In vitro and Ex vivo study targeting the development of a Lavandula stoechas L. (Ustukhuddūs) loaded Unani Transdermal patch: Implication of Unani Medicine in the treatment of Nisyan (Dementia)

Ustukhuddūs (Lavandula stoechas L.) has been extensively used orally and topically in treating various neurological disorders, including dementia. The optimum potential of traditional dosage forms of Ustukhuddūs is limited for various reasons. Transdermal drug delivery system (TDDS) is a novel means of drug delivery and is known to overcome the drawbacks associated with traditional dosage forms. The current study aimed at fabricating and evaluating Ustukhuddūs hydro-alcoholic extract (UHAE) and essential oil (UEO) loaded matrix-type transdermal patches having a combination of hydrophilic - hydroxyl propyl methyl cellulose (HPMC) and hydrophobic - ethyl cellulose (EC) polymers. ATR-FTIR, DSC, XRD, and SEM analysis were carried out to study drug-polymer interactions, confirming the formation of developed patches and drug compatibility with excipients. We assessed the fabricated patches to evaluate their physicochemical properties, in vitro drug release, and permeation characteristics via ex vivo experiments. The physicochemical characteristics of patches showcased the development of good and stable films with clarity, smoothness, homogeneity, optimum flexibility and free from causing skin irritancy or sensitization. In vitro drug release and ex vivo permeation profile of developed patches were evaluated employing Franz diffusion cells. UHAE and UEO patches exhibited a cumulative drug release of 81.61 and 85.24 %, respectively, in a sustained-release manner and followed non-Fickian release mechanisms. The ex vivo permeation data revealed 66.82 % and 76.41 % of drug permeated from UHAE and UEO patches, respectively. The current research suggests that the formulated patches are more suitable for TDDS and hold potential significance in the treatment of dementia, contributing to enhanced patient compliance, thereby highlighting the implication of Unani Medicine in Nisyan (Dementia) treatment.

Arq Ajīb - a wonder Unani formulation for inhibiting SARS-CoV-2 spike glycoprotein and main protease - an in silico approach

OBJECTIVES

The current pandemic caused by Severe Acute Respiratory Syndrome Corona-Virus 2 (SARS-CoV-2) has become a global health menace with significant morbidity and mortality besides huge socioeconomic implications. Despite the approval of few vaccines for the prevention of the disease, the discovery of safe and effective countermeasures especially from natural sources is of paramount importance, as the number of cases continues escalating. Arq Ajīb has long been used for various diseases and its ingredients have been reported for antiviral, antimicrobial, antipyretic, anti-inflammatory, antioxidant activities. The present study investigates the inhibitory effect of phytocompound of Arq Ajīb on potential drug targets of SARS-CoV-2.

METHODS

The structures of phytocompounds present in Arq Ajīb were retrieved from PubChem database and some were illustrated using Marvin Sketch. SARS-CoV-2 S glycoprotein (PDB ID: 6LZG) and 3CLpro (PDB ID: 7BQY) were selected as the target protein. Dock Prep module in UCSF Chimera software was used for receptor structure processing. AutoDock Vina was used to calculate the binding affinities between the protein and ligands and to predict most promising compounds with best scores.

RESULTS

Molecular docking results predicted that the phytocompounds of Arq Ajīb had good binding affinity and interaction with S glycoprotein and 3CLpro. Quercetin and Isorhoifolin from Mentha arvensis were identified as promising candidates with the potential to interact with 3CLpro and spike glycoprotein and inhibit the viral replication and its entry into the host.

CONCLUSIONS

Arq Ajīb may prove valuable for developing novel therapeutic candidate for COVID-19; however, it has to be substantiated further with in-vitro and in-vivo studies.

Effect of natural and synthetic androgen hormone on sex reversal of Nile Tilapia (Oreochromis niloticus)

The present study aimed to produce a monosex population of all male Nile tilapia (Oreochromis spp.) using 17α-methyl testosterone and common carp testes (as a source of natural androgen). Trial was conducted into two consecutive phases, the first was fry (4-5 days old)administration with negative control (without hormone) and positive control (with hormone) feed viz., MT1:60mg/kg, MT2:70mg/kg (17α-MT), carp testis CT1:70% and CT2:80% for 30 days to reverse the sex of male fish and the second phase was nursing the fingerlings for two months on control diet (32% Crude protein).Results revealed a significant growth rate (P<0.05) in the control group where final weight (4.8±0.34ab) and weight gained was recorded as 0.66±0.03ac. In proximate chemical composition of body meat, CT2 treatment showed maximum retention of crude protein, crude fat, and ash whereas dry matter showed maximum retention in MT2 and CT1 treatments. Morphological and histological examination revealed significant difference (p<0.05) in phenotypic males of Nile tilapia fed with the highest percent in MT-treated diet (MT2) of 95±0.58a while MT1, CT2 and CT1 had males of 85±6.0b, 70±5.0b and 65±6.5b, respectively. It was concluded that synthetic androgen (17αMT) was more effective for masculinization but natural androgen scan be an alternative method to produce male tilapia population in an environment-friendly manner as they are inexpensive, eco-friendly, and radially available. These results suggested that synthetic and natural androgen supplementation in the diet plays a significant role in improving growth performance and body composition.

Analytical review of Tiryāq-i-Wabāī - A Unani panacea for the control of COVID-19

Introduction

COVID-19 has affected the whole world drastically and led to a substantial loss of human life. Relentless research is underway to identify effective treatment to control the disease. Traditional systems are also being explored to search for a potent drug. Unani formulation 'Tiryāq-i-Wabāī' has long been used in cholera, plague and other epidemic diseases. This review is aimed at analysing the possible role of Tiryāq-i-Wabāī in the prevention and control of COVID-19.

Methodology

Unani classical texts and Pharmacopoeias available in the library of Regional Research Institute of Unani Medicine, Chennai were reviewed to collect information related to epidemics, commonly prescribed drugs during epidemics, and therapeutic uses of Tiryāq-i-Wabāī ingredients. ScienceDirect, Springer, PubMed and Google Scholar were searched to collect information regarding current pandemic and pharmacological activities of ingredients and phytoconstituents present in the formulation. The collected data was analyzed and interpreted.

Results

Tiryāq-i-Wabāī was found to be the most recommended prophylactic and curative drug during epidemics. The formulation ingredients, Sibr (Aloe vera (L.) Burm.f.), Murr Makki (Commiphora myrrha (T.Nees) Engl.) and Zāfrān (Crocus sativus L.) are categorized under Tiryāqi Advia (literally - antidote drugs) and are considered to be very effective in SARS related conditions. These ingredients have been reported to exhibit immunomodulatory, antioxidant, antiviral, antibacterial, antitussive, smooth muscle relaxant, antipyretic and anti-inflammatory activities corroborating the traditional use of Tiryāq-i-Wabāī.

Conclusion

Scientific data imply great potential and utility of the formulation which could be a possible alternative approach for the prevention and control of current and future pandemics.

Effect of Ḥijāma (wet cupping), Dalk (massage) and Bukhūr (medicated steam) in amelioration of Waja al-Zahr (non-specific low back pain) - an open prospective clinical trial

OBJECTIVES

Low back pain is the most widespread musculoskeletal ailment and a common cause of disability worldwide. Conventional medicine typically treats low back pain with a combination of physical therapy; activity modification and rest; pain-relieving and anti-inflammatory medications which are associated with huge socioeconomic implications and adverse drug reactions. In contrast Ḥijāma, Dalk and Bukhūr are ancient medical techniques recommended in the management of musculoskeletal disorders with little or no adverse effects. To evaluate the safety and effectiveness of Ḥijāma bi'l Shart (wet cupping), followed by Dalk (Massage) with Roghan Dafli and Bukhūr (medicated steam) with Tukhm Soya (Anethum graveolens Linn) in patients of Waja al-Zahr (Non-specific Low back pain).

METHODS

Patients of either gender in the age group of 18-50 years with low back pain persisting for four weeks or more as chief complaint were recruited in the trial. The study was GCP compliant. The duration of the protocol therapy carried out was 14 days.

RESULTS

Ninty two patients of NSLBP were screened, of which 34 who fulfilled the inclusion criteria and were willing to participate in the study were recruited. Three participants were lost to follow-ups due to personal reasons and 31 patients completed the trial during the study period. Overall therapeutic response observed in this study was 97% while 3% of the patients did not respond to intervention.

CONCLUSIONS

The study findings imply that there is a credible evidence to ensure that the regimens intervened are safe and effective in ameliorating the symptoms of Waja al-Zahr.

Effects of co-administration of Unani pharmacopoeia formulations Qurs Tabasheer Sartani and Arq Hara Bhara with CAT-I antitubercular drugs in rats

OBJECTIVES

Tuberculosis continues to be a major public health problem globally, despite incredible advancements in healthcare system. In Unani system of medicine, Qurs Tabasheer Sarthani (QTS) and Arq Hara Bhara (AHB) have been traditionally used for tuberculosis like conditions. The study was aimed to investigate the effects of co-administration of QTS and AHB with category I first line antitubercular drugs (CAT-I) on the indices of liver and kidney function in rats.

METHODS

QTS and AHB were prepared individually and mixed to achieve final compound Unani pharmacopoeia formulation (UPF). The human equivalent doses for rats were calculated and administered with and without CAT-I. The effects of the formulations on serum indices of kidney and liver function, hematological markers and plasma CAT-I drug levels were estimated at 14th, 60th & 180th days of treatment.

RESULTS

The administration of UPF, CAT-I and UPF + CAT-I altered the levels of aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP) and gamma glutamyltransferase (GGT) and haematological markers. These alterations were within permissible range and randomly distributed among groups during various time points. Administration of CAT-I alone resulted in moderate histopathological changes which were completely abrogated in CAT-I + UPF co-administered animals. The co-administration of UPF with CAT-I improved the plasma peak rifampicin (RIF) levels, without altering the liver and kidney functions.

CONCLUSIONS

The co-administration of UPF with ATT improved liver and kidney functions and increased the plasma levels of RIF. These beneficial findings provide a scope to evaluate the pharmacokinetic studies in humans.

Emergence of antimicrobial resistance and magnitude of Unani medicine - scope and challenges

Emergence of antimicrobial resistance, with practically all newly developed and even more potent antibiotics like carbapenem and colistin, has become a matter of great public health concern. A number of common diseases of public health importance are becoming harder and sometimes impossible to treat due to increased resistance of pathogens. These alarming threats seek prime attention of scientific community to develop newer antibiotics with long-lasting efficacy, least side effects, and low economic burden. Unani classical texts have enormous citations on different infectious diseases. Many single drugs and compound formulations are in vogue since ages for the treatment of infectious diseases. Use of Afaviya (spices), Mufarrehat (exhilarants), Tiryaqi Advia (drugs with antidote properties) and Sirka (vinegar) is highly advocated in treating various infectious diseases. Though, enormous research activities have been undertaken worldwide to explore and develop newer antibiotics from natural resources, indicating massive magnitude of natural products in treating various infectious diseases, however, the higher plants, still largely seems to be unexplored. Moreover, elaborated and well controlled clinical studies are still lacking to authenticate their clinical significance. Hence, a rigorous, well-designed & well-structured research is highly paramount to ascertain the provision of newer, relatively safe and cost effective natural antibiotics.

Lithotriptic effect of Safūf Hajar-al Yahūd in patients of Hasat-ul Kilya (Nephrolithiasis) - an open prospective clinical validation trial

BACKGROUND

Hasat-ul Kilya (Nephrolithiasis) is one of the most common chronic conditions and has been known to the mankind since antiquity. The incidence is increasing globally with geographic, racial and gender variation in its occurrence. Medical management of Nephrolithiasis still poses a considerable challenge for modern medical practice. Unani drugs possessing lithotriptic activity are not only cost effective but also have least side effects. Safūf Hajar-al Yahūd has been used since long for the treatment of Hasat-ul Kilya (Nephrolithiasis) but no documentary evidence based on scientific parameters as to its safety and efficacy are available.

OBJECTIVE

To validate the safety and efficacy of Safūf Hajar-al Yahūd in the treatment of Hasat-ul Kilya.

METHODOLOGY

An open prospective clinical trial was carried out on 107 subjects of renal calculi of 3-7 mm diameter diagnosed by Ultrasonogram-KUB (USG-KUB). Subjects were evaluated by clinical history & examination, laboratory investigations followed by USG-KUB for confirmation. The safety was assessed by reporting of adverse events and by pathological and biochemical investigations. Assessment of efficacy was based on improvement observed in VAS score and expulsion/reduction of stone size as detected by USG-KUB.

RESULTS

Substantial reduction (53%) in the size of calculi confirmed by USG-KUB and considerable lowering of VAS score (75%) were observed with the active intervention in majority of the cases.

CONCLUSION

The trial has revealed that the Unani pharmacopoeal formulation Safūf Hajar-al Yahūd was well tolerated and has the therapeutic potential in the reduction and expulsion of renal calculi.

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.

Antimicrobial and wound healing potential of Marham-e-Aatshak (A Herb-o-Mineral formulation)

Marham-e-Aatshak (MA) is a Unani ointment, with wide use for treating chronic and infectious wounds since long time. This study was designed to screen the antimicrobial and wound healing potential of MA to validate the ethno-therapeutic claims. The agar diffusion method was used to study the antimicrobial action of MA as well as for all of its ingredients. Inhibition zone diameters were measured and MIC values were calculated. Wound healing activity was studied in models of both, excision and incision wounds. Wound contractibility was measured at different intervals in excision wound model; similarly tensile strength was measured in incision wound model. MA and its ingredients showed remarkable inhibitory activity against most of the organisms. In excision wound, a significantly enhanced wound contraction and significantly reduced epithelialization period was observed. In incision wound, significant increase in the mean breaking strength in the test group was observed. The results indicate that MA is capable of fighting against wound infections and able to potentiate the natural healing process.

Frequency and reasons of donor deferral prior to blood donation process: a single centre experience

OBJECTIVE

The aim of the study was to determine the frequency and reasons for donor deferral prior to the blood donation process in our population.

BACKGROUND

Transfusion is an irreversible event that carries potential risks as well as benefits to the recipient. Therefore, donor selection prior to blood donation is one of the most important steps in ensuring the safety of blood and blood products.

METHODS

A cross-sectional study was carried out at the blood bank department in our hospital from January 2012 to December 2014. All the blood donors who visited our department in the study period were included in this study.

RESULTS

A total of 25 901 potential donations were recorded during the study period, comprising 24 309 (93·8%) replacement and 1592 (6·2%) voluntary donations. Females accounted for only 222 (0·9%) of potential donations. Deferral occurred in 3156 (12·2%) of attempts; 280 (1·1%) were permanently deferred, while 2876 (11·1%) were temporarily deferred. The most common reason for permanent deferral was a history of hepatitis B infection (n = 147, 4·7% of all deferrals). Major reasons for temporary donor deferral were low levels of haemoglobin (n = 971, 30·76%), low levels of platelets (n = 611, 19·35%) and previous history of jaundice (n = 192, 6·1%).

CONCLUSIONS

This study reported a fairly similar pattern of donor deferrals as in other regional studies. Low haemoglobin levels and a history of hepatitis B infection were the most common factors for temporary and permanent donor deferrals, respectively.

Factors Associated with Periodontal Disease in Pregnant Diabetic Women

There have been an association between systemic diseases and hormonal changes particularly diabetes which has been cited as a risk factor in the progression of periodontitis in pregnant women. The incidence and severity of periodontal diseases are increasing at a higher rate and a common condition in pregnant diabetic women among Bangladeshi population. This cross sectional study included 200 pregnant women who were selected from gynecological department and examined at the dental unit. The clinical parameters used were the Silness and Loe plaque index (PI), gingival scores and periodontal status and any relationship to socio demographic variables (age, occupation, level of education and urban or rural residence) and clinical variables (gestation period, previous pregnancy, type of diabetes and periodontal maintenance) were evaluated. The results showed that these clinical parameters increased concomitantly with an increase in the stage of pregnancy and in women with multiple pregnancies. Increased age, lower level of education, unemployment and patients residing in rural areas were associated with significantly higher gingival scores and periodontal measures. Women with increased age and multiple pregnancies usually have less interest to frequent periodontal maintenance showing a significant statistical relation between an increased age and changes in gingival and periodontal status; however no significant association was found between increased age and plaque index. It is concluded that gingival inflammatory symptoms are aggravated during pregnancy in diabetic women and are related to different clinical and demographic variables.

Effect of detoxification (tadbeer) in content of toxic metabolites of Strychnos nux-vomica: A Unani approach for its use in human

Background:

Azaraqi (Strychnos nux-vomica, Loganiaceae) has been the important Unani medicine since long time as a stimulant, anti-inflammatory, and blood purifier. It has been used very frequently by the Unani practitioner. But the Unani system recommends application of azaraqi in medicine only after its detoxification (tadbeer) may be because of the presence of its deadly poisonous alkaloids (strychnine and brucine). In the present investigation, an attempt has been made to quantify the actual content of their toxic alkaloids before and after the tadbeer.

Materials and Methods:

A sensitive high-performance thin layer chromatographic (HPTLC) method has been developed for estimation of strychnine and brucine in different samples of azaraqi before and after tadbeer. Precoated HPTLC silica gel plates were used as stationary phase and (toluene: Ethyl acetate: Dietylamine 7:2:1 v/v/v) was used as mobile phase.

Result:

The R_f value of strychnine and brucine was found as 0.53 and 0.41, respectively. Detection and quantification were performed by densitometry at 270 nm. The calibration plot was linear in the range of 50–1000 ng of strychnine and brucine, respectively, with the correlation coefficient (r²) 0.993 and 0.991 for strychnine and brucine, respectively, which confirms good linearity. The content of strychnine was 0.175, 0.07, 0.18, 0.051, and 0.075% w/w whereas brucine was 0.16, 0.117, 0.061, 0.045, and 0.057 in crude azaraqi, azaraqi without outer cover, azaraqi outer cover only, azaraqi mudabbar and azaraqi mudabbar by fried in ghee, respectively.

Conclusion:

The detoxification results in sharp decrease in content of toxic metabolites. The process by boiling in milk was found much effective but tedious as compare to frying method.

Open access colonoscopy in the training setting: which factors affect patient satisfaction and pain?

BACKGROUND AND STUDY AIM

Patient satisfaction with colonoscopy is important for quality assurance; it may be affected by various factors, including patient characteristics, physician training level, and procedural or organizational features. We aimed to analyze how these factors influenced patient satisfaction and pain in an outpatient training setting.

METHODS

Consecutive patients for open access colonoscopy (OAC) were enrolled in a prospective, single-blinded, controlled study. Primary and secondary outcomes were satisfaction and pain scores with and without trainee participation. A multivariate analysis was designed to achieve an 80 % power with an alpha value of 0.05.

RESULTS

368 patients were enrolled. Satisfaction with the procedure was high (mean score 1.36; 1 = best to 5 = worst). In the multivariate analysis only waiting time in the endoscopy suite was significantly associated with lower satisfaction scores ( P = 0.024). Satisfaction was unaffected by patient factors (gender, American Society of Anesthesiologists' [ASA] score, anxiety, etc). Higher pain scores were associated with higher anxiety levels ( P = 0.02), female gender ( P = 0.02), longer procedure ( P< 0.001), and lower sedation levels ( P = 0.001); trainee involvement (49 % of procedures) did not adversely affect satisfaction or pain scores.

CONCLUSIONS

Patient satisfaction with OAC using sedation appears to depend primarily on organizational factors (waiting time beforehand). In contrast, pain is associated with patient characteristics (female gender, anxiety) and procedural factors (lower sedation, longer procedure). Trainee participation did not affect satisfaction or pain scores, a finding which may help to reassure patients undergoing OAC with trainee participation.

Secretin: hypothalamic distribution and hypothesized neuroregulatory role in autism

1. This study aims (1) to determine whether secretin is synthesized centrally, specifically by the HPA axis and (2) to discuss, on the basis of the findings in this and previous studies, secretin's possible neuroregulatory role in autism. 2. An immunocytochemical technique with single-cell resolution was performed in 12 age/weight-matched male rats pretreated with stereotaxic microinjection of colchicine (0.6 microg/kg) or vehicle into the lateral ventricle. Following 2-day survival, rats were anesthetized and perfused for immunocytochemistry. Brain segments were blocked and alternate frozen 30-microm sections incubated in rabbit antibodies against secretin, vasoactive intestinal peptide, glucagon, or pituitary-adenylate-cyclase-activating peptide. Adjacent sections were processed for Nissl stain. Preadsorption studies were performed with members of the secretin peptide family to demonstrate primary antibody specificity. 3. Specificity of secretin immunoreactivity (ir) was verified by clear-cut preadsorption control data and relatively high concentrations and distinct topographic localization of secretin ir to paraventricular/supraoptic and intercalated hypothalamic nuclei. Secretin levels were upregulated by colchicine, an exemplar of homeostatic stressors, as compared with low constitutive expression in untreated rats. 4. This study provides the first direct immunocytochemical demonstration of secretinergic immunoreactivity in the forebrain and offers evidence that the hypothalamus, like the gut, is capable of synthesizing secretin. Secretin's dual expression by gut and brain secretin cells, as well as its overlapping central distribution with other stress-adaptation neurohormones, especially oxytocin, indicates that it is stress-sensitive. A neuroregulatory relationship between the peripheral and central stress response systems is suggested, as is a dual role for secretin in conditioning both of those stress-adaptation systems. Colchicine-induced upregulation of secretin indicates that secretin may be synthesized on demand in response to stress, a possible mechanism of action that may underlie secretin's role in autism.

Laparoscopic cholecystectomy: a report on 2000 cases

BACKGROUND/AIMS

This is a retrospective study to evaluate the results of laparoscopic cholecystectomy after 2000 cases at a single center.

METHODOLOGY

Between June 1992 and February 2000, 2000 patients (1458 females and 542 males, mean age 39.8 years) with symptomatic gallstones underwent laparoscopic cholecystectomy. All cases were diagnosed by abdominal ultrasonography. Preoperative endoscopic retrograde cholangiopancreatography was done for 31 patients. Four trocars were used for all except 20 cases.

RESULTS

The mean operative time was 45 +/- 15 minutes. Conversion to open cholecystectomy occurred in 147 patients (7.35%). Adhesions were the commonest cause of conversion (2.9%). There was no technique-related mortality. Bile duct injury occurred in 7 cases (0.35%), reconstruction by Rouxen-Y hepaticojejunostomy was necessary in 5 cases and the injury was successfully managed by endoscopic stent in 2 cases. Bile leakage occurred in 11 cases (0.55%), peritonitis in 5 cases (0.25%), internal hemorrhage in 9 cases (0.45%), cystic artery injury in 17 cases (0.85%), pneumothorax in one case (0.05%) and subcutaneous emphysema in 3 cases (0.15%).

CONCLUSIONS

Laparoscopic cholecystectomy is a good alternative to open cholecystectomy with an acceptable morbidity. Conversion to open cholecystectomy at the proper time will prevent major complications.

Epicardial echocardiography for correct placement of the intracardial biventricular assist device (Impella)

BACKGROUND

Correct placement of the intracardial biventricular assist device (Impella) as a supporting system for off-pump coronary surgery is routinely checked by transesophageal echocardiography and invasive pressure measurements. However, it remains difficult to verify the accurate position of the right heart system when the posterior wall is exposed.

METHODS

In 23 patients undergoing augmented beating heart CABG surgery, the correct placement of the lmpella-system was controlled by TEE as well as by a new 15-6 L epicardial echotransducer (EE) (Agilent, Andover, MA).

RESULTS

TEE assisted well in inserting the system in all patients. The correct placement of the distal end of the right heart system 1.5 cm behind the pulmonary valve was verified in 18/23 cases by TEE vs. 23/23 cases by EE. Dislocation of the devices during tilting of the heart could only be verified by EE.

CONCLUSIONS

Epicardial echocardiography is a useful, innovative method for monitoring the correct placement of the new intracardial biventricular assist device during beating-heart surgery.

Immunogenicity of a serogroup B meningococcal vaccine against multiple Neisseria meningitidis strains in infants

BACKGROUND

The serogroup B meningococcus is responsible for the majority of cases of meningococcal disease in temperate countries. Infants and young children <2 years of age are at greatest risk of disease. This study assessed the immunogenicity in infants of a serogroup B meningococcal outer membrane protein vaccine that has been used extensively in disease outbreaks in Cuba and several Latin American countries and shown to be efficacious in teenagers.

METHOD

One hundred five healthy infants entering the routine vaccination schedule in Havana, Cuba, were given either 2 or 3 doses of the serogroup B meningococcal vaccine VA-MENGOC-BC at 3.5, 5.5 and 7.5 months of age. Immune response pre- and postvaccination was determined by the conventional serum bactericidal assay (SBA), a more sensitive novel whole blood bactericidal assay (WBA) and immunoglobulin ELISA.

RESULTS

In 52 and 46% of infants >50% killing of the vaccine serogroup B strain (B:4:P1.19,15) and serogroup C strain, respectively, was demonstrated by the WBA after 2 doses of the vaccine. Serum bactericidal activity (4-fold increase in titer) was induced in only 27% against the vaccine serogroup B strain and in 14% against the serogroup C strain. The changes in WBA and SBA were mirrored by the serogroup B and C immunoglobulin ELISA. Cross-reactive immunogenicity against other (heterologous) serogroup B strains was demonstrated for one of the four further strains assessed by WBA. By age 16 to 18 months SBA, WBA and ELISA responses had declined considerably. The addition of a third dose of vaccine did not appear to significantly influence immunogenicity at 17 months of age.

CONCLUSION

The serogroup B outer membrane protein vaccine VA-MENGOC-BC induces a demonstrable immune response in infants against both the serogroup B vaccine strain and against a serogroup C strain. Cross-reactive immunogenicity against other (heterologous) serogroup B strains is limited in this age group.

Assessment of immune response to meningococcal disease: comparison of a whole-blood assay and the serum bactericidal assay

A whole-blood assay (WBA), which assesses the complete bactericidal activity of blood, was compared with the serum bactericidal assay (SBA), which measures antibody and complement mediated cell lysis. Twenty children infected with serogroup B strains and 25 infected with serogroup C strains were studied 8-12 weeks after disease, and 29 healthy children were used as controls. The infecting strain (convalescent children only) and two reference strains, MC58 (B:15:P1.7, 16) and NCTC 8554 (C:NT:P1.5) were used. In children previously infected with a serogroup B strain, bactericidal activity was detected in 95% and 85% to their infecting strain by the WBA (>50% killing) and the SBA (s), respectively. Bactericidal activity to the reference serogroup B and C strain was detected by WBA in 70 and 75% of children, respectively, and the SBA in 45% and 20%. In contrast bactericidal activity was detected to both serogroup C strains in >80% of children previously infected with a serogroup C strain using either assay and in 48% (WBA) and 20% (SBA) to the reference serogroup B strain. Levels of bactericidal activity were detectable in fewer control children. Children convalescing from meningococcal disease develop an immune response to their infecting strain, detectable by both the WBA and SBA, which is independent of age. However, the WBA appears to be a more sensitive measure of bactericidal activity to heterologous strains than the SBA.

Activation of complement by mannose-binding lectin on isogenic mutants of Neisseria meningitidis serogroup B

Mannose-binding lectin (MBL) is a serum protein that has been demonstrated to activate the classical complement pathway and to function directly as an opsonin. Although MBL deficiency is associated with a common opsonic defect and a predisposition to infection, the role of the protein in bacterial infection remains unclear. We have investigated MBL binding to Neisseria meningitidis serogroup B1940 and three isogenic mutants, and the subsequent activation of the two major isoforms of C4 (C4A and C4B) by an associated serine protease, MASP. The mutants lacked expression of the capsular polysaccharide (siaD-), the lipo-oligosaccharide (LOS) outer core that prevented LOS sialylation (cpsD-), or both capsule and LOS outer core (cps-). Using flow cytometry, it was possible to detect strong MBL binding to the cps- and cpsD- mutants over a wide range of concentrations. In contrast, minimal or no MBL binding was detected on the parent organism, with binding to siaD- only at higher MBL concentrations. C4 was activated and bound by mutants that had previously bound MBL/MASP, but there was no significant difference in the amounts of C4A and C4B bound. When sialic acid residues were removed from the parent organism by neuraminidase treatment, the binding of both MBL and C4 increased significantly. Our results suggest that MBL may bind to and activate complement on these encapsulated organisms, and the major determinants of these effects are the LOS structure and sialylation.

Rat pineal alpha 1-adrenoceptor subtypes: studies using radioligand binding and reverse transcription-polymerase chain reaction analysis

1. The pharmacological characteristics of alpha 1-adrenoceptor binding sites in rat pineal gland membranes, detected by use of a selective alpha 1-adrenoceptor antagonist ([125I]-iodo-2-[beta-(4-hydroxyphenyl) ethylaminomethyl]tetralone, [125I]-HEAT), were investigated with the alkylating agent, chloroethylclonidine (CEC), and in competition experiments with a number of adrenoceptor agonists and antagonists. 2. Chloroethylclonidine (CEC) treatment (10 microM, 10 min) of rat pineal membranes inactivated approximately 70% of specific [125I]-HEAT binding sites. Higher concentrations of CEC (up to 100 microM) or longer treatment periods (up to 40 min) were no more effective. 3. Adrenoceptor agonists and antagonists competitively inhibited [125I]-HEAT binding with Hill coefficients close to unity indicating a single alpha 1-adrenoceptor subtype is present. The affinity (Ki) of subtype selective agonists (oxymetazoline, SDZ NVI-085) and antagonists (5-methylurapidil, WB4101, benoxathian, phentolamine) was consistent with binding to an alpha 1B-adrenoceptor subtype. 4. The (-)- and (+)-enantiomers of niguldipine had an equal and low affinity for alpha 1-adrenoceptor binding sites both in untreated (log Ki-6.66 and -6.90 respectively) and CEC-treated membranes in which approximately 70% of sites had been inactivated (log Ki-6.41 and -6.86 respectively). This indicates that the small proportion of alpha 1-adrenoceptors insensitive to CEC are not alpha 1A-adrenoceptors. 5. mRNA was isolated from rat pinealocytes, cDNA was synthesized and then amplified by the polymerase chain reaction with alpha 1-adrenoceptor subtype specific primers. These experiments identified both alpha 1A- and alpha 1B-adrenoceptor mRNA, but not alpha 1D-mRNA in rat pinealocytes, although all three adrenoceptor subtypes were readily identified in rat brain cortex. 6. These data indicate that although both alpha 1A- and alpha 1B-adrenoceptor mRNAs are present in the pineal the major subtype of alpha 1-adrenoceptor expressed is the alpha 1B.

Peritoneal dialysate IgG/C3 levels do not predict susceptibility to peritonitis

OBJECTIVE

To investigate the usefulness of dialysate IgG and C3 concentrations in predicting likelihood of developing peritonitis.

DESIGN

Prospective, longitudinal, and comparative study.

SETTING

Single university teaching hospital dialysis unit and outpatient clinic.

PATIENTS

Thirty-four uremic patients were studied (20 males, 14 females: mean age 47.2, range 20-73 years). Monthly serum and overnight dialysate (eight- to eleven-hour dwell) samples were obtained for IgG and C3 estimations over the first six months of the study, and trimonthly samples were obtained thereafter. All patients performed exchanges using standard transfer sets (Baxter system II, Baxter Healthcare Ltd., Thetford, Norfolk, U.K.), used no hypertonic fluid (3.86%) for overnight exchanges, and were followed up for a minimum of 18 months.

OUTCOME MEASURES

Dialysate and serum levels of IgG and C3; peritonitis episodes.

RESULTS

Forty-five episodes of peritonitis occurred in 24 patients during the study period. We examined opsonin levels in the group as a whole, and then in two subgroups of patients: those who remained peritonitis-free throughout the study, and those who did not. There were no significant differences between IgG and C3 levels in the two groups at any time point, and large interpatient and intrapatient variation in levels were seen.

CONCLUSION

Dialysate levels of IgG and C3 from the overnight dwell are not helpful in predicting the risk of developing continuous ambulatory peritoneal dialysis peritonitis in individual patients. No correlation was found between opsonin levels and onset of clinical peritonitis.

Ranitidine increases the bioavailability of imbibed alcohol by accelerating gastric emptying

To investigate the mechanism of the increase in alcohol bioavailability by ranitidine, we determined by nuclear scan the changes in gastric emptying of a 10% ethanol solution (containing 0.3 g ethanol/kg body weight and 300 microCi of technetium-labeled diethylene triamine pentacetic acid) in 8 normal men, before and after treatment with 300 mg ranitidine orally each evening for 1 week. We compared these changes with those of ethanol bioavailability, calculated by integration of the Michaelis-Menten function over the entire alcohol curves after random i.v. and, on a separate day, oral administration of the same ethanol dose, pre- and post-ranitidine. With ranitidine, we found an acceleration of gastric emptying in 7 of 8 subjects, with 20% shortening of the time to 50% emptying (51.8 +/- 4.1 min vs 64.3 +/- 3.4, without ranitidine; P < .001 by paired t test). Despite the disappearance (from the stomach) of most of the dose by the end of the blood alcohol curves, only 83 +/- 4% reached the systemic blood vs 64 +/- 4% without ranitidine (P < .02), most likely because of a shortened exposure of alcohol dehydrogenase to optimal ethanol concentrations. As a result, after oral but not intravenous alcohol administration, ranitidine increased blood alcohol concentrations (29 +/- 4 mg/dl vs 22 +/- 3, without ranitidine; P < .02), with a corresponding decrease in first pass metabolism of ethanol from 107 +/- 16 mg/kg to 47 +/- 16 (P < .01).

The investigation of Epstein-Barr viral sequences in 41 cases of Burkitt's lymphoma from Egypt: epidemiologic correlations

BACKGROUND

Epstein-Barr virus (EBV) is associated with many human neoplasms, including Burkitt's lymphoma (BL). Endemic BL in central Africa is more often EBV-associated than BL in the United States, where seroconversion for EBV occurs somewhat later than in Africa. Therefore, the EBV association rate in BL may correlate more with the socioeconomic status of the population studied, which influences the age of EBV seroconversion, than with such factors as malaria, which may relate to the overall higher incidence rate in endemic regions.

METHODS

Forty-one patients with BL in Egypt, which differs both climatically and racially from central African countries (i.e., Kenya, Uganda) where BL is endemic, were analyzed. All biopsies were evaluated for EBV-encoded RNAs (EBER1) by RNA in situ hybridization, analyzed for p53 protein expression using the monoclonal antibody D07, and immunophenotyped using a panel of monoclonal antibodies that included L26 (CD20), Leu 22 (CD43), and A6 (CD45RO). Twelve cases were evaluable for EBV subtype by polymerase chain reaction with EBV-specific primers.

RESULTS

The median age at diagnosis was 9 years (range, 2-22 years). The biopsy site was extranodal in 29 patients and nodal in 12 patients. All 41 cases were documented as B-cell neoplasms. A hybridization signal for EBER1 RNA was identified in greater than 95% of the neoplastic cells in 30 of 41 cases (73%), whereas no signal was observed in 11 cases (27%). Epstein-Barr virus subtype 1 was found in 10 patients, subtype 2 in two patients. Immunostaining for p53 was observed in greater than 5% of the neoplastic cells in 9 of 37 cases (24%). No significant correlation was observed between EBV positivity and sex, biopsy site, or p53 immunostaining.

CONCLUSIONS

The prevalence of EBV in BL from Egypt is slightly lower than in BL in endemic regions, but significantly higher than in sporadic BL. Epstein-Barr virus positivity probably reflects the socioeconomic status of the patient population, and age at seroconversion. The prevalence of EBV subtype 1 suggests that immunodeficiency does not play a role in Egyptian Burkitt's lymphoma, in contrast to endemic Burkitt's lymphoma, in which holoendemic malaria is thought to contribute to immunodeficiency, a higher incidence rate, and the observed prevalence of subtype 2.

An unusual case of retroperitoneal fibrosis

With several hundred cases reported there is still much speculation about the etiology of idiopathic retroperitoneal fibrosis. We report an unusual case of retroperitoneal fibrosis with histologically identical lesion in the maxillary sinus, which has not been previously described. Both lesions showed dramatic response to corticosteroids but relapsed frequently on withdrawal of steroids, highlighting the importance of long-term follow-up.

Serum lipoprotein (a) concentrations in patients undergoing continuous ambulatory peritoneal dialysis

Lipoprotein (a) is a subspecies of low-density lipoprotein which possesses as part of its protein moiety a mutant form of plasminogen termed apolipoprotein (a), and which may be closely related to the risk of ischaemic heart disease and cerebral infarction. We have investigated the serum concentrations of lipoprotein (a) and other lipoproteins in 24 male patients on CAPD and compared them to healthy men (n = 100) and to age-matched healthy controls (n = 38). The most striking finding was a substantial elevation of serum lipoprotein (a) in CAPD patients in whom it was 46.9 (2.2-168) mg/dl (median and range) compared to 9.0 (< 0.6-87.4) mg/dl in healthy control group and 6.7 (< 0.6-84.2) mg/dl in age-matched controls (both P < 0.001). Patients, when compared to healthy men, also had significantly increased serum triglycerides (median and range, 1.94 (0.55-8.00) versus 1.24 (0.36-4.40) mmol/l; P < 0.001), very-low-density lipoprotein cholesterol (median and range, 0.98 (0.10-3.71) versus 0.46 (0.10-1.17) mmol/l; P < 0.001), and lower-high-density lipoprotein cholesterol (mean +/- 1 SD, 1.26 +/- 0.29 versus 1.35 +/- 0.31 mmol/l). Of these, however, only the difference in very-low-density lipoprotein cholesterol remained statistically significant (P < 0.001) in comparison to age-matched controls. The marked elevation of serum lipoprotein (a) in patients on CAPD may be due to increased hepatic synthesis as a consequence of the substantial amounts of plasma proteins lost in the dialysate. Elevated serum lipoprotein (a) concentrations in CAPD patients may contribute to their risk of coronary artery disease.

Simultaneous occurrence of IgA nephropathy and sarcoidosis in the context of pre-existent minimal change nephrotic syndrome

Simultaneous occurrence of IgA nephropathy and sarcoidosis is described in a 42-year-old Asian female, who earlier had a steroid-resistant, no light microscopy change nephrotic syndrome that resolved spontaneously. Occurrence of three, apparently unrelated conditions in this case may be fortuitous, or causally related. We discuss the possible causal relationship amongst these conditions.

Imipenem versus netilmicin and vancomycin in the treatment of CAPD peritonitis

Imipenem/cilastatin is a new thienamycin antibiotic with a broad bactericidal spectrum. We undertook a prospective randomised study to compare the safety and efficacy of intraperitoneal (IP) imipenem/cilastatin (2 gm daily) [group A; 21 patients, mean age 49.2 years] with a combination of IP netilmicin and vancomycin (500 and 60-100 mg daily resp.) [group B; 20 patients, mean age 55.2 years] in CAPD peritonitis. Each patient underwent 4 daily CAPD exchanges with antibiotics in alternate exchanges. The causative organisms were similar in both the groups as was the duration of therapy (gr.A: 6.8 +/- 0.27 days; gr.B: 7.2 +/- 0.51 days; p = NS). Complete cure was marginally better with imipenem/cilastatin (gr.A; 94.1%, gr.B: 83.3%) with less relapses (gr.A: 1 episode; gr.B: 3 episodes). One episode in gr.A (S. aureus) and 2 in gr.B (Yeast & Proteus) failed to resolve and required catheter removal. Two gr. A patients developed generalised convulsions which settled after discontinuation of the drug. Whilst the results show no significant difference in the outcome in the two groups, the use of IP imipenem would offer a possible advantage as a single antibiotic. Larger experience is needed before imipenem can be recommended as a 'blind' first line agent for CAPD peritonitis.

Two actions of gamma-aminobutyric acid on the responses of the isolated basilar artery from the rabbit

1 In the isolated basilar artery of the rabbit, gamma-aminobutyrate acid (GABA) (ED50 +/- s.e. mean, 2.4 +/- 1.1 x 10(-5) M) produced a relaxation, if the tone had been increased with 5-hydroxytryptamine (5-HT). 2 3-Aminoproprane sulphonic acid (3-APS) produced a similar, but smaller relaxation, while baclofen had no effect. The relaxation produced by GABA was inhibited by bicuculline. 3 Transmural electrical stimulation produced a reproducible contraction of the isolated basilar artery. In 9 out 14 preparations GABA (ED50 +/- s.e. mean, 5.6 +/- 2.1 x 10(-7) M) caused a reduction of the response, with a maximum of 49.2 +/- 4.3%. Bicuculline did not inhibit these responses to GABA. 4 Baclofen (ED50 +/- s.e. mean, 6.8 +/- 1.4 x 10(-7) M) produced a similar inhibition (47.4 +/- 3.2% maximum) but 3-APS had no effect. 5 GABA (10(-4) M) had no effect on the tone of isolated mesenteric or internal carotid arteries from the rabbit, whether or not the tone was increased with 5-HT. Similarly, GABA (10(-4) M) did not produce any change in the responses to transmural stimulation in isolated mesenteric or internal carotid arteries. 6 These findings are consistent with the presence of two types of GABA receptor on the rabbit basilar artery.

Setaria cervi: enzymes in microfilariae and in vitro action of antifilarials

Microfilariae of bovine filarial parasite Setaria cervi are equipped with the enzymes of glycolysis, pentose phosphate and PEP-succinate pathways and thus resemble the adult form in its metabolic pattern. Malate dehydrogenase was the most active enzyme in microfilariae followed by lactic dehydrogenase and fumarase, while phosphoglucoisomerase, PEP-carboxykinase and FDP-aldolase were comparatively less active. The very low ratio of PK/PEPCK in S. cervi microfilariae indicates active fixation of CO2 into PEP to produce oxalacetate. Centperazine and diethylcarbamazine significantly inhibited PEP-carboxykinase, fumarate reductase and succinic dehydrogenase, suggesting that these antifilarials probably exert microfilaricidal action by blocking the PEP-succinate pathway.

Actions of dopamine and apomorphine on the vasoconstrictor responses of perfused mesenteric arteries of mouse, rat and rabbit

Dopamine (10(-7)--10(-6) M) and apomorphine (5 x 10(-7)--5 x 10(-6) M) inhibited the vasoconstrictor responses of the perfused mesenteric artery preparations of rat, rabbit and mouse to adrenergic nerve stimulation but did not affect responses to added noradrenaline. The inhibitory effects of both dopamine and apomorphine were prevented by haloperidol (3 x 10(-7) M) but not by yohimbine (3 x 10(-8) M) in rat and rabbit mesenteric artery preparations. In contrast, yohimbine (3 x 10(-8) M), but not haloperidol, antagonized the inhibitory effect of dopamine and apomorphine in mouse mesenteric artery preparations. In higher concentrations, dopamine (10(-6)--10(-4) M) produced a direct vascoconstrictor effect, which involved post-junctional alpha-adrenoceptors in all three species. However, in preparations contracted with 10(-7) M 5-hydroxytryptamine and in the presence of phentolamine (3 x 10(-7) M) and propranolol (10(-6) M), dopamine (10(-6)--10(-4) M) produced a direct relaxant effect in rabbit mesenteric artery preparations but not in those of rat and mouse. It is suggested that inhibition of neurogenic vasoconstrictor responses, by dopamine and apomorphine, may be mediated through a specific prejunctional inhibitory dopamine receptor in the mesenteric artery of rat and rabbit whereas in the mouse they involve activation of alpha-adrenoceptors.