Efficacy of contrast enhanced grey scale ultrasound in characterisation of hepatic focal lesions: A pilot study

Background

Contrast enhanced ultrasound (CEUS) has recently gained widespread acceptance as an adjunct to conventional grey scale ultrasound. The present pilot study was undertaken to evaluate the efficacy of this technique in characterisation of hepatic focal lesions.

Methods

Adult patients who had at least one focal liver lesion underwent ultrasound evaluation in regular and contrast mode before and after intravenous administration of sulphur hexafluoride. The diagnoses were confirmed by comparison with a reference standard (multidetector CT), response to treatment or pathological correlation.

Results

The rate of correct diagnosis for unenhanced ultrasound was 54%, CEUS was 72% and multidetector CT (MDCT) was 92%. A comparison of unenhanced ultrasound versus CEUS using the McNemar test yielded a p value of 0.0704 (>0.05). However, comparison of CEUS versus MDCT using the McNemar test yielded a p value of 0.0265 (<0.05). Additionally, comparison of unenhanced ultrasound versus MDCT using the McNemar test yielded a p value of <0.0001.

Conclusion

CEUS increases diagnostic efficacy over unenhanced ultrasound but does not have any significant advantages over MDCT. Currently it may be used as a problem solving tool in atypical haemangiomas, echogenic focal liver lesions, contrast sensitivity and to avoid multiple studies utilising ionising radiation.     

Effects of bisoprolol and cilazapril on the central retinal artery blood flow in patients with essential hypertension—preliminary results

Background

A growing body of evidence suggests that effective blood pressure reduction may inhibit the progression of microvascular damage in patients with essential arterial hypertension. However, the potential influence of anti-hypertensive drugs on ocular circulation has not been studied sufficiently.

Purpose

The aim of our study was to evaluate the effects of anti-hypertensive therapy on blood flow in the central retinal artery in patients with systemic arterial hypertension.

Material and methods

Twenty patients with essential arterial hypertension, aged 32–46 years, were examined with Doppler ultrasonography (10 MHz ultrasound probe). Blood flow velocities, pulsatility, and vascular resistance were determined before and 3 hours after systemic application of either bisoprolol 5 mg or cilazapril 2.5 mg.

Results

Administered bisoprolol significantly decreased maximum (9.8 ± 0.5 cm/s versus 8.5 ± 0.6 cm/s; P < 0.05) and minimum (2.75 ± 0.19 cm/s versus 1.75 ± 0.27 cm/s; P < 0.02) velocity, increased the Pourcellot''s index (0.71 to 0.79; P < 0.05) in central retinal artery. There were no statistically significant changes in central retinal artery blood flow after administration of cilazapril.

Conclusion

Systemic application of beta-blockers may unfavourably disturb the ocular blood flow.     

Neuroprotection by S-PBN in hyperglycemic ischemic brain injury in rats

Background

Hyperglycemia exacerbates focal ischemic brain damage supposedly through various mechanisms. One such mechanism is oxidative stress involving reactive oxygen and nitrogen species (RONS) production. Nitrones attenuate oxidative stress in various models of brain injury. Sodium 2-sulfophenyl-N-tert-butyl nitrone (S-PBN) can be administered experimentally and has been shown to be neuroprotective in experimental brain trauma.

Aims of the study

We hypothesized that S-PBN might be neuroprotective in hyperglycemic focal cerebral ischemia.

Material and methods

Rats were made hyperglycemic by an intraperitoneal bolus injection of glucose (2 g/kg) and then subjected to 90 min transient middle cerebral artery occlusion (MCAO). They were randomized to a therapeutic regime of S-PBN (156 mg/kg) or saline given intravenously. Neurological testing according to Bederson and tetrazolium red staining were performed after 1 day.

Results

S-PBN improved the neurological performance at day 1 both in Bederson score (1.3 ± 0.8 versus 2.7 ± 0.48) and on the inclined plane (74.5% ± 4.6 (S-PBN) versus 66% ± 8.3 (control), P < 0.05) but did not reduce the infarct size. Physiological data did not differ between groups.

Conclusion

S-PBN may improve neurological performance at short-term survival (1 day) in the present model of hyperglycemic-ischemic brain injury in rats. This effect appeared not to be primarily related to reduced infarct size.     

Mean platelet volume could be a promising biomarker to monitor dietary compliance in celiac disease

Background

Celiac disease (CD) is an autoimmune disease that develops in patients with a genetic predisposition, incurring a susceptibility to gluten-containing foods such as barley, wheat, and rye. The elimination of gluten from the diet is the main therapeutic approach and usually leads to clinical and laboratory improvement. There are no ideal markers that objectively assess dietary compliance in CD patients.

Materials and methods

Sixty newly diagnosed CD patients (male/female: 43/17) and 40 healthy subjects (male/female: 23/17) were enrolled in this study. The diagnosis of CD was established by both histological findings of duodenum biopsy (total villous atrophy and lymphocytic infiltration) and positive antibodies against endomysium or gliadin.

Results

A significantly higher mean platelet volume (MPV) was observed in the CD group compared with healthy subjects (8.45 ± 0.96 fL versus 7.93 ± 0.63 fL; p = 0.004). After introduction of a gluten-free diet, the MPV of CD patients in the dietary adherent group was significantly lower than that of the non-adherent group (8.09 ± 0.6 fL versus 8.9 ± 1.08 fL; p = 0.001). Overall dietary adherence rate was 71.6% (43/60 CD patients). In the dietary compliant group, initiation of gluten-free diet was associated with a significant decrease in MPV from base-line values (8.56 fL versus 8.25 fL; p = 0.008). In the non-adherent group, MPV on 3-month follow-up was higher than at base-line (8.05 fL versus 8.91 fL; p = 0.001).

Conclusion

MPV could be a promising and easily available biomarker for monitoring of dietary adherence in CD patients at a low cost in comparison with other modalities.     

Can poison control data be used for pharmaceutical poisoning surveillance?

Objective

To determine the association between the frequencies of pharmaceutical exposures reported to a poison control center (PCC) and those seen in the emergency department (ED).

Design

A statewide population-based retrospective comparison of frequencies of ED pharmaceutical poisonings with frequencies of pharmaceutical exposures reported to a regional PCC. ED poisonings, identified by International Classification of Diseases, Version 9 (ICD-9) codes, were grouped into substance categories. Using a reproducible algorithm facilitated by probabilistic linkage, codes from the PCC classification system were mapped into the same categories. A readily identifiable subset of PCC calls was selected for comparison.

Measurements

Correlations between frequencies of quarterly exposures by substance categories were calculated using Pearson correlation coefficients and partial correlation coefficients with adjustment for seasonality.

Results

PCC reported exposures correlated with ED poisonings in nine of 10 categories. Partial correlation coefficients (r_p) indicated strong associations (r_p>0.8) for three substance categories that underwent large changes in their incidences (opiates, benzodiazepines, and muscle relaxants). Six substance categories were moderately correlated (r_p>0.6). One category, salicylates, showed no association.

Limitations

Imperfect overlap between ICD-9 and PCC codes may have led to miscategorization. Substances without changes in exposure frequency have inadequate variability to detect association using this method.

Conclusion

PCC data are able to effectively identify trends in poisonings seen in EDs and may be useful as part of a pharmaceutical poisoning surveillance system. The authors developed an algorithm-driven technique for mapping American Association of Poison Control Centers codes to ICD-9 codes and identified a useful subset of poison control exposures for analysis.     

Comparison of lipid profile in different grades of non-alcoholic fatty liver disease diagnosed on ultrasound

Objective

To detect and compare serum lipid abnormalities in patients diagnosed with different grades of non-alcoholic fatty liver on ultrasonography.

Methods

A total of 70 cases which included 30 males and 40 females, diagnosed as non-alcoholic fatty liver disease (NAFLD) on ultrasound were investigated with serum lipid profile. Then a comparison of lipid abnormalities between different grades of fatty liver diagnosed on ultrasound was done. P value was calculated by using analysis of variance test (ANOVA) and P value <0.05 was considered as statistically significant.

Results

Out of 70 cases which were diagnosed as NAFLD on ultrasonography, grade I NAFLD cases were 47.15%, grade II were 42.85% and grade III were 10%. The mean age of the patients was 49.14 years. Male to female ratio was 3:4. Serum triglycerides, total cholesterol, LDL and VLDL levels were raised in 67.14%, 45.71% 34.28%, 25.71% of cases respectively. Low serum HDL levels were seen in 62.85% of patients. On statistical analysis we found increasing grades of NAFLD were significantly associated with increasing values of total cholesterol (P value-0.001), LDL (P value-0.000) and VLDL (P value-0.003) and decreasing HDL (P value-0.000).

Conclusion

Most of the patients of NAFLD in India is asymptomatic, non-diabetic and non-hypertensive. Though liver biopsy is the gold standard method for diagnosis of NAFLD, Ultrasonography which is non-invasive, simple tool, can be used for the early detection of NAFLD in asymptomatic patients.     

Antiarthritic effects of Ajuga bracteosa Wall ex Benth. in acute and chronic models of arthritis in albino rats

Objective

To evaluate the antiarthritic activity of Ajuga bracteosa using albino rats.

Methods

The antiarthritic activity of 70% ethanolic extract of Ajuga bracteosa (EEAB) was evaluated against turpentine oil- and formaldehyde- induced acute non immunological and complete freund''s adjuvant (CFA)-induced chronic immunological arthritis in albino rats.

Results

EEAB showed a significant (P<0.05) and dose dependent inhibitory effect against acute and chronic models of arthritis. EEAB exhibited better antiarthritic activity than the standard aspirin.

Conclusions

EEAB exhibits a significant and promising antiarthritic activity against acute and chronic arthritis and supports the traditional use of Ajuga bracteosa for rheumatism and other inflammatory diseases.     

The prevalence of Linguatula serrata nymphs in camels slaughtered in Mashhad slaughterhouse,Northeast, Iran

Objective

To evaluate the prevalence of nymphal stages of L. serrata in mesenteric lymph nodes of camels slaughtered in Mashhad slaughterhouse, Northeast of Iran.

Methods

For this purpose, mesenteric lymph nodes of 400 camels of different sex and age were examined. The lymph nodes were examined macroscopically and a digestion method was also applied for investigation of samples which was negative macroscopically.

Results

The mesenteric lymph nodes of 73 camels out of 400 (18.25%) were infected by L. serrata nymphs.

Conclusions

Prevalence of L. serrata nymphs in males and females and different age was not significantly different (P>0.05), but difference was observed between the prevalence in different seasons (P< 0.05). The potential importance of these findings to human health is discussed. This is the first report of infection with L. serrate of camels in camels slaughtered at northeast of Iran.     

Studies on the anti-diarrheal properties of leaf extract of Desmodium puchellum

Objective

To evaluate the pharmacological activity against diarrhea of methanol and petroleum ether extract of Desmodium puchellum (Family: Fabaceae) leaves.

Methods

The extract was evaluated for castor oil-induced diarrhea and enteropooling as well as intestinal motility in rats. Both of the extracts were given to the rats at 200 mg/kg orally. Loperamide was used as a standard drug for diarrhea.

Results

The diarrheal severity was reduced significantly (P<0.05) by methanol and petroleum ether extracts by 31.95% and 28.33%, respectively, whereas 54.75% inhibition was found for standard drug loperamide at 5 mg/kg. The two extracts also significantly (P<0.05) reduced the intestinal volume in case of castor oil induced enteropooling.

Conclusions

It is concluded that both fractions contain some biologically active ingredients that are active for anti-diarrheal actions whereas methanol fraction has better potential.     

Multidetector CT Evaluation in Arterial Stenting

Background

Multidetector CT (MDCT) represents breakthrough in CT technology, significantly improving CT Angiography applications.

Methods

Twenty one patients with aortoiliac & branch aneurysms or stenosis were evaluated by Digital Subtraction Angiography (DSA) and Multidetector CT (MDCT) before and after endovascular repair.

Results

There were eight cases of aortic & branch aneurysms and 13 with stenosis. Four cases had aortic aneurysms, while one case had left subclavian artery aneurysm, thoracic aneurysm, femoral and popliteal artery pseudoaneurysms. Of the 13 cases with stenotic lesions, iliac stenosis was seen in eight patients. The others included carotid, vertebral, aortic, renal and aortic bifurcation stenotic. MDCT offered accurate information on shape and size of aneurysm, shape and patency of graft, the presence or absence of perigraft thrombosis or endoleaks, while in stenotic lesions it provided useful information on shape of graft, its location, its patency and the presence and quantity of distal flow.

Conclusion

MDCT was found to be a potentially useful modality during initial evaluation and follow up of patient undergoing endovascular repair.Key Words: Multidetector Computed Tomography, Endovascular stents, Arterial disease     

Analgesic,anti-inflammatory and anti-diarrheal activities of ethanolic leaf extract of Typhonium trilobatum L. Schott

Objective

To explore the efficacy of ethanolic leaf extract of Typhonium trilobatum L. Schott in treating diarrhea, pain and inflammation using experimental models.

Methods

In the present study, acetic acid-induced writhing, xylene-induced ear edema and castor oil-induced diarrheal model were used to evaluate the analgesic, anti-inflammatory and anti-diarrheal activities, respectively. Acute toxicity test was carried out to fix the safe doses of the plant extract.

Results

The plant extract demonstrated a significant inhibition of writhing (P<0.01) compared with the control group in acetic acid-induced writhing test in mice. The extract also significantly inhibited the xylene induced ear edema formation (P<0.05). In anti-diarrheal test, the extract significantly decreased the frequency of defecation and increased the mean latent period (P<0.01) in castor oil-induced diarrheal model mice at the doses of 250 and 500 mg/kg body weight.

Conclusions

These results suggest that the extract possesses significant analgesic, anti-inflammatory and anti-diarrheal activities that support to the ethnopharmacological uses of this plant.     

CpG island methylation of TMS1/ASC and CASP8 genes in cervical cancer

Background

Gene silencing associated with aberrant methylation of promoter region CpG islands is an acquired epigenetic alteration that serves as an alternative to genetic defects in the inactivation of tumor suppressor and other genes in human cancers.

Aims

This study describes the methylation status of TMS1/ASC and CASP8 genes in cervical cancer. We also examined the prevalence of TMS1/ASC and CASP8 genes methylation in cervical cancer tissue and none - neo plastic samples in an effort to correlate with smoking habit and clinicopathological features.

Method

Target DNA was modified by sodium bisulfite, converting all unmethylated, but not methylated, cytosines to uracil, and subsequently amplified by Methylation Specific (MS) PCR with primers specific for methylated versus unmethylated DNA. The PCR product was detected by gel electrophoresis and combined with the clinical records of patients.

Results

The methylation pattern of the TMS1/ASC and CASP8 genes in specimens of cervical cancer and adjacent normal tissues were detected [5/80 (6.2%), 3/80 (3.75%)-2/80 (2.5%), 1/80 (1.2%) respectively]. No statistical differences were seen in the extent of differentiation, invasion, pathological type and smoking habit between the methylated and unmethylated tissues (P > 0.05).

Conclusion

The present study conclude that the frequency of TMS1/ASC and CASP8 genes methylation in cervical cancer are rare (< 6%), and have no any critical role in development of cervical cancer.     

Frequency doubling technology and standard automated perimetry in detection of glaucoma among glaucoma suspects

Background

Frequency Doubling perimetry (FDT) has been found to precede visual loss detected by standard automated perimetry (SAP) by as much as four years and the initial development of glaucomatous visual field loss as measured by SAP was found to occur in regions that had previously demonstrated abnormalities on FDT testing.

Methods

A study on 55 glaucoma suspects (determined as per American Academy Guidelines, Preferred Practice Pattern, Oct 2010), was compared to 50 healthy participants (HP). Both glaucoma suspects and HP underwent SAP and FDT in random order. Only reliable fields were compared.

Results

Mean deviation of FDT Matrix was significantly lower than SAP SITA in suspect and healthy group ; two devices showed significant correlation amongst both groups (suspects p = 0.002, healthy p = 0.011). Significant difference was found in PSD of SAP SITA and FDT Matrix (p = 0.001) in the glaucoma suspect group, PSD of FDT Matrix was significantly higher than PSD of SAP SITA in the healthy group (p < 0.001). PSD of SAP SITA significantly correlated with FDT Matrix PSD in glaucoma group (r = 0.579; p = 0.001) but no significant correlation found in healthy group (r = 0.153; p = 0.290). Percentages of normal test locations significantly higher in FDT Matrix compared to SAP SITA in glaucoma suspects and healthy participants.

Conclusion

FDT correlates well with SAP and may be used for patients who are unable to perform well and reliably with SAP but does not show any features of earlier glaucoma changes in this study.     

The occurrence of Helicobacter pylori in hydatid liver disease

Objective

To detect the prevalence of Helicobacter pylori (H. pylori) in hydatid liver disease.

Methods

A total of 58 patients with hydatid liver disease attending AL-Sadder Teaching Hospital in Al-Najaf and Al-Basrah governorate from February to August, 2008 were included in the study and served as group A. One hundred and twenty 1st degree relative patients (group B) and 20 normal persons including 10 male and 10 female (group C) as control were detected for the presence of H. pylori infection in general population. Chest X-ray was done for the above groups to exclude lung hydrated cyst. The patients were screened by ultrasound to obtain intra abdominal hydrated cyst and enzyme-linked immuno sorbent assay (ELISA) test was utilized to detect the H. pylori infection.

Results

Fifty eight patients from group A with hydatid liver disease, 30 male (51.7%) and 28 female (48.3%) were screened for the presence of H. pylori infection by using ELISA test. We found that 28 patients from group A had positive ELISA test including 19 male (32.8%) and 9 female (15.5%) (P<0.01). However, there were no positive results of H. pylori infection in group B and C by chest X-ray, ultrasound and ELISA test.

Conclusions

It can be concluded that there is a strong relationship between hydatid liver disease and presence of H. pylori.     

Evaluating distinctive features for early diagnosis of primary sclerosing cholangitis overlap syndrome in adults with autoimmune hepatitis

Aims

Overlap syndromes constitute a significant proportion of autoimmune liver disease. Our aim was to describe our cohort and evaluate practical methods of correctly diagnosing autoimmune hepatitis / primary sclerosing cholangitis overlap syndrome as early as possible clinically.

Methods

118 autoimmune hepatitis patients were screened for cholestatic liver function tests. 24 patients with cholestatic liver function tests were investigated for possible primary sclerosing cholangitis by clinicopathological review and magnetic resonance cholangiography. Retrospectively, potential predictors of autoimmune hepatitis / primary sclerosing cholangitis overlap syndrome were compared with a control group.

Results

Overlap syndrome was diagnosed in twelve (50%) of 24 autoimmune hepatitis patients with recent cholestasis. Thecholestatic group had a lower AST (p=0.012) and International Autoimmune Hepatitis Group (IAHG) score (p=0.102), and higher IgM (p=0.002) at disease presentation. More patients in the cholestatic group developed ulcerative colitis (p=0.138).

Conclusions

Identifying AIH / PSC overlap syndrome at diagnosis is often difficult. Certain clinical and biochemical features should alert the clinician. All patients with AIH, and biochemical cholestasis should be investigated with MRC.     

Significance of decoy receptor 3 in sera of hepatocellular carcinoma patients

Objective

Decoy receptor 3 (DcR3), a member of the tumor necrosis factor receptor superfamily, is amplified and over-expressed in various cancers. The objective of the present study was to investigate the concentration of DcR3 in sera of hepatocellular carcinoma (HCC) patients and its clinical significance.

Methods

Serum concentrations of DcR3 were measured by enzyme-linked immunosorbent assay (ELISA) in 67 patients with HCC, 8 with liver cirrhosis, 17 with cholecystitis, and in 28 healthy individuals. Immunohistochemistry was employed to access protein expression of DcR3 in the corresponding HCC tissues.

Results

Serum concentrations of DcR3 in patients with HCC or cirrhosis were significantly higher than in healthy individuals (P < 0.01). Moreover, serum concentrations of DcR3 in HCC patients were associated with TNM stage, para-cirrhosis, capsular infiltration, and metastasis or recurrence of disease (P < 0.05). There was a positive correlation between the serum concentration of DcR3 and protein expression in HCC tissues (r = 0.472, P < 0.01).

Conclusions

The high serum concentration of DcR3 might play a certain role in pathogenesis, progress, and metastasis of HCC. Moreover, DcR3 might serve as a valuable molecular indicator in early diagnosis and contribute to predicting the clinical outcome in HCC patients.     

Anti-inflammatory and analgesic activities of Melanthera scandens

Objective

To evaluate the anti-inflammatory and analgesic activities of leaf extract of Melanthera scandens (M. scandens).

Methods

The crude leaf extract (39–111 mg/kg) of M. scandens was investigated for anti-inflammatory and analgesic activities using various experimental models. The anti-inflammatory activity was investigated using carragenin, egg-albumin induced oedema models, while acetic acid, formalin-induced paw licking and thermal-induced pain models were used to evaluate the antinociceptive property.

Results

The extract caused a significant (P<0.05 – 0.001) dose-dependent reduction of inflammation and pains induced by different agents used.

Conclusions

The leaf extract possesses anti-inflammatory and analgesic effects which may be mediated through the phytochemical constituents of the plant.     

Increased serum nitric oxide and malondialdehyde levels in patients with acute intestinal amebiasis

Objective

To determine the level of oxygen-nitrogen stress parameters in the pathogenesis of amebiasis.

Methods

Twenty-four acute intestinal amebiasis patients and 20 healthy controls were enrolled in the present study. Serum malondialdehyde and nitric oxide levels were determined spectrophotometrically.

Results

Serum malondialdehyde and nitric oxide levels were significantly higher in acute intestinal amebiasis patients than healthy controls (P<0.001).

Conclusions

These results suggest that oxidative and nitrosative stress may play a major role in tissue damage in acute intestinal amebiasis patients. Also these parameters can be used to supplement the conventional microscopic method for reliable diagnosis of intestinal amebiasis.     

Pharmacognostic study and anti-inflammatory activity of Callistemon lanceolatus leaf

Objective

To study detail pharmacognosy and anti-inflammatory activity of Callistemon lanceolatus (C. lanceolatus) leaf.

Methods

Leaf sample was studied by organoleptic, macroscopical, microscopical, phytochemical and other WHO recommended methods for standardizations. The methanolic leaf extract of the plant was also screened for anti-inflammatory activity on carrageenan-induced paw edema in rat at doses of 200 and 400 mg/kg, orally. The detail pharmacognostic study of the C. lanceolatus leaf was carried out to lay down the standards which could be useful in future experimental studies.

Results

C. lanceolatus methanolic leaf extract showed significant (P<0.05) anti-inflammatory activity at doses of 200 mg/kg and 400 mg/kg. This significant anti-inflammatory of C. lanceolatus methanolic leaf extract at the dose of 400 mg/kg was comparable with diclofenac sodium.

Conclusions

The pharmacognostic profile of the C. lanceolatus leaf is helpful in standardization for quality, purity and sample identification. The methanolic extract at a dose of 400 mg/kg shows a significant activity in comparison with the standard drug diclofenac sodium (50 mg/kg).     

Acute and subacute oral toxicity study on the flavonoid rich fraction of Monodora tenuifolia seed in albino rats

Objective

To investigate the effects of the flavonoid rich fraction of Monodora tenuifolia seed on the haematology, histopathology and liver profile of Wistar albino rats.

Methods

Toxicity study was investigated on the flavonoid rich fraction of Monodora tenuifolia in rats administered different concentrations orally for 28 d using standard laboratory procedures.

Results

The LD₅₀ of the flavonoid rich fraction was found to be above 5 000 mg/kg body weight in mice observed for 48 h. After the Day 14, biochemical markers of liver injury such as serum alanine aminotransferase, and aspartate aminotransferase decreased significantly (P<0.05 at doses of 100 and 200 mg/kg body weight and P<0.01 at 400 mg/kg) while serum alkaline phosphatase increased non-significantly (P>0.05). There was non-significant (P>0.05) effect observed across the groups in the levels of serum total protein, albumin, globulin, urea and creatinine. The result of histological examination showed various degrees of peribiliary hepatitis after the Day 14 which fizzled out after the Day 28.

Conclusions

The result therefore suggests that the seed extract is potentially safe.