Impact of Flaxseed Oil Supplementation on Tobacco Dependence, Craving, and Haematological Parameters in Tobacco-Dependent Subjects

Background Tobacco is prevalently used in smoking or smokeless forms and remains a major public health concern worldwide, with its adverse effects on overall health. Omega-3 fatty acid (FA) has shown its promising effects in various health conditions. Objective The purpose of this study was to evaluate the effect of flaxseed oil (omega-3 supplementation) on tobacco dependence, craving, withdrawal symptoms, and haematological parameters in tobacco users. Methods In this randomised, single-blind, placebo-controlled study, 104 tobacco users (54 in the omega-3 group and 50 in the placebo group) were supplemented with 10 ml of food-grade flaxseed oil and 10 ml of placebo for six months, respectively. Their demographics, frequency of daily tobacco use, tobacco dependence, tobacco craving, tobacco withdrawal symptoms, and complete blood count (CBC) were assessed at baseline (before intervention) and after a six-month intervention. Results The demographic characteristics of the two groups were similar except for gender at baseline. There were 50 males and four females in the omega-3 group, while there were 42 males and eight females in the placebo group. After a six-month flaxseed oil intervention, BMI values showed a significant reduction (p = 0.0081) in the omega-3 group when compared to baseline; however, CBC parameters did not show any significant changes when comparing baseline to follow-up values. On the contrary, haemoglobin and red blood cells (RBCs) showed significant changes when comparing the follow-ups of the omega-3 group with the placebo group, indicating p = 0.0016 and p = 0.0163, respectively. Also, omega-3 effectively decreased daily tobacco use frequency (p<0.0001), tobacco dependence (p<0.0001), and craving (p<0.0001). Conclusion Supplementation of 10 ml of flaxseed oil per day (omega-3 FA) for six months significantly reduced tobacco dependence and cravings. Additionally, the flaxseed oil supplementation effectively reduced the frequency of daily tobacco intake and modulated tobacco withdrawal symptoms. Thus, our results suggest that flaxseed oil supplementation is a useful adjunct for tobacco users who intend to quit tobacco use.

Primary Cardiac Sarcoma: Clinical Characteristics and Prognostic Factors over the Past 2 Decades

BACKGROUND

Primary cardiac sarcomas (PCS) are extremely rare malignant tumors involving the heart. Only isolated case reports have been described in the literature over different periods of time. This pathology has been associated with a dismal prognosis and given its rarity; treatment options are very limited. Furthermore, there are contrasting data about the effectiveness of current treatment modalities in improving the survival of patients with PCS, including surgical resection which is the mainstay of therapy. There is a paucity of data on the epidemiological characteristics of PCS. This study has the objective of investigating the epidemiologic characteristics, survival outcomes, and independent prognostic factors of PCS.

METHODS

A total of 362 patients were ultimately registered in our study from the Surveillance, Epidemiology, and End Results (SEER) database. The study period was from 2000 to 2017. Demographics such as clinical characteristics, overall mortality (OM), and PCS-specific mortality (CSM) were taken into account. A p value of <0.1 in the univariate analysis leads to the incorporation of the variable into multivariate analysis adjusting for covariates. Adverse prognostic factors were represented by a Hazard Ratio (HR) greater than one. The five-year survival analysis was carried out using the Kaplan-Meier method and the log-rank test was used to compare survival curves.

RESULTS

Crude analysis revealed a high OM in age 80+ (HR = 5.958, 95% CI 3.357-10.575, p < 0.001), followed by age 60-79 (HR = 1.429, 95% CI 1.028-1.986, p = 0.033); and PCS with distant metastases (HR = 1.888, 95% CI 1.389-2.566, p < 0.001). Patients that underwent surgical resection of the primary tumor and patients with malignant fibrous histiocytomas (HR = 0.657, 95% CI 0.455-0.95, p = 0.025) had a better OM (HR = 0.606, 95% CI 0.465-0.791, p < 0.001). The highest cancer-specific mortality was observed in age 80+ (HR = 5.037, 95% CI 2.606-9.736, p < 0.001) and patients with distant metastases (HR = 1.953, 95% CI 1.396-2.733, p < 0.001). Patients with malignant fibrous histiocytomas (HR = 0.572, 95% CI 0.378-0.865, p = 0.008) and those who underwent surgery (HR = 0.581, 95% CI 0.436-0.774, p < 0.001) had a lower CSM. Patients in the age range 80+ (HR = 13.261, 95% CI 5.839-30.119, p < 0.001) and advanced disease with distant metastases (HR = 2.013, 95% CI 1.355-2.99, p = 0.001) were found to have a higher OM in the multivariate analyses adjusting for covariates). Lower OM was found in patients with rhabdomyosarcoma (HR = 0.364, 95% CI 0.154-0.86, p = 0.021) and widowed patients (HR = 0.506, 95% CI 0.263-0.977, p = 0.042). Multivariate cox proportional hazard regression analyses of CSM also revealed higher mortality of the same groups, and lower mortality in patients with Rhabdomyosarcoma.

CONCLUSION

In this United States population-based retrospective cohort study using the SEER database, we found that cardiac rhabdomyosarcoma was associated with the lowest CSM and OM. Furthermore, as expected, age and advanced disease at diagnosis were independent factors predicting poor prognosis. Surgical resection of the primary tumor showed lower CSM and OM in the crude analysis but when adjusted for covariates in the multivariate analysis, it did not significantly impact the overall mortality or the cancer-specific mortality. These findings allow for treating clinicians to recognize patients that should be referred to palliative/hospice care at the time of diagnosis and avoid any surgical interventions as they did not show any differences in mortality. Surgical resection, adjuvant chemotherapy, and/or radiation in patients with poor prognoses should be reserved as palliative measures rather than an attempt to cure the disease.

A Rare Case of Refractory Catastrophic Antiphospholipid Syndrome Successfully Treated With Rituximab and Plasma Exchange

A small subset of patients with antiphospholipid syndrome (APS) may develop widespread thrombotic disease with organ damage, referred to as catastrophic APS (CAPS) that is associated with a high mortality. Medical therapy typically involves a combination of anticoagulation, systemic glucocorticoids, plasmapheresis, and intravenous immune globulin (IVIG). There is currently no consensus for the management of refractory cases of CAPS. However, monoclonal antibodies such as rituximab and eculizumab have shown some benefits. Herein, we present a 29-year-old female with previous pulmonary embolism who presented with necrotic left toes and was eventually diagnosed with refractory CAPS, successfully treated with Plasmapheresis and Rituximab. With this case report, we hope to encourage the usage of Rituximab in the management of CAPS.

The role of the bio-psychosocial model in public health

It is pertinent to understand the role of factors in the development of the diseases. After careful recognition a healthcare worker can better direct an appropriate treatment response. The bio-psychosocial model showed how biology, psychology and socio-environmental factors play a role in health. In contrast, biomedical model assumed that each occurrence of the disease was a result of deviation of biological molecules inside the body. The bio-psychosocial model is a stronger model focusing more on the person as a whole rather on the illness alone. It has generated a new perception to see the health of the population. It has broadened the horizon of public health agencies to see and examine the illness with a different approach and to provide better results in the preventative approaches. This review highlights the importance of the bio-psychosocial model in public health.

Antileishmanial efficacy of Boerhaavia diffusa L. and Ocimum sanctum L. against experimental visceral leishmaniasis

The chemotherapy of visceral leishmaniasis (VL) has several limitations including resistance and toxicity of the existing drugs. Down regulation of immune system further aggravates the problems. To combat this situation we evaluated the leishmanicidal efficacy of Boerhaavia diffusa and Ocimum sanctum through oral route in L. donovani infection in BALB/c mice. Results have demonstrated maximum clearance of the parasites from infected animals treated with combination of B. diffusa and O. sanctum (@ 100 and 400 mg/kg body wt., respectively 5 days) as depicted through Leishman Donovan Units in liver. Up-regulation of cell-mediated immunity was also observed in animals of this group as heightened delayed type hypersensitivity responses and increased IgG2a levels were observed. Moreover, increased levels of SGOT, SGPT, serum urea, blood urea nitrogen and serum creatinine were brought down to normal levels. Since VL is associated immunosuppression, the above treatment is a good option as it helps in the up-regulation of Th1 responses and reduction in parasite load in L. donovani infected mice. These findings suggest a new option for antileishmanial chemotherapy at lower cost and nil toxicity.

Association of diabetic autonomic neuropathy with red blood cell aldose reductase activity

OBJECTIVE

Activation of polyol pathway based on increased activity of aldose reductase (AR) has been implicated in the development of diabetic complications including diabetic autonomic neuropathy (DAN). The relationship between DAN and hyperglycemia-induced activation of polyol pathway is still uncertain. In the present study, we investigate the association between aldose reductase activity and diabetic autonomic neuropathy by measuring AR level in red blood cells (RBC).

METHOD

In this study, 145 subjects with diabetes with or without DAN and 32 subjects without diabetes have been included. All subjects have been investigated for autonomic function tests and RBC aldose reductase activity. DAN was defined if results of any 2 of the tests of parasympathetic function were abnormal. RBC aldose reductase level was determined spectrophotometrically and expressed as unit/g of hemoglobin. The values were expressed as mean ± standard deviation, and ANOVA test has been applied for comparison between groups.

RESULTS

RBC aldose reductase activity was found to be significantly higher in people with diabetes with autonomic neuropathy in comparison to people with diabetes without autonomic neuropathy and healthy individuals without diabetes. Aldose reductase (AR) level ranges from 0.8 units/g Hb to 14.2 units/g Hb. The mean AR level was 8.6±2.95 units in subjects of DM with autonomic neuropathy, while mean AR level was 4.1±1.78 units and 2.0±0.89 units in people with diabetes without neuropathy and normal healthy individuals, respectively (p<0.001).

CONCLUSIONS

High aldose reductase activity is associated with the presence of autonomic neuropathy in subjects of type 2 DM.

Variations in 7-day/24-h circadian pattern of ambulatory blood pressure and heart rate of type 2 diabetes patients

AIMS/INTRODUCTION

Diabetes has profound consequences on the cardiovascular system leading to cardiovascular morbidity and mortality in diabetic patients. Blood pressure (BP) has a characteristic and reproducible circadian pattern, with high values during the day and low values at night. A 7-day timed analysis of BP through ambulatory blood pressure monitoring has been used not only to diagnose day and night dipping patterns of blood pressure, but also to measure day-to-day variability and the circadian hyper-amplitude-tension, a condition in which excessive circadian BP amplitude precedes the chronic established hypertension. Our objective was to assess the 7-day/24-h circadian pattern of BP and heart rate in diabetic patients, as it could be helpful in the diagnosis and prevention of cardiovascular morbidity.

MATERIALS AND METHODS

A total of 50 diabetic patients with type 2 diabetes and 50 non-diabetic participants were recruited for the study. General health records were individually maintained, and 7-day/24-h ambulatory blood pressure monitoring using an ambulatory blood pressure monitor was carried out.

RESULTS

The rhythmic parameters of systolic and diastolic BP, heart rate, double amplitude, acrophase and 3-h fractionated hyperbaric index were found to be significantly high in diabetic patients. A total of 12 participants were diagnosed with circadian hyper-amplitude-tension. These data suggest that diabetic patients have certain variations in the circadian pattern of blood pressure and heart rate, which can result in disturbed vascular events, and thus are at greater risk of cardiovascular morbidity.

CONCLUSION

Seven-day/24-h monitoring might be useful as an early predictive tool in assessing future cardiovascular risk, guiding treatment and management of these patients.

Identification, purification, and characterization of a thermally stable lipase from rice bran. A new member of the (phospho) lipase family

A thermally stable lipase (EC 3.1.1.3.) was first identified in rice (Oryza sativa) bran, and the enzyme was purified to homogeneity using octyl-Sepharose chromatography. The enzyme was purified to 7.6-fold with the final specific activity of 0.38 micromol min(-1) mg(-1) at 80 degrees C using [9,10-(3)H]triolein as a substrate. The purified enzyme was found to be a glycoprotein of 9.4 kD. Enzyme showed a maximum activity at 80 degrees C and at pH 11.0. The protein was biologically active and retained most of its secondary structure even at 90 degrees C as judged by the enzymatic assays and far-ultraviolet circular dichroism spectroscopy, respectively. Differential scanning calorimetric studies indicated that the transition temperature was 76 degrees C and enthalpy 1.3 x 10(5) Calorie mol(-1) at this temperature. The purified lipase also exhibited phospholipase A(2) activity. Colocalization of both the hydrolytic activities in reverse-phase high-performance liquid chromatography and isoelectric focusing showed that the dual activity was associated with a single protein. Further, a direct interaction between both the substrates and the purified protein was demonstrated by photoaffinity labeling, using chemically synthesized analogs of triolein and phosphatidylcholine (PC). Apparent K(m) for triolein (6.71 mM) was higher than that for PC (1.02 mM). The enzyme preferentially hydrolyzed the sn-2 position of PC, whereas it apparently exhibited no positional specificity toward triacylglycerol. Diisopropyl fluorophosphate inhibited both lipase and phospholipase activities of the purified enzyme. This enzyme is a new member from plants in the family of lipases capable of hydrolyzing phospholipids.

Spitz nevus

A case of Spitz nevus is presented in view of the difficulties of differentiating it from malignant melanoma. Spitz nevus with predominantly epithelioid cell is uncommon.

Peutz-Jeghers syndrome: confirmation of linkage to chromosome 19p13.3 and identification of a potential second locus, on 19q13.4

Peutz-Jeghers syndrome (PJS) is an autosomal dominant disease with variable expression and incomplete penetrance, characterized by mucocutaneous pigmentation and hamartomatous polyposis. Patients with PJS have increased frequency of gastrointestinal and extraintestinal malignancies (ovaries, testes, and breast). In order to map the locus (or loci) associated with PJS, we performed a genomewide linkage analysis, using DNA polymorphisms in six families (two from Spain, two from India, one from the United States, and one from Portugal) comprising a total of 93 individuals, including 39 affected and 48 unaffected individuals and 6 individuals with unknown status. During this study, localization of a PJS gene to 19p13.3 (around marker D19S886) had been reported elsewhere. For our families, marker D19S886 yielded a maximum LOD score of 4.74 at a recombination fraction (theta) of .045; multipoint linkage analysis resulted in a LOD score of 7.51 for the interval between D19S886 and 19 pter. However, markers on 19q13.4 also showed significant evidence for linkage. For example, D19S880 resulted in a maximum LOD score of 3.8 at theta = .13. Most of this positive linkage was contributed by a single family, PJS07. These results confirm the mapping of a common PJS locus on 19p13.3 but also suggest the existence, in a minority of families, of a potential second PJS locus, on 19q13.4. Positional cloning and characterization of the PJS mutations will clarify the genetics of the syndrome and the implication of the gene(s) in the predisposition to neoplasias.