Berberis extract and berberine to normal and experimental diabetic rats produced a significant (p < 0.05) reduction in blood glucose levels from days 3-7 days of treatment. Significant effects were also observed on the glucose tolerance, glycosylated haemoglobin, serum lipid profiles and body weight of experimental animals. Berberis extract and berberine demonstrated similar effects on all parameters measured, and although the extract was comparable in efficacy to berberine, it did not produce any effects additional to those shown by pure berberine. The results support the use of the extract in traditional medicine, and demonstrate that apart from being a highly cost-effective means of treating with berberine, the total extract does not appear to confer any additional benefits or disadvantages compared with the pure compound.

Altered gene expression profiles define pathways in colorectal cancer cell lines affected by celecoxib

It is well established that celecoxib, a selective inhibitor of cyclooxygenase-2 (COX-2) and a tested chemopreventive agent, has several COX-2-independent activities. In an attempt to better understand COX-2-independent molecular mechanisms underlying the chemopreventive activity of celecoxib, we did global transcription profiling of celecoxib-treated COX-2-positive and COX-2-deficient colorectal cancer cell lines. Celecoxib treatment resulted in significantly altered expression levels of over 1,000 to 3,000 transcripts in these cell lines, respectively. A pathway/functional analysis of celecoxib-affected transcripts, using Gene Ontology and Biocarta Pathways and exploring biological association networks, revealed that celecoxib modulates expression of numerous genes involved in a variety of cellular processes, including metabolism, cell proliferation, apoptotic signaling, cell cycle check points, lymphocyte activation, and signaling pathways. Among these processes, cell proliferation and apoptotic signaling consistently ranked as the highest-scoring Gene Ontology terms and Biocarta Pathways in both COX-2 expresser and nonexpresser cell lines. Altered expression of many of the genes by celecoxib was confirmed by quantitative PCR and at the protein level by Western blotting. Many novel genes emerged from our analysis of global transcription patterns that were not previously reported to be affected by celecoxib. In the future, in-depth work on selected genes will determine if these genes may serve as potential molecular targets for more effective chemopreventive strategies.

Comparison of CT scan and colour flow Doppler ultrasound in detecting venous tumour thrombous in renal cell carcinoma

BACKGROUND

Renal cell carcinoma has marked tendency to spread into renal vein, inferior vena cava and right side of heart. Extension of tumour thrombus into these veins will alter the surgical approach. We have compared the CT scan with Colour flow Doppler ultrasound in detecting venous tumour thrombus in renal vein and inferior vena cava.

METHODS

This cross-sectional study included 30 adult patients presenting with renal tumour. Patients of either gender were included in the study. Non probability convenience sampling was used. All patients underwent colour flow Doppler ultrasound and CT scan with contrast to asses the renal vein and inferior vena cava. The results were confirmed by intra operative findings and histopathology. The data was analyzed using SPSS version 12.

RESULTS

Out of 30 patients, 20 (66%) were males and 10 (34%) female. The tumour was predominantly on the right side (60%), as was renal venous tumour thrombus (44%). Inferior vena cava was involved in 4 cases predominantly due to right sided tumours. The sensitivity of Doppler ultrasound in detecting renal venous tumour thrombus (88% on right and 100% on left side) was higher than CT scan (63% on right and 60% on left side). Doppler ultrasound was also superior to CT scan in detecting vena caval thrombus.

CONCLUSION

The overall sensitivity of Doppler sonography was higher than CT scan in detecting tumour extension into renal veins and inferior vena cava. Therefore, it can be used as a complementary tool in equivocal cases.