Traditional Sri Lankan Medicine Intervention In The Management Of Knee Osteoarthritis (janu Sandigatavata): Case Series

Background: Osteoarthritis (OA) of the knee is a degenerative disease, which significantly restricts the functions of the joint. Janu Sandigatavata (JS) is considered to be the close equivalent in traditional medicine to OA in modern medicine. The aim of this case series was to report the effectiveness of Traditional Sri Lankan Medicine (TSM)on JS patients attend to National Ayurveda Teaching Hospital. Method: Reported cases (n=10) were at the age range of 45years to70 years and both female (n=8) and male (n=2) patients were diagnosed as having JSof the knee joints. Radiology (X?ray) reported by a radiologist confirmed that they were in Kellgren?Lawrence grade III or less. TSM treatments were given as regimens up to 86days.At the end point, external treatment of oleation and herbal immune enhancing drugs were further continued over 8weeks. Visual analogue scale for pain, knee scores in Knee Society clinical Rating System (KSS) and Ayurveda clinical assessment criteria were used to evaluate the effects of treatment. Results: Reductions of visual analogue scale for pain was observed between baseline and the 86 days endpoint. Clinical assessment criteria and the KSS scores of pain, movement and stability were also improved up to good level and function score were improved up to excellent level. During the follow?up period, joint symptoms and signs and the knee scores were remaining unchanged. Conclusions: Study explored that substantial decrease in clinical parameters of OA in knee and improved patients’ quality of life by the intervention of the TSM.

MTHFR Gene variants C677T, A1298C and association with Down syndrome: A Case-control study from South India.

BACKGROUND: The 5,10-methylenetetrahydrofolate reductase (MTHFR) polymorphisms and low folate levels are associated with inhibition of DNA methyltransferase and consequently DNA hypomethylation. The expanding spectrum of common conditions linked with MTHFR polymorphisms includes certain adverse birth outcome, pregnancy complications, cancers, adult cardiovascular diseases and psychiatric disorders, with several of these associations remaining still controversial. Trisomy 21 or Down syndrome (DS) is the most common genetic cause of mental retardation. It stems predominantly from the failure of chromosome 21 to segregate normally during meiosis. Despite substantial research, the molecular mechanisms underlying non-disjunction leading to trisomy 21 are poorly understood. MATERIALS AND METHODS: Two common variants C677T and A1298C of the MTHFR gene were screened in 36 parents with DS children and 60 healthy couples from Tamil Nadu and Karnataka. The MTHFR genotypes were studied by RFLP analysis of PCR-amplified products and confirmed by sequencing. RESULTS: The CT genotype was seen in three each (8.3%) of case mothers and fathers. One case father showed TT genotype. All the control individuals exhibited the wild type CC genotype. A similar frequency for the uncommon allele C of the second polymorphism was recorded in case mothers (0.35) and fathers (0.37) in comparison with the control mothers (0.39) and fathers (0.37). CONCLUSION: This first report on MTHFR C677T and A1298C polymorphisms in trisomy 21 parents from south Indian population revealed that MTHFR 677CT polymorphism was associated with a risk for Down syndrome.

Anthropometric characteristics of elderly people: observations at a large diarrheal hospital in Dhaka, Bangladesh.

There is a lack of evidence-based information to assist health policy makers in preparing for appropriate health, nutrition, and social-support guidelines for the elderly in Bangladesh. We examined selected indicators of the nutritional status of elderly people attending the Dhaka Hospital of ICDDR,B, Dhaka, Bangladesh. The population constituted of 1,196 individuals (718 men and 478 women), aged 60 to 106 years, who attended the hospital between 1 January 1993 and 31 December 2003. Patients were recruited from a hospital-based systematic sampling, regardless of age and gender, that presented to the facility. Men were heavier, and taller than women were (p < 0.001 for both comparisons). Using MUAC cut-off of < 22 cm for females and < 23 cm for males, at least 50% of the elderly were peripherally wasted (malnourished). Among all the study population, 40% had a BMI within the optimal range (18.5-24.9 kg/m(2)). Using the chronic energy deficiency (CED) classification, at least half of elderly (> or= 60 year) women were chronic energy deficient (BMI < 18.5). A significantly higher proportion of elderly women (7%) compared to men (2%) were overweight (BMI > or = 25, p < 0.001). Among the elderly ( > or = 60 year), males and females from a higher socioeconomic status (SES) had significantly higher BMI (p < 0.001, p = 0.001, respectively) and MUAC values (p < 0.001, p < 0.001, respectively) than their less well-off SES counterparts. We consider that, although our data were not valid for assessing the country situation, they are still useful as baseline information for longitudinal studies and for highlighting the need for studies in other geographical locations and in other population groups.

Tumoral calcinosis with hyperphosphatemia.

Tumoral calcinosis is a rare disorder of mineral metabolism among adolescents and young adults characterized by deposition of calcific masses around large joints. It is less commonly reported in pediatric population and commonly mistaken for bone tumors. Typical lab parameters include hyperphosphatemia with normal levels of serum calcium, parathyroid hormone (PTH) and alkaline phosphatase. A ten-year-old boy with typical features of tumoral calcinosis is presented.

Down syndrome child with 48,XXY,+21 karyotype.

Cytogenetic analysis in 60 clinically suspected cases of Down syndrome and their parents was carried out using conventional Giemsa-trypsin-banding technique. Fifty-five individuals (91%) exhibited a free trisomy 21. Robertsonian translocations were seen in three cases and two cases exhibited a normal karyotype. A four-month-old child, the second-born of non-consanguineous parents, possessed an extra X chromosome in addition to trisomy 21. The proband's parents and his brother showed a normal karyotype. The phenotypic characteristics of this child have been discussed in the light of the published reports on double aneuploidies of XXY and trisomy 21.

Trisomy 4p and partial monosomy 18q due to paternal translocation t(4;18) (p11; q21.3).

A carrier status for balanced translocation in either of the parents increases the risk of congenital malformation in the offspring. A case of multiple congenital anomalies in a female newborn was found to be associated with trisomy 4p and partial monosomy 18q as a result of a reciprocal translocation, t(4; 18) (p11; q21.3) in the father. The clinical and cytogenetic findings are compared with characteristic features of trisomy 4p, monosomy 18q and two similar cases reported earlier.

A Bisatellited Supernumerary Marker Chromosome Associated With Recurrent Miscarriages.

(RSAs) revealed the presence of a supernumerary, metacentric, bisatellited microchromosome marker in the male partner. His karyotype was 47,XY,+mar. Molecular analysis revealed the marker to be an idic 14 or 22 (q11-12). We herein discuss two aspects with respect to the presence of the marker: firstly, the karyotype-phenotype relationship in the carrier as well as the possibility of the marker causing abnormality in the next generation and, secondly, the possible role of the marker in the causation of RSAs.

Beneficial effects of long-term metoprolol therapy on cardiac haemodynamics in patients with mitral stenosis in sinus rhythm--a randomised clinical trial.

We conducted a placebo controlled randomised clinical trial to evaluate the effects of 6 months therapy with metoprolol on resting and exercise haemodynamics in 31 patients with isolated mitral stenosis in sinus rhythm. Twenty six of them (placebo n = 13, metoprolol n = 13) completed the study protocol. Their mean age was 23.1 +/- 7.9 years and the mean mitral valve area was 0.93 +/- 0.25 cm2. The dose of metoprolol ranged between 50-100 mg per day. The primary outcome variables for the study were the resting and exercise mean pulmonary capillary wedge pressure (PCWP) and cardiac index (CI) and the secondary outcome variables consisted of resting and exercise heart rate, mean pulmonary artery pressure (PAP), mean pulmonary vascular resistance (PVR) and clinical improvement on visual analog scale. These outcome variables were assessed blindly. The resting and exercise mean PCWP (mmHg) increased by 9.1 +/- 3.1 and 16.4 +/- 6.4 on placebo and 2.5 +/- 2.1 and -4.6 +/- 2.3 on metoprolol after 6 months therapy. These differences were statistically significant (p < 0.01). The resting and exercise CI (liters/min/m2) decreased by 0.2 +/- 0.1 and 0.1 +/- 0.1 on placebo and 0.3 +/- 0.5 and 0.3 +/- 1.0 on metoprolol. These haemodynamic effects were accompanied with much better symptomatic improvement in patients treated with metoprolol. The differences in change in mean PAP and PVR in two groups were statistically not significant. Our results suggest that the symptomatic patients with MS, waiting for definitive intervention for 6 months or less, would benefit if given beta blockers during this period.

A study of platelet aggregation, thromboxane A2 and prostacyclin in central aortic and coronary sinus blood in ischemic heart disease.

Aortic and coronary sinus platelet aggregation, thromboxane A2 (TXA2) and prostacyclin (PG12) levels were studied in fourteen patients of stable angina (SA), six of vasopastic angina (VA) and six control subjects (C). Patients of SA were studied at rest and during incremental atrial pacing and patients with VA were studied at rest and during various stages of vasospasm. Platelet aggregation was studied with different working concentrations of ADP, epinephrine and collagen. TX A2 and PGI2 concentrations were estimated by measuring levels of their stable metabolites viz. thromboxane B2 (TXB2) and 6-keto prostaglandin F1 alpha (PGF1 alpha) respectively. Platelet aggregation was increased in SA and VA patients (p < 0.01) and further increase was seen during vasospasm (p < 0.001). However, it failed to increase on incremental atrial pacing. Similarly, TXB2 and PGF1 alpha levels were raised in SA and VA patients. While TXB2 further increased during vasospasm but not during atrial pacing. PGF1 infinity failed to rise with either. Thus platelets are in an activated state in SA and VA. This activated state is a cause and not an effect in SA and VA. An imbalance in the levels of TXA2 and PG12 could account for the vasospasm.

Study of platelet ultrastructure in ischemic heart disease.

The present work was undertaken to study the ultrastructural morphology of blood platelets in angiographically proven patients of ischemic heart disease by scanning and transmission electron microscopy. Various morphological forms of platelets viz. discoid, pseudotubular, membranous, saccular, pseudopodical and hyaline were observed. They showed varying degrees of alterations in organelles and membrane systems. These morphological changes prove that platelets are in an activated state in ischemic heart disease, explaining the functional alterations that have been extensively studied in previous reports.

Platelet serotonin kinetics in acute myocardial infarction before and after thrombolysis.

Platelet count, platelet serotonin uptake and platelet serotonin content were analysed in 21 subjects consisting of 11 patients of evolving acute myocardial infarction (AMI) and 10 matched healthy controls before and after administration of streptokinase. Platelet counts were significantly reduced in AMI with a subsequent rise following thrombolysis. Platelet 5-HT uptake was also significantly increased in AMI and following thrombolysis, it showed a trend towards normalization. Platelet 5-HT content was significantly increased in AMI with no further significant change following thrombolysis. The results suggest that platelet activation as revealed by reduced platelet count and altered platelet serotonin kinetics, occurs in AMI and this activation is inhibited following thrombolysis. Further, it is also apparent that it is not the reperfusion but the thrombolytic agent that is responsible for inhibition of platelet activation.

Chromosomal break points in irradiated and ethyl methane sulphonate treated leucocytes of patients with Down syndrome.

Frequencies of chromosomal damage in the peripheral leucocytes of patients with Down syndrome, on exposure to gamma rays (2Gy) or ethyl methane sulphonate (EMS, 1x 10(-4) M), were assessed. Analysis of break points in the chromosomes of irradiated cells revealed a non-random occurrence. Six of the break points observed in EMS-treated cells were found to overlap with those recorded in irradiated cells. Thirteen break points observed were found to correlate with the location of cancer-specific break points and four of these coincided with the bands where oncogenes have been located. Two break points were localised to the same bands as that of known heritable fragile sites.

The efflux of nor-epinephrine from platelets in genetic hypertension.

Platelets have been used as a model of sympathetic neurons to study the storage of nor-adrenaline in normotensive individuals belonging to families with essential hypertension for at least two generations. The efflux and initial efflux rate (K) of noradrenaline was determined in 36 young relatives (mean age 29.2 years) and in 20 young controls with no family history of hypertension (mean age 26.5 years). From the groups of relatives all those with definite hypertension had been excluded. Efflux and efflux rate K was significantly higher in young relatives (50.82 +/- 3.84 and 28.2 +/- 6.3) than in the controls (39.2 +/- 0.71 and 15.2 +/- 4.8). Of the relatives 25.2% had higher K values than any of the controls.

Use of captopril as an isolated agent for the management of stable angina pectoris--a double blind randomised trial.

In this double blind randomised placebo controlled study, we investigated the antianginal efficacy of oral captopril in 33 patients of angiographically documented coronary artery disease (chronic stable angina). Apart from sublingual nitrates, all other antianginal drugs were withdrawn. Patients were then evaluated both subjectively by questionnaire and objectively by treadmill stress test. No patient had more than mild hypertension and all patients had good left ventricular function. One group of patients received oral captopril while the other group was given placebo. A repeat assessment was done after six weeks and the results compared with baseline. Anginal attacks decreased from 20.11 +/- 1.86 per week on placebo to 9.92 +/- 1.38 (p < 0.01) on captopril as also the number of sublingual nitrates (18.84 +/- 3.01 to 11.14 +/- 2.94, p < 0.01). Assessment by the treadmill stress test showed that in comparison to the pretreatment test, captopril therapy resulted in a significantly increased exercise duration (6.26 +/- 0.21 to 6.98 +/- 0.31 minutes, p < 0.05), total work done (6.76 +/- 0.26 METS to 7.48 +/- 0.29 METS, p < 0.05). In addition there was a significant increase in time to angina (6.16 +/- 0.18 to 6.85 +/- 0.24 min, p < 0.05) and time to 1mm ST depression (5.18 +/- 0.26 to 6.46 +/- 0.30 min, p < 0.01). We conclude that captopril is an effective monotherapy for patients with chronic stable angina and has both antianginal as well as anti-ischemic effects, possibly secondary to direct coronary vasodilation.

The efflux of nor-epinephrine from platelets in essential hypertension.

The precise role of sympathetic nervous system in initiation and/or maintenance of essential hypertension is unclear even today. Platelets have been used as a suitable model for studying neuronal turnover of biogenic amines. The present study comprised of hypertensive subjects (23) and normotensive controls (10). Hypertensive subjects exhibited significantly enhanced norepinephrine efflux from platelets at both 30 minutes and 60 minutes (p less than 0.001). The percent norepinephrine efflux from platelets correlated with diastolic (r = 0.66 and 0.76) and mean arterial blood pressure (r = 0.54 and 0.65) but not with systolic blood pressure. The norepinephrine efflux rate (K) similarly correlated with diastolic and mean arterial blood pressure in hypertensive subjects studied. From the above findings it appears that operative sympathetic nervous system activity is enhanced in essential hypertension. The enhanced efflux of norepinephrine from platelets may also indicate activated state of platelets in hypertension. Both could be important in genesis and complications of essential hypertension.

Clinical relevance of vegetations in infective endocarditis.

Two-dimensional echocardiograms of 58 patients with infective endocarditis were examined to determine if presence and/or size of vegetations on echocardiogram were predictive of morbidity and mortality. Group 1 (38 patients) with one or more vegetations, had a significantly higher rate of complications (emboli, congestive heart failure, need for surgery and death) than group 2 (20 patients) without vegetations (p less than 0.001). Analysis of morphologic characteristics of the vegetations in group 1 was of no predictive value for complications in individual patients. In contrast, patients whose echocardiograms demonstrated vegetations on aortic valve had a significantly higher incidence of heart failure, embolisation, surgery and death than those with vegetations on mitral valve. Thus, the detection of vegetations on initial echocardiogram clearly identifies a subgroup at risk for complications, more so if vegetations are present on the aortic valve, but the vegetations size does not predict an adverse clinical outcome.