Meta‐analysis: levamisole improves the immune response to hepatitis B vaccine in dialysis patients

Background Patients undergoing maintenance dialysis often fail to mount protective antibodies to hepatitis B virus surface antigen (HBsAg) following vaccination against hepatitis B virus (HBV). Some authors have suggested that levamisole improves immune response to HBV vaccine in dialysis population. However, consistent information on this issue does not exist. Aim To evaluate efficacy and safety of levamisole as adjuvant to hepatitis B virus (HBV) vaccine in dialysis patients by performing a systematic review of the literature with a meta‐analysis of clinical trials. Methods We used the random‐effects model of DerSimonian and Laird, with heterogeneity and sensitivity analyses. Only trials comparing the seroresponse rate in study subjects (levamisole plus HBV vaccine) vs. controls (HBV vaccine alone) were included. The end point of interest was the rate of patients showing seroprotective anti‐hepatitis B titres at completion of HBV vaccine schedule in study vs. control groups. Results We identified four studies involving 328 unique patients on regular dialysis. Only prospective, randomized clinical trials (RCTs) were included. Pooling of study results showed a significant increase in response rates among study (levamisole plus HBV vaccine) vs. control (HBV vaccine alone) patients; the pooled Odds Ratio was 2.432 (95% Confidence Intervals, 1.34; 4.403), P = 0.002. No study heterogeneity was found. These results did not change in various subgroups of interest. Conclusions Our meta‐analysis showed that levamisole significantly improves immune response to hepatitis B vaccine in dialysis population. The limited number of patients precluded more conclusions.     

Preparation and performance evaluation of plain proliposomal systems for cytoprotection

Plain liposomal systems composed of soyabean lecithin, cholesterol and stearylamine were formulated using various approaches. The prepared products were characterized and evaluated for their cytoprotective performance against the necrotizing NSAID's (i.e. aspirin and phenylbutazone). Liposomes derived from proliposomes (effervescent granules based) demonstrated the best cytoprotective activity and physical and stability characteristics. This system was shown to be superior. An increased availability of regular and small sized liposome born phospholipids to the damaged mucosal systems accounted for its better and enhanced performance.     

Testicular cell population dynamics following palmitine hydroxide treatment in male dogs

Palmitine hydroxide isolated from the roots of Berberis chitria administered orally to dogs 30 mg/kg per day for 60 days brings about a consistent impairment of primary and secondary spermatocytes and elongated spermatids (Stages IV-VIII). The primary and secondary spermatocytes were reduced by 60 and 68%, respectively, and the elongated spermatids were decreased by 58%. The number of spermatogonia and Sertoli cells remained unaltered. The production of immature and mature Leydig cells decreased by 66% and 27%, respectively. Protein, sialic acid and glycogen content and acid phosphatase activity of testes and epididymides were lowered to varying extents. Testicular cholesterol was elevated significantly. Weights of the testes and epididymides were significantly reduced. The antispermatogenic action of palmitine hydroxide may be mediated by disturbances in Leydig cell function.     

Risk stratification for recurrence in patients with esophageal and junctional carcinoma treated with neoadjuvant chemotherapy and surgery

Aim To stratify the risk for recurrence in patients with esophageal cancer treated with neoadjuvant chemotherapy and surgery. Materials and Methods The prognostic and predictive factors were analyzed in 62 patients who underwent curative resection following chemotherapy. The factors found significant on multivariate analysis were stratified into good, intermediate and high risk groups for recurrence. Results Kaplan–Meier survival at 3 and 5 years was 32% and 20%, respectively, with a median survival of 19 months. Pathological response and percent node positive were the significant factors on multivariate analysis. Three groups were formed and their recurrence free survivals were calculated using Kaplan–Meier method. The low risk composed of good responders and patients with less than 20% positive lymph node; the intermediate risk composed of non-responders and patients with less than 20% positive lymph node and the high risk group composed of non-responders and patients with more than 20% positive lymph node. The median recurrence time was 8 months for the high risk group, 39 months for the intermediate group, and it has not reached in the low risk group. Hazard ratio was 0.39(95% C.I. 0.09–0.98) for the risk group low to intermediate, 0.1(95% C.I. 0.04–0.25) for the low to high risk group and 0.26(95% C.I. 0.11-0.66) for the intermediate to high risk group. Conclusions Pathological response rate and percent node positive were significant predictive factors on multivariate analysis. Stratification based on these two predictive factors may help in optimizing any adjuvant treatment.     

Clofazimine induced nail changes

Two cases of lepromatous leprosy with erythema nodosum leprosum who were on high doses of clofazimine, showed discoloration of nail plate, subungual hyperkeratosis and onycholysis. These nail changes gradually disappeared when the dose of clofazimine was reduced.     

The evolution and genesis of supraventricular waltz & duet

Objective. This study documents and traces the evolution of triple rhythm (Waltz) linking the great veins, corresponding systemic or pulmonary venous sinuses and pectinated right or left atrium in frog, turtle, snake and human hearts. Alternating rhythm (duet) between systemic and pulmonary veins has also been documented in these hearts. Material Studied. The hearts of six dead hammer-head sharks were examined with the naked eye. Air-breathing, fresh-water fish (three Channa striata and three Indian catfish) were anaesthetised with ketamine and their pharynx insufflated with oxygen. Six frogs, three turtles, and two snakes were anaesthetised, intubated and ventilated. Contractions of the exposed hearts of these animals were correlated with their electrocardiograms using superimposed videos. The human heart was observed carefully during surgery through median sternotomy or anterolateral thoracotomy by visual inspection especially during instillation of or recovery from cardioplegia. Digital videos were taken and studied in slow motion replay later. Observations. In the air-breathing fish, Channa striata and Indian catfish and presumably the shark, the cardinal veins and thin walled sinus venosus do not contract. In the frog, turtle, and snake there is sequential contraction of the systemic veins, systemic venous sinus and pectinated right atrium. Likewise, there is waltz on the arterial side. There is a duet between systemic and pulmonary veins, contractions of the former preceding the latter in the frog, turtle and snake. The observations are similar in the human heart except that the inferior vena cava does not contract. Conclusions. There is sequential contraction of the superior vena cava, the systemic venous sinus and the pectinated part of the right atrium in the human heart. Likewise, there is a waltz linking the terminal pulmonary veins, pulmonary venous sinus and pectinated part of the left atrium in the human heart. This waltz or triple rhythm, as well as a duet between the systemic and pulmonary veins are seen in frog, turtle and snake. The duet is also observable in the human heart, during recovery from cardioplegia. It is likely that the waltz and duet are conducted by a neurogenic mechanism. Clinical Implications. The understanding, preservation and restoration of the mechanism sustaining supraventricular waltz and duet is relevant to surgical and interventional procedures for control of atrial arrhythmia, Fontan circulation, technique for cardiac transplantation and planning atriotomies.     

Growth hormone secretagogue (GHS) analogue, hexarelin stimulates GH from peripheral lymphocytes.

The role of growth hormone releasing hormone (GHRH) and growth hormone releasing peptide-6 (GHRP-6) analogue hexarelin was investigated in the regulation of GH production from lymphocytes. Porcine and bovine blood mononuclear cells were separated using density gradient centrifugation method by layering the whole blood or buffy coat cells on lymphodex. Cells were incubated for 3 or 5 days with or without phytohemagglutinin (PHA-M), GHRH, GHRP-6 analogue hexarelin, somatostatin or GHRH + hexarelin. Growth hormone was fractionated from supernatants by gel chromatography and further concentrated by lyophilization at - 20 degrees C. A nearly two fold increase in basal secretion of GH (porcine: 3.5 +/- 0.1 ng/ml, bovine: 3.2 +/- 0.2 ng/ml) was achieved by GHRH and hexarelin at concentrations of 0.1, 1.0, 10 and 100 nM in both porcine and bovine cells. Lymphocytic GH release was also stimulated in response to PHA-M (10 micro g/well). Neither a dose dependent nor a synergistic nor an additive effect was apparent on GH secretion from lymphocytes. GHRH stimulated lymphocytic GH secretion, whereas, somatostatin had no effect. This study reports for the first time that hexarelin stimulates the secretion of GH from peripheral lymphocytes.     

MR imaging of facial nerve enhancement in Bell palsy or after temporal bone surgery

The authors evaluated magnetic resonance (MR) images obtained with intravenously administered gadolinium in ten patients who had facial paralysis and no facial nerve tumor. In patients with either Bell palsy (four patients) or facial paralysis after temporal bone surgery (six patients), intratemporal facial nerve enhancement was seen. Facial nerve enhancement on MR images proved to be a nonspecific finding.