Modulation of Penile Erection in Rabbits by Mondia Whitei: Possible Mechanism of Action

Mondia whitei root was evaluated to validate its anecdotal use and determine its possible mode of action in the management of erectile dysfunction. Rabbits were administered with daily oral doses of 100–400 mg kg⁻¹ crude ethanolic extract of M. whitei and sildenafil (50 mg kg⁻¹) as positive control for 6 weeks. Cavernosal tissue NOS activity and levels of NO and cGMP, and NOS and PDE protein expressions were investigated. The effect of the crude extract, chloroform and petroleum ether fractions in vitro on cavernosal tissue NOS activity and levels of NO and cGMP at 0.01 and 0.10 mg g⁻¹ tissue were also investigated. Results indicate that the crude extract increased NOS activity by 7% at 200 mg kg⁻¹ with corresponding increases in NO (88%) and cGMP (480%) levels. No significant changes in these measurements were observed with the 100 and 400 mg kg⁻¹ doses whilst sildenafil slightly reduced them (15.9–37.5%). NOS and PDE protein expressions in test animals were not different from controls. Pre-incubation of cavernosal tissue in vitro with the crude extract of M. whitei and its chloroform fraction markedly increased NOS activity (26–132%) and levels of NO (25%) and cGMP (50–400%) at 0.01 mg g⁻¹ tissue but these were reduced to near control levels when their concentrations were increased to 0.10 mg g⁻¹ tissue whilst the petroleum ether fraction had no effect. These findings suggest that M. whitei may influence erectile function through activation/stimulation of NOS with corresponding increases in tissue NO and cGMP levels and that certain chemical constituents present in the chloroform fraction may be responsible for biological activity.     

Evaluation of the “Kosish Cocktail” in Treating Severe Pain in “Home Care” in Morphine-na?ve Communities

Background:

Inavailability of morphine continues to plague most parts of India. Good palliative care must, however, focus on resources that are locally available, culturally acceptable, financially affordable, and easily applicable. These factors were all integral to the development of the “Kosish cocktail” for use in severe pain. This cocktail is a mixture of ketamine, midazolam, pentazocine lactate, and other adjuvants for use in the domiciliary set-up as intermittent subcutaneous injections in a morphine-naïve community. Our aims and objectives were: (1) To assess the efficacy of the “Kosish cocktail” in treating severe pain in terminally ill patients; (2) To assess the safety profile and note any adverse effects; (3) To evaluate its use in domiciliary set-ups in terms of safety and efficacy; (4) To empower the patient and the family in the process of patient care.

Materials and Methods:

Eight patients with advanced cancer and severe pain, who were already on WHO Step II drug therapy, were enrolled for this study. The cocktail was administered subcutaneously in every four hours and SOS. Subjective and objective parameters were recorded and the data analyzed using Student’s t-test with a P<0.05 being considered significant.

Results:

There was a statistically significant improvement in the subjective parameters 12 hours after the initiation of therapy, except for the persistence of fatigue.

Conclusions:

On the basis of this qualitative study, the authors confirm the efficacy and safety of the use of the Kosish cocktail in treating severe pain, and strongly recommend it for newly started hospices, especially for use in the domiciliary set-up.     

Risk behaviours among HIV positive injecting drug users in Myanmar: a case control study

Background  

The severity of HIV/AIDS pandemic linked to injecting drug use is one of the most worrying medical and social problems throughout the world in recent years. Myanmar has one of the highest prevalence rates of HIV among the IDUs in the region.     

Limited Margins Using Modern Radiotherapy Techniques Does Not Increase Marginal Failure Rate of Glioblastoma

PURPOSE: We investigate the patterns of failure in the treatment of glioblastoma(GBM) based on clinical target volume(CTV) margin size,dose delivered to the site of initial failure,and the use of temozolomide and intensity-modulated radiotherapy(IMRT).METHODS: Between August 2000 and May 2010,161 patients with GBM were treated with radiotherapy with or without concurrent temozolomide.Patients were treated with CTV expansions that ranged from 5 to 20 mm using a shrinking field technique.Patterns of failure and time to progression and overall survival were compared based on CTV margin,use of temozolomide,and use of IMRT.Kaplan Meier analysis was used to estimate survival times,and χ test was used for comparison of cohorts.RESULTS: For patients treated with 5-,10-,and 15-to 20-mm CTV,79%,77%,and 86% experienced failures in the 60 Gy volume,respectively.Forty-eight percent,55%,and 66% of patients with 5-,10-,and 15-to 20-mm CTV experienced failures in the 46 Gy volume,respectively.There was no statistical difference between patients treated with 5-,10-,15-to 20-mm margins with regard to 60 Gy failure(P=0.76),46 Gy failure(P=0.51),or marginal failure(P=0.73).Eighty percent of patients receiving temozolomide experienced failures in the 60 Gy volume.There was no increased likelihood of marginal failures in patients receiving IMRT(P =0.97).CONCLUSIONS: Modern treatment techniques including use of concurrent temozolmide,limited CTV margin size,and IMRT have not greatly changed the patterns of failure of GBM.     

Behçet's disease and hearing loss

OBJECTIVES: The aim of this study was to determine the incidence and severity of hearing loss in different frequencies in Beh?et's patients in a Turkish population. MATERIAL AND METHOD: Sixty-three consecutive cases with Beh?et's syndrome and 63 sex- and age-matched healty subjects as control group were included in this study. A detailed history was taken, all patients underwent neuro-otolological, ophthalmologic and dermatologic examination. Audiometric pure-tone thresholds at 125-8000Hz were obtained in all subjects in both groups. The results of the two groups were statistically evaluated by Chi-square, Student's-t and McNemar tests. RESULTS: In 35 patients (55%), a hearing loss equal or more than 30dB hearing level was detected. 24 of 35 patients (68%) showed hearing loss in the higher frequencies (6 and 8kHz). 12 of 35 patients (34%) showed hearing loss in speech frequencies (500-2000Hz). No relationship could be found between hearing loss and other system involvements in Beh?et's group. Also there was no correlation between hearing loss and duration of the disease, but the mean age of Beh?et's patients with hearing loss was found to be significantly higher than the mean age of the patients without hearing loss. CONCLUSION: We suggest that presence of hearing loss in Beh?et's disease is prevalent and represents a fourth clinical symptom after oral, genital ulcers and skin lesions and especially there is a statistically significant hearing loss at high frequencies when compared with the speech frequencies.     

ACCURACY OF SERUM – ASCITES ALBUMIN GRADIENT IN THE AETIOLOGICAL DIAGNOSIS OF ASCITES

50 adults with ascites admitted to our hospital were studied. Simultaneous samples of ascitic fluid and blood were collected and subjected to analysis including ascitic fluid total protein and serum ascites albumin gradient The cut off value of serum-ascites albumin gradient for differentiating between high and low gradient was taken as 1.1 gm % and of ascitic fluid protein for differentiating exudate and transudate as 2.5 gm%. The sensitivity, specificity, positive predictive value and negative predictive value of high gradient and transudative ascites in diagnosing portal hypertension were 943%, 60%, 84.6%, 81.8% and 62.9%, 133%, 91.7% and 50% respectively. High gradient ascites is a sensitive test in the diagnosis of portal hypertension as a cause of ascites. The exudate-transudate approach has severe limitations in the differential diagnosis of ascites.KEY WORDS: Albumin Gradient, Ascites, High Gradient Ascites, Serum-Ascites     

AN EPIDEMIC OF PLEURISY AMONGST MILITARY RECRUITS

An epidemic amongst recruits who presented with acute viral exudative pleural effusion with lymphocytic pleocytosis is analysed. Histologic and bacteriologic proof of tuberculosis was lacking in majority. Most of them recovered without pleural thickening. Overcrowding, inadequate clothing protection, stress and strain of vigorous recruit training could be important precipitating factors. None reported with parenchymal tuberculosis in two year follow up.KEY WORDS: Pleural effussion, Viral