Change seen in histological pattern in patients with lupus nephritis with positive antiphospholipid serology

Background: it is debatable whether a repeat renal biopsy during lupus nephritis [LN] flare is helpful in guiding the treatment and predicting prognosis

Objective: to determine the value of serial renal biopsies in detecting histological changes in patients with lupus nephritis with APL antibodies

Study design, settings and Duration: this cross sectional retrospective study was conducted at King Saud University Medical City Riyadh, Kingdom of Saudi Arabia [KSA] during May 2013 to August 2017

Patients and Methods: patients having diagnosis of systemic lupus erythematosus [SLE] with positive APL antibodies and who underwent two or more renal biopsies for various indications were included into the study. The histological features of serial renal biopsies were compared. Renal biopsies were reassessed with light microscopy, immunofluorescence and electron microscopic studies and were categorized according to ISN/RPS 2004 classification. Data was analyzed using chi-square test to assess the differences between categorical study variables

Results: a total of 15 patients with LN having positive APL antibodies were included. The mean age of the patients was 38 +/- 10.5 years, and the disease duration was 160 +/- 9 months. The Interval between the two biopsies was 73.5 +/- 48 months. Antiphospholipid syndrome nephropathy [APSN] was noted in 4 [26%] patients at time of the first renal biopsy and in 9 [60%] on repeat biopsies. Thrombotic microangiopathy [TMA] which is the hallmark of APSN was detected in the repeat biopsy in two patients Change in the histological class was frequent and was seen in 12 out of the 15 patients while patients with proliferative LN class switching to non-proliferative class was rare

Conclusion: histological changes are common in serial biopsies in patients with lupus nephritis with positive APL serology. Repeat renal biopsies led to change in immunosuppression treatment in more than half of patients on average

Oxidative stress and histopathologic biomarkers of exposure to bisphenol-A in the freshwater fish, Ctenopharyngodon idella

ABSTRACT Bisphenol-A (BPA) belongs to the family of endocrine disrupting chemicals (EDCs) and it is used in the production of polycarbonate plastic and epoxy resins. The reproductive toxicity of BPA is well documented but it also exerts its toxic effects through multiple pathways especially by inducing a state of oxidative stress and causing damage to the vital organs. In the present study, histopathologic and oxidative damage caused by BPA in liver and kidneys of fresh water cyprinid, Ctenopharyngodon idella was evaluated. LC50 of BPA for Ctenopharyngodon idella was determined by probit regression analysis. Fish were exposed to a sublethal concentration of BPA i.e. 3.2 ppm (1/2 LC50) for 14 days. Histologic studies revealed that BPA caused degenerative changes in liver and kidneys and exposure of sublethal concentration of BPA caused oxidative damage in both organs. Lipid peroxidation significantly increased in liver and kidneys of treated group. Catalase activity and reduced glutathione content significantly decreased in the group exposed to BPA compared to control and glutathione-S-transferase activity increased significantly in both organs exposed to the sublethal concentration of BPA. From this study it is concluded that BPA caused toxic effects in fish species by changing oxidative balance and damaging the vital organs.

Assessment of antinociceptive, antipyretic and antimicrobial activity of Piper cubeba L. essential oil in animal models

This study was designed to investigate the possible antiniciceptive, antipyretic and antimicrobial activities of the essential oil obtained from the fruits of Piper Cubeba [L.]. To assess the antinociceptive and antipyretic activities, three doses [150, 300 and 600 mg/kg, i.p.] were tested in acetic acid-induced abdominal writhing, tail flick reaction and hot-plate and Brewer's yeast-induced hyperpyrexia test models in animals. Moreover, the antimicrobial activity was examined using agar diffusion method and broth micro-dilution assay for minimum inhibitory concentrations [MIC]. The Piper Cubeba essential oil [PCEO] showed a marked antinociception [17, 30 and 54%] and an increase in reaction time in mice in the flick tailed and hot-plate tests. The brewer's yeast induced hyperpyrexia was decreased in a dose dependent manner. PCEO also exhibited a strong antimicrobial potential. These findings confirm the traditional analgesic indications of P. cubeba oil and provide persuasive evidence and support its use in Arab traditional medicine

Comparison of parameters of bone profile and homocysteine in physically active and non-active postmenopausal females

Background and objectives: Optimal physical activity is important in attaining a peak bone mass. Physically active women have better bone mineral density and reduce fracture risk as compared to females living a sedentary life. The objective of this study was to compare parameters of bone profile and serum homocysteine levels in physically active and non-active postmenopausal females

Methods:In this cross sectional study postmenopausal females between 50-70 years of age were recruited and divided into two groups: Physically inactive [n=133] performing light physical activity and Physically active [n=34] performing moderate physical activity. Physical activity [in metabolic equivalents], bone mineral density and serum homocysteine levels were assessed. Spearman's rho correlation was applied to observe correlations. Two independent sample t test and Mann Whitney U test were applied to compare groups. P-value

Results:Parameters of bone profile were significantly higher and serum homocysteine levels were significantly lower in postmenopausal females performing moderate physical activity as compared to females performing light physical activity. Homocysteine was not significantly related to T-score and Z-score in both groups

Conclusion:Improving physical activity could be beneficial for improving the quality of bone, decreasing fracture risk and decreasing serum homocysteine levels

Histological features of antiphospholipid nephropathy in patients with systemic lupus erythematosus

To determine the histological features of renal biopsies of Systemic Lupus Erythematosus [SLE] patients with and without antiphospholipid antibodies in Saudi population. Cross-sectional, comparative study. King Khalid University Hospital, Riyadh, Saudi Arabia, from January to December 2013. Consecutive SLE patients admitted to King Khalid University Hospital, Riyadh for renal biopsy for evaluation of proteinuria or deterioration of renal function were recruited. SLE patients with renal involvement were divided in two groups. Group one included patients with positive APS antibodies and group two included patients with negative APS antibodies. The histological features of renal biopsies of the two patients groups were compared. Data was analyzed using simple statistical analysis. The mean age of APS antibodies-positive patients was 30.37 +/- 10.714 years while mean age of APS negative patients was 33.62 +/- 11.717 years [p=0.224]. Twenty five [83.33%] patients were females and 5 [16.67%] patients were males in APS positive patients while 42 [89.36%] were females and 5 [10.63%] were males in group two. Acute lesions like thrombotic microangiopathy were in 2 [6.7%] of APS positive patients while chronic lesions like focal cortical atrophy was found in 6 [20%] and fibrous intimal hyperplasia was found in 9 [30%]. Other significant histological findings in APS antibodies positive group were glomerular basement membrane wrinkling in 12 [40%], glomerular double wall contour in 17 [56.7%], fibrous adhesions in 11 [36.7%] patients with APS antibodies. Systemic Lupus Erythematosus [SLE] patients with positive APS antibodies has specific histological findings suggesting an important role of APS antibodies in the pathogenesis of APS nephropathy

Pattern of MRI brain abnormalities in rheumatic patients with neurological involvement: a tertiary care teaching hospital experience

To explore the pattern of abnormalities seen on MRI in rheumatic patients with neurological manifestations and to interpret the findings in relation to clinical picture. Descriptive study. Rheumatology unit, King Khalid University Hospital, Riyadh, Saudi Arabia from January 2013 to February 2014. We prospectively included rheumatic patients with neurological symptoms and signs. The clinical data were correlated with MRI findings by a team comprising of a rheumatologist, neurologist and neuro-radiologist. Data was analyzed using simple statistical analysis. Fifty patients were recruited with a mean age of 36.4 +/- 10.76 years [range 17-62]. Among SLE patients with seizures, focal deficit and headache white matter hyperintensities were found in 9 [64.28%], 4 [50%], 4 [80%] patients respectively. Out of seven SLE patients with global dysfunction, 3 [42.85%] had brain atrophy and 2 [28.57%] normal MRI. In Behcet's disease with focal deficit, 3 [75%] patients had white matter hyperintensities and 1 [25%] had brainstem involvement. In Behcet's disease with headache, 2 [50%] had normal MRI, 1 [25%] brainstem hyper-intensities and 1 [25%] had subacute infarct. Two [66%] of three Primary APS patients had white matter hyperintensities while third [33%] had old infarct. Both patients of polyarteritisnodosa, had white matter hyperintensities. Out of two Wegener's granulomatosis one had white matter hyperintensities and other had ischemic changes in optic nerves. The only one scleroderma patient had white matter hyperintensities. We found that white matter hyperintensities was the most common MRI abnormality in our study group which in most of the cases had poor clinical correlation. No distinct pattern of CNS involvement on MRI was observed in various rheumatic disorders

Pulmonary manifestations of systemic lupus erythematosus patients with and without antiphospholipid syndrome

To uncover the pulmonary manifestations of Systemic Lupus Erythematosus [SLE] patients alone and to compare findings with antiphospholipid syndrome [APS] associated with SLE. This cross sectional comparative study was carried out at King Khalid University Hospital [KKUH]/King Saud University [KSU], a tertiary care hospital, Riyadh, Kingdom of Saudi Arabia. From June 2012 to March 2014, 96 diagnosed SLE patients with respiratory symptoms were included in the study and divided into two groups. Group one included SLE without antiphospholipid syndrome [APS] and group two SLE with APS. We compared Demographic features, clinical manifestations and findings of chest X-Ray, Arterial Blood Gases, Pulmonary function tests, six minute walk test, ventilation perfusion scan, echocardiography and chest high resolution computed tomography. Demographic and clinical characteristics of two groups were similar. Previous history of deep venous thrombosis [3% vs 27.6%, p=0.001], pulmonary embolism [3% vs34.5%, p<0.0001] and abortions [7.5% vs 27.6%, p=0.019] were significantly more in group two. Levels of Anticardiolipin antibody [0% vs 100%, p<0.0001] and lupus anticoagulant [1.5% vs 79.3%, p<0.0001] were also significantly higher in group two. Hypoxemia measured by pulse oximetry [43.3% vs 65.5% p=0.045, pulmonary Arterial Hypertension [15.5% vs 39.3% p=0.014]], and pulmonary embolism [3.4% vs 21.4% p=0.013] and ventilation perfusion mismatch on V/Q scan [1.5% vs 24.1% p=0.001] were more frequent in group two. Hypoxemia, pulmonary embolism and pulmonary arterial hypertension were significantly high in SLE patients with APS, requiring long term anticoagulation and treatment and close follow-up

Quantification of glycyrrhizin in anti-stress herbal formulations by validate HPTLC method: a rational paradigm towards quality control of herbals

In the present study an analytical method of high-performance thin-layer chromatography [HPTLC] has been developed for quantification of glycyrrhizin for marketed antistress liquorice root capsules [LRC] and herbal tea [HT]. Chromatography was performed by using mobile phase ethyl acetate [EA]: glacial acetic acid [GAA]: Methanol [MeOH]: water [H2O] in proportion of 6:2:2:1, v/v/v/v. The developed plate was scanned and quantified densitometrically at absorption maxima 254nm. The method was validated for various analytical parameters viz. precision, accuracy, recovery, robustness, specificity, detection and quantification limits. The developed system was found to give compact spot for glycyrrhizin [Rf = 0.33 +/- 0.001]. The linearity relationship was described by the equation Y=6.841X+ 70.428. The limit of detection [34 ng band-1], limit of quantification [101ng band-1], recovery [99.4-99.8%], and precision [

Pattern of MRI brain in neuro-psychiatric SLE. effect of anti-phospholipid antibodies: a study at a tertiary care teaching hospital

To compare the neuro-radiologic findings in Systemic lupus erythematosus [SLE] patients with and without antiphospholipid antibodies [aPL] in different neuro-psychiatric manifestations. This cross-sectional comparative study was carried out at King Khalid University Hospital, a tertiary care teaching hospital, Riyadh, Saudi Arabia from June 2012 to January 2015. Ninety seven SLE patients with neuro-psychiatric manifestations were included in the study and divided into two groups. Group I [50 patients] SLE with aPL and group II [47 patients] SLE without aPL. We compared Demographic features, clinical manifestations and magnetic resonance imaging [MRI] brain findings. Demographic and clinical characteristics of two groups were similar. In Group-l, anticardiotipin antibodies [aCL] were most common [86%]. In patients with headache, most of the patients in Group-l had white matter hyperintensities [WMHIs] [50% vs 27%] while most of the patients in Group-ll had normal MRI brain [38% vs 73%]. Similarly WMHIs were found more in Group-l patients with seizures [60% vs 21%], while ischemia/infarction, atrophy and normal MRI were found in Group-ll. MRI brain in patients with neurological deficit and psychiatric disorder were not much different in both the groups. We found no statistically significant differences in frequencies of MRI brain abnormalities in SLE patients with and without aPL antibodies. Each of the three aPL may have a variable effect on the brain

Hypovitaminosis D and its association with lifestyle factors

The present study was designed to determine the serum vitamin D levels and their relation with demographic features and life style factors in young adults. It was an analytical cross-sectional study on 88 subjects aged 18-40 years. Relevant information about physical activity, job place, duration of sun exposure, educational status and socioeconomic conditions was obtained.Serum levels of 25-OH vitamin D were measured by ELISA. Data was analyzed using SPSS 20. Mean serum vitamin D level was 8.44+/-0.49 [Range: 1.00-21.08] ng/ml in participants. Vitamin D deficiency was found in 98.86% of the population. Mean vitamin D levels were significantly lower in females [p=0.0001], physically less active [p=0.006], indoor job holders [p=0.0001], less sun exposed [p=0.001], highly educated [p=0.020] and high socioeconomic status [p=0.007] bearing and in subjects having relatively fair skin complexion [p=0.041]. Serum vitamin D levels of study population were below normal and were associated with female gender, less physical activity, indoor jobs, less sun exposure, higher education and higher socioeconomic class and relatively fair skin complexion

Variations in cerebral arterial circle of Willis in adult Pakistani population

To identify the anatomical variations in cerebral arterial circle of Willis. Descriptive study. Department of Anatomy, University of Health Sciences, Lahore, from February 2009 to January 2010. Human brains were removed from fifty-one consecutive cadavers at the time of autopsy from Forensic Department, King Edward Medical University, Lahore, to observe anatomical variations in the cerebral arterial circle regarding its completeness, pattern and symmetry. The individual cerebral vessels were also noted for the presence, origin, caliber and symmetry. Pictures from each dissection, showing the complete circle were taken. The variations of the circle as whole and segmental variations were studied and described in percentage. Thirty-seven [72.5%] of the 51 [100%] cerebral arterial circles were complete; 15 subjects [29.4%] had typical configuration; 25 [49%] had symmetrical arrangement and 39 subjects [76.4%] had different types of variations in their component vessels. Variations were most common in the posterior communicating artery followed by anterior communicating artery, pre-communicating segments of the posterior cerebral and pre-communicating segments of anterior cerebral arteries. No circle was found with aneurysm. Different variations in the formation of circle of Willis and in its component vessels are common in the local adult population of Pakistan. These should be taken into consideration during angiographic evaluation and neurosurgical procedures on the anterior circulation