Corrigendum: Structural informatics approach for designing an epitope-based vaccine against the brain-eating Naegleria fowleri

[This corrects the article DOI: 10.3389/fimmu.2023.1284621.].

Structural informatics approach for designing an epitope-based vaccine against the brain-eating Naegleria fowleri

Primary Amoebic Meningoencephalitis (PAM), a severe lethal brain disease, is caused by a parasite, Naegleria fowleri, also known as the "brain-eating amoeba". The chances of a patient's recovery after being affected by this parasite are very low. Only 5% of people are known to survive this life-threatening infection. Despite the fact that N. fowleri causes a severe, fatal infection, there is no proper treatment available to prevent or cure it. In this context, it is necessary to formulate a potential vaccine that could be able to combat N. fowleri infection. The current study aimed at developing a multi-epitope subunit vaccine against N. fowleri by utilizing immunoinformatics techniques and reverse vaccinology approaches. The T- and B-cell epitopes were predicted by various tools. In order to choose epitopes with the ability to trigger both T- and B-cell-mediated immune responses, the epitopes were put through a screening pipeline including toxicity, antigenicity, cytokine-inductivity, and allergenicity analysis. Three vaccine constructs were designed from the generated epitopes linked with linkers and adjuvants. The modeled vaccines were docked with the immune receptors, where vaccine-1 showed the highest binding affinity. Binding affinity and stability of the docked complex were confirmed through normal mode analysis and molecular dynamic simulations. Immune simulations developed the immune profile, and in silico cloning affirmed the expression probability of the vaccine construct in Escherichia coli (E. coli) strain K12. This study demonstrates an innovative preventative strategy for the brain-eating amoeba by developing a potential vaccine through immunoinformatics and reverse vaccinology approaches. This study has great preventive potential for Primary Amoebic Meningoencephalitis, and further research is required to assess the efficacy of the designed vaccine.

Quality Control and Stability Testing of Arq Formulations of Unani Pharmacopeia of India Using HPTLC and GC-MS

BACKGROUND

There is an increasing global demand for traditional medicines because of their efficacy, ease of availability, and few or no side effects. The Unani medicines have long been used in India and abroad for various disorders and diseases. Arqiyat (Arq; distillate) is one of the most widely used Unani formulation prepared by simple distillation from single or combination drugs.

OBJECTIVE

In the present investigation, an attempt has been made to generate data for quality control and stability testing of Arq formulations of the Unani Pharmacopeia of India that includes only three Arq formulations.

METHOD

Arq-e-Nana (AeN), Arq-e-Gazar (AeG), and Arq-e-Brinjasif (AeB) were prepared through hydrodistillation. Quality control and stability analysis were performed by using HPTLC and GC-MS.

RESULTS

Dichloromethane extract of AeB showed maximum of 10 bands at different retardation factor values; however, there are 7 bands in AeN as well as in AeG. GC-MS analysis showed presence of 10 metabolites in AeG, 8 in AeN, and 9 in AeB. Stability studies showed that the shelf life of Arq formulations would be enhanced at refrigeration (5 ± 2°C) conditions.

CONCLUSIONS

The present study highlights quality control and stability analysis of Arq formulations of Unani Pharmacopeia of India using HPTLC and GC-MS.

Aromatic aldehyde compound cuminaldehyde protects nonalcoholic fatty liver disease in rats feeding high fat diet

Nonalcoholic fatty liver disease (NAFLD) is caused by fat accumulation and is related with obesity and oxidative stress. In this study, we investigated the effect of cuminaldehyde on NAFLD in rats fed a high fat diet (HFD). Male Wistar rats were fed a HFD for 42 days to induce NAFLD. The progression of NAFLD was evaluated by histology and measuring liver enzymes (alanine transaminase and aspartate transaminase), serum and hepatic lipids (total triglycerides and total cholesterol), and oxidative stress markers (thiobarbituric acid reactive substances, glutathione, superoxide dismutase, and catalase). The HFD feeding increased the liver weight and caused NAFLD, liver steatosis, hyperlipidemia, oxidative stress, and elevated liver enzymes. Administration of cuminaldehyde ameliorated the changes in hepatic morphology and liver weight, decreased levels of liver enzymes, and inhibited lipogenesis. Our findings suggest that cuminaldehyde could improve HFD-induced NAFLD via abolishment of hepatic oxidative damage and hyperlipidemia. Cuminaldehyde might be considered as a potential aromatic compound in the treatment of NAFLD and obesity through the modulation of lipid metabolism.

Hysteroscopic tissue removal systems for the treatment of intrauterine pathology: a systematic review and meta-analysis

BACKGROUND

The use of mechanical tissue removal systems is more frequently implemented as the first line approach for the treatment of intrauterine pathology. Scientific evidence is provided that their use is easier and faster than the conventional resectoscope. It is necessary to objectively evaluate the results on tissue removal systems for the treatment of endometrial pathology as the reports in the literature are still conflicting.

OBJECTIVE

To review and compare mechanical hysteroscopic tissue removal systems (Truclear®, Myosure® or IBS®) versus conventional bipolar and monopolar resectoscopy for the treatment of polyp and myoma removal. Operation time, completeness of tissue removal, complication rate, fluid deficit, tolerability and learning curve were evaluated.

METHODS

Electronic databases PubMed; Medline and Web of Science were searched for papers published from 1st January 2010 to 1st May 2019 using terms: ("hysteroscopic" or "hysteroscopy" or "hysteroscopic surgery") and ("myoma" or "polyps"). Studies were included if they were retrospective, observational and prospective randomized clinical controlled trials if they investigated the techniques between the tissue removal systems (Truclear®, Myosure® or IBS®) and conventional resectoscopy for the treatment of intrauterine pathology. Data were extracted from the included studies by two independent reviewers. Meta-analysis was performed by Rev Man 5 software (Cochrane Collaboration, London, UK). Results: Overall, 498 patients were analysed from five studies in which there was no difference in age and size of pathology treated either by the hysteroscopic tissue removal systems and the conventional resectoscope. Hysteroscopic tissue removal systems showed a significantly higher success rate of complete endometrial pathology removal (P=0.002) and a significantly shorter operation time for polyp removal (P<0.0001) compared to conventional resectoscopy. No significant differences, in terms of complications rate, were found (P=0.09). The fluid deficit was significantly higher in the tissue removal system group, compared to conventional resectoscopy (P=0.02).

CONCLUSION

Hysteroscopic tissue removal systems showed a major advantage in successful removal of the pathology and total operation time. It is likely that the tissue removal systems are more accessible and have a lower complication profile including perforation, via falsa and bleeding due to its specific action mechanism and shorter operation time but higher-quality trials will be required to confirm this hypothesis.

Operative hysteroscopy with the Bigatti shaver (IBS ®) for the removal of placental remnants

BACKGROUND

About 15-20% of pregnant women will miscarry spontaneously during the first trimester. Traditionally, the surgical treatment of placental remnants has been dilation and curettage (D&C). However, because of its 'blind' nature there is a risk of serious complications, such as infection, adhesion, uterine perforation, or bowel injury. Hysteroscopy, with direct visualization of the uterine cavity, decreases these complications. In this retrospective case series we evaluated the efficacy and the feasibility of operative hysteroscopy using the Intrauterine Bigatti Shaver (IBS ® ) for the treatment of placental remnants, both, in a University hospital in Italy and in a private hospital in Iran.

MATERIALS AND METHODS

From December 2013 to April 2018 a retrospective medical records review, of patients undergoing placental remnant removal with the IBS ® , was performed. Sixty-five patients suspected of retained products of conception (RPOC) underwent operative hysteroscopy during this period using the IBS ® . Placental remnants were confirmed histologically in 52 cases (80%). The median age of the patients was 36 years. Placental remnants were observed after 42 early miscarriages, 5 terminations of pregnancy, 4 vaginal deliveries and 1 cesarean delivery. Thirty-two patients had abnormal uterine bleeding, 15 were asymptomatic and 5 had subfertility after miscarriage. Most cases (90%) were diagnosed by transvaginal ultrasound.

RESULTS

The median interval between surgery and the end of pregnancy was 56 days (a range of 15-90 days). The size of placental remnants was between 15 and 30mm. Three women showed a cavity filled with placental tissue residual (more than 4cm). The median resection time was 4.5 minutes and the median total surgery time was 6.6 minutes. Median fluid deficit [saline solution] was 240 ml. In two cases there was excessive intraoperative bleeding, and one patient required a conversion to bipolar resectoscope for hemostatic reasons. No perforation or postoperative complications occurred. There was no need for second-look operative hysteroscopy and postoperative ultrasound confirmed complete evacuation of the RPOC. Only one patient had a minor adhesion.

CONCLUSION

The IBS ® seems to be an effective and safe instrument for the removal of placental remnants. It allows for short operation time with a high success and low complication rate.

The 19 Fr. Intrauterine Bigatti Shaver (IBS®): a clinical and technical update

In this case report we describe the first two surgeries conducted with the 19 Fr. IBS®. The indication for operative hysteroscopy in both patients was the removal of polyps. The size of the polyps was between 15 mm and 20 mm with a mean resection time of 40 seconds. Normal saline solution (500 ml) was used with a negative fluid loss (100 ml). Both operations were successfully performed under general anaesthesia and no speculum, no tenaculum and no dilatation of the cervical canal were necessary.

Investigation of anti-asthmatic potential of Kanakasava in ovalbumin-induced bronchial asthma and airway inflammation in rats

ETHNO-PHARMACOLOGICAL RELEVANCE

Kanakasava is an Indian traditional Ayurvedic formulation containing Datura (Datura metel), Vasaca (Adhatoda vasica), Dhataki (Woodfordia fruticosa) and Grape (Vitis vinifera) extracts as major constituents and used to treat pulmonary diseases including coughing, breathing difficulty and asthma. The present study was designed to assess the safety and therapeutic efficacy of Kanakasava against ovalbumin-induced bronchial asthma and related airway inflammation in rats due to lack of evidence based therapeutic efficacy data.

MATERIAL AND METHODS

Male wistar rats were sensitized with allergen (ovalbumin, 40mg/rat+aluminum hydroxide, 2.0mg/rat) and treated orally with standard dexamethasone (2.5mg/kg, b.w.) or Kanakasava (1.23 and 2.46ml/kg, b.w.) from day 1 to day 28. Inflammatory markers, including cell counts and cytokines such as interleukins (IL-4, IL-5, IL-1β), tumor necrosis factor (TNF-α), leukotriene (LTD-4), immunoglobulin (IgE), nitric oxide and nitrite levels in both blood and broncheo alveolar lavaged fluid (BALF) were analyzed. Abdominal mesentery was studied histologically for mast cell degranulation, whereas lung functions were investigated by spirometer. Method was also developed to quantify gallic acid and ethyl gallate content in Kanakasava by HPTLC for its quality control.

RESULTS

None of the rats exhibited mortality and Kanakasava was found to be safe at the tested doses. Treatment with Kanakasava significantly (P<0.01) reversed elevated levels of IgE, cytokines, nitrites and influx of eosinophils and neutrophils in blood and BALF. These findings were further supported by the significant improvement in lung functions (P<0.01) and suppression (P<0.01) of degranulation of mast cells. The content of gallic acid and ethyl gallate in Kanakasava was found to be 1.94% and 0.98%, respectively.

CONCLUSION

These findings demonstrated the preventive effect of Kanakasava in allergen induced model of asthma providing scientific basis for its traditional use in Ayurveda, since long time.

Investigation of anti-asthmatic potential of dried fruits of Vitis vinifera L. in animal model of bronchial asthma

Background

Fruits of Vitis vinifera L., commonly known as grapes, are largely consumed worldwide because of their high nutritional and medicinal benefits.

Context and purpose

The present study investigated effects of V. vinifera fruits in ovalbumin-induced animal model of bronchial asthma.

Methods

Male wistar rats (except group 1) were sensitized with allergen (ovalbumin, 40 mg/rat + aluminum hydroxide, 2 mg/rat). Groups of sensitized animals were treated orally with either vehicle (0.4 mL/kg), standard dexamethasone (2.5 mg/kg) or alcoholic extract of V. vinifera dried fruits (31 and 42.5 mg/kg) from day 1 to 28 (n = 6 for all groups). Inflammatory markers including cell counts, cytokines such as interleukin (IL)-4, IL-5, IL-1β, tumor necrosis factor, immunoglobulin E (IgE), leukotrienes and nitrite levels in both blood/serum and bronchoalveolar fluid were analysed. Breathing rate and tidal volume as lung function parameters were examined by spirometer. Lung tissues were studied for histamine content and histopathology.

Results

Treatment of sensitized animals with dexamethasone or two doses of V. vinifera fruits extract inhibited recruitment of inflammatory cytokines, IgE, nitrites and circulating cells particularly eosinophils in blood/serum and bronchoalveolar fluid (p < 0.001, p < 0.01 and p < 0.05). Dexamethasone and V. vinifera fruits extract treatment also normalized lung functions and histamine levels compared to ovalbumin-sensitized controls (p < 0.05 and p < 0.01). Moreover, both drugs exhibited protection against airway inflammation in lung histology.

Conclusion

Results of study demonstrate the effectiveness of V. vinifera fruits in allergic asthma possibly related to its ability to inhibit cellular response and subsequent production of inflammatory cytokines.

Electronic supplementary material

The online version of this article (doi:10.1186/s13223-016-0145-x) contains supplementary material, which is available to authorized users.

Standardization and in vitro antioxidant activity of jatamansi rhizome

Background:

Nardostachys jatamansi Linn. commonly known as jatamansi is a well notorious drug in Indian systems of medicines having various health-related benefits and employed in various herbal formulations due to the presence of high levels of valuable phenolic constituents. The present study was aimed to quality assessment of Jatamansi rhizome by studying macro- and micro-scopic characters along with physicochemical tests, chemo-profiling using thin layer chromatography (TLC), and gas chromatography–mass spectrometry (GC-MS), in vitro antioxidant activity.

Materials and Methods:

Standardization was carried out as per the pharmacopeial guidelines and contaminant estimation was carried out by analyzing the samples for the determination of heavy metals, pesticides, and aflatoxins. Chemo-profiling was done with TLC by optimizing the mobile phase for different extracts. The GC-MS chemo-profiling was also carried out by using hexane soluble fraction of the hydroalcoholic extract. The drug is well known for a protective role in the human body as an antioxidant, so total phenolic contents and in vitro antioxidant efficacy was also determined by using established methods.

Results:

The results of quality control and anatomical studies were very much useful for its identification, whereas significant antioxidant efficacy was also observed. The drug was found free of contaminants when analyzed for pesticides and aflatoxins, whereas heavy metals were found under the pharmacopeial limit.

Conclusion:

The findings of the present research can be utilized for the identification and quality control of the jatamansi rhizome.

Quality control and in vitro antioxidant potential of Coriandrum sativum Linn

Background:

Coriandrum sativum Linn., commonly known as coriander, is a well-known spice and drug in India. It has various health-related benefits and used in various Unani formulations. In this present study, quality assessment of coriander fruits was carried out by studying anatomical characters, physicochemical tests, and chemoprofiling using high performance thin layer chromatography (HPTLC) and gas chromatography-mass spectroscopy (GC-MS) along with in vitro antioxidant potential.

Materials and Methods:

Standardization was carried out as per the pharmacopeial guidelines. Estimation of heavy metals, pesticides, and aflatoxins was carried out to ascertain the presence of any contaminant in the sample. Chemoprofiling was achieved by thin layer chromatography (TLC) by optimizing the mobile phase for different extracts. The most of the pharmacological activities of coriander are based on volatile oil constituents. Hence, GC-MS profiling was also carried out using hexane-soluble fraction of hydro-alcoholic extract. The total phenolic contents and in vitro antioxidant efficacy were determined using previously established methods.

Results:

The quality control and anatomical studies were very valuable for the identification whereas good antioxidant potential was observed when compared to ascorbic acid. The drug was found free of contaminant when analyzed for pesticides and aflatoxins whereas heavy metals were found under reported limits.

Conclusion:

The work embodied in this present research can be utilized for the identification and the quality control of the coriander fruit.

Matrix solid-phase dispersion extraction and quantification of alpinetin in amomum seed using validated HPLC and HPTLC methods

Alpinetin is a flavonoidal constituent of seeds of Amomum subulatum Roxb., recently reported to possess vasorelaxant and antiHIV activities. Simple, accurate and precise HPLC and HPTLC methods were developed for the analysis of alpinetin in A. subulatum seed extracts and extraction technique was optimized to get maximum yield using conventional, ultrasonic and matrix solid phase dispersion extraction. HPLC was performed on a C18 column with methanol and water (70:30, v/v) as mobile phase at a flow rate of 1.0 ml/min whereas HPTLC on silica aluminum sheet (60F₂₅₄) using toluene, dichloromethane and ethyl acetate as solvent system. A sharp peak was obtained for alpinetin at a retention time (R_t) of 5.7 min by HPLC and retardation factor (R_f) of 0.48 by HPTLC. Both methods were validated as per the ICH guidelines and the content of alpinetin was estimated in different extracts. Matrix solid phase dispersion technique was found most suitable for extracting alpinetin as compared to other techniques. Validation data are indicative of good precision and accuracy and proved the reliability of the methods.

Rapid, sensitive, and validated UPLC/Q-TOF-MS method for quantitative determination of vasicine in Adhatoda vasica and its in vitro culture

Background:

Adhatoda vasica a perennial herb has been used in Ayurvedic and Unani system of medicines since last 2000 years and has been employed for the treatment of respiratory tract ailments.

Objective:

To develop and validate new, rapid, and highly sensitive high throughput ultra-performance liquid chromatography/quadrupole-time-of-flight mass-spectrometry (UPLC/Q-TOF-MS) method for the quantitative estimation of vasicine in the leaves and to establish in vitro cultures of Adhatoda vasica for production of vasicine.

Materials and Methods:

The chromatographic separation was achieved on a Waters ACQUITY UPLC™ BEH C8 (100.0 × 2.1 mm; 1.7 μm) column packing using isocratic mobile phase consisting of acetonitrile: 20 mM ammonium acetate (90:10; v/v) in a multiple reactions monitoring mode using the transitions m/z 189.09 → 171.08 for vasicine.

Results:

The vasicine was eluted at 2.58 ± 0.05 min and established a dynamic range of linearity over the concentration range of 1-1000 ng/ml (r² = 0.999 ± 0.0005). The lower limit of detection and quantification was 0.68 and 1.0 ng/ml, respectively. There was no significant difference observed in the content of vasicine (0.92-1.04%w/w) among the eleven samples collected from different locations of India. The in vitro cultures developed showed that addition of extra 28 mM KNO₃ and 100 mM NaCl in MS medium supplemented with 2,4-dichlorophenoxyacetic acid (2,4-D) + benzyladenine (BA) + indole acetic acid (IAA) (1 ppm each) produces faster biomass and higher amount of quinazoline alkaloids.

Conclusion:

Rapid, efficient, and sensitive UPLC/Q-TOF-MS method was developed for the estimation of vasicine and an efficient protocol for development of in vitro cultures was proposed, which can be used at large scale for industrial production of vasicine using bioreactors.

Formulation of nanoemulsion: a comparison between phase inversion composition method and high-pressure homogenization method

There is lot of confusion in the literatures regarding the method of production of nanoemulsion. According to some authors, only the methods using high energy like high-pressure microfluidizer or high-frequency ultra-sonic devices can produce actual nanoemulsions. In contrast to this concept, one research group reported for the first time the preparation of nanoemulsion by a low-energy method. Later on many authors reported about the low-energy emulsification method. The purpose of this work is to formulate, evaluate and compare nanoemulsions prepared using high-energy as well as low-energy method. Nanoemulsions formulated were based on the phase inversion composition technique (low energy method) and were selected from the ternary phase diagram based on the criterion of their being a minimum concentration of S(mix) used in the formulation. For high-pressure homogenization method (high energy method) Design-Expert software was used, and the desirability function was probed to acquire an optimized formulation. No significant difference (p > 0.05) was observed in the globule size of formulations made by each method, but the value of poly-dispersibility index between the two methods was found to be extremely significant (p < 0.001). A very significant difference (p < 0.001) was observed in the drug release from formulations made by each method. More than 60% of the drug was released from all the formulations in the initial 2 h of the dissolution study.

Simple spectrophotometric method for estimation of disodium edetate in topical gel formulations

A simple, sensitive, cost-effective and reproducible UV-spectrophotometric method has been developed and validated for the estimation of disodium edetate in topical gel formulations. Solution of disodium edetate reacts with ferric chloride to form complex in 0.1 N HCl giving λmax at 270 nm. Beer's law was obeyed in the concentration range of 5-50 μg/mL (r (2)= 0.9997). The limit of detection and limit of quantitation were found to be 1.190 and 3.608 μg/mL, respectively. The results show that the procedure is accurate, precise, and reproducible (relative standard deviation < 1%), while being simple and less time consuming. The study concluded that the UV-spectrophotometric method could be used for the quantification of disodium edetate in pure form as well as in pharmaceutical formulations.

Influence of nanotechnology on herbal drugs: A Review

Herbal medicines have been widely used all over the world since ancient times and have been recognized by physicians and patients for their better therapeutic value as they have fewer adverse effects as compared with modern medicines. Phytotherapeutics need a scientific approach to deliver the components in a sustained manner to increase patient compliance and avoid repeated administration. This can be achieved by designing novel drug delivery systems (NDDS) for herbal constituents. NDDSs not only reduce the repeated administration to overcome non-compliance, but also help to increase the therapeutic value by reducing toxicity and increasing the bioavailability. One such novel approach is nanotechnology. Nano-sized drug delivery systems of herbal drugs have a potential future for enhancing the activity and overcoming problems associated with plant medicines. Hence, integration of the nanocarriers as a NDDS in the traditional medicine system is essential to conflict more chronic diseases like asthma, diabetes, cancer, and others.

Autoimmune responses in periodontal diseases

Periodontal diseases are characterized by localized infections and inflammatory conditions and directly affect teeth supporting structures which are the major cause of tooth loss. Several studies have demonstrated the involvement of autoimmune responses in periodontal disease. Evidences of involvement of immunopathology have been reported in periodontal disease. Bacteria in the dental plaque induce antibody formation. Lymphocytes, cytokines and complement system are reported to have an important role in the progression of periodontal disease. The present review describes the involvement of autoimmune responses in periodontal diseases. The mechanisms underlying these responses are also discussed.

Current remedies for vitiligo

Vitiligo is a disorder with complex causes and is a type of autoimmune disease in which the immune system targets the body's own pigment cells and tissues. Our aim is to present an overall view of the current remedies widely adopted for the treatment of vitiligo. Medical treatments target the immune system, and try to reverse the destruction. The goal is to restore the skin's color by restoring healthy melanocytes to the affected area. Apart from melanocytes, vitiligo autoantigens appear also on other cells. Even though antibodies to pigment cells are not an agent of vitiligo, the most valuable contribution is that anti-melanocyte antibody reactivity can help in identifying relevant antigens. T cells from vitiligo skin are highly reactive towards melanoma cells and serve as an effective source to treat melanoma and stays as a solution for vitiligo. There have been many treatments to cure vitiligo such as use of steroid creams, PUVA (psoralen and ultraviolet A light), narrow band UVB (ultraviolet B), various surgical techniques, vitamin D analogues and pseudocatalase. These treatments are subjected for undesired side effects whereas some herbal and natural treatments act against the immune system with no side effects.

Prevalence of obesity in Indian women

Comparison of two major studies conducted by National family health survey (NFHS-2) in 1998-1999 and NFHS-3 in 2005-2006 shows that prevalence of obesity among Indian women has elevated from 10.6% to 12.6% (increased by 24.52%). The prevalence is more profound in the women of age between 40-49 years (23.7%), residing in cities (23.5%), having high qualification (23.8%), belonging to Sikh community (31.6%) and households in the highest wealth quintile (30.5%). Highest percentage of obese women is found in Punjab (29.9%). Although this number seems small in the international perspective, it is significant because of the sheer size of population in India. While the problem of under-nutrition still exists in many parts of India, the additional burden of obesity due to increasing sedentary lifestyle, junk food habits in some urban and economically sound areas is really alarming. Prevention and control of this serious problem through awareness programmes to adopt diversified nutritional food and healthy lifestyle are strongly recommended.

Febrile neutropenia in paediatric peripheral blood stem cell transplantation, in -vitro sensitivity data and clinical response to empirical antibiotic therapy

OBJECTIVE

To find the in-vitro sensitivity data and clinical response in order to determine the changes required in empiric antibiotic therapy for management of febrile neutropenia in paediatric patients undergoing peripheral blood stem cell transplantation.

DESIGN

A descriptive study.

PLACE AND DURATION OF STUDY

Paediatric bone marrow transplant unit at Bismillah Taqee Institute of Health Sciences and Blood Disease Center from September 1999 to May 2004.

PATIENTS AND METHODS

All patients were treated according to institutional protocol for febrile neutropenia. Empirical antibiotics include Ceftriaxone and Amikacin. In non-responders, changes made included Imipenem and Amikacin, Piperacillin Tazobactum/Tiecoplanin or Vancomycin/Cloxacilin/Ceftazidime. In non-responders, amphotaracin was added until recovery.

RESULTS

Out of 52 patients, 5 did not develop any fever; in the remaining 47 patients there were 57 episodes of febrile neutropenia. The mean days of febrile episodes were 4.71 (range 3-8). Fever of unknown origin (FUO) occurred in 31 (54.3%) episodes. Microbiologically documented infection (MDI) occurred in 17 (29.8%) episodes of fever. Clinically documented infection (CDI) occurred in 9 (15.7%) episodes. Gram-negative organisms were isolated in 10 while gram-positive organisms in 7. Klebseilla, S. aureus were the most common isolates. Empirical therapy was effective in 12 of the 33 (36%) episodes. Out of 28, 26 (92%) responded to Imipenem/Amikacin as second line therapy while those who received any other second line combination, only 11 out of 22 (50%) showed response. Systemic Amphotericin was used in 4 patients, 2 responded. Infection related mortality rate was 4%.

CONCLUSION

Gram-negative infections predominated, Imipenem/ Amikacin found to be most effective therapy while a low mortality rate is recorded in our setting suggesting good infection control.

Antidiabetic activity of an ethanol extract obtained from the stem bark of Psidium guajava (Myrtaceae)

This study analyzed the antidiabetic properties of an ethanol extract of the stem bark of Psidium guajava, an indigenous medicinal plant used to control diabetes in Indian System of Medicine. The anti-hyperglycaemic activity of this plant on blood glucose levels of normal, normal glucose loaded (OGTT) and alloxan-induced hyperglycaemic rats was evaluated. The results showed that ethanol stem bark extract exhibited statistically significant hypoglycaemic activity in alloxan-induced hyperglycaemic rats but was devoid of significant hypoglycaemic effect in normal and normal glucose loaded rats (OGTT).

In-vivo purging with the anti-CD20 antibody rituximab along with standard allogeneic peripheral blood stem cell transplantation (PBSCT) for relapsed childhood pre-B acute lymphoblastic leukaemia (ALL)

This case report describes the use of Rituximab for in vivo purging (by intravenous infusion) in a 12 years old boy with second remission of pre-B ALL. It was followed by conditioning therapy consisted of Busulphan and Cyclophosphamide. rh-G-CSF primed stem cells from an HLA identical sibling donor were infused. Standard graft versus host disease prophylaxis was given. He engrafted within two weeks. He did not develop acute graft versus host disease (aGvHD) but localized chronic GvHD developed. He had been on regular follow-up at CMH, Rawalpindi and is in complete remission 13 months post-PBSCT with no evidence of chronic GvHD at present.

Effect of Aralia cachemirica Decne root extracts on blood glucose level in normal and glucose loaded rats

An aqueous and alcoholic extract of the roots of Aralia cachemirica (Araliaceae) were evaluated for hypoglycemic activity in normal fasted and glucose induced hyperglycemic rats. The aqueous and alcoholic extracts at a dose of 250 mg/kg showed statistically significant (p < 0.01) hypoglycemic activity in glucose loaded animals however no effect was observed in normal fasted rats.

Effect of aqueous extract of Pterocarpus marsupium wood on alloxan-induced diabetic rats

An aqueous extract of Pterocarpus marsupium wood was screened for hypoglycemic activity on alloxan-induced diabetic rats. During both acute and sub-acute tests, the water extract, at an oral dose of 250 mg/kg, showed statistically significant hypoglycemic activity.

Hepatoprotective activity of Abutilon indicum on experimental liver damage in rats

The aqueous extract of Abutilon indicum was tested for hepatoprotective activity against carbon tetrachloride- and paracetamol-induced hepatotoxicities in rats. A. indicum exhibited significant hepatoprotective activity by reducing carbon tetrachloride- and paracetamol-induced change in bio-chemical parameters that was evident by enzymatic examination. The plant extract may interfere with free-radical formation, which may conclude in hepatoprotective action. Acute toxicity studies revealed that the LD50 value is more than the dose of 4 g/kg body wt.

Allogeneic peripheral blood stem cell transplantation in patients with haematological malignancies

OBJECTIVE

To report the initial data on allogeneic peripheral blood stem cell transplantation for haematological malignancies in Pakistan.

DESIGN

A single centre descriptive study.

PLACE AND DURATION OF STUDY

Bismillah Taqee Institute of Health Sciences and Blood Diseases Centre from September 1999 to June 2004.

PATIENTS AND METHODS

Patients with haematological malignancies were included who had received allogeneic PBSC transplantation of Filgrastim (rhG-CSF) mobilized peripheral blood stem cells from HLA-identical siblings (except one 5/6 antigen sibling) with Busulphan and Cyclophosphamide standard conditioning therapy in all patients. No patient received antibiotics for gut decontamination. Empirical antibiotics included Ceftriaxone and Amikacin for febrile neutropenia, oral Itraconazole for antifungal prophylaxis while oral acyclovir was used for antiviral prophylaxis. All donors and recipients were CMV IgG positive Cyclosporin A / Methotrexate were given for graft versus host disease (GvHD) prophylaxis. Stem cells were harvested using Haemonetics MCS+ cell separator. All patients received G-CSF starting from day +4 until their neutrophil count rose to normal.

RESULTS

There were 21 patients with age range of 8-38 years and male to female ratio of 2:1. Engraftment was achieved in all patients; median time to absolute neutrophil count of > 0.5 x 10(9)/l was 10 days (range 8 - 12 days) and platelet count of > 20 x 10(9)/l was 14 days (12-17 days). Acute graft versus host disease ( aGvHD) was seen in 7 patients; one patient had grade IV skin and hepatic GvHD; another patient had grade III gut GvHD, grade II GvHD was seen in 3 patients while grade I skin aGvHD was seen in 2 patients. Median hospital stay was 34 days. Treatment related mortality was seen in 3 patients (18%). Chronic GvHD was seen in 5 patients. Four more patients died during the follow-up period. Malaria was seen in 2 while tuberculosis developed in one case. Relapse was seen in 2 patients. The estimated probability of survival at one hundred day, at one year and five years was 82, 47 and 40 percent respectively.

CONCLUSION

Haematopoietic stem cell transplant programme can be developed in a developed country setting. Post transplant complications are similar to what have been reported in the developed countries. In endemic areas malaria could prove to be fatal if not recognised and treated early.

Effect of aqueous extract of Cyamopsis tetragonoloba Linn. beans on blood glucose level in normal and alloxan-induced diabetic rats

Effect of feeding orally the aqueous extract of beans of Cyamopsis tetragonoloba was investigated on fasting blood glucose levels in glucose loaded, normal and alloxan-induced diabetic rats and compared with gliclazide, a reference drug. The aqueous extract of beans at 250 mg/kg body wt significantly lowered blood glucose levels in alloxan-induced diabetic rats within 3 hr of administration. Continued administration of the extract at the same dose daily for 10 days produced statistically significant reduction in the blood glucose levels while marginal activity was seen in normal and glucose-loaded rats.

Effect of water extract of Psidium guajava leaves on alloxan-induced diabetic rats

A water extract of Psidium guajava leaves was screened for hypoglycemic activity on alloxan-induced diabetic rats. In both acute and sub-acute tests, the water extract, at an oral dose of 250 mg/kg, showed statistically significant hypoglycemic activity.

Allogeneic peripheral blood stem cell transplantation for aplastic anaemia: a single centre experience

OBJECTIVE

To assess the feasibility of stem cell transplantation in local setting.

SETTING

A tertiary care haematology centre.

STUDY DESIGN

This is a single centre retrospective analysis of the outcome of allogeneic peripheral blood stem cell transplantation for severe aplastic anaemia.

OBJECTIVES

Preliminary data on stem cell transplantation in Pakistan.

PATIENTS AND METHODS

Aplastic anaemia is an uncommon disorder with a high mortality without treatment. Immunosuppression and bone marrow transplantation remains the mainstay of treatment. Stem cell transplantation facility became available in Pakistan in 1999, since then both allogeneic and autologous procedures are carried out for severe aplastic anaemia, b-thalassaemia major and haematological malignancies. Between April 2000 and July 2002, 20 allogeneic peripheral blood stem cell transplants were carried out for aplastic anaemia from HLA identical siblings. Donors were primed with G-CSF 10 mcg/kg/day subcutaneously for 4 days; stem cells were harvested on 5th day using Haemonetics MCS+ cell separator. Cyclophosphamide was used for conditioning; cyclosporin A and methotrexate were given for graft versus host disease prophylaxis.

RESULTS

Eighteen out of 22 patients survived transplant in a follow up period of 788 days. The causes of death were intra-cranial haemorrhage on day +7, herpes encephalitis on day +180, graft failure and mucour mycosis on day +353 and TB meningitis on day +544. Allogeneic peripheral blood stem cell transplantation resulted in 81% event free survival in our hands.

CONCLUSION

Allogeneic peripheral blood stem cell transplantation is feasible and life saving in an otherwise fatal disorder. This could be carried out effectively in Pakistan.

New oleanene and fernane-type triterpenes from the stem bark of Betula pendula roth

A new oleanene-type triterpene, named betuloleanolic acid acetate and fernane-type triterpenes, namely betufernanediol A and betufernanediol B (isomers) have been isolated from the stem bark of Betula pendula. Their structures have been established as olean-12-en-3beta-ylacetate-29-oic acid, fern-22(29)-en-3beta,12beta-diol and fem-22(29)-en-3alpha,12beta-diol, respectively, on the basis of spectral data analysis and chemical reactions.

Peripheral blood stem cell transplantation in children with beta-thalassemia major

OBJECTIVE

To share the preliminary data on stem cell transplantation in Pakistan.

DESIGN

This is a single center retrospective analysis of the outcome of allogeneic peripheral blood stem cell (PBSC) transplantation in b-thalassemia major patients.

PLACE AND DURATION OF STUDY

Bismillah Taqee Blood Diseases Centre, Karachi; a tertiary care hematology center from September 1999 to September 2002.

PATIENTS AND METHODS

Twelve patients with b-thalassemia major received allogeneic PBSC transplantation from HLA identical sibling donors except in one case where mother was the donor. All patients received busulphan and cyclophosphamide conditioning therapy and cyclosporin A/methotrexate for graft versus host disease (GVHD) prophylaxis. Donors were primed with G-CSF for 4 days and stem cells were harvested using Haemonetics MCS + cell separator on 5th day. All patients received G-CSF starting from day + 4 until their neutrophil count rose to normal.

RESULTS

Engraftment was achieved in all patients except one who required a second dose of bone marrow graft on day +21. Median time to achieve absolute neutrophil count of > 0.5 x 10(9)/l was 9.0 days (range 8-31 days) and platelet count of > 20 x 10(9)/l was 14 days (12-35 days). Acute GVHD was seen in 3 patients, one patient had grade IV gut GVHD; another patient had grade III gut GVHD while third patient had grade II skin GVHD. Median hospital stay was 29 days. Six patients were well and transfusion independent 3 to 36 months posttransplant. One episode of primary graft failure required a second dose of bone marrow harvest. Another episode of graft rejection received two doses of donor lymphocytes infusion. There were 4 deaths due to grade IV gut GVHD because of uncontrolled systemic Candida infection and one due to hepatic veno-occlusive (VOD) disease.

CONCLUSION

Allogeneic peripheral blood stem cell transplantation can be safely and economically carried out in Pakistan. Although there had been 4 deaths during 36 months follow-up, with increasing understanding and experience the outcome is expected to improve.

Two new anthraquinones from the roots of Rubia cordifolia Linn

Two new anthraquinones, named cordifoliol and cordifodiol, have been isolated from the roots of Rubia cordifolia. Their structures have been established as 1-hydroxy-3-ethyl-9,10-anthraquinone (1) and 1,8-dihydroxy-11, 20 (15-pentyl-naphthaquinonyl) phenanthrene (2) on the basis of spectral data analyses and chemical reactions.

Norditerpenic ester and pentacyclic triterpenoids from root bark of Calotropis procera (Ait) R. Br

A new norditerpenyl ester, named Calotropterpenyl ester, and two unknown pentacyclic triterpenoids, namely calotropursenyl acetate and calotropfriedelenyl acetate have been isolated from the root bark of Calotropis procera. Their structures have been established as 6,10,14-trimethylpentadec-6-enyl-2',4',8',12',16'-pentamethyl nonadecane ester, urs-12,19(29)-diene-3 beta-yl acetate and friedelin-1-ene-3 beta-yl acetate, respectively, on the basis of spectral data analyses and chemical reactions.

Antihyperglycemic activity of Euphrasia officinale leaves

The effects of the aqueous extract of the leaf of Euphrasia officinale on blood glucose levels in normal and alloxan-diabetic rats were investigated. The treatment of alloxan-induced diabetic rats brought down the raised glucose levels, while the extract was devoid of hypoglycemic effect in normal rats.