Toxicological screening and evaluation of anti-allergic and anti-hyperglycemic potential of Sonneratia caseolaris (L.) Engl. fruits

Background

Sonneratia caseolaris (L.) Engl. (S. caseolaris) belonging to the Sonneratiaceae family is commonly known as Ora. It is traditionally used as an astringent, antiseptic, to treat sprains, swellings, cough and in arresting hemorrhage. The ethanolic extract of S. caseolaris (L.) Engl. fruits was investigated in the present study for its toxicity as well as anti-allergic and anti-hyperglycemic potentials.

Methods

Major phenolic compounds were identified and quantified by HPLC. Behavioral change, body weight, mortality and different blood parameters were measured to assess the toxicological effect of the extract. Anti-allergic activity was evaluated using TDI-induced allergic model mice. Oral glucose tolerance test (OGTT) and STZ-induced diabetic mice were used to evaluate the anti-hyperglycemic activity.

Results

Crude extract contained ellagic acid, vanillic acid and myrecitin (27.41, 3.06 and 7.93 mg per 100 g dry extract respectively). No major toxicity was observed in both acute and sub-acute toxicity study. Oral administration of the extract significantly ameliorated TDI-induced allergic symptoms like sneezing, scratching, swelling, redness and watery rhinorrhoea in the experimental mice. The extracts also reduced the total and differential count of leukocytes in the blood. The extract treated mice showed significant reduction in blood glucose, SGOT, SGPT, cholesterol, triglycerides, urea, creatinine and bilirubin level.

Conclusions

S. caseolaris contains bioactive phytoconstituents which may be the possible precursors to isolate and characterize the novel compounds targeting the diseases like allergy and diabetes.

Anticancer Perspectives on the Fungal-Derived Polyphenolic Hispolon

BACKGROUND

Cancer is a dreadful disease causing thousands of deaths per year worldwide, which requires precision diagnostics and therapy. Although the selection of therapeutic regimens depends on the cancer type, chemotherapy remains a sustainable treatment strategy despite some of its known side-effects. To date, a number of natural products and their derivatives or analogues have been investigated as potent anticancer drugs. These drug discoveries have aimed for targeted therapy and reduced side-effects, including natural therapeutic regimens.

OBJECTIVE

This review introduces a prospective fungal-derived polyphenol, Hispolon (HIS), as an anticancer agent. Accordingly, this review focuses on exploring the anticancer effect of hispolon based on information extracted from databases such as PubMed, ScienceDirect, MedLine, Web of Science, and Google Scholar.

METHODS

A literature search in PubMed, ScienceDirect, MedLine, Web of Science, and Google Scholar was accomplished, using the keyword 'Hispolon', pairing with 'cancer', 'cytotoxicity', 'cell cycle arrest', 'apoptosis', 'metastasis', 'migration', 'invasion', 'proliferation', 'genotoxicity', 'mutagenicity', 'drug-resistant cancer', 'autophagy', and 'estrogen receptor.

RESULTS

Database-dependent findings from reported research works suggest that HIS can exert anticancer effects by modulating multiple molecular and biochemical pathways, including cell cycle arrest, apoptosis, autophagy, inhibition of proliferation, metastasis, migration, and invasion. Moreover, HIS inhibits the estrogenic activity and exhibits chemoprevention prospects, possibly due to its protective effects such as anticancer and anti-inflammatory mechanisms. To date, a number of HIS derivatives and analogues have been introduced for their anticancer effects in numerous cancer cell lines.

CONCLUSION

Data obtained from this review suggest that hispolon and some of its derivatives can be promising anticancer agents, and may become plant-based cancer chemotherapeutic leads for the development of potent anticancer drugs, alone or in combination with other chemotherapeutic agents.

Prevalence and Risk Factors of Hypertension among Government Employees Serving in Rangpur City, Bangladesh

Hypertension (HTN) is an important cause of cardiovascular mortality and the prevalence of hypertension is increasing particularly in middle- and low-income countries including Bangladesh. No data are available for the prevalence of hypertension among the government employees in Bangladesh. In this cross-sectional study, conducted from 30 October to 31 December 2016, 1219 government employees aging ≥18 years working in Rangpur city were evaluated for the presence of HTN and its risk factors. Socio-demographic and anthropometric data, data on the presence of various known risk factors of hypertension were collected. Hypertension was defined with systolic BP ≥140mmHg and/or diastolic BP ≥90mmHg or those getting treatment for hypertension. Statistical analysis was done by using SPSS version 23.0; odds of hypertension among subjects with risk factors were calculated and p ≤0.05 was considered to be statistically significant. The prevalence of hypertension was 38.3% among the study subjects. Significantly higher odds of having hypertension were observed in study subjects with the age groups of 35-49 (OR 2.12, 95% CI: 1.51-2.99, p<0.001) and ≥50 (OR: 4.96, 95% CI: 3.43-7.18, p<0.001) years than age group <35 years. Employees who were averagely satisfied and not satisfied for their jobs also had higher odds (OR: 1.38, 95% CI: 1.00-1.91, p=0.049 and OR: 1.48, 95% CI: 3.43-7.18, p=0.337) of having hypertension than fully satisfied ones. Having diabetes mellitus was found to increase the odds (OR 2.12, 95% CI: 1.51-2.99, p<0.001) of hypertension. Male gender, urban/suburban residence, not doing physical exercise, sedentary/light working habit, overweight/obesity also increased the odds of having hypertension though these were not statistically significant. There is a high burden of hypertension among the government employees in Rangpur city. Age, job satisfaction and diabetes were independent risk factors of hypertension.

Analgesic Activity, Chemical Profiling and Computational Study on Chrysopogon aciculatus

Present study was undertaken to evaluate the analgesic activity of the ethanol extract of Chrysopogon aciculatus. In addition to bioassays in mice, chemical profiling was done by LC-MS and GC-MS to identify phytochemicals, which were further docked on the catalytic site of COX-2 enzymes with a view to suggest the possible role of such phytoconstituents in the observed analgesic activity. Analgesic activity of C. aciculatus was evaluated by acetic acid induced writhing reflex method and hot plate technique. Phytochemical profiling was conducted using liquid chromatography mass spectrometry (LC-MS) and gas chromatography mass spectrometry (GC-MS). In docking studies, homology model of human COX-2 enzyme was prepared using Easy Modeler 4.0 and the identified phytoconstituents were docked using Autodock Vina. Preliminary acute toxicity test of the ethanol extract of C. aciculatus showed no sign of mortality at the highest dose of 4,000 mg/kg. The whole plant extract significantly (p < 0.05) inhibited acetic acid induced writhing in mice at the doses of 500 and 750 mg/kg. The extract delayed the response time in hot plate test in a dose dependent manner. LC-MS analysis of the plant extract revealed the presence of aciculatin, nudaphantin and 5α,8α-epidioxyergosta-6,22-diene-3β-ol. Three compounds namely citronellylisobutyrate; 2,4-dihydroxy-7-methoxy-(2H)-1,4-benzoxazin-3(4H)-one and nudaphantin were identified in the n-hexane fraction by GC-MS. Among these compounds, six were found to be interacting with the binding site for arachidonic acid in COX-2 enzyme. Present study strongly supports the traditional use of C. aciculatus in the management of pain. In conclusion, compounds (tricin, campesterol, gamma oryzanol, and citronellyl isobutyrate) showing promising binding affinity in docking studies, along with previously known anti-inflammatory compound aciculatin can be held responsible for the observed activity.

Toxicogenetic study of omeprazole and the modulatory effects of retinol palmitate and ascorbic acid on Allium cepa

Omeprazole (OME) is a proton pump inhibitor used for the treatment of various gastric and intestinal disease; however, studies on its effects on the genetic materials are still restricted. The present study aimed to evaluate possible toxicogenic effects of OME in Allium cepa meristems with the application of cytogenetic biomarkers for DNA damage, mutagenic, toxic and cytotoxic effects. Additionally, retinol palmitate (RP) and ascorbic acid (AA) were also co-treated with OME to evaluate possible modulatory effects of OME-induced cytogenetic damages. OME was tested at 10, 20 and 40 μg/mL, while RP and AA at 55 μg/mL and 352.2 μg/mL, respectively. Copper sulphate (0.6 μg/mL) and dechlorinated water were used as positive control and negative control, respectively. The results suggest that OME induced genotoxicity and mutagenicity in A. cepa at all tested concentrations. It was noted that cotreatment of OME with the antioxidant vitamins RP and/or AA significantly (p < 0.05) inhibited and/or modulated all toxicogenic damages induced by OME. These observations demonstrate their antigenotoxic, antimutagenic, antitoxic and anticitotoxic effects in A. cepa. This study indicates that application of antioxidants may be useful tools to overcome OME-induced toxic effects.

Evaluation of antioxidant and chemopreventive effect of Cocos nucifera L

This study revealed the antioxidant and anticancer activities of the ethanolic extract of the tender fruits of Cocos nucifera. In antioxidant screening, IC50 value was found to be 7.71μg/mlfor ascorbic acid and44.67 μg/ml for C. nucifera fruits. The phenolic content, total flavonoid and total tannin content were 537.89 mg GAE/100 gm, 40.69mg of QE/100 gm and 44.61 mg of GAE/100 gm of dry powder of C. nucifera respectively. In DMBA and croton oil-induced skin cancer in model mice,the extract significantly decreased the number, size, yield and burden of tumor when compared with carcinogenic control. The extract increased the level of natural antioxidants like GSH, SOD and Catalase. Moreover, substantial decrease in SGPT, SGOT (liver activity marker) was observed at different doses ofthe crude extract. Lipid profile of mice treated with C. nucifera was brought back to normal level to some extent when compared to carcinogenic control. In conclusion,C. nucifera fruits have antioxidant activity as well as preventive role on cancer initiation and propagation without major toxicity.Jahangirnagar University J. Biol. Sci. 6(2): 47-58, 2017 (December)

Enhanced responsivity resonant RF photodetectors

The responsivity of room-temperature, semiconductor-based photodetectors consisting of resonant RF circuits coupled to microstrip buslines is investigated. The dependence of the photodetector response on the semiconductor material and RF circuit geometry is presented, as is the detector response as a function of the spatial position of the incident light. We demonstrate significant improvement in detector response by choice of photoconductive material, and for a given material, by positioning our optical signal to overlap with positions of RF field enhancement. Design of RF circuits with strong field enhancement are demonstrated to further improve detector response. The improved detector response demonstrated offers opportunities for applications in RF photonics, materials metrology, or single read-out multiplexed detector arrays.

Analgesic and Anti-inflammatory Activities of Ethanolic Extract of Clerodendrum inerme (L.) Gaertn

Clerodendrum inerme (L.) Gaertn. (Verbenaceae) is very popular among the traditional practitioners in Bangladesh for the treatment of local pain and inflammation, skin diseases, topical burns etc. However, so far no scientific study has been carried out which may support its uses in traditional medicine. In the present study, we evaluated the possible analgesic and anti-inflammatory activities of the ethanol extract of C. inerme for the first time. Analgesic activity was assessed by using acetic acid-induced writhing and heat-induced pain in mice and anti-inflammatory activity using xylene-induced ear edema in mice at the doses of 250 and 500 mg/kg body weight. The extract significantly (P< 0.05) attenuated the acetic acid-induced writhing with the highest activity being observed at 500 mg/kg b.w. (45.83%) comparable to that of diclofenac sodium (57.64%), the standard drug. A significant dosedependent increase (P< 0.05) of the latency period was also observed in hot plate method. In the xylene-induced inflammation assay, the extract showed significant (P<0.05) and dose dependant inhibitory effect on the edema formation. These findings indicate that the extract has significant analgesic and anti-inflammatory activities which support the folkloric claim of this plant and thus it has a great potential as source of natural products-derived drug. DOI: http://dx.doi.org/10.3329/bpj.v17i1.22317 Bangladesh Pharmaceutical Journal 17(1): 62-66, 2014

Transcriptional microarray analysis reveals suppression of histamine signaling by Kujin alleviates allergic symptoms through down-regulation of FAT10 expression

Previously, we have shown that hot water extract from Kujin, the dried roots of Sophora flavescens alleviates allergic symptoms by suppressing histamine signaling at the transcription level in toluene 2,4-diisocyanate (TDI)-sensitized rats. To know more insights into the mechanism of the anti-allergic action of Kujin, we carried out the microarray analysis to explore genes that were up-regulated by treatment with TDI and also were suppressed these up-regulated gene expression by Kujin. Microarray analysis revealed the substantial up-regulation of FAT10 (also called UbD) mRNA due to TDI sensitization and Kujin extract significantly suppressed this up-regulation. FAT10 is an ubiquitin like protein having an active role in the immune system and is induced by proinflammatory cytokines. Activation of NF-κB by FAT10 also has been reported. However, the role of FAT10 in allergic pathogenesis remains unknown. Here we investigated the correlation of FAT10-NF-κB signaling with histamine signaling in TDI-sensitized rats. Real time RT-PCR analysis confirmed that treatment with TDI up-regulated FAT10 mRNA expression in the nasal mucosa of TDI-sensitized rats and Kujin extract suppressed this elevation. Treatment with H(1)-antihistamines suppressed the TDI-induced up-regulation of FAT10 mRNA expression in TDI-sensitized rats. Direct administration of histamine into the nasal cavity of non-TDI-treated normal rats up-regulated the expression of FAT10 mRNA. Our data suggest that Kujin might alleviate allergic symptoms by inhibition of NF-κB activation through suppression of histamine-induced up-regulation of FAT10 mRNA expression.

Injection practices at primary healthcare units in bangladesh: experience at six upazilla health complexes

BACKGROUND

Indiscriminate usage of injections and lack of safe practices during injection administration have been reported worldwide. Unnecessary and unsafe injection usage not only increases the financial burden but are also responsible for spreading blood borne diseases including HIV, HBV and HCV. To attain a better understanding of the situation of injection usage in Bangladesh, a study was conducted at six Upazilla Health Complexes (UHCs), which are primary healthcare units in Bangladesh.

METHOD

The study involved the retrospective collection of treatment sheets of 1048 in-patients at six UHCs from January 2009 to June 2009. The data was then analyzed using statistical tests.

RESULTS

Among the patients investigated, 60.11% of the patients received injections and among them the male population received more injection than the female population (males vs. females = 62.50% vs. 55.85%). Patients below 12 years of age received the highest proportion of injections and highest usage of injections was observed in the month of March. The average number of injection(s) prescribed to a patient was 2.44 incurring a prescription cost of 280.22 Taka (USD 3.92 approx.). Injections were mostly prescribed in patients who were diagnosed with physical assault and acute watery diarrhea where intravenous fluids and antibiotics were most widely prescribed. Non-compliance to recapping of used injections was very common which accounted for 22.22% needle stick injuries.

CONCLUSION

The data suggest that indiscriminate and unsafe injection practices were occurring in all UHCs. Such practices resulted in financial losses as well as compromising safety for healthcare providers and patients.

An unusual case of carotid dissection

Carotid dissection is a rare, but potentially fatal, cause of ischaemic stroke in young patients. It occurs when a small tear forms in the tunica intima of the arterial wall creating a space between the inner and outer layers of the vessel where blood can enter and form a haematoma. This can cause a stenosis or complete occlusion. Thromboembolic events are thought to be the cause of infarction in the majority of cases of stroke, rather than haemodynamic insufficiency, in patients with carotid dissection. Although traditionally thought to be most commonly caused by head or neck trauma, spontaneous carotid dissection is now an increasingly recognised cause of stroke in young patients. Clinical signs can often be subtle, with mild cerebral or cranial nerve dysfunction. Here, a case is reported of a spontaneous internal carotid artery dissection in a previously well 38-year-old man. An appropriate imaging modality is important to confirm the diagnosis before commencing anticoagulation treatment.

Kujin suppresses histamine signaling at the transcriptional level in toluene 2,4-diisocyanate-sensitized rats

Kujin, the dried root of Sophorae flavescensis, has been used in Chinese folklore medicine against allergy. Evaluation of its anti-allergic potential as well as its mechanism of action has rarely been established. We investigated the effect of Kujin on toluene-2,4-diisocyanate (TDI)-induced allergic behavior and related histamine signaling including mRNA levels of histamine H(1) receptor (H1R) and histidine decarboxylase (HDC), H1R and HDC activities, and histamine content in rat nasal mucosa. We also investigated the effect of Kujin on the mRNA levels of helper T cell type 2 (Th2)-cytokine genes closely related to histamine signaling. TDI provocation caused acute allergic symptoms accompanied with up-regulations of H1R and HDC mRNAs and increases in HDC activity, histamine content, and [(3)H]mepyramine binding activity in the nasal mucosa, all of which were significantly suppressed by pretreatment with Kujin for 3 weeks. Kujin also suppressed the TDI-induced IL-4 and IL-5 mRNA elevations. These data suggest that oral administration of Kujin showed anti-allergic activity through suppression of histamine signaling by the inhibition of TDI-induced H1R and HDC mRNA elevations followed by decrease in H1R, HDC protein level, and histamine content in the nasal mucosa of TDI-sensitized rats. Suppression of Th2-cytokine signaling by Kujin also suggests that it could affect the histamine-cytokine network.

Sho-seiryu-to suppresses histamine signaling at the transcriptional level in TDI-sensitized nasal allergy model rats

BACKGROUND

The therapeutic use of Kampo medicine, Sho-seiryu-to (SST) in allergic disorders is well known. As histamine plays a central role in allergic diseases, it is possible that SST affects the allergy-related histamine signaling. In this study, we investigated the effect of SST on allergy-related histamine signaling in the nasal mucosa of toluene 2, 4-diisocyanate (TDI)-sensitized nasal allergy model rats.

METHODS

Six-week-old male, Brown Norway rats were sensitized for 2 weeks with 10 microl of 10% TDI, and after a 1 week interval, provocation was initiated with the same amount of TDI. SST (0.6g/rat) was given orally 1 hour before TDI treatment began for a period of 3 weeks. Nasal symptoms were scored for 10 minutes immediately after TDI-provocation. The genes expression in nasal mucosa was determined using real-time quantitative RT-PCR.

RESULTS

SST significantly suppressed TDI-induced nasal allergy-like symptoms. TDI provocation showed a significant up-regulation of histamine H(1) receptor (H1R) and histidine decarboxylase (HDC) gene expressions. Prolonged pre-treatment of SST significantly suppressed the mRNA levels of H1R and HDC that was up-regulated by TDI. SST also suppressed TDI-induced interleukin (IL)-4 and IL-5 mRNA elevation. However, SST showed no significant effect for TDI-induced mRNA elevation of IL-13.

CONCLUSIONS

These results demonstrate that SST alleviates nasal symptoms by the inhibition of histamine signaling through suppression of TDI-induced H1R and HDC gene up-regulation. SST also suppresses cytokine signaling through suppression of IL-4 and IL-5 gene expression. Suppression of histamine signaling may be a novel mechanism of SST in preventing allergic diseases.

Suppression of histamine signaling by probiotic Lac-B: a possible mechanism of its anti-allergic effect

It has been shown that probiotic bacteria are effective for the treatment of allergic diseases. As histamine plays a central role in allergic diseases, it is possible that probiotic bacteria affect the allergy-related histamine signaling. Here, we investigated the effect of Lac-B, a mixture of freeze-dried Bifidobacterium infantis and Bifidobacterium longum, on the allergy-related histamine signaling. In the nasal allergy model rats made by sensitization and provocation with toluene 2,4-diisocyanate (TDI) for 3 weeks, TDI provocation caused acute allergy-like behaviors along with significant up-regulation of histamine H(1) receptor (H1R) and histidine decarboxylase (HDC) mRNA expression, increased HDC activity, histamine content, and [(3)H]mepyramine binding activity in nasal mucosa. Prolonged treatment with Lac-B (40 mg/rat, p.o.) significantly suppressed both the allergy-like behaviors and all of the above mentioned factors involved in histamine signaling. Our findings indicate that oral administration of Lac-B showed significant anti-allergic effect through suppression of both H1R and HDC gene expression followed by decrease in H1R, HDC protein level, and histamine content. Suppression of histamine signaling may be a novel target of probiotics in preventing allergic diseases.

Stimulation of histamine H1 receptor up-regulates histamine H1 receptor itself through activation of receptor gene transcription

Histamine is a major mediator in allergy acting mainly through the histamine H(1) receptor (H1R). Although H1R up-regulation has been suggested as an important step for induction of allergic symptoms, little is known about the regulation of H1R level. Here we report that the activation of H1R up-regulates H1R through augmentation of H1R mRNA expression in HeLa cells. Histamine stimulation significantly increased both H1R promoter activity and mRNA level without alteration in mRNA stability. H1R protein was also up-regulated by histamine. An H1R antagonist but not histamine H(2) receptor antagonist blocked histamine-induced up-regulation of both promoter activity and mRNA expression. A protein kinase C (PKC) activator, phorbol-12-myristate-13-acetate, increased H1R mRNA expression, whereas an activator of PKA or PKG (8-Br-cAMP or 8-Br-cGMP, respectively) did not. Furthermore, histamine-induced up-regulation of both promoter activity and mRNA level were completely suppressed by the PKC inhibitor Ro-31-8220. H1R antagonists have long been thought to block H1R and inhibit immediate allergy symptoms. In addition to this short-term effect, our data propose their long-term inhibitory effect against allergic diseases by suppressing PKC-mediated H1R gene transcription. This finding provides new insights into the therapeutic target of H1R antagonist in allergic diseases.

Dexamethasone suppresses histamine synthesis by repressing both transcription and activity of HDC in allergic rats

BACKGROUND

Histamine synthesized by histidine decarboxylase (HDC) from L-histidine is a major chemical mediator in the development of nasal allergy which is characterized by nasal hypersensitivity. However the regulatory mechanism of histamine synthesis by HDC remains to be elucidated. The objectives of the present study were to examine the changes of histamine content, HDC activity and HDC mRNA expression in the nasal mucosa of allergy model rats sensitized by the exposure to toluene diisocyanate (TDI) and to investigate the effect of dexamethasone on the above mentioned allergic parameters.

METHODS

Rats were sensitized and provocated by TDI and the nasal allergy-like behaviors were scored during a 10 minute period after provocation. Histamine content and HDC activity in the nasal mucosa were determined using fluorometric high performance liquid chromatography. The expression of HDC mRNA in nasal mucosa was determined using real-time quantitative reverse transcriptase-polymerase chain reaction (RT-PCR).

RESULTS

In TDI-sensitized rats, nasal allergy-like behaviors such as sneezing and watery rhinorrhea were induced. Histamine content, HDC activity and HDC mRNA expression in nasal mucosa were also significantly increased after TDI provocation. Pretreatment with dexamethasone significantly suppressed nasal allergy-like behaviors, up-regulation of histamine content, HDC activity and HDC mRNA induced by TDI in TDI-sensitized rats.

CONCLUSIONS

These findings indicate that increased synthesis of histamine through up-regulation of HDC gene expression and HDC activity in nasal mucosa plays an important role in the development of nasal hypersensitivity. Repression of HDC gene expression and HDC activity by dexamethasone may underlie its therapeutic effect in the treatment of allergy.

Intra-individual variation of serum prostate specific antigen levels in men with benign prostate biopsies

OBJECTIVE

To determine the intra-individual (physiological) variation of prostate-specific antigen (PSA) measurements in men after a benign prostatic biopsy.

PATIENTS AND METHODS

Sixty-four men were prospectively assessed, all of whom had a benign prostatic biopsy within the preceding 13 months. The degree of intra-individual variability was established by calculating the coefficient of variation on four PSA levels obtained from each patient weekly over a month.

RESULTS

Six patients were subsequently diagnosed with prostate cancer and their data are presented separately. In the remaining 58 patients the median (range) individual mean PSA value was 6.3 (0.5-34.1) ng/mL. The median (range) coefficient of variation within the group was 9.5 (2.4-76.1)%. There was a clear linear relationship between mean PSA level and the standard deviation.

CONCLUSION

In 48 of the 63 patients analysed, the coefficient of variation for serum PSA values in the group as a whole was greater than the variation claimed for the assay technique. The significance of the linear relationship between PSA and the standard deviation is discussed, with particular reference to those men who had a benign prostate biopsy.

PHYSICIAN-PATIENT COMMUNICATION REGARDING PRESCRIBED MEDICATION IN AN AMBULATORY CARE SETTING IN KATHMANDU, NEPAL

Physician-patient interactions often lead to prescription of medicines. Safety andcompliance in the use of these medicines are largely dependent on proper verbal aswell as written communication between prescriber and patient. However, severalpublished reports suggest that such communication is often inadequate. The presentstudy indicated suboptimal doctor-patient communication at a tertiary care hospitalin Nepal. Fifty-two (21.7%) of the 240 patients/caregivers interviewed after out-patientconsultation claimed that doctors did not provide any information on prescribedmedicines. Nearly a quarter of the 188 patients/caregivers who did report havingreceived information could not recall what they had been told, and in more than halfof these cases the lack of recall was attributed to problems in communication. Frequentuse of the English language and Latin abbreviation in prescribed dosing schedulesindicated a need for improvement in written communication as well.Key Words: prescribing information; communication; physician-patient interaction; Nepal.

Retinopathy progression and visual outcomes after phacoemulsification in patients with diabetes mellitus

OBJECTIVES

To determine the rate of progression of diabetic retinopathy after phacoemulsification surgery, and whether surgeon experience and/or surgical duration adversely affect visual outcome.

METHODS

A retrospective review of 150 eyes of 119 diabetic patients who underwent phacoemulsification surgery during a 5-year period was performed. Data collected included patient age, sex, type and duration of diabetes, diabetic control, associated systemic health factors, preoperative visual acuity and retinopathy grade, duration of surgery, intraoperative complications, and postoperative course. The effect of these factors on visual outcome and rate of retinopathy progression was studied by means of univariate and stepwise multivariate logistic regression analyses. Resident and private cases were compared.

RESULTS

Visual acuity improved by 2 or more lines in 117 eyes (78%); 93 eyes (62%) had a final visual acuity of at least 20/40. Retinopathy progression was seen in 37 eyes (25%) with 6 to 10 months of follow-up. Preoperative nonproliferative diabetic retinopathy, proliferative diabetic retinopathy, and limited surgical experience were statistically associated with retinopathy progression and poor visual outcome.

CONCLUSIONS

The visual results and rate of retinopathy progression after phacoemulsification surgery in our series did not differ significantly from those reported that used other techniques. Nonproliferative and proliferative diabetic retinopathy and surgical inexperience resulted in an increased rate of retinopathy progression. Arch Ophthalmol. 2000;118:912-917

Retinopathy progression and visual outcomes after phacoemulsification in patients with diabetes mellitus

OBJECTIVES

To determine the rate of progression of diabetic retinopathy after phacoemulsification surgery, and whether surgeon experience and/or surgical duration adversely affect visual outcome.

METHODS

A retrospective review of 150 eyes of 119 diabetic patients who underwent phacoemulsification surgery during a 5-year period was performed. Data collected included patient age, sex, type and duration of diabetes, diabetic control, associated systemic health factors, preoperative visual acuity and retinopathy grade, duration of surgery, intraoperative complications, and postoperative course. The effect of these factors on visual outcome and rate of retinopathy progression was studied by means of univariate and stepwise multivariate logistic regression analyses. Resident and private cases were compared.

RESULTS

Visual acuity improved by 2 or more lines in 117 eyes (78%); 93 eyes (62%) had a final visual acuity of at least 20/40. Retinopathy progression was seen in 37 eyes (25%) with 6 to 10 months of follow-up. Preoperative nonproliferative diabetic retinopathy, proliferative diabetic retinopathy, and limited surgical experience were statistically associated with retinopathy progression and poor visual outcome.

CONCLUSIONS

The visual results and rate of retinopathy progression after phacoemulsification surgery in our series did not differ significantly from those reported that used other techniques. Nonproliferative and proliferative diabetic retinopathy and surgical inexperience resulted in an increased rate of retinopathy progression. Arch Ophthalmol. 2000;118:912-917

A combination light-pipe, soft-tipped suction, and infusion cannula instrument for macular translocation

PURPOSE

To describe a combination light-pipe, soft-tipped suction needle, and infusion cannula instrument for use in macular translocation surgery.

METHODS

Macular translocation surgery was performed in human cadaver and live rabbit eyes with a combination light-pipe, soft-tipped suction needle, and infusion cannula instrument.

RESULTS

A combination light-pipe, soft-tipped suction needle, and infusion cannula can be used for macular translocation. This instrument is useful for relocating the retina after a 360 peripheral retinotomy is created. It can also be used for macular translocation with the scleral imbrication technique when superior movement of the fovea is required. When used in combination with another soft-tipped suction needle instrument, this surgical instrument allows precise bimanual placement of the retina with simultaneous infusion of liquid perfluorocarbon for fixating the macula to its new location.

CONCLUSION

A combination light-pipe, soft-tipped suction needle, and infusion cannula instrument may be a useful tool for macular translocation surgery.

The use of topical aqueous suppressants in the prevention of postoperative intraocular pressure elevation after pars plana vitrectomy with long-acting gas tamponade

OBJECTIVE

To determine whether topical aqueous suppressant therapy applied after pars plana vitrectomy with gas tamponade prevents postoperative intraocular pressure (IOP) elevation.

DESIGN

Prospective, nonrandomized comparative study.

PARTICIPANTS

Forty-one patients who met inclusion criteria and underwent pars plana vitrectomy with gas tamponade (SF6 18%-20% or C3F8 12%-16%) over a 1-year period.

INTERVENTION

Treatment eyes received topical aqueous suppressants at the end of surgery.

MAIN OUTCOME MEASURES

Postoperative IOP at 4 to 6 hours, 1 day, and 1 week.

RESULTS

Twenty-one control and 20 treatment eyes met the inclusion criteria. The IOP (in mmHg) measured at 4 to 6 hours (23.05 [control, 14.73 [treatment]) and 1 day (23.24 [control], 17.28 [treatment]) postoperatively showed a statistically significant difference between the groups (P = 0.0038) at 4 to 6 hours and a trend toward significance (P = 0.057) at 1 day. Eleven control and three treatment eyes had an IOP spike above 25 mmHg at 4 to 6 hours or 1 day postoperatively (P = 0.02), and six control eyes and one treatment eye had postoperative IOP greater than 30 mmHg. A pressure rise greater than 40 mmHg was seen in two control eyes and no treatment eyes.

CONCLUSIONS

Use of topical aqueous suppressants after pars plana vitrectomy with long-acting gas tamponade is effective in preventing significant postoperative IOP elevation in most cases.

The development of choroidal neovascularization in pregnancy

PURPOSE

To evaluate the possible association between the development of choroidal neovascularization (CNV) and pregnancy.

METHODS

A retrospective review was performed of the clinical records of three patients who were pregnant at the time a choroidal neovascular membrane (CNVM) was diagnosed. The clinical presentations and treatment of the CNVM occurring in association with the pregnancies are described.

RESULTS

Each patient had a decrease in visual acuity during her pregnancy: one in the first trimester, one in the second trimester, and one in the third trimester. Two patients were diagnosed with CNV related to presumed ocular histoplasmosis syndrome (POHS) and one with an idiopathic CNVM. The two-patients with POHS showed progression of CNV after childbirth. All patients received laser photocoagulation directly to the site of the CNV. The two patients with ocular histoplasmosis experienced recurrence after treatment; one received further photocoagulation treatment, and the other underwent vitrectomy with removal of the CNVM.

CONCLUSIONS

Pregnancy and the immediate postpartum period may be associated with development or recurrence of CNV in POHS or idiopathic cases. This may be related to hormonal changes during pregnancy, or the cases described may reflect only a coincidental association. This report discusses possible causal factors and mechanisms.

Ancient-modern concordance in Ayurvedic plants: some examples

Ayurveda is the ancient (before 2500 b.c.) Indian system of health care and longevity. It involves a holistic view of man, his health, and illness. Ayurvedic treatment of a disease consists of salubrious use of drugs, diets, and certain practices. Medicinal preparations are invariably complex mixtures, based mostly on plant products. Around 1,250 plants are currently used in various Ayurvedic preparations. Many Indian medicinal plants have come under scientific scrutiny since the middle of the nineteenth century, although in a sporadic fashion. The first significant contribution from Ayurvedic materia medica came with the isolation of the hypertensive alkaloid from the sarpagandha plant (Rouwolfia serpentina), valued in Ayurveda for the treatment of hypertension, insomnia, and insanity. This was the first important ancient-modern concordance in Ayurvedic plants. With the gradual coming of age of chemistry and biology, disciplines central to the study of biologic activities of natural products, many Ayurvedic plants have been reinvestigated. Our work on Commiphora wightti gum-resin, valued in Ayurveda for correcting lipid disorders, has been described in some detail; based on these investigations, a modern antihyperlipoproteinemic drug is on the market in India and some other countries. There has also been concordance for a few other Ayurvedic crude drugs such as Asparagus racemosus, Cedrus deodara, and Psoralea corylifolia.

Ancient-modern concordance in Ayurvedic plants: some examples

Ayurveda is the ancient (before 2500 b.c.) Indian system of health care and longevity. It involves a holistic view of man, his health, and illness. Ayurvedic treatment of a disease consists of salubrious use of drugs, diets, and certain practices. Medicinal preparations are invariably complex mixtures, based mostly on plant products. Around 1,250 plants are currently used in various Ayurvedic preparations. Many Indian medicinal plants have come under scientific scrutiny since the middle of the nineteenth century, although in a sporadic fashion. The first significant contribution from Ayurvedic materia medica came with the isolation of the hypertensive alkaloid from the sarpagandha plant (Rouwolfia serpentina), valued in Ayurveda for the treatment of hypertension, insomnia, and insanity. This was the first important ancient-modern concordance in Ayurvedic plants. With the gradual coming of age of chemistry and biology, disciplines central to the study of biologic activities of natural products, many Ayurvedic plants have been reinvestigated. Our work on Commiphora wightti gum-resin, valued in Ayurveda for correcting lipid disorders, has been described in some detail; based on these investigations, a modern antihyperlipoproteinemic drug is on the market in India and some other countries. There has also been concordance for a few other Ayurvedic crude drugs such as Asparagus racemosus, Cedrus deodara, and Psoralea corylifolia.

Visual outcomes after pars plana vitrectomy for epiretinal membranes associated with pars planitis

OBJECTIVE

To evaluate the results of pars plana vitrectomy and membrane stripping for visually significant macular epiretinal membranes associated with chronic idiopathic pars planitis.

DESIGN

Consecutive noncomparative case series.

PARTICIPANTS AND METHODS

The records of all patients who underwent pars plana vitrectomy for pars planitis from 1988 through 1997 were retrospectively reviewed. Seven eyes of five patients who were diagnosed with visually significant epiretinal membranes associated with pars planitis and who underwent vitrectomy and membrane stripping were analyzed. Patients were diagnosed with pars planitis based on characteristic clinical signs and pertinent negative laboratory test results.

INTERVENTION

Pars plana vitrectomy and epiretinal membrane stripping.

MAIN OUTCOME MEASURES

Visual acuity and inflammatory grade were compared between the last preoperative visit and the most recent follow-up visit. Intraoperative and postoperative complications were also analyzed.

RESULTS

The mean patient age was 31 years (range, 6 to 45 years). The mean duration of uveitis was 6.4 years (range, 6 months to 13 years). All patients were treated with combinations of periocular, topical, and oral corticosteroids before surgery. Five eyes had laser retinopexy, and two eyes had cryopexy to the inferior retina at the time of surgery. Five eyes had at least 3 Snellen lines of visual acuity improvement, and visual acuity in one eye worsened by 2 lines. Mean preoperative visual acuity was 20/73 (range, 20/50 to 20/300), and mean final visual acuity was 20/37 (range, 20/25 to 20/70). Five eyes had a final visual acuity of 20/40. Vitritis improved in all cases. Mean follow-up was 23 months (range, 3 to 54 months). Six of seven eyes had progressive cataract development, four of which underwent cataract extraction. No other intraoperative or postoperative complications occurred.

CONCLUSIONS

Removal of epiretinal membranes associated with pars planitis can be safely performed and may result in improved visual acuity. Patients often require subsequent cataract extraction to obtain the best long-term final acuity.

Progression of diabetic retinopathy after endophthalmitis

OBJECTIVE

To determine the effect of endophthalmitis on diabetic retinopathy.

DESIGN

Noncomparative case series.

METHODS

The records of all consecutive patients with endophthalmitis treated between 1992 and 1997 at the Medical College of Wisconsin were retrospectively reviewed. Those patients with diabetes mellitus were analyzed.

PARTICIPANTS

From 77 reviewed records, 11 patients (12 eyes; 14%) were identified as diabetics with endophthalmitis and were studied.

MAIN OUTCOME MEASURES

Stage of diabetic retinopathy, time to retinopathy progression, and visual acuity.

RESULTS

Mean patient age was 68 years, and mean duration of diabetes was 11.7 years. Mean patient follow-up was 17 months. Of the six cases without evidence of retinopathy before the endophthalmitis, none went on to develop retinopathy. Of six eyes with pre-existing nonproliferative retinopathy, four showed evidence of progression within 6 months of the infection. Three developed severe proliferative disease and macular edema, and one developed severe nonproliferative disease. More patients without pre-existing retinopathy achieved a final visual acuity of 20/40 or greater.

CONCLUSIONS

Patients with pre-existing diabetic retinopathy may be at increased risk for rapid retinopathy progression and a poorer visual outcome after endophthalmitis. These results support the concept that inflammation may exacerbate diabetic retinopathy.

Optic nerve sheath decompression for progressive central retinal vein occlusion

OBJECTIVE

To review our results with optic nerve sheath decompression (ONSD) for progressive central retinal vein occlusions (CRVO).

METHODS

Patients selected all had evidence of progressively worsening CRVO, a component of optic nerve swelling, and most were already monocular from prior disease in the contralateral eye. ONSD was performed using a nasal approach under retrobulbar anesthesia.

RESULTS

Eight eyes from 8 patients with a mean follow-up of 12 months were analyzed. Six patients improved, 2 worsened. Mean preoperative visual acuity was 20/160, and mean final postoperative visual acuity was 20/70. No complications occurred. Nonischemic CRVOs, patients < 65 years old, and those undergoing ONSD within 3 months of presentation seemed to do better.

CONCLUSION

ONSD may improve vision or stabilize visual loss in patients with progressive CRVO.

A case of ureteric obstruction, retroperitoneal fibrosis, and carcinoid tumour

We report the incidental finding at surgery for retroperitoneal fibrosis of a carcinoid tumour causing complete right ureteric obstruction. Retroperitoneal fibrosis is an uncommon inflammatory disease that leads to extensive fibrosis throughout the retroperitoneum. It can occur at any age, peak incidence being in patients between 40 and 60 years of age. Carcinoid tumours arise from enterochromaffin or amine precursor uptake and decarboxylation cells that occur in gastrointestinal tract. Carcinoid tumours are an uncommon clinical entity and incidence varies with gender and age. No association between retroperitoneal fibrosis and carcinoid tumour has been previously reported in the English literature, although one case has been reported in a French journal.

Methotrexate treatment for sarcoid-associated panuveitis

OBJECTIVE

To determine the safety and efficacy of low-dose methotrexate (MTX) for sarcoid-associated panuveitis.

DESIGN

Retrospective noncomparative case series.

PARTICIPANTS

Twenty eyes from 11 patients were analyzed. Eight patients had sarcoidosis. Three patients were clinically suspected of sarcoidosis despite negative laboratory testing. All charts of patients with sarcoidosis and idiopathic uveitis seen by the Duke Uveitis Service from 1989 to 1997 were retrospectively reviewed. Those with sarcoid-associated or sarcoid-suspected panuveitis treated with MTX with a minimum of 6 months of follow-up were studied.

INTERVENTION

Low-dose MTX was administered to patients weekly and patients were followed with serial ophthalmologic and medical examinations.

MAIN OUTCOME MEASURES

Visual acuity, oral and topical corticosteroid requirements, anterior chamber inflammation, and ability to undergo successful cataract extraction were used to measure the efficacy of MTX therapy.

RESULTS

After MTX treatment was initiated, 90% of eyes had preserved or improved visual acuity. Mean initial Snellen visual acuity was 20/62 and mean final acuity was 20/40 (P = 0.044). Of those patients initially requiring oral corticosteroids, the dosage was decreased in 100%, and they were completely discontinued in 86%. The mean initial oral corticosteroid dose was 26.6 mg and the mean final dose was 1.5 mg (P = 0.012). Topical corticosteroids were decreased in 63% of eyes. The mean initial use was once every 1.6 hours, and the mean final use was once every 3.9 hours (P = 0.001). Ninety-five percent of eyes had stabilized or decreased inflammation. The mean initial inflammation score was 1.2, and the mean final score was 0.5 (P = 0.007). Five of six eyes previously unable to have cataract extraction because of uncontrolled inflammation became quiet on MTX and underwent surgery. One hundred percent of these eyes had improved vision after surgery. Side effects were mild and transient or reversible.

CONCLUSION

Low-dose MTX is an effective and safe adjunct to treat chronic sarcoid-associated panuveitis.

Retinopathy progression and visual outcomes after phacoemulsification in patients with diabetes mellitus

PURPOSE

To determine the rate of progression of diabetic retinopathy following phacoemulsification surgery and to determine if surgeon experience and/or surgical duration adversely affect visual outcome.

METHODS

A retrospective review of 150 eyes of 119 diabetic patients who underwent phacoemulsification surgery over a 5-year period was performed. Data collected included patient age, sex, type and duration of diabetes, diabetic control, associated systemic health factors, preoperative visual acuity and retinopathy grade, duration of surgery, intraoperative complications, and postoperative course. The effect of these factors on visual outcome and rate of retinopathy progression was studied. Resident and private cases were compared.

RESULTS

The visual acuity improved by two or more lines in 117 eyes (78%). Ninety-three eyes (62%) had a final visual acuity greater than or equal to 20/40. Retinopathy progression was seen in 37 eyes (25%) followed up for 6 to 10 months. Preoperative nonproliferative diabetic retinopathy, prolonged surgical duration, and limited surgical experience were statistically associated with retinopathy progression.

CONCLUSIONS

The visual results and rate of retinopathy progression after phacoemulsification surgery in our series do not appear to differ significantly from those reported using other techniques. Nonproliferative diabetic retinopathy, longer surgical duration, and surgical inexperience resulted in an increased rate of retinopathy progression.

Rupture of the triceps muscle at its attachments

A case of rupture of the triceps muscle at both the origin and insertion is presented and no similar case has been reported in the literature, to the best of our knowledge.

Decrease in intraocular pressure after orbital decompression for thyroid orbitopathy

BACKGROUND

The effect of thyroid orbitopathy on intraocular pressure (IOP) remains controversial. We carried out a study to determine the effect of orbital decompression surgery on the IOP in patients with advanced thyroid orbitopathy.

METHODS

The records of 12 consecutive patients (22 eyes) who underwent decompression surgery for severe thyroid orbitopathy between 1985 and 1996 were reviewed. All patients were maintained on essentially the same medications before and after surgery. The IOP readings, obtained by means of applanation tonometry in primary gaze, from the pre- and postoperative visits were recorded, and the net change was calculated.

RESULTS

The mean preoperative and postoperative IOP values were 19.8 mm Hg and 16.8 mm Hg respectively, a significant difference (p = 0.008). Seven of eight eyes with an IOP of 21 mm Hg or greater preoperatively had a postoperative IOP less than 21 mm Hg; these eyes showed a mean decrease in IOP of 5.6 mm Hg. The degree of preoperative IOP elevation was found to be a strong predictor of the amount of IOP lowering after surgery (p = 0.014).

INTERPRETATION

Our results support the concept that orbital congestion associated with thyroid orbitopathy produces an increase in IOP by elevation of episcleral venous pressure (EVP) and that orbital decompression may reduce the IOP by decreasing EVP. Decompression surgery may obviate the need for more aggressive management of glaucoma in patients with severe thyroid orbitopathy.