Alphacalcidol Supplementation Improves AcetylcholineMediated Relaxation in Aorta of Diabetic Rats on Vitamin D-Deficient Diet

@#Introduction: Vitamin D deficiency has been implicated as one of the factors involved in endothelial dysfunction associated with diabetes. This study aimed to evaluate the effects of active vitamin D (alphacalcidol) supplementation on aortic endothelial function in diabetic rats receiving vitamin D-deficient diet. Methods: Streptozotocin-induced diabetic rats were fed with standard diet (D) or vitamin D-deficient diet (DD and DDS) for 10 weeks. Group DDS was then supplemented with 0.2 μg/kg alphacalcidol at the last four weeks of the study duration. Non-diabetic rats were fed with standard diet (N) or vitamin-D deficient diet (ND). At the end of the experiment, the rats were sacrificed, and their aortic rings were harvested for endothelial functional study. Results: Acetylcholine-induced relaxation in aorta of diabetic rats (D and DD) were significantly lower compared to non-diabetic rats (N). In the presence of endothelial nitric oxide synthase blocker (L-NAME), maximal relaxation induced by acetylcholine in aorta of D and DD groups were significantly higher compared to N, ND and DDS groups, indicating involvement of non-nitric oxide (NO) relaxation pathways in diabetes. Four weeks supplementation with alphacalcidol in DDS group significantly improved acetylcholine-induced relaxation and reduced the reliance on non-NO relaxation pathways. Conclusion: The present study suggests that impairment of acetylcholine-induced relaxation in aorta of diabetes and diabetes with vitamin D-deficient diet was largely due to a decrease in NO related pathways, and this was compensated by non-NO pathways. Supplementation with alphacalcidol alleviated endothelial impairment in aorta of diabetic rats with vitamin D-deficient diet.

Effects of Arterial Stiffness on Visual Field Severity and Progression in Malay Patients with Primary Open Angle Glaucoma

@#Introduction: Vascular dysregulation is postulated to be involved in the pathogenesis of primary open angle glaucoma (POAG). Systemic arterial stiffness may accelerate the pre-existing damage. The purpose of this study was to determine the association of arterial stiffness with severity and progression of visual field in Malay patients with POAG. Methods: A cross-sectional study was conducted with 55 patients with POAG and 55 age- and sex-matched control subjects. The patients with POAG were further divided in accordance with their Advanced Glaucoma Intervention Study (AGIS) scores on their visual fields (VFs) (mild in 23 patients, moderate in 18, and severe in 14). Progression was defined as the worsening of the VF defect quantified as an increase in AGIS score of 4 points from the baseline. Arterial stiffness was measured using SphygmoCor and quantified as pulse wave analysis (PWA) and pulse wave velocity (PWV). Results: No significant differences in PWA and PWV were found between the patients with POAG and the control subjects (p=0.333 and p=0.443, respectively). The mean follow-up duration for the patients with POAG was 4.7±3.1 years. PWA and PWV showed no significant association with POAG severity after the confounding factors were controlled for. Ten patients with progression of VF were identified. In the analysis of covariance, a significantly higher PWV was found in the patients with disease progression (p=0.036). Conclusion: VF severity and progression were not associated with systemic arterial stiffness. The probable reason is that other factors affecting retinal microcirculation may play a larger role in the severity and progression of POAG.

Urine Drugs of Abuse Testing at Hospital Universiti Sains Malaysia: A Review of Trends from 2009 – 2019

@#Introduction: Substance abuse is a major social and health bane worldwide, including Malaysia, inflicting extensive morbidity and mortality. Our study aims to review the request and results of urine drugs of abuse testing conducted at the Pharmacology Laboratory of Hospital Universiti Sains Malaysia, Health Campus, Kelantan, Malaysia, over a period of 11 years. Methods: Data for urine drugs of abuse testing requested and their results performed at the Pharmacology Laboratory between January 2009 and December 2019 was retrospectively extracted. Data on patient demographics, types of drugs requested, and types of drugs tested positive were analysed. Testing was performed using the enzyme multiplied immunoassay technique. Results: The absolute number and percentage of positive cases for amphetamine type stimulant (ATS) drugs has steadily risen over the past decade making it the current drug of abuse of most concern. Opiate abuse, although still seen, remained static. The peak age range for abusing drugs falls between 25–34 years with a male predominance; an alarming finding was of positive cases observed among neonates and children below the age of 12. Majority of requests came from the Psychiatric and Emergency Departments. Conclusion: Over the past eleven years, ATS abuse has superseded opiate in being the most abused drug type, detected even at young ages. Therefore, societal awareness and education on the dangers of ATS abuse, and intensive detection of ATS use must be implemented.

Arterial stiffness during acute and recovery phases of children with rheumatic fever

Acute rheumatic fever (ARF) is associated with systemic inflammation and arterial stiffness during the acute stage. It has not been reported if arterial stiffness remains after recovery. The aim of this study was to determine the arterial stiffness during acute stage and 6 months after recovery from ARF. Arterial stiffness was assessed by carotid femoral pulse wave velocity (PWV) in 23 ARF patients during the acute stage of ARF and 6 months later. Simultaneously, erythrocyte sedimentation rate (ESR) and other anthropometric measurements were taken during both stages. There was a significant reduction in PWV; 6.5 (6.0, 7.45) m/s to 5.9 (5.38, 6.48) m/s, p=0.003 6 months after the acute stage of ARF. Similarly, ESR was also significantly reduced from 92.0 (37.5, 110.50) mm/hr to 7.0 (5.0, 16.0) mm/hr, p=0.001. In conclusion, arterial stiffness improved 6 months after the acute stage with routine aspirin treatment; this correlates well with the reduction in systemic inflammation.

Abnormal Microvascular Reactivity with Hypercholesterolaemia in Pregnancy

Background: Post-occlusive skin reactive hyperaemia (PORH) is a model used to assess microvascular reactivity. This study aims to compare PORH response among pregnant hypercholesterolaemic patients with age and gestational age-matched controls. Methods: This cross sectional study involved 17 hypercholesterolaemic, pregnant women and 20 pregnant controls entering their early third trimester. Laser Doppler fluximetry (LDF) was used to measure skin perfusion. The process of PORH was performed by occluding the upper arm with an occlusion cuff at 200 mmHg for 3 minutes. Skin perfusion was recorded before, during, and after occlusion release. Baseline perfusion, time to achieve peak perfusion (Tp), peak perfusion after occlusion release (PORHpeak), and maximum change in perfusion due to occlusion (PORHmax) were recorded. Results: Serum total cholesterol (TC) was significantly different (P < 0.001) between the 2 groups: 7.25 (SEM 0.18) mmol/L for hypercholesterolaemic women and 5.54 (SEM 0.15) mmol/L for the control group. There were no significant differences in their baseline, PORHpeak, and PORHmax. However, Tp in the hypercholesterolaemic group was significantly increased (P = 0.024) compared with the controls at 14.9 (SEM 0.6) seconds and 13.1 (SEM 0.5) seconds, respectively. Conclusion: Pregnant hypercholesterolaemic patients showed an abnormal microvascular reactivity response. Tp with ischemia was significantly increased compared with normocholesterolaemic controls.

Supraventricular tachycardia from a left bundle branch block - an unusual presentation of Wolff-Parkinson-White syndrome

Wolff-Parkinson-White syndrome [WPW] is an electrocardiographic diagnosis based on a short PR interval with the presence of a delta wave, but it can mimic a variety of electrocardiographic conditions. We present a case in a 6-year-old Saudi female whose WPW was easily mistaken as a left bundle branch block