The Treatment of Visceral Leishmaniasis: Safety and Efficacy

Visceral leishmaniasis is the disease of poor; however availability of only expensive treatment of this disease impinges the socioeconomic condition of those affected. If untreated, almost all cases of visceral leishmaniasis are fatal. The demonstration of the leishmania donovani bodies from the tissue aspirates or serological tests confirms the diagnosis of the disease. Pentavalent antimony, amphotericin B, paromomycin, diamine pentamidine, miltefosine, sitamaquine and some new combinations are integrated in the limited therapeutic armoury for treatment of visceral leishmaniasis. The recommended first and second line therapy in the Indian sub-continent is miltefosine and amphotericin B respectively.Pentavalent antimonial, preceding first line therapy, has been replaced by miltefosine due to former increasing failure rate and toxicity.The problem of drug resistance, some of the serious drug toxicities along with high-priced drugs extends challenges equally to pharmaceutical companies and medical practitioners.More research on adverse drug events for the existing drugs and efforts to develop safer and effective drugs to counter resistance outbreaks for the successful management of visceral leishmaniasis are needed.  Keywords: amphotericin; miltefosine; pentavalent antimony; paromomycin.    

Functional Outcome in Patients with Chronic Plantar Fasciitis Treated with Plantar Fascia Stetching vs Tendoachilles Stretching Exercises

DOI: http://dx.doi.org/10.2126/joim.v35i1.8895 Journal of Institute of Medicine, April, 2013; 35:32-38

Transforming growth factor-beta 1 (TGF-B1) liberation from its latent complex during embryo implantation and its regulation by estradiol in mouse

Transforming growth factor-beta (TGF-B) plays an important role in embryo implantation; however, TGF-B requires liberation from its inactive latent forms (i.e., large latent TGF-B complex [LLC] and small latent TGF-B complex [SLC]) to its biologically active (i.e., monomer or dimer) forms in order to act on its receptors (TGF-BRs), which in turn activate SMAD2/3. Activation of TGF-B1 from its latent complexes in the uterus is not yet deciphered. We investigated uterine latent TGF-B1 complex and its biologically active form during implantation, decidualization, and delayed implantation. Our study, utilizing nonreducing SDS-PAGE followed by Western blotting and immunoblotting with TGF-B1, LTBP1, and latency-associated peptide, showed the presence of LLC and SLC in the uterine extracellular matrix and plasma membranous protein fraction during stages of the implantation period. A biologically active form of TGF-B1 (~17-kDa monomer) was highly elevated in the uterine plasma membranous compartment at the peri-implantation stage (implantation and nonimplantation sites). Administration of hydroxychloroquine (an inhibitor of pro-TGF-B processing) at the preimplantation stage was able to block the liberation of biologically active TGF-B1 from its latent complex at the postimplantation stage; as a consequence, the number of implantation sites was reduced at Day 5 (1000 h), as was the number of fetuses at Day 13. The inhibition of TGF-B1 showed reduced levels of phosphorylated SMAD3. Further, the delayed-implantation mouse model showed progesterone and estradiol coordination to release the active TGF-B1 form from its latent complex in the receptive endometrium. This study demonstrates the importance of liberation of biologically active TGF-B1 during the implantation period and its regulation by estradiol.

The treatment of visceral leishmaniasis: safety and efficacy

Visceral leishmaniasis is the disease of poor; however availability of only expensive treatment of this disease impinges the socioeconomic condition of those affected. If untreated, almost all cases of visceral leishmaniasis are fatal. The demonstration of the leishmania donovani bodies from the tissue aspirates or serological tests confirms the diagnosis of the disease. Pentavalent antimony, amphotericin B, paromomycin, diamine pentamidine, miltefosine, sitamaquine and some new combinations are integrated in the limited therapeutic armoury for treatment of visceral leishmaniasis. The recommended first and second line therapy in the Indian sub-continent is miltefosine and amphotericin B respectively.Pentavalent antimonial, preceding first line therapy, has been replaced by miltefosine due to former increasing failure rate and toxicity.The problem of drug resistance, some of the serious drug toxicities along with high-priced drugs extends challenges equally to pharmaceutical companies and medical practitioners. More research on adverse drug events for the existing drugs and efforts to develop safer and effective drugs to counter resistance outbreaks for the successful management of visceral leishmaniasis are needed.

Kyphoplasty for the treatment of pain distant to osteoporotic thoracolumbar compressive fractures

Vertebral fractures are one of the most common osteoporotic fractures. We sought to investigate the incidence of distant pain after osteoporotic vertebral compressive fracture (OVCF) at the thoracolumbar junction, and to explore the effect of kyphoplasty in the treatment of distant pain post-OVCF. Eighty-seven patients diagnosed OVCF between T11 and L2 were included in the study. The region of pain and its proximity to the thoracolumbar compressive fracture was recorded. For pain management, all patients received kyphoplasty. The follow-up period was every 3 months for 1-year post-surgery. The Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were used pre-operatively, post-operatively, and at 3-, 6-, and 12-month follow-ups to assess patient status. All patients completed the operation, with 72 patients having focal pain over the compression fracture. Eleven cases also had pain distal to the fracture region in the following areas: lower back, near the iliac crest (n = 6), the groin (n = 3), and the trochanteric region (n = 2). Four cases had pain in distant to the fracture: lower back, near iliac crest (n = 3), and the trochanteric region (n = 1). All patients had a significant improvement in clinical symptoms. The average VAS and the ODI decreased significantly pre-operatively to post-operatively (p < 0.05). In addition to focal tenderness, many patients with thoracolumbar compression fractures may have pain distant to the fracture. This can be successfully treated using kyphoplasty. This phenomenon also indicates that patients at risk of osteoporosis who also have lower back pain should not neglect the potential for a thoracolumbar fracture.

Turmeric (curcumin) remedies gastroprotective action

The purpose of this review is to summarize the pertinent literature published in the present era regarding the antiulcerogenic property of curcumin against the pathological changes in response to ulcer effectors (Helicobacter pylori infection, chronic ingestion of non-steroidal anti-inflammatory drugs, and exogenous substances). The gastrointestinal problems caused by different etiologies was observed to be associated with the alterations of various physiologic parameters such as reactive oxygen species, nitric oxide synthase, lipid peroxidation, and secretion of excessive gastric acid. Gastrointestinal ulcer results probably due to imbalance between the aggressive and the defensive factors. In 80% of the cases, gastric ulcer is caused primarily due to the use of non-steroidal anti-inflammatory category of drug, 10% by H. pylori, and about 8-10% by the intake of very spicy and fast food. Although a number of antiulcer drugs and cytoprotectants are available, all these drugs have side effects and limitations. In the recent years a widespread search has been launched to identify new antiulcer drugs from synthetic and natural resources. An Indian dietary derivative (curcumin), a yellow pigment found in the rhizome of Curcuma longa, has been widely used for the treatment of several diseases. Epidemiologically, it was suggested that curcumin might reduce the risk of inflammatory disorders, such as cancer and ulcer. These biological effects are attributed to its anti-inflammatory and antioxidant activities. It can, therefore, be reported from the literature that curcumin PRevents gastrointestinal-induced ulcer and can be recommended as a novel drug for ulcer treatment.

Assessment of assimilative capacity of Kanhan river stretch using MIKE-11 modeling tool

In the present paper, it is attempted to carry out computer simulation studies for Kanhan river stretch using MIKE-11 modeling tool to evaluate Assimilative Capacity (AC) based on existing and projected waste load scenarios. AC of Kanhan river was estimated in relation to biochemical oxygen demand (BOD) and dissolved oxygen (DO). MIKE-11 model simulates the DO and BOD parameters in a one dimensional fashion by calibrating with field data different constant and model parameters. The modeling studies would help in deciding the appropriate waste load allocation based on stream's AC rather than simple effluent standards. The model studies will provide vital information and greater insight into the impact of point and non-point sources of pollution on quality of Kanhan river in a stretch of 120 km.

Cancer stem cells in osteosarcoma: recent progress and perspective

BACKGROUND

To review the current progress in osteosarcoma stem cells, including isolation and identification, special cell surface markers, relationship between drug-resistance and metastasis, and the involving signal pathways.

METHODS

A review of the literature encompassing osteosarcoma stem cells was performed.

RESULTS

Although the cancer stem cells hypothesis was first proposed about 50 years ago, it is only in the last 10 years that advances in stem cell biology have provided increasing experimental evidence supporting this hypothesis. It has been postulated that within a tumor, a minor subpopulation of cells, termed cancer stem cells (CSC), drive the self-renewal and differentiation that account for the initiation, proliferation, metastasis, therapeutic resistance and recurrence of cancer. The CSC hypothesis opens up a novel conceptual approach for curing tumors that selectively kills CSCs, making it possible to eradicate cancer. Currently, osteosarcoma stem cells have been isolated and identified using various methods. Given the specific stem cell features, the study of CSCs has important implications in osteosarcoma prevention, detection and treatment, especially in curing early metastasis and preventing drug resistance. Focusing on their stem-like character, CSCs can be appropriately targeted by identifying links between the cells and their microenvironment.

CONCLUSION

All of this research is in its infancy - many problems still exist. Further studies are needed to search for specific targeted therapies for osteosarcoma, in-depth study of mechanism of drug resistance, identifying the role that CSCs play in tumor metastasis, and demonstrate the imbalance of specific pathways in osteosarcoma stem cells.

Nutritional Variation of Different Feed Ingredients and Compound Feed Found in Different Parts of Nepal

Many feed industries in various parts of the country have been producing and marketingdifferent types of compound feeds. The source of feed ingredients also varies greatly which willultimately lead to the variation in the quality of finished products. Altogether 493 samples of 50different feed ingredients and compound feed were collected from Baglung, Baitadi, Banke,Chitwan, Darchula, Dolakha, Dolpa, Gorkha, Ilam, Jhapa, Kathmandu, Kaski, Lalitpur,Lamjung, Morang, Mahottary, Makwanpur, Myagdi, Nawal Parasi, Parbat, Parsa, Rasuwa,Rupandehi, Sankhuwasava, Sunsari, Saptari, Sarlahi, Sindhupalchok, Siraha, Syangja andTanahun districts. Highest content of dry matter (99.51%), organic matter (98.45%), total ash(98.14%) and crude protein (67.85%) was recorded for oyster cell, white maize grain, oyster celland meat meal respectively. Similarly, the rice husk was found to be superior in crude fibrecontent (34.46%) In terms of mineral oyster cell was found to be superior in calcium content(35.94%) and bone meal in phosphorous content (1.59%) as compared to other feed ingredients.Key words: Crude fibre; crude protein; dry matter; feed ingredients; organic matter; total ashDOI: 10.3126/narj.v7i0.1872Nepal Agriculture Research Journal Vol.7 2006 pp.75-81

Profiling of E-cadherin, β-catenin and Ca2+in embryo-uterine interactions at implantation

Establishment of early pregnancy is promoted by a complex network of signalling molecules that mediate cell-to-cell and cell-to-extracellular matrix communications between the receptive endometrium and the invasive trophectoderm. In this study, we have attempted to evaluate the expression profiles of cadherin and catenin during embryo implantation in the mouse. Western blotting studies along with immunocytochemical analysis revealed that E-cadherin is expressed rather ubiquitously in the uterine epithelial cells, distinct enrichment is observed on the apical membrane in the endometrium of peri-implantation uterus specifically at the implantation sites and not at the inter-implanation sites. beta-Catenin also is upregulated and is specifically restricted to apical membrane of epithelial cells of implantation sites. Progesterone induced expression of E-cadherin and 17beta-estradiol regulated the expression of catenin in implantation-delayed uteri. Interestingly, estradiol imparted negative modulation on cadherin expression when co-administered with progesterone. On the contrary, trophoblast exhibits a striking down regulation of cadherin, catenin and Ca(2+) at peri implanting stage. These observations suggest that the trophoblasts exhibited an invasive phenotype while the endometrial epithelium displayed an adhesive phenotype during the window of implantation. Thus, embryo implantation presents an instance where two interacting surfaces showed mutually complementing interaction phenotypes.

Identification of non-mitochondrial NADPH oxidase and the spatio-temporal organization of its components in mouse spermatozoa

Though the spermatozoa are known to produce superoxide anion radicals, the enzyme system(s) that produce superoxide in these cells are not yet identified. Using Western blot assays and confocal laser scan microscopy, we detected gp91(phox) and p67(phox) associated with spermatozoa from testis and epididymis. We could not detect p22(phox) in any of the sperm samples analyzed. While the expression of gp91(phox) p67(phox) appeared to be constitutive, p47(phox) was detectable only in spermatozoa from testis and vas deferens. Importantly, p40(phox) could be seen in very high quantities in testicular spermatozoa, which also showed the highest levels of NADPH-oxidase activity. Spermatozoa from cauda epididymidis and vas deferens also showed the presence of p40(phox), though the amount was low when compared with that of testicular spermatozoa. The absence of p22(phox) and the striking correlation between the presence of p40(phox) and the NADPH-oxidase activity suggest that the NADPH oxidase associated with spermatozoa is p22(phox)-independent and that its activity is positively modulated by p40(phox). Further, since the confocal imaging detected that the subunits of the NADPH oxidase are located significantly on the head domains, the spermatozoa appear to present a case with dominant non-mitochondrial superoxide anion producing capabilities.

A mutant Stat5b with weaker DNA binding affinity defines a key defective pathway in nonobese diabetic mice

A number of cytokines that finely regulate immune response have been implicated in the pathogenesis or protection of type 1 diabetes and other autoimmune diseases. It is, therefore, of pivotal importance to examine a family of proteins that serve as signal transducers and activators of transcription (STATs), which regulate the transcription of a variety of cytokines. We report here a defective gene (Stat5b) located on chromosome 11 within a previously mapped T1D susceptibility interval (Idd4) in the nonobese diabetic (NOD) mice. Our sequencing analysis revealed a unique mutation C1462A that results in a leucine to methionine (L327M) in Stat5b of NOD mice. Leu(327), the first residue in the DNA binding domain of STAT proteins, is conserved in all identified mammalian STAT proteins. Homology modeling predicted that the mutant Stat5b has a weaker DNA binding, which was confirmed by DNA-protein binding assays. The inapt transcriptional regulation ability of the mutated Stat5b is proved by decreased levels of RNA of Stat5b-regulated genes (IL-2Rbeta and Pim1). Consequently, IL-2Rbeta and Pim1 proteins were shown by Western blotting to have lower levels in NOD compared with normal B6 mice. These proteins have been implicated in immune regulation, apoptosis, activation-induced cell death, and control of autoimmunity. Therefore, the Stat5b pathway is a key molecular defect in NOD mice.

Antinociceptive activity of chromophoric chain substituted hemicyaninocolourants

Some of the chromophoric chain substituted hemicyaninocolourants (CCHCs) were synthesized and confirmed on the basis of nitrogen analysis. These were tested for their antinociceptive activity in albino rats against tail flick technique and sodium chloride induced writhing test. Test compounds were given in graded doses (10, 20 and 50 mg/kg, intraperitoneally) and compared with morphine and aspirin as standard controls. Two compounds CCHC-1 and CCHC-2 showed antinociceptive activity in a dose-dependent manner in both the experimental models. The compound CCHC-3 did not exhibit antinociceptive activity to any significant extent.

Computed tomography (CT) in late infantile metachromatic leucodystrophy

Computed tomographic features of 7 cases of the late infantile form of MLD confirmed by sural nerve biopsy are presented. Diffuse symmetrical white matter, low attenuation of the cerebral parenchyma was the common feature. Hypodensity of the temporal lobes and the cerebellar hemispheres are 2 features which have not been reported earlier. Three patients had brainstem atrophy without evidence of cerebral atrophy. Awareness of the various CT features of MLD may help in more definitive radiological diagnosis of the disease and to differentiate it from other dysmyelinating diseases of the central nervous system.

An improved polychrome staining method for thick epoxy sections

Improved polychrome staining of 1-1.5 mum epoxy sections is achieved with sequential applications of a single basic fuchsin-methylene blue mixture at two different pH values. The dye solution is applied for 2-3 min at 50-52 C first at pH 7.9, then at pH 6.7. In sections of mouse mammary tissue, epithelial cells are stained deep blue, connective tissue pink, and fat cells bright olive-green. This simple technique consistently yields uniform, vivid, contrasting colors that sharply delineate the elements of the complex glandular architecture of the mammary gland. Similar polychromatic effects are obtained in applications to other tissues, such as stomach, adrenal gland, mammary tumor and artery.