Antibacterial and antibiotic potentiating capabilities of extracts isolated from Burkillanthus malaccensis, Diospyros hasseltii and Cleisthanthus bracteosus against human pathogenic bacteria

@#Antibiotics which once a boon in medicine and saved millions of lives are now facing an ever-growing menace of antibacterial resistance, which desperately needs new antibacterial drugs which are innovative in chemistry and mode of action. For many years, the world has turned to natural plants with antibacterial properties to combat antibiotic resistance. On that basis, we aimed to identify plants with antibacterial and antibiotic potentiating properties. Seventeen different extracts of 3 plants namely Burkillanthus malaccensis, Diospyros hasseltii and Cleisthanthus bracteosus were tested against multi-drug resistant Acinetobacter baumannii, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Methicillinresistant Staphylococcus aureus (MRSA) and methicillin-susceptible Staphylococcus aureus (MSSA). Antibacterial activity of hexane, methanol and chloroform extracts of bark, seed, fruit, flesh and leaves from these plants were tested using, disk diffusion assay, minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) assays. Antibiotic potentiating capabilities were tested using time-kill assay. B. malaccensis fruit chloroform extract showed the biggest zone of inhibition against MRSA (13.00±0.0 mm) but C. bracteosus bark methanol extract showed the biggest inhibition zone against MSSA (15.33±0.6 mm). Interestingly, bark methanol extract of C. bracteosus was active against MRSA (8.7±0.6 mm), MSSA (7.7±0.6 mm) (Gram-positive) and A. baumannii (7.7±0.6 mm) (Gram-negative). Overall, the leaf methanol and bark methanol extract of C. bracteosus warrants further investigation such as compound isolation and mechanism of action for validating its therapeutic use as antibiotic potentiator importantly against MRSA and A. baumannii.

Celastrol Nanoemulgel Formulation And In Vitro Penetration Test

Objective: To obtain formulations of Celastrol (Cst) nanoemulgel via transdermal route. Celastrol is classified in BCS 4 class as an anti-inflammatory drug. These routes are considered to reduce the risk of Celastrol side effects and have the same characteristics as skin morphology. Methods: Celastrol nanoemulgel was prepared by a high-pressure homogenizer (HPH) technique. To find the optimum nanoemulsion area by using the Chemix 7.00 ternary phase program. Celastrol nanoemulgel was evaluated by measuring the particle size, PDI, morphology, zeta potential, stability tests and in vitro using Franz diffusion cell Results: Results showed the ideal formula based on the ternary phase diagram using chemix 7.00 is oil: smix: water (5:45:50), with particle size 89.9±5 nm, PDI 0.1, and zeta-21 mV. The morphological shape is quite spherical ≤ 100±5 nm. The pH value of this formula is 4.5, which compatible with the pH of the skin. The highest recovery rate of Celastrol and encapsulation efficiency (EE) were formulas 3 μg/ml and 5 μg/ml, with EE 91.70% and 94.54%, respectively. In vitro test results showed that the formula 3 μg/ml and 5 μg/ml give better penetration results than the formula 2.5 μg/ml. Thus, Celastrol nanoemulgel formula has good potential to be developed as a transdermal anti-inflammatory drug. Conclusion: Transdermal nanoemulgel containing Celastrol has been successfully developed with particle size ≤ 200±2 nm.

Infective Endocarditis Diagnosis and Management

Background: Infective endocarditis (IE) is a microbial (usually bacteria) infection affecting the heart tissue orthe adjacent vascular endothelium. The blood-circulating microbes usually need to be available in a certaininoculum to allow invasion and thus infect the heart. Moreover, if the valve annulus is affected, the infection willspread into the extravascular areas. The main causative agents in IE are bacteria; however, other causes such asfungi are still a possibility in many cases. The most common bacteria seen are staphylococci and streptococci,and they collectively account for approximately 80% of cases; while S. Aureus, in particular is the most aggressiveone. Objectives: We aimed to review the literature regarding the pathophysiology of infective endocarditis,clinical features, risk factors, diagnosis, and management of this disease. Methodology: PubMed database wasused for articles selection. Conclusion: Diagnosing of infective endocarditis remains the pivotal step inmanagement of these patients; thus, it had been studied widely for many years. Duke or modified Duke Criteriaremain the most famous tool in diagnostic assessment, and they incorporate information from multiple sourcesinto minor and major criteria which will reflect the probability of the disease in the suspected patients. Themainstay treatment of infective endocarditis is intravenous antibiotics, titred to serum levels, and the choicedepends on the suspected causative organism and the valve involved in IE being native or prosthetic. Infectiveendocarditis prophylaxis is still a major point of difference among clinicians. Some institutions advocate forantibiotic prophylaxis in patients undergoing any dental procedure; while, others advised against prophylacticantibiotic.

The dichotomy of the systemic and local cytokine responses of mucosal leishmaniasis patients in Sudan: A pilot study

@#Sudanese mucosal leishmaniasis (ML) is a rare clinical form of leishmaniasis and characterized by persistent ulcer of the oral and/or the nasal mucous membranes caused by Leishmania donovani. No data is available about the systemic and local immune responses in mucosal leishmaniasis. This study aimed to measure the systemic and the local cytokines responses of Sudanese ML patients compared to cured cutaneous leishmaniasis patients (Leishmanin skin test positive, LST+ve) and unexposed healthy controls (Leishmanin skin test negative, LST-ve). Six parasitological confirmed ML patients, 7 LST+ve, and 6 LST-ve were enrolled. Systemic Th-1 (IFN-γ and TNF-α), Th-2 (IL-10 and IL-13), Treg (TGF-β1), and inflammatory cytokines IL-6 and IL-8 concentration were measured in the supernatant of whole blood samples following stimulation with live L. donovani promastigotes using ELISA. Local intralesion IL-10, IFN-γ, and IL-13 expression was measured using Real Time PCR. A significant high concentrations of IFN-γ, TNFα, IL-10, TGFβ, IL-6, and IL-8 were detected in the supernatant of stimulated whole blood samples of ML patients compared with the LST+ve and LST-ve controls. Using Real Time-PCR and primers for various cytokines, a significant high expression of TH2 cytokines IL-10 and IL-13 mRNA was detected in contrast to a low TH1 cytokine IFN-γ mRNA in the mucosal lesion. There is a clear dichotomy in the cytokine response during Mucosal leishmaniasis. A significantly high TH1, inflammatory and Treg cytokines response is produced systemically, in contrast to a significant high TH2 cytokines response in the mucosal lesion.

MTHFR gene polymorphisms in hypothyroidism and hyperthyroidism among Jordanian females

ABSTRACT Objective Methylenetetrahydrofolate reductase (MTHFR) is involved in DNA methylation that is associated with autoimmune pathology. We investigated the association between MTHFR genetic polymorphisms at g.677C>T and g.1298A>C and their haplotypes, and the risk of thyroid dysfunction among Jordanian females. Subjects and methods A case-control study involving 98 hypothyroidism cases, 66 hyperthyroidism cases and 100 controls was conducted. Polymerase chain reaction/restriction fragment length polymorphism technique was performed to determine genotypes. Statistical analysis using SPSS software was performed. Results Genetic analysis showed a significant difference in genotype frequency of g.1298A>C between cases, and controls [hypothyroidism: AA (45.9%), AC (37.8%), CC (16.3%); hyperthyroidism: AA (9.1%), AC (69.7%), CC (21.2%); controls: AA (37.8%), AC (29.6%), CC (32.7%); CChypo vs. AAhypo: 2.55, 95% CI: (1.18-5.52); OR at least on Chypo: 1.79, 95% CI: (1.07-2.99)]; CChyper vs. AAhyper: 4.01, 95% CI: (1.79-9.01); OR at least on Chyper: 0.18, 95% CI: (0.07-0.48)]. There was no significant difference in genotype frequency of g.677C>T between cases and controls [hypothyroidism: CC (50.0%), CT (32.7%), TT (17.3%); hyperthyroidism: CC (77.3%), CT (15.2%), TT (7.6%); controls: CC (55.6%), CT (32.3%), TT (12.1%)]. There was a significant difference of MTHFR haplotypes among hypothyroidism cases and controls. TA and CC had a lower hypothyroidism risk whereas; TC showed a higher risk. Conclusions g.1298A>C genetic polymorphism of MTHFR may modulate the risk of thyroid disease. CC, TA, and TC haplotypes affect the risk of hypothyroidism. Larger samples should be included in the future to verify the role of MTHFR polymorphisms in thyroid diseases.

Risk factors associated with glaucoma disease progression

Background: Glaucoma is a disease which damage the eye's optic nerve. That so many instances of glaucoma can be undiscovered ways that research studies based in hospitals or specialist clinics, as an example, can be biased to specific classes of referred patients and so not representative of the Glaucoma associate

Objective: In this review we discuss risk factors that lead to onset of glaucoma and focus on risk factors affecting the progression of this disease, to give information to prevent and start early treatment

Method: PubMed and Embase database were searched up to July, 2018 for relevant studies that discussing the risk factors of glaucoma

Conclusion: The most consistent factors are older age and also higher baseline IOP. Currently, there is very little we can do about age, due to the fact that it is probably a surrogate threat factor for various other potentially more important elements, for example, mitochondrial performance. Because IOP can be lowered either medically or operatively, it is a flexible threat or prognostic element for open-angle glaucoma

Soil-Transmitted Helminths in Malaysia landscape: an aborigines study

Soil-transmitted helminths (STH) is a group of parasitic nematodes, including Trichuris trichiura, Ascaris lumbricoides, Ancylostoma duodenale and Necator americanus, which can cause gastrointestinal disorders in humans. STH is prevalent among neglected communities in both developing and developed countries. This present study aims to determine the current prevalence of STH infections in Aboriginal population after mass delivering of antihelminthic drugs was proposed by WHO in 2005 and a health education learning package (HELP) was initiated in Malaysia in 2012. A total of 235 human fecal samples were collected and a pre-tested questionnaire was given to gather information about the socio-demographic of the Aborigine communities living in Kedah and Selangor, Malaysia. The samples were screened by a direct-fecal smear and confirmed by formalin-ether sedimentation methods. From human faeces, 81.7% was found to be infected with one or more STH species. T. trichiura was the most commonly detected (76.6%), followed by hookworms (26.4%) and A. lumbricoides (19.1%). Triple infections were found in 6.4% of the studied population. Univariate analysis showed that individuals with age group, male, presence of indoor toilet, family size with <7 members and bad living habits (i.e., without antihelminthic drugs) were significantly associated with STH infections. The analysis further showed that walking barefoot was the significant contributing factor to hookworm infections. The high prevalence of human STH infections is alarming. Thus, the urgency in implementing health education related behavioral practice and hygiene to reduce disease burden in these rural communities are a crucial need.

Laparoscopic appendectomy between the advantages and complicationsra cross section study -Jeddah - Saudi Arabia - 2016

Background: Appendectomy is the most common surgical procedure performed in emergency surgery. Laparoscopic appendectomy [LA] for acute appendicitis has several advantages over open appendectomy [OA]

In cases of complicated appendicitis, LA is converted to OA at a constant rate, though converting appendectomy [CA]. In this study, we aimed to assess the LA complication and the prevalence of CA

Methods: A cross Sectional survey conducted among 243 patients with acute appendicitis who were suitable for the study between April and July 2016. Operative time, length of hospital stay, post-operative complication return to normal activity has been assessed among the all patients

Results and Conclusion: Our results showed the advantages of the laparoscopic appendectomy approach including shorter hospital stay, decreased need for postoperative analgesia, early food tolerance, earlier return to work, lower rate of wound infection. Furthermore we found a considerable preference [during the collection of consent] of patients and a high satisfaction after the surgery

Assessment of the left ventricular function in normotensive prediabetics: a tissue Doppler echocardiography study

ABSTRACT Objective Several studies have shown that left ventricular (LV) dysfunction is increased in individuals with diabetes. However, there are scarce data about LV function in prediabetics. This study assessed the early changes in LV diastolic and systolic myocardial function in normotensive prediabetics using tissue Doppler echocardiography (TDE). Subjects and methods We evaluated 94 patients with prediabetes (mean age of 50.8 ± 6.9 years, 78 female) without known cardiovascular diseases and 70 healthy volunteers with similar demographic characteristics. Systolic and diastolic function of the left ventricle was evaluated with transthoracic echocardiography according to the latest consensus recommendations including TDE. Results The mean results of septal and lateral parts of the mitral annulus Pulsed wave TDE showed that myocardial systolic wave (Sm), myocardial early diastolic wave (Em) and Em to atrial peak velocity (Am) ratio were significantly lower whereas early diastolic peak flow velocity (E) to Em ratio, myocardial isovolumetric relaxation time (IVRTm), myocardial isovolumetric contraction time (IVCTm) and myocardial performance index (MPI) values were significantly higher in patients with prediabetes (preDM). In addition, mean left atrium (LA) diameter measured with M-mode echocardiography was significantly higher in prediabetics than controls. Conclusion PreDM is associated with subclinical LV systolic and diastolic dysfunction as evaluated by TDE.

In vitro antiplasmodial activity, macronutrients and trace metals in the medicinal plants: Phyllanthus spp. and Alpinia conchigera Griff

An antiplasmodial screening of Phyllanthus debilis and Phyllanthus urinaria was carried out. The medicinal plants were extracted and evaluated for in vitro antiplasmodial activity against D10 (chloroquine-sensitive, CQS) and Gombak A (chloroquine-resistant, CQR) strains of Plasmodium falciparum. The methanolic crudes from the soxhlet extraction were active against both strains however, P. urinaria (IC50 8.9 μg/ml with CQR strain) exhibited better anti-malarial activity compared to P. debilis (IC50 12.2 μg/ml with CQR strain). Furthermore, the methanolic crude of P. urinaria obtained by the cold extraction has good anti-malarial activity towards CQS (IC50 4.1 μg/ml). The concentration of macronutrients (calcium and magnesium) and trace metals (copper, manganese, iron and zinc) from three Phyllanthus species i.e. P. debilis Klein ex Wild., Phyllanthus niruri L., P. urinaria L. and Alpinia conchigera Griff. were determined using microwave digestion method and analyzed by Flame Atomic Absorption Spectroscopy. Standard Reference Material 1547 (peach leaves) was used to validate the method throughout this study. The recovery values were in the range of 80% to 120% which were in very good agreement with the certified values. The three Phyllanthus species and leaves of A. conchigera showed the highest concentration of calcium compared to other metals and macronutrients studied. The significant presence of all the important macronutrients and trace metals which are essential for human health and wellbeing substantiate their use medicinally in traditional practices.

Effects of Eurycoma Longifolia Extract on the Isolated Rat Heart

Eurycoma longifolia (E. longifolia) which is better known locally as Tongkat Ali is an indigenous plant in Malaysia. It belongs to the family of Simaroubaceae and is popular as a traditional medicine for its aphrodisiac properties. Throughout the years, several studies have been conducted to prove its effect on aphrodisiac action, antimalarial, antibacterial and anxiolytic properties but its effect to the cardiovascular system had not been fully explored. This study was aimed to demonstrate the changes that take place in the isolated heart following the injection of the extract. Methods: Three parameters that were measured included the coronary perfusion pressure (CPP), the left ventricular developed pressure (LVDP) and the heart rate (HR). Eighteen isolated rat hearts were used and were divided equally into three groups. The first group was to observe the effect of Isoprenaline, a β agonist while the second group was to see the effect of sodium nitroprusside (SNP), a nitric oxide (NO) donor. The dose which gave the maximum effect for these two positive controls was used to compare with the effect of E. longifolia water extract in the third group of rats. Isolated heart was mounted using the Langendorff apparatus and perfused with modified Krebs-Henseleit buffer. Doses of controls and the extract were instilled through an injection port, and the effect of each dose was monitored. Results: E. longifolia extract was found to reduce the CPP in normotensive rat at two of the highest doses. A dose of 1.0 mg of the extract reduced the CPP significantly from 34.52 ± 4.99 mmHg of the baseline value to 31.99 ± 4.93 mmHg while the dose of 10.0 mg of the extract reduced the CPP significantly to 32.67 ± 3.89 mmHg. However, there were no significant changes of effect of the extract on the LVDP and HR as compared to control. Conclusion: These early findings suggest that E. longifolia extract may have vasodilatory property, which supports its traditional usage with minimum cardiovascular side effects.

Celiac disease in children with short stature: a hospital based study

To identify the prevalence of celiac disease [CD] among children with short stature. Celiac disease [CD] is genetically determined gluten-sensitive enteropathy resulting in nutrient malabsorption, with an increasing incidence world-wide. A retrospective, hospital based study is conducted at a pediatric endocrine clinic, King Khalid University Hospital, Riyadh. During the period between January 1990 and December 2009, the medical records of patients evaluated for short stature were reviewed. After a proper detailed history and physical examination, growth analysis, followed by radiological [bone age], and laboratory screening [CBC, and thyroid function] were performed. Celiac serological screening and chromosomal analysis were performed when appropriate, followed by small intestinal biopsy if indicated. Growth hormone stimulation test was performed in suspected patients, followed by magnetic resonance imaging [MRI] in positive cases. Hundred and ten patients were evaluated for short stature over the period under review. Their age ranged from 2.6 to 14 years. The male to female ratio was 1.3:1. The commonest cause was genetic and found in approximately 51.8%, while in the other 48.2%, variable endocrine and non-endocrine causes were noted. Of the non-genetic short stature, 5 [10%] patients were found to have celiac disease, i.e. 4.5% of short children. The prevalence of celiac disease is not rare in this study, therefore, celiac disease must be considered as an important cause of short stature. As, it could be a silent disease, it is recommended that a serological screening be done first to all patients before performing dynamic growth hormone testing in the evaluation of short stature

Isolation and molecular characterization of Brucella melitensis from seropositive goats in Peninsula Malaysia

A study was carried out to isolate Brucella melitensis using established bacteriological and PCR techniques in Brucella seropositive goats in farms in Selangor, Negeri Sembilan, Melaka and Pulau Pinang. Brucella melitensis was isolated from 7 of 134 reactors with the highest isolation from the vaginal swabs (57.14%) followed by the spleen (28.57%), uterine fluid (14.29%). No Brucella was isolated from the lymph nodes. PCR confirmed all the seven isolates as B. melitensis and isolates were phylogenetically related to other isolates from India, Iran, and Israel but most closely related to isolates from Singapore.

Prevalence of carotid calcification detected on panoramic radiographs in a Saudi population from a training institute in Central Saudi Arabia

To determine the prevalence of carotid artery calcification as detected on panoramic radiographs in a Saudi population. This cross sectional study was conducted at the College of Dentistry, King Saud University, Saudi Arabia between March 2008 and January 2009. Five hundred and fifty-five panoramic radiographs of Saudi patients aged 30 years and above was collected from the patient charts. The panoramic radiographs were examined by 3 trained and calibrated examiners to detect any carotid artery calcification. Carotid artery calcification was noted in 28 [5%] of the 555 radiographs. Among these, 21 images were obtained from men [3.75%] and 7 from women [1.25%]. Dentists should be aware of the techniques to detect carotid artery calcification on the widely used panoramic radiographs. Consequently, information on a life-threatening condition could be provided to the patient, and a precautionary treatment could be suggested

Role of norepinephrine & angiotensin II in the neural control of renal sodium & water handling in spontaneously hypertensive rats.

Background & objectives: A wealth of information concerning the essential role of renal sympathetic nerve activity (RSNA) in the regulation of renal function and mean arterial blood pressure homeostasis has been established. However, many important parameters with which RSNA interacts are yet to be explicitly characterized. Therefore, the present study aimed to investigate the impact of acute renal denervation (ARD) on sodium and water excretory responses to intravenous (iv) infusions of either norepinephrine (NE) or angiotensin II (Ang II) in anaesthetized spontaneously hypertensive rats (SHR). Methods: Anaesthetized SHR were acutely denervated and a continuous iv infusion of NE (200 ng/min/kg) or Ang II (50 ng/min/kg) was instigated for 1 h. Three 20-min urine clearances were subsequently collected to measure urine flow rate (UV) and absolute sodium excretion (UNaV). Results: Higher UV and UNaV (P<0.05) were observed in denervated control SHR as compared to innervated counterparts. The administration of NE or Ang II to innervated SHR produced lower UV and UNaV (P<0.05 vs. innervated control SHR). Lower diuresis/natriuresis response to ARD was observed in NE-treated SHR compared to denervated control SHR (P<0.05). Salt and water excretions in denervated NE-treated SHR, however, were significantly higher (P<0.05) relative to the excretion levels in control denervated SHR. Conversely, there was a higher (all P<0.05) diuresis/natriuresis response to ARD when Ang II was administered to SHR compared to denervated control or innervated Ang II-treated SHR. Interpretation & conclusions: NE retains its characteristic antidiuretic/antinatriuretic action following ARD in SHR. Typical action of Ang II on salt and water excretions necessitates the presence of an intact renal innervation. Ang II is likely to facilitate the release of NE from renal sympathetic nerve terminals through a presynaptic site of action. Moreover, there is a lack of an immediate enhancement in the renal sensitivity to the actions of NE and Ang II following ARD in a rat model of essential hypertension.

Prospective surveillance of nosocomial device-associated bacteremia in three adult intensive units in Malaysia

Nosocomial blood stream infection (or nosocomial bacteremia) is a common problem in hospitals worldwide, including Malaysia. A three-year prospective cohort study (October 2003-March 2007) of the incidences, risk factors, and patterns of the microorganisms causing bacteremia was conducted using a validated surveillance form in three intensive care units (ICUs) in Malaysia. Center for Disease Control criteria were used to diagnose bacteremia. Patients were monitored from admission until the end point of study, which was the first detection of bacteremia in the blood in each patient. The frequency of occurrence of bacteremia with clinical symptoms was 10.7% (n = 23). Bacteremia was observed to occur within a mean length of stay of 10 days in ICU. The rate of device-related infection was 10.4% per device utilization days with a device utilization rate of 95.9%/1000 patient days. The total number of patient days was 2309 and the period of device utilization was 2211 days. The common bacteria detected were extended-spectrum beta-lactamases (ESBLs) Klebsiella pneumoniae (n = 6); Pseudomonas aeruginosa (n = 6); Acinetobacter species (n = 5); Methicillin-resistant Staphylococcus aureus (MRSA)(n = 3); and (non- ESBL) Klebsiella pneumoniae (n = 2). Multivariable analysis using Cox Proportional Hazard Model showed that the predictors for developing bacteremia were cancer, MRSA carriage, duration of central venous catheter (CVC) infusion, frequency change of CVC, and the administration of hydrocortisone drugs. These results indicate that a combination of nursing and medical interventions as well as patients' severity of illness could lead to bacteremia in ICU. Strategic implementation of quality assurance measures in ICUs could help to control this problem.

Isolation of mycoplasma gallisepticum and mycoplasma synoviae from native, ross and lohmann chickens in hail region of Saudi Arabia

In this study, M gallisepticum and M synoviae were isolated from different breeds of chickens in Flail region of Saudi Arabia. Out of 200 samples [trachea, lungs, air sacs and synovial swabs] taken from native chickens of different ages, 100 pure mycoplasma isolates were recovered. When typed by morphological, biochemical and serological methods, 39 isolates were identified as M synoviae, 31 isolates were identified as M. gallisepticum. of 60 samples from Lohmman layers, 11 pure isolates were obtained and 6 of them were identified as M synoviae, I was M gallisepticum. of 140 samples collected from Ross chickens and breeders, only samples collected from breeders aging 8 14 weeks [40 samples] resulted in positive mycoplasma isolation. Fifteen pure mycoplasma isolates were recovered of which 3 were identified as M gallisepticum, 4 were identified as M synoviae. Tracheal samples and synovial fluids resulted in the highest isolation rates from native and Lohmman chickens, respectively while synovial fluid and tracheal samples resulted in equal rates of Mycoplasma isolation from Ross chickens. Agar media containing tryptone soy agar base resulted in bigger Mycoplasma colonies and nipples

Surface properties and microporosity of polyhydroxybutyrate under scanning electron microscopy

This study was designed to investigate the surface properties especially surface porosity of polyhydroxybutyrate (PHB) using scanning electron microscopy. PHB granules were sprinkled on the double-sided sticky tape attached on a SEM aluminium stub and sputtered with gold(10nm thickness) in a Polaron SC515 Coater, following which the samples were placed into the SEM specimen chamber for viewing and recording. Scanning electron micrographs with different magnification of PHB surface revealed multiple pores with different sizes.

Effect of diclofenac alone or in combination with alpha-tocopherol on the oxidative activity of polymorphonuclear leukocytes in healthy and osteoarthritic individuals

To investigate the effects of diclofenac alone or when combined with alpha-tocopherol on the oxidative activity of polymorphonuclear leukocytes [PMNs] in healthy and osteoarthritic [OA] patients. The study was carried out at the College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia, over the period 1999 to 2000. Twelve healthy controls and 12 osteoarthritic patients were recruited to the study. Twelve healthy controls and osteoarthritic patients were given diclofenac 50 mg thrice daily orally, initially for 5 days then alpha-tocopherol at 200 mg thrice daily orally, was added for another 5 days. Blood samples were drawn before the start of the study [pre-treatment] and at 5 days following treatment with diclofenac alone and 10 days following treatment with diclofenac and alpha-tocopherol. Chemiluminescence [CL] response was measured for whole blood and isolated polymorphonuclear leukocytes [PMNs] on all samples. Diclofenac enhanced CL response of whole blood and of PMNs of healthy controls when stimulated with phorbol myristate acetate [PMA] and opsonized zymosan [OPZ]. Co-treatment with alpha-tocopherol resulted in no appreciable change in the CL response of whole blood when stimulated with PMA or OPZ but a further significant enhancement of CL response of isolated PMNs when these cells were stimulated by either PMA or OPZ. In osteoarthritic patients, diclofenac alone and when combined with alpha-tocopherol showed no significant change in CL response of whole blood. The CL response of PMNs from OA patients was decreased by diclofenac alone. However, this inhibitory effect was not observed when alpha-tocopherol was used together with diclofenac. The effect of diclofenac alone or in combination with alpha-tocopherol did not produce a consistent effect on the CL response of whole blood or isolated PMNs of healthy or osteoarthritic patients