In vivo and in vitro anti-inflammatory activity evaluation of Lebanese Cannabis sativa L. ssp. indica (Lam.)

ETHNOPHARMACOLOGICAL RELEVANCE

Cannabis sativa L. is an aromatic annual herb belonging to the family Cannabaceae and it is widely distributed worldwide. Cultivation, selling, and consumption of cannabis and cannabis related products, regardless of its use, was prohibited in Lebanon until April 22, 2020. Nevertheless, cannabis oil has been traditionally used unlawfully for many years in Lebanon to treat diseases such as arthritis, diabetes, cancer and few neurological disorders.

AIM OF THE STUDY

The present study aims to evaluate the phytochemical and anti-inflammatory properties of a cannabis oil preparation that is analogous to the illegally used cannabis oil in Lebanon.

MATERIALS AND METHODS

Dried Cannabis flowers were extracted with ethanol without any purification procedures to simulate the extracts sold by underground dealers in Lebanon. GC/MS was performed to identify chemical components of the cannabis oil extract (COE). In vivo anti-inflammatory effect of COE was evaluated by using carageenan- and formalin-induced paw edema rat models. TNF-α production were determined by using LPS-activated rat monocytes. Anti-inflammatory markers were quantified using Western blot.

RESULTS

Chemical analysis of COE revealed that cannabidiol (CBD; 59.1%) and tetrahydrocannabinol (THC; 20.2%) were found to be the most abundant cannabinoids.Various monoterpenes (α-Pinene, Camphene, β-Myrecene and D-Limonene) and sesquiterpenes (β-Caryophyllene, α-Bergamotene, α-Humelene, Humulene epoxide II, and Caryophyllene oxide) were identified in the extract. Results showed that COE markedly suppressed the release of TNF-α in LPS-stimulated rat monocytes. Western blot analysis revealed that COE significantly inhibited LPS-induced COX-2 and i-NOS protein expressions and blocked the phosphorylation of MAPKs, specifically that of extracellular signal-regulated kinase (ERK), c-Jun NH2-terminal kinase (JNK) and p38 MAPK. COE displayed a significant inhibition of paw edema in both rat models. Histopathological examination revealed that COE reduced inflammation and edema in chronic paw edema model.

CONCLUSION

The current findings demonstrate that COE possesses remarkable in vivo and in vitro anti-inflammatory activities which support the traditional use of the Lebanese cannabis oil extract in the treatment of various inflammatory diseases including arthritis.

A Low-Sodium Diet Boosts Ang (1-7) Production and NO-cGMP Bioavailability to Reduce Edema and Enhance Survival in Experimental Heart Failure

Sodium restriction is often recommended in heart failure (HF) to block symptomatic edema, despite limited evidence for benefit. However, a low-sodium diet (LSD) activates the classical renin-angiotensin-aldosterone system (RAAS), which may adversely affect HF progression and mortality in patients with dilated cardiomyopathy (DCM). We performed a randomized, blinded pre-clinical trial to compare the effects of a normal (human-equivalent) sodium diet and a LSD on HF progression in a normotensive model of DCM in mice that has translational relevance to human HF. The LSD reduced HF progression by suppressing the development of pleural effusions (p < 0.01), blocking pathological increases in systemic extracellular water (p < 0.001) and prolonging median survival (15%, p < 0.01). The LSD activated the classical RAAS by increasing plasma renin activity, angiotensin II and aldosterone levels. However, the LSD also significantly up-elevated the counter-regulatory RAAS by boosting plasma angiotensin converting enzyme 2 (ACE2) and angiotensin (1-7) levels, promoting nitric oxide bioavailability and stimulating 3'-5'-cyclic guanosine monophosphate (cGMP) production. Plasma HF biomarkers associated with poor outcomes, such as B-type natriuretic peptide and neprilysin were decreased by a LSD. Cardiac systolic function, blood pressure and renal function were not affected. Although a LSD activates the classical RAAS system, we conclude that the LSD delayed HF progression and mortality in experimental DCM, in part through protective stimulation of the counter-regulatory RAAS to increase plasma ACE2 and angiotensin (1-7) levels, nitric oxide bioavailability and cGMP production.

Increased serum levels of MIC1/GDF15 correlated with bone erosion in spondyloarthritis: A pilot study

INTRODUCTION

To assess the association between growth differentiation factor-15 (GDF15) and radiographic features including bone marrow edema and bone erosion in Spondyloarthritis (SpA).

METHODS

Patients with SpA (n = 120) receiving treatment in the Guangdong General Hospital, China, between August 2012 and December 2016 were retrospectively included. Serum of patients and healthy controls (n = 30) were collected and GDF15 levels were measured using ELISA. Inflammation was assessed by C-reactive protein (CRP), and magnetic resonance imaging (MRI) of the sacroiliac joint using Spondyloarthritis Research Consortium of Canada score and a method of dichotomy to assess fat metaplasia, bone erosion, and ankylosis. Radiographs of the pelvis were scored using the modified New York (mNY) score.

RESULTS

Serum GDF15 levels were higher in SpA patients compared to controls (503.52 ± 222.92 vs. 190.86 ± 104.18 pg/mL, P < .0001). Patients who suffered from bone erosion on MRI had higher levels of GDF15 (525.72 [186.33, 801.62]vs. 428.06 [255.15, 670.98] pg/mL, P = .0375). There was a positive correlation between serum GDF15 and CRP (r = 0.5442, P < .0001). Moreover, GDF15 levels were related to CRP levels (r = 0.5658, P < .0001) in those X-ray scores were III, according to 1984mNY criteria. Receiver operating characteristic (ROC) analysis showed that GDF15 levels above 501.98pg/mL could predict presence of bone erosion on MRI.

CONCLUSION

The present study suggested that serum GDF15 levels are higher in SpA patients than in healthy controls. The GDF15 level was correlated with CRP and may be a surrogate biomarker in bone erosion.

In Vivo and In Vitro Anti-Arthritic Effects of Cardenolide-Rich and Caffeoylquinic Acid-Rich Fractions of Periploca forrestii

Periploca forrestii Schltr. (P. forrestii) is a species used in Traditional Chinese Medicine (TCM) known as “Miao medicine”, and has a long history of use in the treatment of rheumatism, rheumatoid arthritis (RA), and joint pain. The present study aimed to evaluate the anti-arthritis effects of the cardenolide-rich and caffeoylquinic acid-rich fractions (CDLFs and CQAFs) of P. forrestii in collagen-induced arthritic (CIA) rats, and defined the mechanisms of therapeutic action in MH7A cells treated with TNF-α. Serum rheumatoid factor (RF), TNF-α, IL-6, IL-1β, PGE₂, NO, SOD, and MDA were determined by ELISA or other commercially assay kits. Histopathological changes in ankle joint tissues were examined. The mRNA expressions of IL-1β, IL-6, COX-2, and iNOS in MH7A cells were measured by qRT-PCR assays. In addition, the expressions of iNOS, COX-2, and p65 proteins, and the phosphorylation of IκBα, p38, ERK_1/2, and JNK proteins in MH7A cells were analyzed by Western blot. The results showed that CDLF and CQAF could suppress the paw swelling in CIA rats at different doses (125 mg/kg, 250 mg/kg, and 500 mg/kg). Histopathological examination suggests that the CDLF and CQAF significantly relieved the damage of the structure of the ankle joint in CIA rats. In addition, serum RF, TNF-α, IL-6, IL-1β, PGE₂, NO, and MDA were decreased, along with increased activity of serum SOD. Furthermore, CDLF and CQAF downregulated the expressions of IL-1β, IL-6, COX-2, iNOS, and p65, and inhibited the phosphorylation of IκBα, p38, ERK_1/2, and JNK in MH7A cells treated with TNF-α. These findings demonstrated that both CDLF and CQAF exhibited anti-arthritic activity, which might be associated with their inhibitory effects on the NF-κB and MAPK signaling pathways.

Serum VEGF-C levels as a candidate biomarker of hypervolemia in chronic kidney disease

Attaining and maintaining optimal "dry weight" is one of the principal goals during maintenance hemodialysis (MHD). Recent studies have shown a close relationship between Na load and serum vascular endothelial growth factor-C (VEGF-C) levels; thus, we aimed to investigate the role of VEGF-C as a candidate biomarker of hypervolemia. Physical examination, basic laboratory tests, N-terminal pro b-type natriuretic peptide (NT-ProBNP), echocardiography, and bioimpedance spectroscopy data of 3 groups of study subjects (euvolemic MHD patients, healthy controls, and hypervolemic chronic kidney disease [CKD] patients) were analyzed. Research data for MHD patients were obtained both before the first and after the last hemodialysis (HD) sessions of the week. Data of 10 subjects from each study groups were included in the analysis. Serum VEGF-C levels were significantly higher in hypervolemic CKD versus in MHD patients both before the first and after the last HD sessions (P = .004 and P = .000, respectively). Healthy controls had serum VEGF-C levels similar to and higher than MHD patients before the first and after the last HD sessions of the week (P = .327 and P = .021, respectively). VEGF-C levels were correlated with bioimpedance spectroscopy results (r 0.659, P = .000) and edema (r 0.494, P =0.006), but not with ejection fraction (EF) (r -0.251, P = .134), blood pressures (systolic r 0.037, P = 0.824, diastolic r -0.067, P = .691), and NT-ProBNP (r -0.047, P = .773). These findings suggest that serum VEGF-C levels could be a potential new biomarker of hypervolemia. The lack of correlation between VEGF-C and EF may hold a promise to eliminate this common confounder. Further studies are needed to define the clinical utility of VEGF-C in volume management.

Effects of chronic exposure to dietary selenomethionine on the physiological stress response in juvenile white sturgeon (Acipenser transmontanus)

Selenium (Se) is an essential micronutrient, but at low concentrations can be toxic to aquatic organisms. Selenomethionine (SeMeth) is the primary dietary form of Se aquatic organisms are exposed to and is an environmental concern because it persists and bioaccumulates. White sturgeon (WS) might be particularly susceptible to bioaccumulative toxicants, such as SeMeth, due to their longevity and benthic lifestyle. Se exposure is known to have adverse effects on the physiological stress response in teleosts, but these effects are unknown in WS. Therefore, the goal of this study was to determine effects of dietary SeMeth on the ability of WS to mount a stress response. Juvenile WS were administered food spiked with 1.4, 5.6, 22.4 and 104.4μg Se/g dry mass (dm) for 72days. Lower doses were chosen to represent environmentally relevant concentrations, while the high dose represented a worst case scenario exposure. On day 72, fish were subjected to a 2min handling stressor, and they were sampled at 0, 2 and 24h post-stressor. Cortisol, glucose and lactate concentrations were quantified in blood plasma and glycogen concentrations were quantified in muscle and liver. Transcript abundance of genes involved in corticosteroidogenesis and energy metabolism were determined using qPCR. Under basal conditions, WS fed 104.4μg Se/g dm had significantly greater concentrations of plasma cortisol and lactate, and significantly lower concentrations of plasma glucose and liver glycogen, compared to controls. Corticosteroid 11-beta dehydrogenase 2 (hsd11b2) abundance was lower in WS fed 22.4 and 104.4μg Se/g dm, indicating less conversion of cortisol to cortisone. Abundance of the glucocorticoid receptor (gcr) was significantly lower in high dose WS, suggesting lower tissue sensitivity to glucocorticoids. The increasing trend in phosphoenolpyruvate carboxykinase (pepck) abundance, with increasing SeMeth exposure, was consistent with greater cortisol and glucose concentrations in high dose WS. Exposure to an acute handling stressor elicited a typical cortisol response, but the magnitude of the response appeared to be significantly lower than those typically observed in teleosts. SeMeth also did not appear to modulate the cortisol response to a secondary stressor. However, WS exposed to 22.4μg Se/g dm and sampled 2h post-stressor, had significantly higher concentrations of muscle glycogen compared to controls, indicating effects on their ability to utilize muscle glycogen for energy. Overall, the results indicate that chronic exposure to dietary SeMeth concentrations >22.4μg/g can affect cortisol dynamics and mobilization of energy substrates in juvenile WS.

Anti-inflammatory activity of fenugreek (Trigonella foenum-graecum Linn) seed petroleum ether extract

OBJECTIVES

The aim of the present work was to study the anti-inflammatory and anti-arthritic activities of petroleum ether extract of fenugreek seeds.

MATERIALS AND METHODS

Fenugreek seed powder was extracted in petroleum ether by cold maceration. This fenugreek seed petroleum ether extract (FSPEE) was analyzed by gas-liquid chromatography (GLC) and tested on rats against carrageenan and formaldehyde-induced paw edema, complete Freund's adjuvant (CFA)-induced arthritis and cotton pellet-induced granuloma. Changes in serum glutamic oxaloacetic tansaminase (SGOT), serum glutamate-pyruvate transaminase (SGPT), and alkaline phosphatase (ALP) activities in liver and serum were also studied in cotton pellet-induced arthritic rats. Data were analyzed by Student's t-test. P <0.05 was considered statistically significant.

RESULTS

GLC of FSPEE showed oleic (33.61%), linoleic (40.37%), and linolenic (12.51%) acids. With 0.5 mL/kg FSPEE treatment, there was 37% (P < 0.05) and 85% (P < 0.05) reduction in inflammation of the paw in carrageenan and formaldehyde-induced paw edema. In CFA-induced arthritis, a biphasic increase in paw volume followed by decrease was seen. There was 42.5% (P < 0.01) reduction in the weight of cotton pellets and significant (P < 0.01) reductions in the elevated SGPT and ALP activities in serum and liver of FSPEE (0.5 mL/kg) treated rats.

CONCLUSION

Thus, petroleum ether extract of fenugreek seeds has significant anti-inflammatory and anti-arthritic activities which are due to the presence of linolenic and linoleic acids.

THE DIFFICULTIES OF DIFFERENTIAL DIAGNOSIS OF EDEMATOUS AND ANEMIC SYNDROMES IN AN EDERLY PATIENT WITH ATYPICAL COURSE OF COELIAC DISEASE

OBJECTIVE

Analysis of the complexities of diagnosis of atypical celiac disease in elderly patients.

KEY POINTS

A clinical observation of the patient 63 years with atypical form of celiac disease, have flowed mainly from edematous and anemic syndrome. High titers of antibodies to gliadin, tissue transglutaminase, histological changes of the mucous membrane of the small intestine (Marsh II), the presence DQA1*0501 of the alleles have confirmed diagnosis. Against the background of strict gluten-free diet and a half years I have come persistent clinical remission with normalization of serum indicators.

CONCLUSION

Inclusion in the plan of diagnostic screening for celiac disease in patients \'vith edematous and anemic syndrome possible to establish the correct diagnosis and to reduce the risk of complications (including malignancies) in this patient.

Studies on anti-inflammatory and analgesic properties of Lactobacillus rhamnosus in experimental animal models

BACKGROUND

Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used for the treatment of inflammatory diseases. However, constant use of NSAID may lead to some side effects like gastrointestinal ulcers, bleeding and renal disorders. This study evaluates analgesic and anti-inflammatory activities of Lactobacillus rhamnosus in female Wistar rats.

METHODS

Diclofenac sodium was used as a standard drug for comparison. L. rhamnosus, drugs and vehicle were administered orally. Acetic acid-induced writhing test and carrageenan-induced paw edema model were used for evaluation. Paw edema and number of writhes were measured subsequently. Pro-inflammatory (interleukin (IL)-6, IL-1β, tumor necrosis factor (TNF)-α and IL-17) and anti-inflammatory (IL-4 and IL-10) cytokines were estimated in serum after 24 h.

RESULTS

Results showed that L. rhamnosus significantly decreased the paw thickness at t=24 h by 28.66 % while drug decreased by 19.33 %. Also, L. rhamnosus treatment and standard drug showed a protection of 66.66 % and 41.66 %, respectively. L. rhamnosus and diclofenac sodium treatment significantly down-regulated pro-inflammatory and up-regulated anti-inflammatory cytokines at p<0.0001. Overall, protection provided by L. rhamnosus was more pronounced in comparison to diclofenac sodium.

CONCLUSIONS

The present study clearly suggests that L. rhamnosus suppressed carrageenan-induced paw edema after second phase and decreased the acetic acid-induced writhings. It ameliorated the inflammatory pathways by down-regulating pro-inflammatory cytokines. However, additional clinical investigations are needed to prove the efficacy of L. rhamnosus in treatment/management of inflammatory joint diseases.

The Effect of Arterial PaCO2 in COPD Exacerbations with and without Peripheral Edema

INTRODUCTION

Studies often suggest hypoxemia is an important factor for sodium retention in chronic obstructive pulmonary disease (COPD), although hypercapnia is also associated with sodium retention in these patients. Hence, we have presented the major role of PaCO(2) in edema due to COPD.

METHOD

COPD patients who were hospitalized due to exacerbation were enrolled in the study and divided into two groups: with and without edema. Exclusion criteria included primary hepatic diseases, nephrotic syndrome and other renal diseases, left heart failure, or using drugs that would interfere with these organs or endocrine function. Data were coded and analyzed by SPSS software. Arterial blood gas variables including bicarbonate, pH, and PaO(2), PaCO(2) and O(2) saturation, and FEV1, FVC, FEV1/FVC were measured and compared between the groups.

RESULTS

No significant difference was found between the averages of bicarbonate, pH, PaO(2), 02 saturation, FEV1, FVC and FEV1/FVC in COPD in the two groups. PaCO(2) levels were significantly higher in patients with edema, compared to those without edema (p = 0.05). A reverse and significant correlation between PaCo(2) and FEV1 levels (p = 0.03) (r = -0.501) was observed in patients with edema.

CONCLUSION

This study suggests that hypercapnia is a major factor in causing edema in COPD patients compared to hypoxemia.

Anti-inflammatory activity studies on the stems and roots of Jasminum lanceolarium Roxb

Jasminum lanceolarium Roxb is an important traditional Chinese medicine. Its stems and roots have been used for the treatment of rheumatism and fever while the leaves are used as an anti-inflammatory agent to relieve pain. In order to support its traditional Chinese medicinal uses, five animal models were designed and the anti-inflammatory and analgesic properties of the 70% EtOH-H2O extracts of J. lanceolarium (EJL) were investigated. Meanwhile, biochemical parameters such as cyclooxygenase-2 (COX-2), 5-lipoxygenase (5-LOX) in blood serum of rats exposed to acute (carrageenan) inflammation model were evaluated. At doses of 400 mg/kg, EJL exhibited higher anti-inflammation effect than that of indomethacin and better analgesic activity than that of aspirin (P<0.001). Furthermore, eleven isolated compounds including six lignanoids (1, 2, 6, 7, 8, and 11) and five iridoids (3, 4, 5, 9, and 10) were isolated from the active extracts and showed significant anti-inflammatory activities with the IC50 values of 1.76-5.22 mg/mL, respectively, when testing their inhibitory effects on phospholipase A2 in vitro. The results demonstrated that the possible anti-inflammatory mechanisms might be attributed to inhibit the hydrolysis of membrane phospholipids, production on both COX-2 and 5-LOX, and then finally inhibit the release of prostaglandins (PGs), which suggested that EJL had a non-selective inhibitory effect on the release or actions of these mediators, and might be a dual LOX-COX inhibitor for the treatment of inflammation from the natural resource. The studies on the animals and the inflammatory mediators, along with the bioactive compounds presumed that the existences of iridoids and lignanoids could be response for their bioactivities of the whole plants.

Anti-inflammatory effect of rosmarinic acid and an extract of Rosmarinus officinalis in rat models of local and systemic inflammation

Rosmarinic acid is a polyphenolic compound and main constituent of Rosmarinus officinalis and has been shown to possess antioxidant and anti-inflammatory properties. We aimed to evaluate the anti-inflammatory properties of rosmarinic acid and of an extract of R. officinalis in local inflammation (carrageenin-induced paw oedema model in the rat), and further evaluate the protective effect of rosmarinic acid in rat models of systemic inflammation: liver ischaemia-reperfusion (I/R) and thermal injury models. In the local inflammation model, rosmarinic acid was administered at 10, 25 and 50 mg/kg (p.o.), and the extract was administered at 10 and 25 mg/kg (equivalent doses to rosmarinic acid groups) to male Wistar rats. Administration of rosmarinic acid and extract at the dose of 25 mg/kg reduced paw oedema at 6 hr by over 60%, exhibiting a dose-response effect, suggesting that rosmarinic was the main contributor to the anti-inflammatory effect. In the liver I/R model, rosmarinic acid was administered at 25 mg/kg (i.v.) 30 min. prior to the induction of ischaemia and led to the significant reduction in the serum concentration of transaminases (AST and ALT) and LDH. In the thermal injury model, rosmarinic acid was administered at 25 mg/kg (i.v.) 5 min. prior to the induction of injury and significantly reduced multi-organ dysfunction markers (liver, kidney, lung) by modulating NF-κB and metalloproteinase-9. For the first time, the anti-inflammatory potential of rosmarinic acid has been identified, as it causes a substantial reduction in inflammation, and we speculate that it might be useful in the pharmacological modulation of injuries associated to inflammation.

Application of vasopressin radioimmunoassay to clinical study: role of vasopressin in hypo- and hypernatremia and some other disorders of water metabolism

Plasma and urinary arginine vasopressin (AVP) in normal subjects and in patients with various water metabolism disorders was measured using a sensitive, specific radioimmunoassay. The AVP plasma levels in normal subjects were 3.1 +/- 1.2 pg/ml. The parallel changes in plasma osmolality, plasma AVP concentration, and urinary osmolality were observed after water load. In patients with various kinds of hyponatremia and impaired water excretion, plasma AVP concentrations were within or over normal levels, suggesting that persistent secretion of AVP may play an important role in the pathogenesis of hyponatremia. Variable levels of plasma AVP were observed in patients with essential hypernatremia, which in turn suggested that osmoreceptors may be selectively damaged in some patients, and that ADH-secreting neurons are also involved in others. Our radioimmunoassay facility made it possible for us to measure plasma and urinary DDAVP in the treatment of diabetes insipidus.

Antiallergic effect of piperine on ovalbumin-induced allergic rhinitis in mice

CONTEXT

Allergic rhinitis (AR) is a global health problem that affects a large number of population. Piperine (PIP) has been reported to exhibit anti-inflammatory, anti-histaminic, and immunomodulatory activities; however, its antiallergic profile has not been studied.

OBJECTIVE

The objective of the study was to investigate the antiallergic potential of PIP in ova-albumin (OVA)-induced AR, mast cell degranulation (MSD), and OVA-induced paw edema.

MATERIALS AND METHODS

Mice were sensitized with OVA alternately on 1, 3, 5, 7, 9, 11, and 13th day. They were treated with either vehicle, PIP (10, 20, and 40 mg/kg, p.o.), or montelukast (10 mg/kg, p.o.) from the 14th to 20th day. On the 21st day, intranasal (OVA: 5% µl) challenge was done. Animals were evaluated for physiological parameters, biochemical parameters, spleen weight, expression of interleukins (IL-6 and IL-1β), and immunoglobin-E (IgE). Histopathology of nasal mucosa, lungs, and spleen was carried out. MSD and paw edema studies were made to understand the mechanism of action.

RESULTS

PIP (10, 20, and 40 mg/kg, p.o.) showed a significant dose-dependent protection with respect to nasal rubbing, redness of nose, and sneezing (p < 0.001) following nasal challenge. PIP dose dependently reduced histamine, NO concentration (p < 0.001), as well as reduced expression of IL-6, IL-1β, and IgE (p < 0.001) as compared with the control group. Histopathology showed inhibition of infiltration of eosinophils and hyperplasia. It dose dependently reduced MSD and paw edema (p < 0.001).

DISCUSSION AND CONCLUSION

PIP acts by mast cell-stabilizing activity, exhibits immunomodulatory and anti-inflammatory activity, thereby providing an effective treatment for AR.

Design, Synthesis and Biological Evaluation of New Thieno[2,3- d]pyrimidines as Anti-inflammatory Agents

BACKGROUND

Long term use of NSAIDS is mainly accompanied by major health implications such as gastrointestinal erosions, ulcerations and nephrotoxicity. These side effects arise from local irritation by the carboxylic acid moiety, that is common to most of NSAIDs (topical effect), in addition to decreased cytoprotective prostaglandin production. Therefore, in the medicinal chemistry research area, there is an ongoing need for the discovery of new, potent and safer anti-inflammatory lead compounds devoid of the irritant carboxylic acid moiety.

METHODS

A series of new 3-substituted-2-thioxo-thieno[2,3-d]pyrimidine derivatives were synthesized through reacting the starting 3-amino-2-thioxo-thieno[2,3-d]pyrimidines with different aromatic aldehydes. The structure of all newly synthesized compounds was confirmed with spectral and elemental analyses. The synthesized thieno[2,3-d]pyrimidines were investigated for in vivo anti-inflammatory activity, using the carrageenan induced paw edema test. The possible antiinflammatory mechanism was also evaluated by determining the concentration of prostaglandin E2 (PGE2) in blood serum using a rat specific PGE2 ELISA kit.

RESULTS

All test compounds could significantly reduce carrageenan induced paw edema comparable to diclofenac sodium as a potent anti-inflammatory drug. Moreover, they could decrease the concentration of PGE2 in blood serum. Interestingly, compound 4c exhibited the most potent in vivo anti-inflammatory activity with protection of 35%, 36% and 42% against carrageenan-induced paw edema after 1h, 2h and 3h, representing 92%, 86% and 88% respectively of diclofenac activity. It also decreased the concentration of PGE2 in blood serum to 19 pg/ mL which is comparable to diclofenac with PGE2 concentration of 12 pg/ mL. Moreover, Compounds 4f, 4a, 4i and 4e exerted significant anti-inflammatory activity after 4h, representing 71%, 69%, 63% and 61% respectively of diclofenac activity. Furthermore, they significantly decreased the concentration of PGE2 in blood serum.

CONCLUSION

These thienopyrimidines may be used as good candidates for the search of promising, potent and safe antiinflammatory leads for being free from acidic functions.

Multi-constituent synergism is responsible for anti-inflammatory effect of Azadirachta indica leaf extract

CONTEXT

Azadirachta indica A. Juss. (Meliaceaes) leaves have been used traditionally to treat swelling and rheumatism in Indian cultures.

OBJECTIVE

To fractionate A. indica leaf extracts using bioactivity guided manner for identification of the active anti-inflammatory principles.

MATERIALS AND METHODS

Polarity-gradient sequential extracts (petroleum ether, chloroform, methanol, and water) of A. indica leaves were screened for their anti-inflammatory potential using the carrageenan-induced rat paw edema model (1 g/kg). The chloroform extract was sequentially fractionated to obtain n-hexane (F-1), n-hexane-chloroform (F-2), and chloroform (F-3) fractions and their inhibitory effect on rat paw edema was evaluated (500 mg/kg). Inhibitory effect of F-2 on granuloma formation, plasma interleukin (IL-1), and tumor necrosis factor (TNF-α) was assessed at the doses of 100, 200, and 400 mg/kg using the cotton pellet assay in rats. Three sub-fractions (SF-1, SF-2, and SF-3) were obtained upon chromatography of F-2, and their inhibitory effect on cyclooxygenase was assessed at 200 µg/mL concentration. The sub-fractions were subjected to gas chromatography-mass spectrometry (GC-MS).

RESULTS

All the extracts showed significant anti-inflammatory effect; however, chloroform extract was the most effective against paw edema (53.25% inhibition). The three fractions of chloroform extract showed significant effect, while F-2 being the most potent (51.02%). F-2 demonstrated dose-dependent inhibition of granuloma and cytokines. Interestingly, all the sub-fractions of F-2 inhibited COX-1 and COX-2 with almost equal potential. GC-MS revealed that chemically the sub-fractions were totally different from each other.

DISCUSSION AND CONCLUSION

Anti-inflammatory effect of A. indica is a result of cumulative and synergistic effects of diversified constituents with varying polarities that collectively exert the effect via suppression of cyclo-oxygenases and cytokines (IL-1 and TNF-α).

Massive vulvar edema in 2 prepartum dairy cows

Two late gestation Holstein cows about to begin the third lactation developed massive vulvar edema. These were the only affected animals in the herd of 500 milking cows. The vulvar edema spontaneously regressed postpartum for both cows. Massive vulvar swelling is seldom observed in dairy cows in advanced pregnancy and is not described in the literature.

P-glycoprotein modulates morphine uptake into the CNS: a role for the non-steroidal anti-inflammatory drug diclofenac

Our laboratory has previously demonstrated that peripheral inflammatory pain (PIP), induced by subcutaneous plantar injection of λ-carrageenan, results in increased expression and activity of the ATP-dependent efflux transporter P-glycoprotein (P-gp) that is endogenously expressed at the blood-brain barrier (BBB). The result of increased P-gp functional expression was a significant reduction in CNS uptake of morphine and, subsequently, reduced morphine analgesic efficacy. A major concern in the treatment of acute pain/inflammation is the potential for drug-drug interactions resulting from P-gp induction by therapeutic agents co-administered with opioids. Such effects on P-gp activity can profoundly modulate CNS distribution of opioid analgesics and alter analgesic efficacy. In this study, we examined the ability of diclofenac, a non-steroidal anti-inflammatory drug (NSAID) that is commonly administered in conjunction with the opioids during pain therapy, to alter BBB transport of morphine via P-gp and whether such changes in P-gp morphine transport could alter morphine analgesic efficacy. Administration of diclofenac reduced paw edema and thermal hyperalgesia in rats subjected to PIP, which is consistent with the known mechanism of action of this NSAID. Western blot analysis demonstrated an increase in P-gp expression in rat brain microvessels not only following PIP induction but also after diclofenac treatment alone. Additionally, in situ brain perfusion studies showed that both PIP and diclofenac treatment alone increased P-gp efflux activity resulting in decreased morphine brain uptake. Critically, morphine analgesia was significantly reduced in animals pretreated with diclofenac (3 h), as compared to animals administered diclofenac and morphine concurrently. These novel findings suggest that administration of diclofenac and P-gp substrate opioids during pain pharmacotherapy may result in a clinically significant drug-drug interaction.

Indicators for detection of septic arthritis in the acutely swollen joint cohort of those without joint prostheses

Differentiating septic arthritis from culture-negative, acute atraumatic joint effusion is difficult. Studies have attempted to elucidate factors that herald infection, but, due to overlap, most conclude that the diagnosis ultimately relies on clinical judgment. Furthermore, studies are limited by broad inclusion criteria. The current retrospective case study sought to examine (1) which markers differentiate a culture-positive septic joint from culture-negative effusion in patients suspicious for infection despite no growth on Gram stain and without previous surgery in the affected joint and (2) whether threshold values of these markers exist that predict septic arthritis. The study was performed by reviewing records of those who underwent operative irrigation and debridement involving the shoulder, elbow, wrist, hip, knee, and ankle. Patients were included if they were older than 18 years and had an acutely swollen/painful joint and no organisms on initial Gram stain. Exclusion criteria were lack of serum markers or synovial fluid aspirate, antibiotics within 1 week, adjacent wound or skin infection, recent trauma to the joint, and previous joint infection or surgery to the joint. Several clinical, serological, and synovial parameters were collected and analyzed using paired t test with Bonferonni correction. Serum C-reactive protein was the only significantly different variable between groups. Serum C-reactive protein greater than 10.5 mg/dL was predictive of infection. In those suspicious for infection despite no growth on Gram stain and without previous surgery in the affected joint, C-reactive protein greater than 10.5 mg/dL is suspicious for joint sepsis and should warrant consideration for urgent irrigation and debridement.

Role of serum lipoprotein at the site of iloprost therapy in the treatment of painful bone marrow edema

The authors hypothesized that the emergence of painful bone marrow edema occurs through microembolisms in the bone marrow that may be reflected in elevated plasma parameters of hypofibrinolysis or a disturbance of the lipid metabolism and that treatment with iloprost may lead to a decrease in or normalization of the elevated serum parameters and, therefore, to pain reduction. Twenty-one patients (12 men and 9 women; mean age, 50 years [range, 22-70 years]) with painful bone marrow edema and elevated lipoprotein(a) (Lp[a]) serum values were treated with intravenous iloprost. Before and 6 weeks after iloprost therapy, the serum concentrations of Lp(a), apolipoprotein A1 (ApoA1), and apolipoprotein B (ApoB) were determined. At 6-week follow-up, 17 patients reported complete resolution of their symptoms. For these patients, complete bone marrow edema resolution was observed on magnetic resonance imaging. Four patients reported that their symptoms were either the same or had worsened but had partial bone marrow edema resolution on magnetic resonance imaging. In these patients, Lp(a) values either increased or remained the same. Hence, the total success rate of iloprost treatment was 86% at a mean follow-up of 17 months (range, 3-45 months). Before iloprost therapy, mean ApoA1, ApoB, and Lp(a) values were 159.8, 108.3, and 69.1 mg/dL, respectively. Six weeks after iloprost therapy, mean ApoA1, ApoB, and Lp(a) values decreased to 147.6 (P=.011), 98.4 (P=.042), and 38.3 (P<.001) mg/dL, respectively. The results of this study indicate a possible role of hypofibrinolysis or a disturbance in the lipid metabolism in the emergence of painful bone marrow edema.

Radiology case of the month. Nausea, vomiting, and diarrhea in a patient with hepatitis C and acquired immunodeficiency syndrome (AIDS). Diffuse, severe gastric-wall thickening, consistent with edema

The patient is a 42-year-old male with a past medical history of HIV/AIDS (his most recent CD4 count, four months before admission, was 19) and hepatitis C who presented to the Emergency Department complaining of one week of persistent nausea, vomiting, and diarrhea. His admit labs were as follows: hemoglobin of 11.8, hematocrit of 35, total protein of 6.0, albumin of 1.6, total bilirubin of 2.3, aspartate aminotransferase (AST) of 141, alkaline phosphatase (ALP) of 146, and alanine aminotransferase (ALT) of 31. Computed tomography (CT) images of the abdomen and pelvis with contrast were obtained (Figures 1 - 4).

[The analysis of selected biochemical parameters concentration in pregnant women with idiopathic edema of the lower limbs--preliminary report]

INTRODUCTION

Pregnancy causes changes in the hormonal balance, musculoskeletal, cardiovascular and lymphatic systems. The swelling of the lower limbs may also be one of the consequences of the enlarging uterus that increases body weight during pregnancy Determination of the serum concentrations of myeloperoxidase - MPO, extracellular matrix metalloproteinase - MMP, and intreleukine-6 - IL-6 allows for the assessment of inflammation. MPO belongs to the group of peroxidase enzymes with strong antibacterial and anti viral action. It is produced and released from the granules of neutrophils in inflammatory reactions, degenerative changes and neoplasmatic diseases. IL-6 is the main mediator of the inflammation in the live organism, released by monocytes and macrophages stimulated by interleukin-1.

OBJECTIVE

To assess the levels of inflammatory mediators: MMP MPO and IL-6 in women in the third trimester of pregnancy both healthy and those who experienced idiopathic edema of the lower limbs.

MATERIAL AND METHODS

We analyzed the changes in the concentration of biochemical parameters as: MMP-1, MPO and IL-6 in the serum of 20 healthy pregnant women between 36 and 40 weeks of gestation, and 8 pregnant women who developed idiopathic edema of the lower limbs. The R&D Systems Elisa tests were used to perform the measurement. The Quantikine Human IL-6 Immunoassay was used to measure the concentration of IL-6. The concentration was expressed in pg/ml. MMP-1 was measured using The Quantikine Human Pro -MMP-1. The value of MMP-1 concentration was expressed in ng/ml. MPO was measured using The Quantikine Human MPO Immunoassay and expressed in ng/ml.

RESULTS

The mean concentration of IL-6 was higher in the group of pregnant women with swelling of the lower limbs (group II) in comparison to healthy pregnant women (group I) and it was approximately 3,01 pg/ml, SD = 2,64, and 2,3 pg/ml, SD = 1,92, respectively. No statistical difference was found (p = 0,436). Parity has no influence on IL-6 concentration. The mean concentration of MPO in group I was 1797,04 ng/ml, SD = 1378,89, in II group it was 1702,54 ng/ml, SD = 1289,64. (p = 0,866). Parity has also no influence on MPO concentration. The mean concentration of MMP-1 in group I was 7,61 ng/ml, SD = 4,6, in group II it was 10,46 ng/ml, SD = 4,03. (p = 0,137). Significantly higher results were observed in primiparas with lower limbs swelling- 11,36 ng/ml when compared to multiparas - 9,57 ng/ml.

CONCLUSIONS

1. There are no significant differences in the concentrations of the studied inflammatory mediators between the groups of healthy pregnant women and those with idiopathic edema observed in the lower limbs. The significance of these differences requires further confirmation. 2. There was a statistically significant difference between the concentrations of MPO in the group of primiparas with a multiparas with lymphatic edema.

Drug rash with eosinophilia and systemic symptoms (DRESS) probably induced by cefotaxime: a report of two cases

We report two cases, one of a 52-year-old man and one of a 32-year-old man, who were treated with cefotaxime. On day 23 and day 28 of the treatment, respectively, the patients manifested clinically with fever, pruriginous skin rash, and facial edema. Blood tests showed marked eosinophilia and atypical lymphocytosis for both patients, and hepatic cytolysis only in the second patient. Cefotaxime was discontinued in both patients; the clinico-biological picture improved gradually and completely disappeared approximately 4 weeks later. Six weeks after complete recovery, both patients underwent intradermal testing which was positive to cefotaxime (2 mg/ml) at the 48-hour reading and negative to benzylpenicillin, amoxicillin, and cefazolin at the 20-minute and 48-hour readings. These clinical pictures suggest drug rash with eosinophilia and systemic symptoms (DRESS) induced by cefotaxime. To the best of our knowledge, only one case of cefotaxime-induced DRESS has been reported in the medical literature. Thus, we add two new cases of cefotaxime-induced DRESS and emphasize the usefulness and safety of intradermal testing in establishing the diagnosis.

The clinical characteristic differences between thrombosis-related edema and lymphedema following radiotherapy or chemoradiotherapy for patients with cervical cancer

Thrombosis-related edema and lymphedema are two principal types of lower extremity edema results from radiotherapy alone or chemoradiotherapy for patients with cervical cancer. To characterize differences between them, a retrospective study was performed. We collected data including age, race, body weight, FIGO stage, histology type, platelet count, haemoglobin, time of definitely diagnosis, therapeutic regimen, edema type and which leg edema firstly occurred in. Of 40 patients who were eligible for this study, 32 were diagnosed as thrombosis-related edema and 8 diagnosed as lymphedema. The differences in patient age (p = 0.004), propotion of race (p = 0.021), the latent time (p = 0.002) and the mean platelet count (p = 0.019) were statistically significant. Among 32 patients with thrombosis-related edema, 34.4% were in stage II and 53.1% in stage III, 78.1% were squamous cell carcinoma. Among 8 patients with lymphedema, 87.5% were in stage II and 62.5% were squamous cell carcinoma. The differences were not statistically significant for weight (p = 0.94), histology type (p = 0.648), edema site (p = 0.236), haemoglobin (p = 0.088) between the two grouping patients. Although the small patient cohort is a limitation, the results suggest that the patients with thrombosis-related edema may have higher proportion, lower age, shorter latent edema time and more platelet count than those with lymphedema. Also, thrombosis-related edema was likely inclined to Uigur and lymphedema to Han race. We did not find statistical differences in weight, edema site, histology type and haemoglobin between patients with thrombosis-related edema and lymphedema.

Antiarthritic activity of various extracts of Mesua ferrea Linn. seed

ETHNOPHARMACOLOGICAL RELEVANCE

Mesua ferrea Linn. (Cluciaseae), Cobra's saffron, is named after the heaviness of its timber and is cultivated in tropical climates for its form, foliage, and fragrant flowers. It is prescribed in the Ayurvedic literature for the treatment of pain, inflammation, and rheumatic conditions.

OBJECTIVE

In present investigation, activity of Mesua ferrea and its evaluation in the formaldehyde and Complete Freund's Adjuvant (CFA)-induced arthritis in rats is reported.

MATERIALS AND METHODS

The extracts obtained from successive extraction were subjected to preliminary phytochemical investigation and antiarthritic activity was evaluated by inducing formaldehyde and CFA. Body weight changes and haematological parameters were measured.

RESULTS

The results indicate that Mesua ferrea protects rats against formaldehyde and CFA induced arthritis. The body weight changes and haematological perturbations induced by CFA were maintained. The overall results indicated that Mesua ferrea exerts a potent protective effect against formaldehyde and adjuvant-induced arthritis in rats.

CONCLUSION

These findings demonstrate that the present study validates the ethnomedicinal use of seeds of Mesua ferrea in the treatment of arthritis conditions.

Assessment of cardiac structure and function in patients without and with peripheral oedema during rosiglitazone treatment

BACKGROUND

Thiazolidinediones cause peripheral oedema, the aetiology of which remains poorly understood.

METHODS

In a sub-study of a 6-month trial comparing rosiglitazone (Rsg) versus placebo, we compared those with versus without oedema among the 74 subjects treated with Rsg with respect to peak oxygen consumption indexed to fat-free mass (VO(2peak-FFM) ), cardiac MRI and markers of plasma volume expansion.

RESULTS

Almost half (49%) of the Rsg-treated patients developed oedema. Baseline VO(2peak-FFM) was not different between those with versus without oedema (25.8 versus 28.2 ml/kg/min; p = 0.22) and declined 5% in the oedema group (Δ -1.3 ml/min/kg; p = 0.005) with no change in those without oedema. Stroke volume increased in both groups (Δ 8.7 and 8.8 ml; p < 0.001 for each); end-diastolic volume increased only in those with oedema (+13.1 ml; p = 0.001). No other cardiac function changes were observed. In both groups, weight increased (3.6 and 2.2 kg) and haematocrit decreased (-3.2% and -2.1%; p < 0.001 for each). In those with oedema, albumin decreased (-0.2 g/dl) and brain natriuretic peptide increased (11.9 pg/ml; p < 0.03 for each).

CONCLUSIONS

Oedema was associated with a small decline in VO(2peak FFM), no adverse effects on cardiac function, and changes in selected measures suggesting that volume expansion underpins Rsg oedema.

Antioxidant and anti-inflammatory properties of Cardiospermum halicacabum and its reference compounds ex vivo and in vivo

AIMS OF THE STUDY

Cardiospermum halicacabum (CH) has been used in Chinese medicine for a long time. However, its fingerprint chromatogram, antioxidant, anti-inflammatory effects and mechanism are still needed to be explored. Therefore, the aims of this study investigated the antioxidant and anti-inflammatory effects of CH extracts and its reference compounds ex vivo and in vivo.

MATERIALS AND METHODS

In HPLC analysis, the fingerprint chromatogram of ethanolic extract of CH (ECH) was established. The effects of ACH (aqueous extract of CH) and ECH extracts were assessed for the antioxidant and LPS-induced NO production in RAW264.7 cells. In vivo anti-inflammatory activities of ECH were evaluated in mouse paw edema induced by λ-carrageenan (Carr). We investigate the anti-inflammatory mechanism of ECH via studies of the activities of catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GPx) in the liver and the levels of malondialdehyde (MDA) and nitrite oxide (NO) in the edema paw. Serum NO and TNF-α were also measured.

RESULTS

ECH had better antioxidant activity than that of ACH. In the anti-inflammatory test, ECH inhibited the development of paw edema induced by Carr and increased the activities of CAT, SOD and GPx in the liver tissue. ECH also decreased the level of NO in edematous paw tissue and in serum level, and diminished the level of serum TNF-α at the fifth hour after Carr injection.

CONCLUSIONS

ECH exerts anti-inflammatory effects by suppressing TNF-α and NO. The anti-inflammatory mechanism of ECH might be related to the decrement of the level of MDA in the edema paw via increasing the activities of CAT, SOD and GPx in the liver. The results showed that ECH might serve as a natural antioxidant and anti-inflammatory agent.

The relationship between peroxisome proliferator-activated receptor-gamma and renin: a human genetics study

CONTEXT

Peroxisome proliferator-activated receptor gamma (PPARgamma) agonists often cause volume retention and edema. A relationship between PPARgamma and renin may play a role in this process.

OBJECTIVE

The aim was to examine the relationship between the PPARgamma gene and plasma renin activity (PRA) levels in human hypertension.

DESIGN, PARTICIPANTS, AND MEASURES

A candidate gene association study was conducted with two distinct groups of human participants: Caucasian hypertensives (n = 395) and African-American hypertensives (n = 55). Single nucleotide polymorphisms of the PPAR(Upsilon) gene were analyzed. Phenotype studies were conducted after participants consumed a low-salt diet (10 mmol/d) for 7 d and included PRA and aldosterone measurements before and after a 60-min angiotensin II infusion (3 ng/kg x min).

RESULTS

Participants homozygous for the minor allele of rs2959272 (CC) had significantly higher PRA levels at baseline (P = 0.016) than major allele carriers (AA, AC) in Caucasian-hypertensive participants. The association of the C allele carrier status with increased PRA levels was replicated in the group of African-American hypertensive participants (P = 0.027). The Fisher's combined P value for both observations was significant (P = 0.002).

CONCLUSIONS

These results demonstrate the first known association between a PPARgamma single nucleotide polymorphism and alterations in PRA levels in humans with hypertension. This link between PPARgamma and renin raises the possibility of a genetically based mechanism for the increased volume retention and edema in some users of PPARgamma agonists.

Effects in the control of edema of the papilla of Vater by epinephrine saline irrigation after endoscopic retrograde cholangiopancreatography in an endoscopy center in Japan, 2003 to 2007: exploratory retrospective analysis to evaluate the characteristics of eligible patients with a focus on serum amylase levels

OBJECTIVE

To evaluate the effects of localized irrigation with epinephrine saline after endoscopic retrograde cholangiopancreatography (ERCP).

PATIENTS AND METHODS

One hundred and fourteen patients who underwent ERCP in our institute were treated with or without irrigation using epinephrine diluted in saline after ERCP to prevent post-ERCP pancreatitis. The serum amylase levels, white blood cell counts, and urine amylase levels were measured at 24 and 48 hours after ERCP.

RESULTS

The treatment resulted in improvements in all items. A univariate analysis of the explanatory variables between the treatment and untreated groups revealed the treatment to be effective, but not statistically significant. Gender and cannulation of the pancreatic duct were the only variables with significant partial regression coefficients in the multiple regression model with all explanatory variables (p=0.045). When a stratified analysis was conducted using gender as a moderator variable, the treatment became a significant preventive factor (p=0.038), and cannulation of the pancreatic duct was a significant risk factor (p=0.027) in female patients.

CONCLUSION

We suggest that irrigating with epinephrine saline into the papilla may be effective for preventing pancreatitis in female patients who received ERCP with cannulation of their pancreatic duct.

[Administration of oral vitaprost for prevention of exacerbations of chronic abacterial prostatitis]

Active substance of vitaprost is a complex of water-soluble biologically active peptides isolated from bovine prostate. The prostatic extract has an organotropic action in relation to the prostate. As all peptide bioregulators, prostatic extract has antiaggregant and anticoagulant properties, enhances synthesis of antihistamine and antiserotonine antibodies, improves microcirculation in the prostatic gland. This accounts for its ability to reduce edema in prostatic inflammation. This clinical trial demonstrated that vitaprost tablets decreases twice probability of chronic prostatitis exacerbation, of development of secondary exacerbations. A prophylactic intake of vitaprost relieves symptoms of chronic prostatitis, first of all pain (discomfort), improvement of quality of life by NIH-CPSI, including exacerbation and significantly reduces size of the prostate. Vitaprost tablets can be effectively used prophylactively in chronic prostatitis for reducing probability of the disease exacerbations and their severity.

Mechanisms of oedema formation: the minor role of hypoalbuminaemia

OBJECTIVES

Seriously ill patients often suffer from disorders of salt and water balance and present with clinical signs of either dehydration or oedema. The relationship of hypoalbuminaemia to oedema is complex and controversial and formed the central issue of this study.

DESIGN

Prospective study.

SETTING

Medical wards of New Somerset Secondary Hospital, November 2004.

SUBJECTS

50 patients admitted consecutively to the medical wards at New Somerset Hospital were evaluated; 26 males and 24 females participated.

OUTCOME MEASURES

An attempt was made to correlate causes of salt and water imbalance with the clinical assessment of volume status, oedema formation, nutritional state and serum albumin levels.

RESULTS

Hypoalbuminaemia was not related to oedema in this study. Of 24 patients with a serum albumin level below 30 g/l, only 6 had oedema. These patients all had other abnormalities that could have resulted in the oedema, notably primary salt retention by failing kidneys, cor pulmonale and malignancy. None of the patients with serum albumin levels below 15 g/l had any signs of oedema. The combined insult of a chronic inflammatory disease and malnutrition had a marked effect on serum albumin levels.

CONCLUSION

Significant hypoalbuminaemia was present in many of our patients, yet oedema was detected infrequently and generally had an easily identifiable cause not related to low albumin levels. Most patients with hypoalbuminaemia presented with normal or positive water balance. This study supports the notion that hypoalbuminaemia is infrequently associated with oedema and plays a minor role in its formation.

[Prevention of hyperhydration complications of intestinal lavage in acute poisonings by psychopharmacological agents]

Examination of 45 patients with acute oral poisonings by psychopharmacological agents who underwent for the body's detoxjication intestinal lavage using salt enteral solution that was isoionic to chymus and isoosotic to plasma has revealed its preventive action on the development of tissue hyperhydration and its corrective effect of plasma ionic composition. It has been ascertained that after intestinal lavage, there are significant increases in partial arterial blood oxygen pressure by 80% and in arteriovenous oxygen difference by 90%.

Formulation Studies and In Vivo Evaluation of a Flurbiprofen-Hydroxypropyl β-Cyclodextrin System

The purpose of this study was 1) to investigate in vivo advantages of a flurbiprofen (FPN)-hydroxypropyl beta-cyclodextrin (HPbetaCD) solid dispersion (SD) in rats, 2) to study factors affecting the drug release from SD formulations, and 3) to evaluate the pharmacokinetic profile of the drug when administered as SD, in humans. The solubility of FPN in water and dissolution media was evaluated as a function of HPbetaCD concentration. The SD was prepared by coevaporation from dilute aqueous NH3 and evaluated in rats. The release of the drug from tablet formulations and capsules of SD was studied in simulated gastric fluid and phosphate buffer, pH 7.2. The bioavailability of drug when administered as SD was evaluated in humans. HPbetaCD enhanced the solubility of the drug, and SD improved bioavailability and reduced ulcerogenicity of the drug in rats. The type of excipient used affected drug release from tablets. Presence of microcrystalline cellulose, a hydrophilic polymeric excipient, resulted in uptake of water and stabilization of the resulting gels-like structure of HPbetaCD-containing tablets. This adversely affected drug release. The release from capsules filled with SD was comparable to that obtained from plain SD powder. The drug-HPbetaCD association constant in water was much lower than the values reported in literature. The bioavailability (which could suffer in case of higher association constant) was enhanced on administration of SD-filled capsules to humans.

Computed tomography versus Acute Physiology and Chronic Health Evaluation II score in predicting severity of acute pancreatitis: a prospective, comparative study with statistical evaluation

OBJECTIVE

The aim of the study was to compare Acute Physiology and Chronic Health Evaluation II score and C-reactive protein as a clinical index and computed tomography-based severity index (CTSI) in predicting the course of acute pancreatitis.

METHODS

One hundred forty-eight patients with acute pancreatitis were enrolled in the study during a 2-year period. All data concerning etiology, Atlanta classification, CT findings, Acute Physiology and Chronic Health Evaluation score, C-reactive protein levels, stay in the intensive care unit, length of hospital stay, treatment, complications, and deaths were analyzed with Mann-Whitney U, Wilcoxon, Pearson, and Spearman statistical tests. The CT was performed on a spiral unit after intravenous administration of contrast material. Images were graded according to the Balthazar-CTSI scoring system.

RESULTS

A very good correlation was noticed between Balthazar-CTSI scores and local complications, whereas no statistically significant correlation was found between CT scores and stay in the intensive care unit. Among survivors and nonsurvivors, there were no statistically significant differences as far as CT scores were concerned.

CONCLUSIONS

Although the extent of necrosis as defined on contrast-enhanced CT examinations is considered as a risk factor for a negative prognosis, our findings suggest that the initially documented disease severity according only to imaging parameters is not highly important for the final patient outcome.

Therapeutic effects of Saireito (TJ-114), a traditional Japanese herbal medicine, on postoperative edema and inflammation after total hip arthroplasty

Saireito (TJ-114) is a traditional Japanese herbal medicine that has been used for treating edema and inflammation in diseases such as nephritic disease. This study investigates the effect of TJ-114 on postoperative edema and inflammation after total hip arthroplasty (THA). Patients who underwent cementless THA were randomly divided into two groups: Group A consisted of 8 hips of 8 patients who were treated with TJ-114 at a dose of 9 g/day 2 days before surgery and for 2 weeks after surgery; Group B consisted of 9 hips of 9 patients who did not take TJ-114. Although no significant difference was observed between the two groups for lower extremity edema, it was found that swelling of the proximal leg in Group A was less than that in Group B. Furthermore, 3 weeks after surgery, every measuring point in the lower extremity showed that TJ-114 tended to decrease postoperative swelling compared to measurements of swelling of patients who did not take TJ-114. Serum C-reactive protein (CRP) levels of 6 out of 8 patients in Group A decreased and became negative 2 weeks after surgery; however, there were no patients in Group B whose CRP levels became negative after 2 weeks. In conclusion, TJ-114 is safe and useful for the prevention and early recovery of postoperative leg edema after THA with an association of rapid CRP reduction.

Serum osmolal gap in patients with idiopathic nephrotic syndrome and severe edema

Pseudohyponatremia in idiopathic nephrotic syndrome with severe edema is attributed to hyperlipidemia that results in displacement of a portion of water phase of plasma. Current methods of measurement of serum electrolytes are unaffected by hyperlipidemia. In this report we demonstrate that patients with idiopathic nephrotic syndrome with severe edema and true hyponatremia may have an increased rather than normal osmolal gap. We believe that this could be secondary to non-Na+ and non-K+ osmoles in response to plasma-volume contraction secondary to hypoalbuminemia. This observation has implications for management of severe edema in such patients, because fluid restriction could increase their risk for pre-renal failure.

Uric acid homeostasis in the evaluation of diuretic-induced hyponatremia

BACKGROUND

Diuretics are one of the most common causes of severe hyponatremia. The responsible pathogenetic mechanisms remain unclear. Serum uric acid concentration has been proposed as an index of differentiating between two pathophysiologic constructs of diuretic-induced hyponatremia-extracellular volume depletion and syndrome of inappropriate antidiuretic hormone secretion (SIADH)-like state-but its discriminating value has not been verified in large series of patients. Here we attempt to illuminate the pathophysiology of diuretic-induced hyponatremia by focusing on uric acid homeostasis. Additionally, we analyze the epidemiology and clinical characteristics of the disorder.

METHODS

We studied prospectively 158 adult patients with hyponatremia on admission to our internal medicine clinic. Here we report on those with diuretic-induced hyponatremia.

RESULTS

Forty patients (13 male and 27 female) had diuretic-induced hyponatremia, rendering it the most common cause of the disorder (25.3%). These patients had lower mean ([Na+]) (121.2 +/- 7.2 vs 126.4 +/- 4.1 mEq/L, p = .0001) than the remaining hyponatremic patients. Patients with serum uric acid levels < 4 mg/dL (n = 14) exhibited a biochemical profile consistent with a SIADH-like state, whereas patients with serum uric acid levels > or = 4 mg/d (n = 26) were consistent with extracellular volume depletion.

CONCLUSIONS

Diuretics are the most common cause of community-developed hyponatremia. The serum uric acid level effectively discriminates between two biochemical profiles of diuretic-induced hyponatremia, one consistent with extracellular volume depletion and another that simulates SIADH.

Earthworm paste (Lampito mauritii, Kinberg) alters inflammatory, oxidative, haematological and serum biochemical indices of inflamed rat

Experiments were conducted to understand the therapeutic properties such as anti-inflammatory, anti-oxidative, haematological and serum biochemical markers of earthworm paste (EP) derived from an indigenous species Lampito mauritii (Kinberg), in comparison with the standard anti-inflammatory drug- aspirin, on Wistar albino rat (Rattus norvegicus). Administration of earthworm paste of Lampito mauritii at the rate of 80 mg/kg into albino rats which were induced of inflammation, was found to reduce inflammation, restore the levels of antioxidants-reduced glutathione, glutathione peroxidase, superoxide dismutase, catalase and thiobarbituric acid reactive substances, normalise the values of erythrocyte, leukocyte, differential levels of neutrophils, lymphocytes, eosinophils, haemoglobin and serum biochemical contents e.g., protein, albumin, glucose, cholesterol, acid and alkaline phosphatase, electrolytes e.g., sodium, potassium and chloride. The anti-inflammatory activity together with antioxidant property of EP seems to be due to the high polyphenolic content of earthworm tissue.

Exogenous oestradiol and progesterone administration does not cause oedema in healthy young women

OBJECTIVE

Oedema is an increase in the extravascular component of extracellular fluid volume (ECFV). Fluid movement across the ECF is controlled by hydrostatic and oncotic pressures, which are influenced by oestradiol and progesterone. Thus we hypothesized that oestradiol decreases, while combined oestradiol + progesterone increases, protein and fluid movement out of the vasculature.

SUBJECTS

Subjects were eight healthy women (22 +/- 2 years).

DESIGN

Oestrogens and progesterone were suppressed with a gonadotropin-releasing hormone antagonist for 16 days; oestradiol (2 x 0.1 mg/day patches) was added for days 5-16 (E(2)) and progesterone (200 mg/day) was added for days 13-16 (E(2)-P(4)).

MEASUREMENTS

We estimated intravascular (plasma) volume (PV), transcapillary albumin escape rate (TER(alb)), and Starling forces (hydrostatic pressures of plasma and interstitium, plasma colloid pressure, capillary filtration coefficient) in the forearm on days 2 (GnRH antagonist), 9 (E(2)) and 16 (E(2)-P(4)).

RESULTS

In E(2), P([E2]) increased from 85 +/- 26 to 984 +/- 136 pmol/ml (P < 0.05), with no change in P([P4]). In E(2)-P(4), P([E2]) increased to 775 +/- 195 pmol/ml and P([P4]) increased from 6.4 +/- 3.2 to 43.8 +/- 16.2 nmol/l, P < 0.05). TER(alb) was lower during E(2) (5.1 +/- 0.9) and E(2)-P(4) (5.0 +/- 1.1) compared to GnRH antagonist (5.8 +/- 0.9%/h, P < 0.05). Plasma volume was unchanged by E(2), and showed a trend (P = 0.07) for an increase during E(2)-P(4) (48.2 +/- 2.9, 49.0 +/- 3.0 and 53.9 +/- 3.5 ml/kg for GnRH antagonist, E(2), E(2)-P(4), respectively). Starling forces were unaffected by hormone treatments. Plasma renin activity and serum aldosterone concentration increased during E(2)-P(4).

CONCLUSIONS

Neither E(2) nor E(2)-P(4) altered TER(alb) sufficiently to impact Starling forces indicating neither E(2) nor P(4) administration at these levels would likely cause oedema.

Hierro libre, transferrina y ferritina séricas en desnutrición aguda grave

INTRODUCTION

"Free" serum iron has been associated with the development of edema in Kwashiorkor-type severe acute malnutrition.

MATERIAL AND METHODS

A descriptive, cross sectional study was performed. Twenty-four children with edematous malnutrition, 22 with marasmus and 20 without malnutrition were compared. "Free" iron, transferrin, saturation index and attachment capacity of iron, ferritin, total protein, albumin, total iron, and C-reactive protein (CRP) were determined in serum.

RESULTS

A significant difference was found between malnourished children with "free" serum iron and the control group in which "free" iron was not found. However, no significant differences were found in "free" serum iron levels between marasmatic and edematous children. Transferrin was negatively correlated with "free" iron (r=-0.519; p=0.000). Total proteins, albumin and transferrin were all significantly lower in children with edema than in those with marasmus. A low transferrin level and a high saturation index could be used to estimate the probability of edema in 67.5% of cases (p=0.001).

CONCLUSIONS

Severe acute malnutrition was associated with the presence of "free" serum iron both in children with marasmus and in those with edema. "Free" iron does not explain the presence of edema but, as with severe hypoalbuminemia, the concurrence of a low transferrin level and a high saturation index may contribute to the etiology of edema.

Effect of Ocimum sanctum Linn. on cardiac changes in rats subjected to chronic restraint stress

Male Wistar rats were subjected to chronic restraint stress (CRS; 6 h/day for 21 days) alone or along with either hydroalcoholic extract of Ocimum sanctum (Os; 100 mg/kg; orally) or MK-801, an NMDA receptor antagonist (0.3 mg/kg; i.p.). In the rats subjected to only CRS, plasma cAMP level was significantly raised on day 21, with no significant change in plasma corticosterone level. There was a significant (p < 0.05) fall in myocardial glutathione level, along with a significant (p < 0.05) rise in myocardial superoxide dismutase (SOD) and catalase activities, while light microscopy showed evidence of myocardial edema. Both Os and MK-801 significantly prevented the CRS-induced rise in plasma cAMP level, myocardial SOD and catalase activities as well as the light microscopic changes in the myocardium. This study revealed that Ocimum sanctum protects rat heart from chronic restraint stress induced changes, through its central effect.

Long-term effects of a midgestational asphyxial episode in the ovine fetus

We and others have shown previously that fetuses at midgestation can survive 30 min of complete umbilical cord occlusion, although hydrops fetalis (or gross fetal edema) results. To investigate whether this hydrops resolves by late gestation and if there are any long-term consequences of the asphyxial insult on the heart and kidneys, eight fetuses were subjected to 30 min of complete umbilical cord occlusion at 0.6 gestation (90 days; term 150 days) and were compared to a sham group (n = 10). During the occlusion period, fetuses became severely hypoxemic, hypercapnemic, and acidotic, with both blood pressure and heart rate decreasing. Most variables had returned to normal by 2-hr recovery. At 129 +/- 1 days of gestation, approximately 40 days post occlusion, some fetuses were still slightly hydropic as skin fold measurements were increased (P < 0.01), although fetal body weight was not different from the sham group. The two groups had similar heart and kidney weights, ventricular cardiac myocyte nucleation, and glomerular number. By contrast, brain weight was reduced by 37% (P < 0.001) and the cerebral lateral ventricles were grossly dilated. Lungs were 50% smaller than in sham fetuses (P < 0.001). Thus, the hydrops that develops at midgestation as a result of a severe asphyxial episode can, but does not always, fully resolve by late gestation. Also, while fetuses at midgestation can survive this asphyxial episode with no long-term impact in renal or cardiac size, nephron number, or cardiomyocyte nucleation, the brain and lungs are severely affected.