In vivo and in vitro Pharmacological Evaluation of Gymnosporia Royleana / Evaluación Farmacológica de Gymnosporia Royleana in vivo e in vitro

ABSTRACT Objective: Gymnosporia royleana (G royleana) Wall ex MA Lawson, locally known as (Sur Azghee), is traditionally used for the management of various diseases. In the current investigation, we made an effort to scientifically validate its traditional use in various pathological conditions, such as microbial infections and cancer, and to explore its additional pharmacological activities via random screening against locally accessible pharmacological methods, irrespective of its traditional uses like antidiabetic, haemagglutination and antioxidant assays. Methods: Extraction was carried out using a cold maceration methodology. Dilution method was used for antimicrobial susceptibility testing using different concentrations. Streptozocin (STZ) induced protocol was used to assess antidiabetic activity at a dose level of 200, 400 mg/ kg. Antioxidant activity, haemagglutination activity, and anticancer activities against HepG-2 and MCF-7 cell lines were determined as per established protocols. Similarly, the maximum amount of phenolic content (12.02 mg 100 g) was determined by using Folin Ciocalteu assay. Results: Promising antimicrobial activities in terms of minimum inhibitory concentration (MIC) were noted for crude extract (25-200 µg/mL), n-hexane (100-400 µg/mL), ethyl acetate (50-200 µg/mL) and aqueous (100-400 µg/mL). Antidiabetic potential was significant at a dose level of 200-400 mg/kg bodyweight by reducing the blood glucose level at days 10 and 15. The percentage of 2,2-diphenyl-1-picrylhydrazyl (DPPH) values increase by increasing the concentration of the plant extract (10-100 µg/mL). The methanol extract was found to possess high agglutination activity. Conclusion: It was concluded that this plant species possess significant antimicrobial, antidiabetic, antioxidant, anticancer and haemagglutination activities, which could be attributed to the phenolic content of the extract.

RESUMEN Objetivo: Gymnosporia royleana (G royleana) Wall ex MA Lawson, localmente conocida como "Sur Azghee", se utiliza tradicionalmente para el tratamiento de diversas enfermedades. En la investigación presente, tratamos de validar científicamente su uso tradicional en varias condiciones, tales como las infecciones microbianas y el cáncer, así como explorar sus actividades farmacológicas adicionales mediante el tamizado aleatorio frente a los métodos farmacológicos localmente accesibles, independientemente de sus usos tradicionales como ensayos antidiabéticos, hemaglutinantes, y antioxidantes. Métodos: La extracción se realizó mediante una metodología de maceración en frío. Un método de dilución se utilizó para la prueba de susceptibilidad antimicrobiana utilizando diferentes concentraciones. Se utilizó el protocolo inducido por estreptozotocina (STZ) para evaluar la actividad antidiabética a un nivel de dosis de 200, 400 mg/kg. La actividad antioxidante, la actividad de hemaglutinación, y las actividades anticancerígenas contra las líneas celulares HepG-2 y MCF-7, se determinaron según los protocolos establecidos. De modo similar. la cantidad máxima de contenido fenólico (12.02 mg 100 g) se determinó mediante el uso del ensayo Folin-Ciocalteu. Resultados: Se observaron actividades antimicrobianas prometedoras en términos de la concentración inhibitoria mínima (CIM) para el extracto crudo (25-200 μg/mL), el n-hexano (100-400 μg/mL), el acetato de etilo (50-200 μg/mL), y el extracto acuoso (100-400 μg/mL). El potencial antidiabético fue significativo a un nivel de dosis de 200-400 mg/kg de peso corporal mediante la reducción del nivel de glucosa en sangre a los 10 y 15 días. El porcentaje de los valores de 2,2-difenil-1-picrilhidracilo (DPPH) se incrementa al aumentar la concentración del extracto de la planta (10-100 μg/mL). Se halló que el extracto de metanol posee una alta actividad de aglutinación. Conclusión: Se concluyó que esta especie de planta posee importantes actividades antimicrobianas, antidiabéticas, antioxidantes, anticancerígenas y hemaglutinantes, que podrían atribuirse al contenido fenólico del extracto.

Patterns of thyroid cancer in southwestern Saudi Arabia

To examine the pattern of thyroid cancer, assess the magnitude of the problem, and evolve a management plan for such malignancies. This is a retrospective cohort study of all thyroid cases operated at Aseer Central Hospital, Abha, Kingdom of Saudi Arabia, between January 1998 and December 2007. Clinical presentations, management regimens, and recurrence were reviewed. Five hundred and sixteen patients were operated for different thyroid lesions. Ninety-two [17.8%] were malignant [20 males and 72 females]. Mean age for males was 41.35 +/- 15.52 years compared to 36.59 +/- 13.28 years for females. Papillary carcinoma constituted 50%, while follicular carcinoma formed only 4.3% of malignant cases. Lymphoma ranked third with only 1.1% of all malignant thyroid lesions. No cases of medullary carcinoma were found. Of 92 patients, 75 reported for follow-up. The recurrence rate for follow-up patients was 29 [31.5%]. High resolution neck ultrasonography and image-guided fine needle aspiration cytology should be considered as routine investigative tools in patients with suspicious thyroid swelling. Total thyroidectomy and removal of all lymph nodes in the central compartment of the neck seem to be the ideal management plan, until such trials emerge. Residual thyroid tissues, following surgery, should be ablated using radioiodine [I131] isotope

Accessibility of medicines and primary health care: the impact of the revolving drug fund in Khartoum State

This paper presents a comprehensive evaluation of a country where a revolving drug fund (RDF) has lasted for fifteen years and serves more than three million patients annually; with more than SDG 2.8 million (Sudanese Pound) (US$11.1 million) annual turn over. Regardless of the fact that the supply of medicines and improvement in public health facilities utilization are among the main objectives of user fees policy; there is little information on the effect of RDF on accessibility of essential medicines and its impact on the utilization of public health services where RDF schemes have been introduced. We measured the percentage of prescribed medicines dispensed to patients in selected health facilities (both RDF and non-RDF); the availability of essential medicines in a twelve month period in order to determine whether the cost of the medicines is a barrier to utilization of public health services with RDF scheme in Khartoum State (KS). Structured interviews with users (186); personal observations; and archival as well as statistical records were used to capture data of interest relevant to the study objective. The average availability rate of key items was greater (93) in the RDF facilities compared to 86in non-RDF facilities. RDF records also showed that the availability of medicines in the RDF health facilities ranged from 95 to 100in the twelve months period studied. Data from the household survey; demonstrated that over a third (36) of respondents did not consult public health facilities when a member of a household was ill two weeks prior to the date of interview. Of note; only 9of them said that this was because of unavailability of medicines. This study suggests that the RDF scheme adopted by KS made essential medicines available at its health facilities and increased health services utilization compared to those without RDF scheme. Therefore; sustained availability of low cost medicines near where people live that benefit previously disadvantaged poor population; particularly the vulnerable rural groups is achievable through RDF

Allergic sensitization in healthy school children in Kuwait: an emerging public health concern

To determine the current level of sensitization in healthy school children in Kuwait. Prospective cross-sectional study. Al-Rashid Allergy Center, Kuwait. Healthy school-children between the ages of 8 -15 years. Skin prick test [SPT] and measurement of serum specific IgE levels. Skin wheal diameter [> 3 mm] and IgE levels [> 0.35 KIU/1]. 47% of children showed positive specific IgE levels and 38% showed a positive SPT to at least one allergen. Poly-sensitization was common in the population [IgE 32%, SPT 20%]. One in three [31%] children showed sensitization to Bermuda Grass [IgE], around one in five showed sensitization to Prosopis juliflora tree [20% IgE], grass mix [19% SPT], to cockroach [18% IgE, 12% SPT] and just slightly less to cat [15% IgE and SPT]. One in 10 healthy children were sensitized to dog [11% IgE, 10% SPT], few to house dust mite [D pteronyssinus] [IgE 8%, SPT 4%], ascaris [IgE 7%]. The lowest rates of sensitization were to Alternaria alternata [IgE 4%, SPT 2%], aspergillus [SPT 4%], and cladosporium [SPT 2%]. Frequent, severe sensitization [Classes 3-6 for specific IgE] was found for Bermuda Grass [16%], prosopis tree [6%] and cat allergen [5%]. Kuwait may be an example of conflict between two aspects of public health endeavour in a desert environment. Practices that make the desert habitable, viz, aforestation and air-conditioning may be the same ones that encourage exposure to allergens, allergic sensitization and allergic disease

Nalidixic acid-resistant Salmonella enterica serotype typhi infection presenting with sub-intestinal obstruction and mesenteric adenitis

Nalidixic acid-resistant Salmonella typhi NARST infections increase minimal inhibitory concentrations of fluoroquinolones, due to chromosomal mutations in the gene encoding DNA gyrase, and can lead to a delayed treatment response. This in turn alters the course of the disease allowing for a protracted period of illness and the occurrence of complications. In this case report, we present a patient from the Indian sub-continent, who was diagnosed with NARST complicated by sub-intestinal obstruction, her diagnosis, treatment, and subsequent recovery

Prevalence of coronary heart disease in Kashmiris.

Coronary Heart Disease (CHD) is one of the major causes of mortality and morbidity in the general population of both the developing and developed countries. Prevalence of CHD in the Indian subcontinent is presently one of the highest and is further on an increase. In the state of Jammu and Kashmir the population like any other developing community, is undergoing lifestyle changes but the unusual stress and strain for the last 15 years of the disturbed situation in the state apparently has contributed to increase the prevalence of CHD. Therefore an epidemiological study was conducted to assess the prevalence of CHD in both rural and urban areas of the valley. This study was carried out in the rural and urban areas of the twin districts of Anantnag and Srinagar by random sampling. The total population of the study area comprised of 44,305 persons out of which the target population was 13,893. The study was carried out on 3128 (23%) subjects (2284 males and 844 females) aged 40 years and above. In rural areas the study was conducted in a cluster of 3 villages in each district on 1552 persons (1088 males and 464 females) and in urban areas it was carried out in 3 mohallas (closed locality) in each district on 1576 persons (1196 males and 380 females). A complete history and clinical examination was done and Rose Questionnaire was recorded for angina. ECG was done in all subjects. Chi square test was used for statistical analysis. The overall prevalence of CHD in the population studied by all diagnostic measures was 7.54%. The overall rural prevalence was 6.70% and urban prevalence was 8.37%. Prevalence of CHD was higher in males, 7.88% and slightly lower in females, 6.63%.

Spinal intramedullary cavernous hemangioma

The spinal cord can be involved in a variety of disease processes. These can be congenital or acquired. An acute onset of symptoms usually allows a defined set of causes to be considered including trauma, ruptured vascular anomalies, demyelination, and myelitis. Intramedullary cavernous hemangioma of the spinal cord is a congenital or acquired vascular malformation, and one of the rare causes of hematomyelia. We present such a case, and discuss the symptoms, diagnosis, and suggested best treatment options based on a review of present day literature

Frequency and comparative analysis of hepatitis in patients seeking treatment for hepatitis B

To find the frequency of hepatitis 'D' in patients of hepatitis 'B' seeking treatment and to compare clinical and biochemical features in patients harboring HDV with those who are not. Cross-sectional study. Medical Unit-IV, Civil Hospital Karachi, Medical Unit-VI and Surgical Unit-VII, Lyari General Hospital, Dow University of Health Sciences, Karachi; from July 2003 to June 2005. HBsAg positive patients seeking treatment were enrolled in the study. Anti-HDV was done in all. Patients were split into two groups according to their anti-HDV status into HDV positive and HDV negative groups. Liver biochemistries and viral profile for HCV, anti-HBc IgM and HBeAg were done and compared between the two groups. A total of 246 patients were selected. HDV was positive in 66 [26.8%] patients. No significant difference was observed in the frequency and stages of cirrhosis between the two groups while significant differences were observed in the mean SGPT [95% CI: -381.09 to -110.74; P = 0.001] and albumin levels [95% CI: 1.87 to 7.73; P = 0.007] and in the frequency of HBeAg [P = 0.001], anti- HBc IgM [P = 0.02] and HBV DNA [P < 0.001]. HDV infection was common in patients with HBV in this cohort of patients. All patients of HBV should be screened for HDV before treatment decision for the former is taken

Family education and social adjustment of psychiatric clients

Efficacy of psycho-educational programme in promotion of social and family functioning among Iranian psychiatric clients is the theme of this study. One hundred and seventy schizophrenics with 174 clients with mood disorders were included in the present study and adopting Solomon's experimental design they were assigned into four groups: 2 experimental and 2 control groups for each illness category. Key family members from experimental groups participated in a weekly educational programme for a duration of six months. Batteries of tests were used to ascertain family's skills in management of client's verbal and non verbal behaviours. Baseline data with those after intervention, i.e., 6 and 18 months were compared, using SPSS programme and running statistical tests such as t-test and ANOVA. Comparing the experimental and control groups, more attitudinal, cognitive and behavioural changes among families followed by more desirable role performance ability by the clients in experimental groups were observed. Results indicated that family education can bring about desirable changes in the family dynamics and better outcome of psychiatric disorders. Psychiatric social workers can use psycho-educational programme in imparting necessary skills for effective management of verbal and non verbal behaviours of psychiatric patients in the family

Retinoblastoma in Karachi, Pakistan.

The objective was to assess epidemiologic aspects of retinoblastoma development in Karachi, Pakistan. Incident cases, diagnosed clinically or microscopically and registered at Karachi Cancer Registry (KCR) during 1(st)January 1998 to 31(st) December 2002 were reabstracted, rechecked and reanalyzed for this purpose. One hundred and one cases of retinoblastoma were reported to KCR over the 5 years (1998-2002). Fifty-seven were residents of Karachi, 34 (59.6%) males and 23 (40.4%) females. The gender ratio (M:F) was 1.5. The mean age at diagnosis was 3.96 years (95% CI 2.92; 4.99) and 3.85 years (95% CI 2.72; 4.98) in males and females respectively. The annual crude incidence of retinoblastomas in Karachi was 4.0/100,000 and 2.4/100,000 in children under the age of 5 and 10 years respectively, the corresponding age standardized rates being 5.3/100,000 and 4.8/100,000. The age groups at risk of developing retinoblastoma, associated morbidity and possibility of almost 100% 5-year survival with available treatments, calls for ophthalmologic screening of all infants below 1 year, and high-risk children until the age of 7 years. In order to detect retinoblastoma, as early as possible, health education for parents and health providers, and improved training of ophthalmologists is essential. Genetic testing for siblings and children of retinoblastoma cases and identification of high-risk children would be helpful, but lacks financial feasibility in developing countries at present. Future health care planning should focus on capacity building for neonatal ophthalmologic screening, handling of parents'and children'emotional reactions and opportunities for education, occupational training and cosmetic rehabilitation for surviving retinoblastoma patients.

Anhidrotic Ectodermal Dysplasia (Christ-Seimens-Touraine syndrome)--case report with a review.

Anhidrotic ectodermal dysplasia commonly transmitted as an x-linked recessive disorder is very rare. The complete syndrome occurs in males and females are carriers. Our patients comprised two sisters who had the complete syndrome. This is much rarer and is reported to be inherited as autosomal recessive disorder, there are only a few case reports of females presenting with a complete syndrome in the literature.

Detection of autonomic nervous dysfunction by SL manoeuvre.

We have evaluated the immediate heart rate response to standing and lying and in 100 Diabetic subjects aged 43 +/- 10 years who underwent five other cardiovascular autonomic tests. Using a specially devised scoring system the patients were divided into three groups: a) 58 subjects without autonomic neuropathy, b) 15 borderliners, c) 27 with autonomic neuropathy. The results were compared with 50, sex and age matched controls. We studied SL1 = ratio between R-R mean before lying and R-R maximum between the 20th to 25th beat and R-R minimum over the first 5 beats after lying. In controls SL1 was 1.35 +/- 0.18 and SL2 was 1.52 +/- 0.23. In diabetic subjects without autonomic neuropathy SL1 was 1.20 +/- 0.86 (p < 0.01), SL2 1.50 +/- 0.02 (p < 0.001). In the group with autonomic neuropathy SL1 was 1.04 +/- 0.02 (p < 0.001) and SL2 was 1.20 +/- 0.09 (p < 0.001). We propose that the lowest normal and highest abnormal limits of SL1 are 1.12 and 1.08 respectively and that normal and highest abnormal limits of SL2 are 1.23 and 1.18 respectively. We suggest the use of SL1 as a pure parasympathetic test and SL2 as a mixed but predominantly sympathetic test in the diagnosis of autonomic neuropathy.

Multiple drug resistant typhoid fever outbreak in Kashmir Valley.

We report the first ever report of multiple drug resistant salmonella typhi epidemic from Asia. The outbreak started in April 1988 and virtually ended by June 1988. The outbreak occurred in Baramullah town of Kashmir valley. In an epidemiological survey 230 cases were diagnosed as enteric fever. 46 cases (20%) were culture positive. A very rare multiple drug resistant strain of S. typhi was identified as phage type biotype II untypeable (UVS2). The strain was sensitive to Norfloxacin. This outbreak of S. typhi has many similarities with Mexico epidemic. Ingestion of contaminated water seems to be the possible cause for the outbreak.

Neuropsychiatric manifestations of typhoid fever.

Various neuropsychiatric syndromes in typhoid fever were seen in nine patients of multiple drug resistant (both in vitro and in vivo) Salmonella typhi infection of a total of 270 suspected cases in the last two years. All but one patient received oral norfloxacin (400 mg 12 hourly) for two weeks with complete recovery, while the other patient died. Bacteremia and toxemia seem to be the only common factor responsible for neuropsychiatric complications.

Derrame pleural post-radioterapia: presentación de un caso / Pleural effusion post-radiotherapy: presentation of a case

Se presenta un caso de derrame pleural post-irradiación en una paciente operada de carcinoma mamario el cual se descartó ser metastásico por citología y biopsia pleural, además de la evolución faborable sin tratamiento específico. Se analizan las causas del derrame pleural en estos casos, de acuerdo a la bibliografía mundial