Anti-inflammatory Assessment of Methanol Extract of Acalypha ciliata Leaves and It’s Leucocyte Mobilization in Adult Wistar Rats

Aim: The study's objective was to examine the anti-inflammatory activity and leucocyte mobilization of a methanol extract of leaves from Acalypha ciliata in adult Wistar rats. Study Design: Egg albumin-induced edema was used for anti-inflammatory test and leucocyte mobilization test was carried out to check for total leucocyte cout and differentials. Place and Duration of the Study: This original study was conducted between January and June 2013 at the Department of Biochemistry, Faculty of Biological Sciences, University of Nigeria Nsukka. Methology: The pulverized leaf of Acalypha ciliata was extracted using cold maceration, and the Treas and Evans technique of phytochemical screening was used. The anti-inflammatory study was conducted using the method of Winter et al., and the acute toxicity study was assessed using Lorke's method. ANOVA was used to statistically examine the collected data. Results: Preliminary phytochemical screening revealed the presence of flavonoids, alkaloids, soluble carbohydrates, phenols, glycosides, saponins, terpenoids and steroids. Flavonoids, Alkaloids, and Soluble carbohydrates appeared in abundant concentration (2199.76±10.81, 2141.6±7.583, 913±21.06). Acute toxicity tests showed no toxicity and mortality at doses up to 5000 mgkg-1. Anti-inflammatory study revealed that group treated with 100, 200 and 400 mg/kg b.w of extract significantly (P =0.05) and in a dose dependant manner decreased in TLC when compared with normal control. Moreover, the group treated with 100,200,400 mg/kg b.w of extract and reference drug(Indometacin) mobilized the leucocyte at the rate of 36, 22, 12 and 62 % respectively. A significant (P = 0.05) reduction in the mean paw oedema was observed for all the treatment groups from 1 hour to 5 hours when compared to the toxic group. Conclusion: As a result of this study's findings, it can be concluded that methanol extract of the Acalypha ciliata leaf has anti-inflammatory characteristics. High dosages of the extract resulted in a better decrease of oedema and an increase in leukocyte mobilization in response to agar suspension than low doses. Many anti-inflammatory herbs and substances alter inflammatory reactions by hastening the breakdown of or reversing the effect of the inflammatory mediators. The plant's anti-inflammatory properties could potentially result from the interaction of different photochemical substances present. The findings suggest that, if used, the plant may serve as a source of anti-inflammatory compounds.

Miositis del subescapular. Una evolución infrecuente en la tendinopatía calcificada. Estudio de un caso / Subscapularis myositis: An uncommon complication in calcific tendinopathy. A case study

RESUMEN La tendinopatía calcificada del hombro se caracteriza por el depósito de cristales de hidroxiapatita en uno o varios tendones del hombro. Dentro de los procesos que ocurren en esta entidad está la fase de reabsorción, en la que los depósitos podrían migrar hacia estructuras adyacentes. Una muy rara complicación es la migración hacia la unión miotendinosa del tendón correspondiente, la cual provoca una importante reacción inflamatoria muscular que puede objetivarse en pruebas complementarias específicas. Presentamos un caso clínico de una tendinopatía calcificante del subescapular, con pos terior migración hacia la unión miotendinosa causando una miositis del mismo.

ABSTRACT Calcific tendinopathy of the shoulder is characterised by the deposit of hydroxy apatite crys tals in one or more tendons of the shoulder. Within the processes that occur within this disorder, there is the resorption phase, in which the deposits could migrate towards adjacent structures. A very rare complication is the migration towards the myotendinous junction of the corresponding tendon, which causes a significant muscular inflammatory reaction that can be seen in specific complementary tests. A clinical case is presented of a subscapular calcific tendinopathy, with subsequent migra tion to the myotendinous junction, causing myositis of the same.

A rare occurrence of Premature Birth and Recurrent Acute Pulmonary Oedema in the mother due to Cushing’s Syndrome: A case report / Journal of the ASEAN Federation of Endocrine Societies

@#Presentation of Cushing’s syndrome during pregnancy is extremely rare. We report a 21-year-old female with Cushing’s syndrome diagnosed at 23 weeks of gestation and had recurrent acute pulmonary oedema during the antepartum and postpartum period. She delivered prematurely via emergency caesarean section at 28 weeks of gestation. This case highlights the rare occurrence of recurrent acute pulmonary oedema during pregnancy and consequential premature birth in a patient with adrenal Cushing’s. She was diagnosed with adrenal Cushing’s during the postpartum period based on unsuppressed serum cortisol after overnight and low-dose dexamethasone suppression test with a suppressed ACTH. CT scan of the adrenal glands revealed a right adrenal cortical adenoma. The risk of complications in infants and mothers who suffer from Cushing’s syndrome needs to be handled carefully. The diagnosis of Cushing’s syndrome in pregnant women often overlaps and is difficult to establish in early pregnancy.

An aqueous pomegranate peel extract (Punica granatum) protect against Elastase-induced pulmonary emphysema in Sprague Dawley rats model

We investigated the effect of Punica granatum peel aqueous extract (PGE), on pulmonary inflammation and alveolar degradation induced by intratracheal administration of Elastase in Sprague Dawley rats. Lung inflammation was induced in rats by intratracheal instillation of Elastase. On day 1 and 2, animals received an intraperitoneal injection of PGE (200 mg/mL), three hours later, they were intratracheally instilled with 25U/kg pancreatic porcine Elastase. Animals were sacrificed 7 days later. Bronchoalveolar lavage (BAL) were collected and cellularity, histology and mRNA expression of Monocyte chemotactic protein 1(MCP-1), Tumor Necrosis Factor-Alpha (TNF-α), Interleukin 6 (IL-6), and Matrix Metalloproteinase-2 (MMP-2) were studied. In addition, activity of TNF- α, IL-6 and MCP-1 on BAL were also analyzed by ELISA Kit. Elastase administration increased: BAL cellularity, neutrophils recruitment and BAL MCP1, IL-6 expressions. It also increased lung TNF-α, MCP-1, MMP-2 expressions, platelets recruitment, histological parameters at 7th day of elastase treatment. Intraperitoneal injection of 200 mg/kg of PGE reduced, significantly, BAL cellularity, and neutrophils recruitment. However, in animal treated with PGE, MCP-1, MMP-2 and IL-6 on day 7, were similar to the Sham group. Treatment with PGE (200 mg/ kg) also significantly reduced lung TNF-α, and MCP-1 expression. This study reveals that PGE Punica granatum protects against elastase lung inflammation and alveolar degradation induced in rats

Clinical Assessment of Macular Involvement and Its Correlation to the Severity of Diabetic Retinopathy in Uncomplicated Type 2 Diabetes Mellitus Patients.

India has roughly 50% of the world’s burden of diabetes and is expected to double by the year 2025. Macular oedema is the leading cause of central vision loss among the diabetic population. Our aim was to detect the presence of macular oedema in type 2 diabetic patients and correlate it to the type and severity of diabetic retinopathy.METHODSThis was a cross-sectional study done on two hundred patients with type 2 diabetes mellitus fulfilling our inclusion criteria. After entering patients’ details, complete history including duration and treatment of diabetes, detailed clinical slit lamp examination, with biomicroscopy/IDO was done and the fundus findings were documented using the fundus camera, and retinopathy was graded according to the ETRS Classification system. Patients' glucose level, HbA1c, cholesterol, urea and creatinine values were collected. BMI was calculated from their height and weight. Macular findings were documented and correlated to the patient variables and also to the severity of diabetic retinopathy and analysed using the Chi-square test.RESULTSOut of 200 patients, 128 were male and 72 were female. Our incidence of CSME was 14% and was more prevalent in patients with Non-Proliferative Diabetic Retinopathy and they all showed statistically significant reduction in their visual acuity. BMI, cholesterol, duration of diabetes, HbA1c and insulin therapy didn’t show any significant correlation to the occurrence of CSME.CONCLUSIONSPeriodic fundus evaluation to detect macular oedema associated with retinopathy is mandatory for diabetic patients. Proper diagnosis and early intervention will help in reducing central vision loss in diabetic patients.

Near death 18 weeks preeclampsia in molar pregnancy

Authors present a case of a molar pregnancy of 18 weeks with preeclampsia complicated with acute pulmonary oedema. A condition carrying a significant risk to mother, therefore, raising an important issue on preeclampsia symptoms on pregnancies before 20 weeks. A 31-year-old woman gravida 2, parity 1 presented with dyspnea at 18 weeks' gestation. Blood pressure was very high (180/110 mmHg) and there was markedly proteinuria (+4). She had severe dyspnea and her oxygen saturation level was 75%. Her chest X-ray graph showed massive acute pulmonary oedema. Ultrasonography shows endometrial cavity containing multiple small cystic spaces, creating a characteristic “snowstorm” and “cluster of grapes” appearance. Markedly elevated quantitative human chorionic gonadotropin (250.000 mIU/mL). The acute pulmonary oedema has been managed by diuretics (Furosemide) and oxygen. There was no cardiac abnormalities in the tranthoracic echocardiogram. Authors administered antihypertensive therapy (intravenous nicardipine and lmethyldopa in per os), and magnesium sulfate in prevention of eclamptic seizures. The pregnancy was terminated by uterine evacuation under oxytocin infusion by manual ultrasound aspiration. She was followed up intensive care unit for two days. Causes of secondary high blood pressure had been eliminated. The patient's blood pressure rapidly normalized two days after delivery. Dyspnea disappeared one day later. Pathologic and cytogenetic analyses revealed a complete hydatiform mole. Two days after delivery; the serum β-hCG level was 99000 mlU/ml. A control ultrasonography shows an empty uterus. Hydatidiform mole is classified into 2 different subtypes, complete hydatidiform mole and partial or incomplete hydatidiform mole development of preeclampsia prior to 20 weeks of gestation should prompt a clinical evaluation to exclude the possibility of an underlying hydatidiform molar pregnancy. Ultrasonography and level of serum BHCG are the initial investigation of choice for the detection of hydatidiform mole. Aspiration is the treatment of reference.

A Prospective Interventional Study to Evaluate the Efficacy of Nepafenac 0.1% for Prevention of Macular Oedema Associated with Cataract Surgery in Patients with Diabetes

Pseudophakic cystoid macular oedema is a significant cause of suboptimal visual acuity post phacoemulsification.Diabetics are at greater risk of developing PCME following cataract surgery. Topical nepafenac ophthalmic suspension 0.1% is used to prevent inflammation postoperatively. We wanted to study the effect of Topical Nepafenac 0.1% eye suspension on macular thickness following phacoemulsification in patients of diabetes mellitus and correlate the final visual acuity and macular thickness.METHODSThis prospective interventional study was conducted between January 2018 and May 2019 in the Department of Ophthalmology, MMIMSR, Mullana, Ambala. 100 patients based on the inclusion and exclusion criteria were included in the study and phacoemulsification was done. They were divided in to two groups of 50 each. Group 1 received topical Nepafenac 0.1% ophthalmic suspension thrice daily along with the routine post-op medications whereas Group 2 received routine post-op medications. The groups were analysed preoperatively and at 2, 4, 6, 8 weeks postoperatively and their CMT was recorded using a SD-OCT. The change in BCVA was analysed with the help of ETDRS letter chart. The data was entered in Microsoft Excel and analysed using SPSS-PC-20 version. Quantitative data was expressed by mean and standard deviation while qualitative data was expressed as percentage. Difference between the proportions was tested with Chi Square Test or Fisher’s Exact test while difference between quantitative variable between the two groups was tested with students ’t’ test or Mann Whitney U test. For comparison of quantitative data between more than two groups, ANOVA or Kruskal Wallis ‘H’ test followed by post hoc test was used. A ‘p’ value of less than 0.05 was considered statistically significant.RESULTSA lower percentage of patients in Group 1 developed ME relative to Group 2 (2% vs. 8%; p-value= 0.36). The mean CMT was significantly lower in Group 1 at 2 (p-value<0.01), 4 (p-value<0.001), 6 (p-value<0.001) and 8 weeks (p-value<0.001). A greater percentage of patients in Group 1 (60%) experienced a gain of >15 letters as compared to the baseline (p-value<0.01)

Mild Presentation of Superior Vena Cava Syndrome in a Patient with Non-Small Cell Lung Cancer: A Case Report

@#Superior vena cava (SVC) syndrome can be fatal if not discovered early. Most SVC syndrome presentations are related to malignancies; lung cancer in particular. The presentations may vary, depending on severity of SVC obstruction. We report a case of mild SVC syndrome of a 70-year-old gentleman who presented with a one-month history of intermittent plethora and facial puffiness. Computed tomography scan of the chest revealed superior mediastinal mass which may represent matted lymph nodes obstructing SVC with bilateral pleural and pericardial effusion. Biopsy of the mass was done, and non-small cell lung carcinoma was diagnosed. Clinical presentation, differential diagnoses and issues relating to SVC syndrome were discussed with the emphasis on early recognition of mild symptoms and prompt management.

Prevalence Of Peripheral Neuropathy In Chronic Musculoskeletal Oedematous Conditions

Background: Neuropathic pain is a compound, persistent pain condition that results from illness or damage to the peripheral nervous system, central nervous system, or both. The nerve might get compressed due to various factors but one of the causes is an increase in oncotic pressure of interstitial fluid which may lead to neuropraxia. So, this may lead to symptoms of peripheral neuropathy. The objectives of the study were to determine the prevalence of peripheral neuropathy in chronic musculoskeletal oedematous conditions and to study the association of peripheral neuropathy in chronic musculoskeletal oedematous conditions with demographic variables. Methods: A total of 52 subjects were assessed and all were included in the study based on inclusion criteria. Peripheral neuropathy was diagnosed using Modified Total Neuropathy Score (mTNS) and pain assessment using Visual Analogue Scale (VAS), oedema assessment and also musculoskeletal assessment was done for assessing the severity of peripheral neuropathy. Results: Statistical results suggests that the prevalence of peripheral neuropathy in chronic musculoskeletal oedematous conditions having moderate neuropathy symptoms is 0.8445, the prevalence of minor neuropathy symptoms is <0.0001 and moderately severe symptoms is <0.0001. As the maximum population has moderate neuropathy symptoms, the prevalence of peripheral neuropathy in chronic musculoskeletal oedematous conditions is 0.8445. Conclusion: Among the fifty-two subjects having oedema, twenty-seven subjects had moderate neuropathy symptoms, fourteen subjects had minor neuropathy symptoms and eleven subjects had moderately severe symptoms. Thus, it clarifies that subjects having oedema are likely to get neuropathic symptoms at a later stage.

A 5 year retrospective study on epidemiological pattern of ocular trauma

Background: One of the delicate structure in the human body is eye and trauma to the eye is essentially a very grave matter. Major cause of preventable monocular blindness and visual impairment in the world is ocular trauma. So any injury to the eye must be deemed to be an ocular emergency and should be handled with utmost care. Despite its public health importance, there is relatively less population based data on the magnitude and risk factors for ocular trauma specially from developing countries. The objective of the study was to find out the epidemiological pattern of ocular trauma.Methods: The present study was 5 year retrospective study of all the patients who reported directly with ocular injury or referred from the casualty to the department of ophthalmology from January 2013 to January 2018. Various parameters like age, sex, mode of injury, type of injury etc. of all patients seen during this period were analyzed.Results: Total of 4192 ocular trauma patients were seen during study period. Maximum number of ocular trauma patients i.e. 1146 were seen in age group of 21-30 years. Males i.e. 3490 outnumbered females in the present study. Road traffic accidents were the most common cause of ocular trauma and accounts for 1760 cases. Most common reported ocular trauma was periorbital oedema/ecchymosis followed by laceration. Surgical intervention was done in 1660 cases whereas 2532 were managed medically.Conclusions: From present study, we may conclude that the maximum number of ocular trauma patients were seen in the age group of 21-30 years with more preponderance in males. Road traffic accidents were the most common cause of ocular trauma. The fact that the lifetime prevalence of ocular trauma is higher than that of eye diseases, which can be decreased by implementing the traffic rules with strict force and imposing heavy fine and license cancellation for drunken driving.

High-altitude pulmonary oedema: Newer treatment modalities for an age-old problem

Background & objectives: High-altitude pulmonary oedema (HAPE) continues to challenge the healthcare providers at remote, resource-constrained settings. High-altitude terrain itself precludes convenience of resources. This study was conducted to evaluate the rise in peripheral capillary saturation of oxygen (SpO2) by the use of a partial rebreathing mask (PRM) in comparison to Hudson's mask among patients with HAPE. Methods: This was a single-centre, randomized crossover study to determine the efficiency of PRM in comparison to Hudson's mask. A total of 88 patients with HAPE referred to a secondary healthcare facility at an altitude of 11,500 feet from January to October 2013 were studied. A crossover after adequate wash-out on both modalities was conducted for first two days of hospital admission. All patients with HAPE were managed with bed rest and stand-alone oxygen supplementation with no adjuvant pharmacotherapy. Results: The mean SpO2on ambient air on arrival was 66.92�.8 per cent for all patients with HAPE. Higher SpO2values were achieved with PRM in comparison to Hudson's mask on day one (86.08�15 vs. 77.23�09%) and day two (89.94�96 vs. 83.39�93%). The difference was more pronounced on day one as compared to day two. Interpretation & conclusions: Mean SpO2values were found to be significantly higher among HAPE patients using PRM compared to those on Hudson's mask. Further studies to understand the translation of this incremental response in SpO2to clinical benefits (recovery times, mortality rates and hospital stay) need to be undertaken.

In-vivo Assessment of Antipyretic and Anti-inflammatory Activities of Gymnosporia Royleana Extract in Mice / Evaluación in vivo de las Actividades Antipiréticas y Antiinflamatorias del Extracto de Gymnosporia Royleana en Ratones

ABSTRACT Objective: Despite the presence of multitude of synthetic drugs against fever and inflammation, none has been proven entirely safe. In contrast, the accepted safety of plant derived natural products is inspiring the world. Based on this fact as well as in view of the diversified activities reported from the genus Gymnosporia, the present study was designed to evaluate the antipyretic and anti-inflammatory activity of Gymnosporia royleana (G royleana). Methods: The methanolic extract of the aerial parts of G royleana was screened for in-vivo antipyretic activity using the brewer's yeast-induced pyrexia mice model and for anti-inflammatory activity using the carrageenan-induced paw oedema and xylene-induced ear oedema mice model. Results: In the antipyretic assay, G royleana extract showed considerable antipyretic activity in a dose dependent fashion. Statistically significant antipyretic effects (p < 0.05) were observed at the end of the second hour of administration for all doses of extract and remained significant until the end of the experiment. The plant extract also displayed promising anti-inflammatory activity, in a dose dependent fashion, in both models of inflammation ie carrageenan- and xylene-induced oedema models, when compared to the controls. In the carrageenan-induced oedema model, significant effects (p < 0.01) were observed for 300 and 600 mg/kg doses after 60 minutes of xylene administration (ie 55.51% and 65.88% inhibition of oedema, respectively). Conclusion: The study provided evidence supporting the antipyretic and anti-inflammatory activity of the G royleana methanolic extract.

RESUMEN Objetivo: A pesar de la presencia de multitud de fármacos sintéticos en el arsenal contra la fiebre y la inflamación, ninguno ha dado pruebas de ser completamente seguro. En contraste con ello, la seguridad aceptada de los productos naturales derivados de las plantas inspira al mundo. Sobre la base de este hecho, así como en vista de las actividades diversificadas que se reportan con respecto al género Gymnosporia, el presente estudio se diseñó con el objeto de evaluar el potencial antipirético y antiinflamatorio de Gymnosporia royleana (G royleana). Métodos: El extracto de metanol de las partes aéreas de G royleana fue tamizado en busca de actividad antipirética in vivo, utilizando el modelo de pirexia inducida por levadura de cerveza en ratones, y de actividad antiinflamatoria utilizando modelos de ratones con oedema de las patas inducido mediante carragenina, y oedema de las orejas inducido mediante xileno. Resultados: En el ensayo antipirético, el extracto de G royleana mostró una actividad antipirética considerable en forma dependiente de la dosis. Se observó un efecto antipirético estadísticamente significativo (p < 0.05) en el transcurso de la segunda hora de administración para todas las dosis de extracto y se mantuvo significativo hasta el final del experimento. El extracto de la planta también mostró una actividad antiinflamatoria prometedora, de una manera dependiente de la dosis, en ambos modelos de inflamación, es decir, modelos de oedema inducido por carragenina y xileno, en comparación con el control. En el modelo de oedema inducido por carragenina, se observó un efecto significativo (p < 0.01) para dosis de 300 y 600 mg / kg después de 60 minutos de administración de xileno (es decir, 55.51% y 65.88% de inhibición del oedema, respectivamente). Conclusión: El estudio proporcionó pruebas suficientes sobre el potencial antipirético y antiinflamatorio del extracto de G royleana.

Manifestaciones dermatológicas en kwashiorkor: reporte de caso y revisión de la literatura / Dermatological manifestations in kwashiorkor: case report and review of literature

RESUMEN Objetivo: presentar un reporte de caso y revisión de la literatura de una paciente diagnosticada con Kwashiorkor, por sus manifestaciones dermatológicas y clínicas. Métodos: se valora en el servicio de Urgencias a una lactante menor, femenina, de 4 meses de edad, con un cuadro de aproximadamente 15 días de lesiones asintomáticas, que se inician en miembros inferiores con posterior diseminación a tronco, miembros superiores y cara. La madre refiere alimentación exclusiva con avena desde el mes de vida. Resultados: se realizó un manejo interdisciplinario, con los servicios de Pediatría, Nutrición y Dermatología con adecuada evolución clínica de la paciente, observando importante mejoría del cuadro cutáneo, a los pocos días de su estancia hospitalaria. Conclusiones: aunque no es una patología muy frecuente hoy en día, sigue sucediendo en países en vía de desarrollo y desarrollados, por lo que es importante siempre tenerla como diagnóstico diferencial para un abordaje adecuado y educar a los padres y cuidadores.

SUMMARY Objective: wepresent a case report and review of the literature of a patient, diagnosed with Kwashiorkor due to its dermatological and clinical manifestations. Methods: a 4-month-old female infant was evaluated in the Emergency department for approximately 15 days of asymptomatic lesionsthat began in the lower limbs with subsequent dissemination to the trunk, upper limbs and face. The mother refers a diet since four months of age only with oats, denies maternal lactation. Results: an interdisciplinary management was carried out, with the Pediatric service, Nutrition and Dermatology with adequate clinical evolution of the patient, observing an important improvement of the cutaneous lesions, after a few days in the hospital. Conclusions: although it is not a very frequent pathology, it is still happening in developing countries and developed, so it is important to always have it as a differential diagnosis for an adequate approach and always educate parents and caregivers.

Brain injury and drug therapy in high-altitude environment: research advances / 国际药学研究杂志

Altitude sickness is a common disease caused by hypotension and hypoxia due to low pressure when people move from the plain to the plateau, which causes injury to the respiratory system, cardiovascular system, and ner- vous system. The brain tissue is very sensitive to the decrease in oxygen partial pressure, which can easily cause neuro- nal dysfunction and even lead to neuron apoptosis. The partial pressure of oxygen in the plateau environment is low, and an effective way to improve the host defense ability is to develop anti-hypoxia drugs that improve the ratio of oxyen utiliza- tion. This paper reviews and summarizes the clinical symptoms of the nervous system in the high-altitude environment, including high-altitude headache, acute mountain sickness and high-altitude cerebral edema, as well as the pathophysio- logical molecular mechanisms and related drug treatments, so as to develop the effective new drugs of anti-hypoxia brain damage and to guide the rational use of clinical scientific drugs.

Bone Marrow Foot Oedema in Adolescents: The Role of Vitamin D

BACKGROUND: Bone marrow oedema (BMO) in children/adolescents is a rare clinical condition without an etiologic cause. It is associated with typical increased signal intensity on T2-weighted magnetic resonance images (MRI) and an increase in bone turnover in which vitamin D plays a pivotal role. No treatment guidelines for these young patients are to date available.METHODS: We performed a retrospective study in a pediatric setting of 13 patients with diagnosis of primary BMO of the foot on the basis of clinical and radiological findings. Data collection included sex, age, patient history, symptoms at presentation, clinical examination, laboratory bone turnover markers, vitamin D levels, MRI, treatment, and outcome.RESULTS: Vitamin D deficiency or insufficiency was found in 76.9% of cases. All patients were treated with adequate vitamin D daily intake, a short course of analgesic therapy, physical therapy, avoiding detrimental feet and ankle immobilization. All fully recovered in 3-month lag period.CONCLUSIONS: Our data highlight that environmental factors, such as underestimated articular or bone microtraumatisms, as well as joint hyper mobility, in a bone turnover milieu of vitamin D deficiency could be the cause of this clinical conditions. Adequate vitamin D supplementation, associated with physical and analgesic therapy, is crucial in the management of BMO.

A possible role of endoneurial fibroblast-like cells in the resolution of endoneurial oedema following nerve crush injury / El posible rol de los fibroblastos endoneurales en la resolución del edema endoneural después de una lesión por aplastamiento nervioso

SUMMARY: Endoneurial oedema is a salient feature of all types of neuropathy. Its elimination is crucial during the complications of nerve recovery. The objective was to study a possible role of the endoneurial fibroblasts in the resolution of nerve edema. Forty-two albino male rats aged between 30 and 40 days (weight 200 g to 250 g) were used in this study. The left sural nerves of 36 rats were subjected to crush injury at one to three-week intervals with six animals per interval. The right and left sural nerves of the remaining six rats were used as controls. At the end of the second week after crush injury, the endoneurium showed channel-like spaces that were lined by fibroblast-like cells and collagen bundles that contained degenerated myelin, and were connected to the subperineurial spaces. Flattened fibroblast-like cells were arranged in several layers in the subperineurial, forming barrier-like cellular sheets localizing to the endoneurial oedema in the space. Fibroblast-like cells also wrapped around the regenerating nerve fibres with their branching cytoplasmic processes. During the third week, the flattened fibroblast-like cells formed nearly continuous cellular sheets in the subperineurial spaces. Macrophages were frequently observed between these cellular barrier-like sheets and in the subperineurial. The endoneurial fibroblast-like cells form barrier-like cellular sheets that probably localise the endoneurial oedema in the subperineurial space. It also appear to create endoneurial channel-like spaces containing degenerated myelin and endoneurial oedema, which may be helpful in localizing and resolving such oedema.

RESUMEN: El edema endoneural es una característica destacada de todos los tipos de neuropatía. Su eliminación es importante durante las complicaciones de la recuperación nerviosa. El objetivo fue estudiar un posible papel de los fibroblastos endoneurales en la resolución del edema nervioso. En este estudio se utilizaron 42 ratas macho albinas con edades entre los 30 y 40 días (peso 200 a 250 g). Los nervios surales izquierdos de 36 ratas se sometieron a lesiones por aplastamiento en intervalos de una a tres semanas con seis animales por intervalo. Se usaron los nervios surales derecho e izquierdo de las seis ratas restantes como controles. Al final de la segunda semana después de la lesión por aplastamiento, el endoneuro mostró espacios en forma de canal que estaban revestidos por células similares a fibroblastos y haces de colágeno que contenían mielina degenerada y se conectaron a los espacios subperineurales. Las células aplanadas de fibroblastos se dispusieron en varias capas en el subperineuro, formando láminas celulares de tipo barrera que se localizaban en el espacio del edema endoneural. Las células similares a fibroblastos también envolvían las fibras nerviosas regeneradoras con sus procesos citoplásmicos ramificados. Durante la tercera semana, las células aplanadas de fibroblastos formaron láminas celulares casi continuas en los espacios subperineurales. Los macrófagos se observaron con frecuencia entre estas láminas similares a barreras celulares y en el subperineuro. Las células de tipo fibroblasto endoneural formaban láminas celulares de tipo barrera que probablemente localizan el edema endoneural en el espacio subperineural. También parece que crea espacios en forma de canal endoneural que contienen mielina degenerada y edema endoneural, que pueden ser útiles para localizar y resolver este edema.

Anti inflammatory effect of rhizome of Curcuma longa. Linn, in Albino rats by the method of Carrageenin induced paw oedema

Background: Curcuma longa or turmeric is a popular Ayurvedic herb, traditionally used for various inflammatory conditions including rheumatoid arthritis and spondylitis. Turmeric which containing phytochemical ingredient curcumin is used in India for centuries as a topical anti inflammatory agent. Many of the currently used anti inflammatory agents like NSAID’s and glucocorticoids have many undesirable adverse effects, especially when they are used for long period. In the present study, Curcuma longa, a plant belonging to the Zingiberaceae family was chosen for investigating its anti-inflammatory effects.Methods: The rhizomes of Curcuma longa were collected locally. The extract was prepared by soxlet extraction with 50% ethanol. Albino rats of Wistar strain (170-250grams) obtained from the animal house of medical college Thiruvananthapuram were used. Aspirin was purchased from sigma Labs, Mumbai. Anti-inflammatory effect of the extract was done in rats by the method of Carrageenin induced paw oedema.Results: The ethanolic extract of Curcuma longa inhibited the development of oedema at the end of 3 hours. The anti-inflammatory activity exhibited by the extract was dose dependent and statistically significant at dose levels of 1000-mg/kg and comparable to that of standard drug used Aspirin.Conclusions: The present study with extract of Curcuma longa revealed that it has significant anti-inflammatory activity.

Valvuloplastia mitral percutánea de emergencia en un paciente con edema pulmonar refractario / Emergency percutaneous mitral valvuloplasty in a patient with refractory pulmonary oedema

Resumen La estenosis mitral usualmente es causada por fiebre reumática. A pesar de ser una patología poco frecuente en los países desarrollados, es prevalente en los países en vía de desarrollo, donde aproximadamente dos tercios de la población mundial vive, haciendo de esta condición, una enfermedad valvular común. Es importante considerar la estenosis mitral en el diagnóstico diferencial de los pacientes con edema agudo de pulmón cardiogénico refractario y la valvuloplastia mitral percutánea de emergencia como el tratamiento definitivo. Se presenta el caso de un paciente femenino de 21 años, con edema agudo de pulmón cardiogénico refractario, secundario a estenosis mitral muy severa de origen reumático, tratado con valvuloplastia percutánea con balón de urgencia. Se realiza una revisión sobre la estenosis mitral y se examina el tratamiento con especial énfasis en los casos publicados en la literatura de valvuloplastia mitral percutánea de emergencia.

Abstract Mitral valve stenosis is usually caused by rheumatic fever. Although it is an uncommon disease in developed countries, it is prevalent in developing countries where approximately two-thirds of the world population lives, making this condition a common valve disease. It is important to consider mitral stenosis in the differential diagnosis of patients with acute refractory cardiogenic pulmonary oedema, and emergency percutaneous mitral valvuloplasty as the definitive treatment. The case is presented of a 21 year-old female with acute refractory cardiogenic pulmonary oedema, secondary to a very severe mitral stenosis of rheumatic origin, and who was treated with an urgent percutaneous balloon valvuloplasty. A review of mitral stenosis is presented, and the treatment is examined, with special emphasis on cases of emergency percutaneous mitral valvuloplasty published in the literature.

Evaluation of Outer Retinal Layers in Diabetic Macula Edema Treated with Intravitreal Ranibizumab

Anti-vascular endothelial growth factor (VEGF) reduces choroidal thickness by choroidal hypoperfusion in diabetic macula oedema (DME) patients. Indirect effect of anti-VEGF towards outer retinal layers (ORL) which supplied by choroidal circulation has not been well described. We evaluate the ORL thickness between retinal pigment epithelium (RPE) with inner-segment-outer-segment photoreceptor junction (IS/OS) and RPE with external limiting membrane (ELM) in pre- and post-intravitreal Ranibizumab (IVR) treated eyes with central foveal diabetic macula edema. A total of 60 eyes (40 patients) were analysed. ORL thickness measured with optical coherence tomography at pre- and post-injection day 1, week 4 and week 6. Mean thickness of RPE-IS/OS was statistically significant over time (p=0.023) but not for RPE-ELM (p=0.216). Thickness ratio between RPE-IS/OS and RPE-ELM and central subfoveal thickness (CST) both showed statistically significant result over time with p=0.038 and p=0.000, respectively. We observed an initial reduction of ORL thickness at day 1 followed by increased in thickness at week 4 with subsequent reduction at week 6 was observed. ORL is an aspect that can be explore and emphasized further in patients considered for IVR injections. The long-term effects of IVR to the ORL however could not be concluded due to short follow up period.