Antihyperlipidemic effects of mature coconut water and its role in regulating lipid metabolism in alloxan-induced experimental diabetes

The present study aims to evaluate the antihyperipidemic effects of mature coconut water (MCW), a natural nutritious beverage and its role in regulating lipid metabolism in experimental diabetes. The experimental animals were divided into four groups—normal control, MCW-alone-treated rats, diabetic control, and diabetic rats treated with MCW. Blood glucose, lipid profile, atherogenic index, phospholipids in various tissues, free fatty acids, activities of various lipogenic enzymes, 3-hydroxy-3-methylglutaryl-coenzyme A (HMG CoA) reductase in liver, lecithin–cholesterol acyl transferase (LACT) in plasma, and lipoprotein lipase (LPL) in heart were evaluated in all the experimental groups. The results indicate that in diabetic rats, MCW treatment reduced the blood glucose and lipid levels in blood and other tissues along with reduced activity of HMG CoA reductase and increased activity of LACT and LPL. In addition, levels of triglycerides, phospholipids, and free fatty acids in various tissues and atherogenic index were significantly lowered. In conclusion, MCW significantly reduced hyperlipidemia and regulated the defects in lipid metabolism in diabetic rats, indicating the therapeutic potential of MCW in diabetes and associated atherogenic complications.     

Retroperitoneal duodenal perforation and IVC injury in blunt abdominal trauma: Pushing the boundaries of non-operative management? Brief report and a review of the literature

IntroductionDuodenal injuries present a significant challenge for trauma management because of the associated injuries and its anatomical inaccessibility. Surgical management can range from simple repair, Roux-en-Y duodenojejunostomies, T-tube decompression, or even pancreaticoduodenectomy as a last resort. Conservative treatment is very rarely described in the literature and in this report we present a case of retroperitoneal duodenal perforation with IVC injury successfully managed conservatively.Case report and discussionWe reviewed other cases described in the literature and attempt to identify the common characteristics which indicate the circumstances where conservative management might be successful. The described case, along with the three other cases reported in the literature, point to the feasibility of conservative management under the following conditions. The patient was coherent with reliable clinical symptoms and signs, which were stable and non-progressive. The retroperitoneal location of the perforation of the duodenum, without pancreatic or biliary injuries, allowed the possibility of non-operative management.In this described case, we demonstrate the feasibility of non operative management with an associated contained IVC injury. Although there is at least a 20-day observation period required for these cases, obviation of considerable surgical morbidity is a significant benefit.ConclusionWhilst our case may not qualify to demonstrate proof-of-concept in conservative management of duodenal perforation and IVC injury, we believe that given the appropriate clinical context, level of monitoring, availability of expertise, and evolution of clinical picture in the positive direction, in highly selected cases, non-operative management of retroperitoneal duodenal and IVC trauma is a viable option.     

Trends in Post‐Mastectomy Reconstruction in an Asian Population: A 12‐Year Institutional Review

Post‐mastectomy breast reconstruction is an integral component of breast cancer treatment. It is often perceived that women in Asian countries have a lower rate of post‐mastectomy reconstruction than Western populations. This study describes trends in timing and types of breast reconstruction performed in the largest healthcare provider in Singapore, over a period of 12 years. It also reports on the oncological outcomes and surgical safety. A retrospective review of all patients who underwent post‐mastectomy reconstruction from January 2001 to December 2012 at the National Cancer Centre Singapore and Singapore General Hospital was performed. Six hundred and twenty post‐mastectomy reconstructions were performed in 579 patients. The proportion of reconstructions increased from 4% in 2001 to 18% in 2012. Younger patients (<50 years old) and those with early stage cancer were more likely to undergo reconstruction. Immediate breast reconstruction was favored by more than 90% of patients. Postoperatively, 9% developed acute surgical complications that were treated surgically; 6% had additional surgery for late complications. Only 4% had delay of adjuvant chemotherapy. At median follow‐up of 63 months (range 3–166), loco‐regional recurrence was 4%, and distant metastases 8%. Post‐mastectomy reconstruction for breast cancer is increasingly performed in our institution. Both younger age and lower stage disease were associated with choice for reconstruction in our study. Low rates of delay to adjuvant therapy were noted, and it may safely be offered to suitable women undergoing mastectomy.     

Sulphated polysaccharides: new insight in the prevention of cyclosporine A-induced glomerular injury

The scope of the current study was to examine the possible effects of sulphated polysaccharides against cyclosporine A-induced glomerular injury. Nephrotoxicity induced by cyclosporine A continues to be a major problem despite its potent immunosuppressive action. Adult male albino rats of Wistar strain were categorized into four groups. Two groups (II and IV) were administered cyclosporine A (25 mg/kg body weight, orally) for 21 days, in which Group IV rats were also treated simultaneously with sulphated polysaccharides (5 mg/kg body weight, subcutaneously) for the same period. A significant loss in body weight was noted in the cyclosporine A-induced rats. Renal damage was assessed in terms of decreased creatinine clearance and increased activity of lysosomal enzymes. The levels of glycoproteins were found to be decreased in the renal tissue, and a noticeable rise in glycosaminoglycanuria coupled with marked proteinuria was more prominent in the cyclosporine A-induced animals. Furthermore, the extent of kidney damage was assessed by histopathological findings. Toxic manifestations were also confirmed by transmission electron microscopic studies. These morphological abnormalities and other alterations in the renal tissue were significantly offset by sulphated polysaccharides supplementation. These findings underline that restoration of normal cells accredits sulphated polysaccharides, from Sargassum wightii, with nephroprotective role, against cyclosporine A-induced renal injury.     

Protective role of sulphated polysaccharides in abating the hyperlipidemic nephropathy provoked by cyclosporine A

Cyclosporine A (CsA)-induced nephrotoxicity hampers the immense therapeutic potential of such a powerful immunosuppressant. The present study was conducted with an aim to explicate the contribution of sulphated polysaccharides (SPS) in abating the lipid abnormalities induced by CsA in the rat kidney. Hyperlipidemia associated with nephrotic syndrome may play a role in the worsening of renal function. Male albino Wistar rats sorted into four groups were used for the study. CsA was given at a dose of 25 mg/kg body weight, orally for 21 days. Significant alterations in the lipid profile as well an increase in the activity of cholesterol ester synthase, coupled with a decrease in cholesterol ester hydrolase and lipoprotein lipase enzyme activities were noted in the plasma and kidneys of CsA-administered rats. A marked increase in the lipoprotein fractions, low-density lipoprotein (LDL) and very low density lipoprotein (VLDL), along with a decrease in the HDL level were found in CsA-administered rats. The degree of nephrotoxicity allied with lipid discrepancies was evident from augmented urinary excretion of urea, uric acid and creatinine. Further, an enhanced susceptibility of the apo B-containing lipoproteins (LDL + VLDL) to oxidation in vitro, induced by copper ions was also found in the plasma of CsA given groups. While SPS co-treated groups (5 mg/kg body weight, subcutaneously) revealed a normalized lipid profile and lipid metabolizing enzymes, the supplementation of SPS also brought back the elevated urinary constituents close to that of the controls and substantially minimized the oxidative changes. With these observations, it may be concluded herein that SPS may be an ideal choice as a renoprotective and hypolipidemic agent against CsA-induced hyperlipidemic nephropathy.