Comparative Efficacy and Safety of Diacerein in Patients with Knee Osteoarthritis: A Pilot Study

Background Osteoarthritis (OA) is the most common chronic rheumatic disease. The prevalence of OA is skyrocketing with time. Providing a proper treatment regimen for OA is also growing as a major public health challenge. Conventional pharmacological treatments are mainly for alleviating pain and have some severe adverse effects. Diacerein is a new oral anti-inflammatory drug especially developed for the management of OA having only mild to moderate adverse effects. However, the evidence of efficacy and safety of Diacerein in OA is not well documented and yet to be explored. Objective To compare the efficacy and safety of Diacerein in knee OA with conventional nonsteroidal anti-inflammatory drugs (NSAIDs). Method A comparative study was conducted among knee OA patients attending OutPatient Orthopedic department in Dhulikhel Hospital, Nepal from December 2019 to September 2020, using self-structured and standard questionnaire. The patients were randomized to receive either a conventional standard treatment (Treatment Group I: NSAIDs) or alternative treatment regimen (Treatment Group II: NSAIDS+ Diacerein). Patients were followed-up after two months and data were analyzed using SPSS 21.0. Result Among 72 patients enrolled in this study, majority (44.44%) were between 51-60 years of age in which 81.94% of the patients were female. Post treatment data was collected from 15 participants. The mean KOOS-PS score of the participants in Treatment Group I decreased from 35.56 ± 14.33 to 35.14 ± 12.65 while that of the Treatment Group II participants reduced from 63.31 ± 12.08 to 49.99 ± 13.10 in two months. Similarly, the mean WOMAC score decreased from 46.87 ± 17.80 to 34.37 ± 16.83 in Treatment Group I and from 54.23 ± 14.66 to 46.22 ± 12.16 in Treatment Group II. The mean Lysholm score in Treatment Group I increased from 55.57 ± 8.16 to 60.86 ± 15.01 and in Treatment Group II, it increased from 46.62 ± 13.01 to 60.25 ± 17.598. Conclusion Diacerein treatment group had better functional outcome compared to the patients in the treatment group with conventionally used drugs. Also, the adverse effects faced by the patients were minor. The current study are suggestive of better efficacy and safety of Diacerein compared to other drugs.

Adherence to Iron, Folic Acid and Calcium Supplement and Factors Affecting it among the Antenatal Care Attending Women in a Tertiary Care Hospital: A Cross Sectional Study

Background Pregnancy or gestation is the time during which a single or more children grows and develops inside a woman. Antenatal care improves the pregnancy outcomes under which a group of medication i.e. iron, folic acid and calcium are supplemented. Despite the effectiveness of such supplements, poor clinical outcomes are often encountered because of poor-adherence to the regimen. Objective To determine the adherence pattern and factors affecting adherence in antenatal care patients under iron, folic acid, and calcium therapy. Method A cross-sectional study was conducted in Dhulikhel Hospital, Kathmandu University Hospital. Pregnant women attending antenatal care under iron, folic acid, and calcium therapy fulfilling the inclusion criteria were enrolled in this study. After obtaining the informed consent from the patients, structured questionnaire was used to interview the patients. Statistical analysis was performed by using SPSS 23.0. P-value < 0.05 was considered as statistically significant. Result Among 191 patients enrolled in this study majority (39.3%) of them belonged to age group 26-30 years. More than half (61.3%) of the patients were illiterate. Of the total 191, 64.40% were non-adherent to the medication. Forgetfulness was the main reason for missing the dose in majority (52.06%) of the non-adherent subjects while adverse effects (55.40%) was the most prominent cause for discontinuing the medication among non-adherent participants. Significant association was found between patients' adherence and busy work schedule, visiting doctor for follow up. Conclusion More than half of the patients had not adhered to the medication under antenatal care. Forgetfulness was the most common factor for missing the dose in nonadherent patients. Illiteracy was associated with poor adherence. Patient-provider relationship, Socio-economic factors were determined as major barrier to medication adherence.

Histopathological Changes in the Chorionic Villi and Endometrial Decidual Tissues in the Product of Conception of Spontaneous Abortion Cases

Background Spontaneous abortion refers to a pregnancy that ends spontaneously before the fetus has reached a viable gestational age or expulsion or extraction of an embryo or fetus weighing 500 g or less from its mother. The Maternal Mortality Morbidity Survey of Nepal 2008/09 reported that 7% of maternal deaths in Nepal were due to complications related to abortion. Objective The main objective of this study was to examine the histopathological changes in the chorionic villi and endometrial decidual tissue in products of conception obtained from women with spontaneous abortion. Method This is a retrospective study of 111 patients admitted in the Department of Obstetrics and Gynecology at Dhulikhel Hospital, Kathmandu University Hospital (DH-KUH) with the diagnosis of spontaneous abortion during the period of January 2013 to January 2014. Result Among 111 cases of spontaneous abortions, products of conception was seen in 73 (65.77%) and with only one cases of choriocarcinoma. Majority of cases belongs to age group 21-30 years. The most common decidual changes were inflammation (41.4%) followed by fibrin deposition 29.7%. Majority of the cases shows hydropic changes as histopathological changes in chorionic villi. In the present study, minimum age of lady was 15 years and the maximum age was 45 years and the mean age was 25.09±5.58 years at the time of abortion. Among the cases, maximum 69 (62.2%) of them belonged to age group 21-30 years. Correlating the age group with number of abortions was found to be significantly different (Chi-square= 92.35, df= 3, p < 0.001) among four different age groups. Conclusion The histopathological diagnosis of spontaneous abortion will help in further management of the patient. Further study is required to know the cause of different histopathlogical changes in villi as well as in the decidua.

Tuberculin Survey in Government High School of Dharan Municipality

This survey was done in 682 out of 1672 children tested with Batch of Tuberculin used for Testing (PPD RT23 with Tween 80) in Jan. 1997 with financial research grant of B.P. Koirala Institute of Health Sciences,Dharan.Dharan City is situated in Eastern Development Region (EDR) of Nepal where a high percentage of migrated population is residing with very high number of sputum positive cases. The majority of populationare from high hills & mountain region where the Annual Risk of Infection (ARI) is less. This survey was doneto know the epidemiological situation of Tuberculosis (TB) in Dharan.Tuberculin survey was done in Eastern Development Region (EDR) (1994) by National Tuberculosis Centre(NTC) / Japan International Cooperation Agency (JICA) in Saptari & Morang. The reported result ofaverage Annual Risk of Infection (ARI) is 2.49% & 2.38% respectively.The mean age of surveyed population was 14.8 yrs. The Bacilli Calmette Guerin (BCG) coverage (scar rate)was 38.3% & BCG 4 - 8 age group 83.3% was highest & it gradually decreased to 37.5% in 12 + age group.The average 23 Tween – 8 – Batch of Tuberculin used for Testing (PPD) positive is 33.6% with 10 mminduration as cutoff line. Annual Risk of Infection (ARI) based on above was 2.7% in 9 - 11 age group &1.31% in 12 + age group. This survey is suggestive of tuberculosis being highly prevalent in Dharan. Thesurvey also showed average ARI to be 2.44% in Dharan in 10 - 15 yrs age group. The finding is suggestive ofhigh ARI although the populations has migrated from hill & mountain. Previous report of average ARI inthis area was 2.5% (Morang & Saptari). The survey result suggests that high priority, effective tuberculosisprogram is necessary and intensive control program can only give impact to control of tuberculosis in Dharan.Key Words: Tuberculin survey, school children, BCG coverage, ARI, Effective tuberculosis programme.

Tuberculin survey in government high school of Dharan municipality

This survey was done in 682 out of 1672 children tested with Batch of Tuberculin used for Testing (PPD RT 23 with Tween 80) in Jan. 1997 with financial research grant of B.P. Koirala Institute of Health Sciences, Dharan. Dharan City is situated in Eastern Development Region (EDR) of Nepal where a high percentage of migrated population is residing with very high number of sputum positive cases. The majority of population are from high hills and mountain region where the Annual Risk of Infection (ARI) is less. This survey was done to know the epidemiological situation of Tuberculosis (TB) in Dharan. Tuberculin survey was done in Eastern Development Region (EDR) (1994) by National Tuberculosis Centre (NTC)/Japan International Cooperation Agency (JICA) in Saptari and Morang. The reported result of average Annual Risk of Infection (ARI) is 2.49% and 2.38% respectively. The mean age of surveyed population was 14.8 yrs. The Bacilli Calmette Guerin (BCG) coverage (scar rate) was 38.3% and BCG 4-8 age group 83.3% was highest and it gradually decreased to 37.5% in 12 + age group. The average 23 Tween-8-Batch of Tuberculin used for Testing (PPD) positive is 33.6% with 10 mm induration as cutoff line. Annual Risk of Infection (ARI) based on above was 2.7% in 9-11 age group and 1.31% in 12 + age group. This survey is suggestive of tuberculosis being highly prevalent in Dharan. The survey also showed average ARI to be 2.44% in Dharan in 10-15 yrs age group. The finding is suggestive of high ARI although the populations has migrated from hill and mountain. Previous report of average ARI in this area was 2.5% (Morang and Saptari). The survey result suggests that high priority, effective tuberculosis program is necessary and intensive control program can only give impact to control of tuberculosis in Dharan.

Interaction of the retinoblastoma protein (pRb) with the catalytic subunit of DNA polymerase delta (p125)

The retinoblastoma gene product (pRb) interacts with many cellular proteins to function in the control of cell division, differentiation, and apoptosis. Several pRb binding proteins complex with pRb through an amino acid sequence called the LXCXE motif. The catalytic subunit of DNA polymerase delta (p125) contains a LXCXE motif. To further study the biochemical function of this polymerase, we sought to determine if p125 interacts with pRb. Experiments using GST-pRb fusion proteins showed that p125 from breast epithelial (MCF10A) cell extracts associates with pRb. In addition, GST-p125 fusion proteins bound pRb from the same cell extracts. The pRb that associated with GST-p125 was largely unphosphorylated. Coimmunoprecipitation experiments using cell cycle synchronized cells revealed that p125 and pRb form a complex predominantly during G1 phase, the phase during which pRb is mostly unphosphorylated. In vitro phosphorylation of GST-pRb by the cyclin dependent kinases reduced the ability of p125 to associate with GST-pRh. Addition of the LXCXE containing protein SV40 large T antigen to GST-pRb blocks the ability of p125 to associate with pRb, suggesting that it may be through a LXCXE sequence by which p125 interacts with pRb. Finally, in vitro polymerase assays demonstrate that GST-pRb fusion protein stimulates DNA polymerase delta activity.

The carboxyl-terminal region of the retinoblastoma protein binds non-competitively to protein phosphatase type 1alpha and inhibits catalytic activity

pRB, a negative-growth regulatory protein, is a demonstrated substrate for type 1 serine/threonine protein phosphatases (PP1). In a recent report from this laboratory, we demonstrated that select forms of phosphorylated as well as hypophosphorylated pRB can be found complexed with the alpha-isotype of PP1 (PP1alpha). This complex can also be observed when PP1 is rendered catalytically dead by toxin inhibition. These data suggested to us that pRB may bind to PP1 at one or more sites other than the catalytically active one on the enzyme and that such binding may play a role other than bringing the substrate into contact with the enzyme to facilitate catalysis. To address this possibility we utilized a series of pRB deletion mutants and coprecipitation studies to map the pRB domain involved in binding to PP1. Together with competition assays using in vivo expression of SV40 T-antigen, we show here that the carboxyl-terminal region of pRB is both necessary and sufficient for physical interaction with PP1. Subsequent biochemical analyses demonstrated inhibition of PP1 catalytic activity toward the standard substrate phosphorylase a when this enzyme is bound to pRB containing this region. K(m) and V(max) calculations revealed that pRB binds to PP1 in a non-competitive manner. These data support the notion that pRB, in addition to being a substrate for PP1, also functions as a PP1 inhibitor. The significance of this finding with respect to the functional importance of this interaction is discussed.

Role of pRB dephosphorylation in cell cycle regulation

pRB, the tumor suppressor product of the retinoblastoma susceptibility gene, is regarded as one of the key regulators of the cell cycle. This protein exerts its growth suppressive effect through its ability to bind and interact with a variety of cellular proteins. In turn, pRB binding and interacting ability is governed by its phosphorylation state. In recent years, this negative growth regulatory protein has captured a great deal of attention from investigators around the world due to its ability to modulate the activity of transcription regulatory proteins, enzymes which modify chromatin, and other cellular proteins which contribute to its complex role in mammalian cells. Hypophosphorylated pRB binds and sequesters transcription factors, most notably those of the E2F/DP family, inhibiting the transcription of genes required to traverse the G1 to S phase boundary. This cell cycle inhibitory function is abrogated when pRB undergoes phosphorylation mediated by cyclin/cdk complexes following cell stimulation by mitogens. Removal of these phosphates appears to be carried out by a multimeric complex of protein phosphatase type 1 (PP1) and noncatalytic regulatory subunits at the completion of mitosis. This dephosphorylation returns pRB to its active, growth suppressive state. While the mechanism of pRB phosphorylation has and continues to be extensively studied, dephosphorylation of pRB has received disproportionately less attention. The goal of this review is to revisit the role of pRB dephosphorylation in regulating the cell cycle. Emphasis will be placed on understanding the function and regulation of pRB during the cell cycle as well as our ever-expanding notions of pRB-PP1 interaction and the mechanism of pRB dephosphorylation at mitotic exit.

Binding of select forms of pRB to protein phosphatase type 1 independent of catalytic activity

The product of the retinoblastoma susceptibility gene, pRB, is a demonstrated substrate for the type 1 serine/threonine protein phosphatases (PP1). Curiously, there has been a paucity of data supporting the idea that phosphorylated pRB can be found in a complex with PP1. To more fully characterize the association between these two proteins, we utilized a PP1-affinity chromatography approach to increase our ability to capture from mammalian cell lysate populations of pRB capable of binding to PP1. Western blot analysis of the bound proteins indicates that both faster migrating, hypophosphorylated pRB, as well as slower migrating, hyperphosphorylated pRB can bind. Phosphorylated pRB binding was confirmed by immunoprecipitation of eluted 32P-labeled pRB. In addition, Western blotting of eluted proteins with pRB phosphorylated-site-specific antibodies revealed select phosphorylated forms of pRB binding to PP1. Similar binding studies performed with toxin-inhibited PP1 indicate that catalytic activity of PP1 is not required for pRB binding. The significance of this finding with respect to the functional importance of this interaction is discussed.

Protein phosphatase type 1, the product of the retinoblastoma susceptibility gene, and cell cycle control

Cell cycle regulation--three words which conjure in the minds of those conducting research in this area a myriad of proteins and biochemical pathways. In this examination, an overview of the mammalian cell cycle is presented with emphasis on the function of the negative growth regulatory protein, the product of the retinoblastoma susceptibility gene, pRb. Since the activity of this protein itself is regulated by phosphorylation on serine and threonine residues, more elaborate discussions on the enzymes involved in placing the phosphates on, and taking them off, are provided. The focus here is on the activity of the members of the type 1 class of serine/threonine phosphatases. More specifically, the role of PP1 in regulating cell cycle progression by dephosphorylating pRb during mitosis, thereby activating the growth suppressing function of pRb, is presented. Suggested avenues for further investigation regarding the functional significance, and ultimately the effect on cell cycle progression, of the complex between pRb and the type 1 phosphatases are also discussed.