Terlipressin in hepatorenal syndrome: a systematic review and meta-analysis

Background  

Hepatorenal syndrome (HRS) is a common complication in patients with cirrhosis or fulminant liver failure. We systematically reviewed the benefits and harms of using terlipressin, a novel vasoconstricting agent in patients with HRS.     

Traditional Indian snacks modified to attain low glycaemic index and confirmed suitable to be consumed without hyperglycaemic effect in type 2 diabetics

The purpose of this study is to determine the glycaemic index of seven traditional Indian snacks modified in composition and preparation and to determine their glycaemic and insulinaemic response in type II diabetics. Blood glucose and insulin level at fasting, postprandial - 1 hour and 2 hours in ten normal healthy volunteers were analysed after oral administration of 50 g pure glucose and later at weekly intervals with each of the test snack. Area under curve was calculated and compared for pure glucose and each test snack to determine the glycaemic index. Each of the test snack was administered in ten type II diabetics and the glycaemic and insulinaemic response was determined at fasting, postprandial - 1 hour, 2 hours and compared with that of the normal volunteers. Changes in blood glucose and insulin levels (mean +/- SD) at fasting and two time Intervals in normal and diabetics were analysed using Student's paired 't' test, and between the two groups using Student's unpaired 't' test for each test snack. Sensory evaluation and satiety factor were obtained using five-point hedonic and visual assessment scale. Area under curve for each test snack was significantly lower (p < 0.001) than that of pure glucose and hence all the snacks are confirmed as having low glycaemic index which ranged from 31 to 47%. The significant rise at postprandial - 1 hour (p < 0.001) and fall at postprandial - 2 hours (p < 0.001) in blood glucose levels and sustained Insulin levels at postprandial - 2 hours was similar in normal and diabetics for each of the test snack. Sensory evaluation and satiety factor were similar for traditional and modified snacks. The seven modified traditional Indian snacks have low glycaemic index and do not have a hyperglycaemic effect in type II diabetics. Besides, their low glycaemic index status, high acceptability, and satiety factor makes these modified snacks most suitable for sustained consumption by type II diabetics and hence better glycaemic control.     

Half of Kidney Transplant Candidates Who Are Older than 60 Years Now Placed on the Waiting List Will Die before Receiving a Deceased-Donor Transplant

Background and objectives: Waiting times to deceased-donor transplantation (DDTx) have significantly increased in the past decade. This trend particularly affects older candidates given a high mortality rate on dialysis.Design, setting, participants, & measurements: We conducted a retrospective analysis from the national Scientific Registry of Transplant Recipients database that included 54,669 candidates who were older than 60 yr and listed in the United States for a solitary kidney transplant from 1995 through 2007. Using survival models, we estimated time to DDTx and mortality after candidate listing with and without patients initially listed as temporarily inactive (status 7).Results: Almost half (46%) of candidates who were older than 60 yr and listed in 2006 through 2007 are projected to die before receiving a DDTx. This proportion varied by individual characteristics: Diabetes (61%), age ≥70 yr (52%), black (62%), blood types O (60%) and B (71%), highly sensitized (68%), and on dialysis at listing (53%). Marked variation also existed by United Network for Organ Sharing region (6 to 81%). The overall projected proportion was reduced to 35% excluding patients who initially were listed as status 7.Conclusions: These data highlight the prominent and growing challenge facing the field of kidney transplantation. Older candidates are now at significant risk for not surviving the interval in which a deceased-donor transplant would become available. Importantly, this risk is variable within this population, and specific information should be disseminated to patients and caregivers to facilitate informed decision-making and potential incentives to seek living donors.Currently, more than half of a million patients have ESRD in the United States. Among these individuals, approximately one half (48%) are older than 60 yr (1). Rates of ESRD have increased in the past decade in virtually all patient groups, most rapidly in older patients (2). Among patients who have ESRD and are medically cleared for the procedure, kidney transplantation has repeatedly been shown to convey a significant survival advantage as compared with the alternative treatment modality of maintenance dialysis (3). This survival advantage is applicable across age groups including a nearly doubling of life expectancy among patients who are older than 60 yr (3,4); however, one of the greatest challenges facing this population is that the number of available organs from deceased donors has not kept pace with the growing number of transplant candidates. There was a 50% rise in the number of new kidney candidate listings from 1997 through 2006—an increase evident across age groups, race, blood type, and gender (5). Consequences of this unmet demand are longer waiting periods for transplantation and increased mortality on the waiting list before receiving an organ. Even among patients who meet initial screening criteria, there is a significantly elevated risk among older candidates of health deterioration while awaiting transplantation, rendering many patients ineligible for the procedure (6,7).Factors that influence patient decisions to list for a deceased-donor transplant are complex, including individual patient preferences, perceived benefit, and the availability and desire to obtain a living donor (8,9). Rates of listing for a deceased-donor transplant and progression on the waiting list vary significantly by race/ethnicity, body mass index, socioeconomic factors, and geographic location (10,11). Numerous reports demonstrated that patients who are proactive and are able to navigate the processes involved to receive a transplant have significantly improved prognoses (12–14). In general, patient prognoses are not the sole determinant of expeditious listing for the procedure. In fact, a sizeable proportion of candidates are listed for renal transplantation and have a relatively poor prognosis, and many patients with substantial life expectancy are never listed (15).We undertook this study to examine specific considerations for prospective older transplant candidates with the primary aim of projecting the likelihood of newly listed older candidates to receive a deceased-donor transplant on the basis of the combination of patient and regional factors. The aim of the study was to provide consolidated information for older candidates concerning individual prognoses, the likelihood to receive a deceased-donor transplant, or alternatively the incentive to consider seeking living donors. In addition, this information may inform policy makers as to the general prognoses for prospective older transplant candidates in the modern era and the potential role and need for organ allocation algorithms based on factors specific to this rapidly growing population.     

Protein extract of kenaf seed exhibits anticoagulant,antiplatelet and antioxidant activities

Objective:To explore the anticoagulant,antiplatelet and antioxidant activities of protein extract of kenaf seed(PEKS).Methods:Sodium dodecyl sulphate polyacrylamide gel electrophoresis and reverse-phase high-performance liquid chromatography techniques were employed for protein characterization.Antioxidant activity of PEKS was assessed using 1,1-diphenyl-2-picrylhydrazyl(DPPH)assay.The protective effect of PEKS on sodium nitrite(NaNO2)induced oxidative stress was evaluated using the in vitro red blood cell model,while the effect of PEKS on diclofenacinduced oxidative stress was examined in vivo in rats.Platelet-rich plasma and platelet-poor plasma were used for anticoagulant and antiplatelet activities of PEKS.Results:PEKS revealed similar protein bands on SDS-PAGE under reduced and non-reduced conditions.Several acidic proteins were present in native PAGE.PEKS showed antioxidant properties by scavenging DPPH with an IC50 of 24.58μg.PEKS exhibited a protective effect on NaNO2 induced oxidative stress in red blood cells by restoring the activity of stress markers.In addition,PEKS alleviated diclofenac-induced tissue damage of the liver,kidney,and small intestine.PEKS showed an anticoagulant effect in both in vivo and in vitro experiments by enhancing normal clotting time.PEKS did not affect prothrombin time but increase activated partial thromboplastin time.Furthermore,PEKS inhibited adenosine diphosphate and epinephrine-induced platelet aggregation.Conclusions:PEKS protects tissues from oxidative stress and exhibits antithrombotic activity.     

Vulvar puritus for one year

A 60-year-old menopausal female presented with vulvar itching for one year. She had noticed a whitish lesion on the vulva that slowly increased in size over the year. She had been unsuccessfully treated with oral fluconazole and topical clotrimazole-mometasone combinations and the plaque had gradually spread to involve the clitoris and peri-urethral area. She was neither diabetic nor hypertensive and had no other systemic complaints. Examination revealed a well-defined non-tender whitish plaque situated on her left labia minora and clitoris (Figure 1). A swab from the plaque did not grow any organism. Routine blood chemistry including a VDRL and HIV ELIZA were within normal limits. A punch biopsy from the lesion was taken and histopathology findings were as seen in (Figures 2 and 3).     

Evaluation of effect of allopurinol and febuxostat in behavioral model of depression in mice

Objective:

To evaluate the effects of allopurinol and febuxostat on depression using Forced Swim Test (FST) in mice.

Materials and Methods:

Allopurinol (39 mg/kg p. o) and febuxostat (15.6 mg/kg p. o) were administered once daily for 21 successive days to Swiss Albino mice. On the 21^st day, the effect of the drug on locomotion was tested using photo-actometer followed by the recording of immobility period in the FST and the results were compared with the standard drug fluoxetine (10 mg/kg p. o).

Results:

Allopurinol and febuxostat expressed significant antidepressant like effect as indicated by reduction in the immobility period of mice in the FST as compared to control group. The effects of allopurinol and febuxostat were found to be comparable to that of fluoxetine.

Conclusion:

The results of the present study indicate that allopurinol and febuxostat possess significant antidepressant like activity.KEY WORDS: Forced swim test, photo-actometer, serotonin, tryptophan