Effect of Supplementation of Vitamin C and Thiamine on the Outcome in Sepsis: South East Asian Region

Introduction: The global burden of sepsis is overwhelming and novel therapeutic agents is the need of the hour. The present study was designed to understand the role of Malondialdehyde as a marker of the oxidative stress in sepsis, as well as the effect of supplementation of Vitamin C and Thiamine in patients of sepsis. Methods: 80 patients of sepsis were randomly divided into 4 groups of 20 each. Twenty age-sex matched healthy volunteers were chosen as controls. The first group received Vitamin C, the second group received Thiamine, the third group received both and the fourth group received neither. Vitamin C (2g 8 hourly) and Thiamine (200 mg 12 hourly) were given intravenously for five days. The outcome was recorded in terms of mortality in the various groups as well as by the improvement in SOFA scores (?SOFA). The serum levels of Vitamin C, Thiamine and Malondialdehyde were estimated. Results: Among the 80 patients, 17 (21%) were in septic shock. The mortality rate was 10% overall, and 47% among patients of septic shock. No additional mortality benefit was observed in the groups supplemented with Vitamin C and Thiamine. However, the ?SOFA score in patients who received both Vitamin C and Thiamine was significantly higher as compared to the other groups. The mean malondialdehyde level was higher in patients of sepsis (1.81±1.18 ?mol/l) as compared with healthy controls (0.78 ± 0.36 ?mol/l). The Vitamin C level and Thiamine level (estimated indirectly by TPP effect), at presentation were 5.14±4.19 ng/ml and 52.99±28.45 % in patients of sepsis, which was significantly lower than that in healthy controls, in whom the levels were 14.64±5.51 ng/ml and 27.55±13.67% respectively. Conclusion: Vitamin C and Thiamine supplementation is a cost-effective approach with a good safety profile. Additional studies including a larger population is required to study the mortality benefits and reaffirm our findings.

Shanmugasundaram Balasubramanian, Singh Vijay Kumar, Shrestha Shrijana, Sarkar Sajib Kumar, Jeevaratnam Kadirvelu, Koner Bidhan Chandra

Coconut oil and sesame oil are commonly used in South India for frying foods. On heating, edible oils form hazardous chemicals. This study explores the effect of consumption of unheated and thermally-altered sesame and coconut oils on coronary artery disease (CAD) risk factors in Wistar rats. Thirty Wistar albino rats were randomly divided into five groups (n=6/group). Group I (Control) was fed only chow, Group II: chow + unheated sesame oil, Group III: chow + heated sesame oil, Group IV: Chow + unheated coconut oil, Group V: chow + heated coconut oil. After eight weeks of treatment, serum lipid profile, hs-CRP, leptin, glucose, insulin, HOMA-IR, TNF-α, IL-6 and plasma homocysteine and fibrinogen levels were estimated. Rats in Group II showed a significant decrease in serum cholesterol, LDL-c, TNF-α, hs-CRP, insulin, and HOMA-IR but a significant increase in HDL-c, Group III showed opposite effects on these parameters, except that it decreased serum triglycerides level. Group IV and V did not show any significant effect on stated parameters. We conclude that consumption of unheated sesame oil gives protective effects against the CAD. Thermally altered sesame oil increases the CAD risk. Unheated and thermally altered coconut oil did not show any significant effect. Hence, we recommend that sesame oil better be used for dressing the food and coconut oil for frying.

Hepatoprotective activity of six polyherbal formulations in CCl4-induced liver toxicity in mice.

To evaluate pretreatment of six polyherbal liquid formulations (PLFs) commercially available in India, on CCl4-induced liver injury, Swiss albino mice were treated for 7 days with distilled water or PLFs (2.6 and 5.2 ml/kg body weight/day, po) followed by single sc injection of 50% (v/v) CCl4 in arachis oil at a dose of 1 ml/kg. The serum biochemical parameters such as alanine transaminases, aspartate transaminases and alkaline phosphatase were estimated. Phenobarbitone-induced sleeping time and liver histopathology were also carried out. CCl4-treated animals showed significant increase in the levels of liver enzymes, phenobarbitone-induced sleeping time and revealed fatty changes and centrizonal necrosis on histological examination of liver indicating hepatic damage. When pretreated with PLFs at a dose of 5.2 ml/kg body weight/day, the CCl4-induced changes were significantly reversed. The pretreatment with PLFs can prevent acute liver damage induced by CCl4 only at a higher dose. Therefore, it is suggested that a dose adjustment of these PLFs may be necessary for their optimal effects in human liver diseases.

Environmental contaminants in pathogenesis of breast cancer.

This review is an attempt to comprehend the diverse groups of environmental chemical contaminants with a potential for pathogenesis of breast cancer, their probable sources and the possible mechanisms by which these environmental contaminants act and interplay with other risk factors. Estrogens are closely related to the pathogenesis of breast cancer. Oxidative catabolism of estrogen, mediated by various cytochrome P450 enzymes, generates reactive free radicals that can cause oxidative damage. The same enzymes of estrogenic metabolic pathways catalyze biological activation of several environmental (xenobiotic) chemicals. Xenobiotic chemicals may exert their pathological effects through generation of reactive free radicals. Breast tissue can be a target of several xenobiotic agents. DNA-reactive metabolites of different xenobiotic compounds have been detected in breast tissue. Many phase I and II xenobiotic metabolizing enzymes are expressed in both normal and cancerous breast tissues. These enzymes play a significant role in the activation/detoxification of xenobiotic and endogenous compounds including estrogens. More than 30 carcinogenic chemicals are present in tobacco smoke; many of them are fat-soluble, resistant to metabolism and can be stored in breast adipose tissue. Similarly, pesticides are also known to cause oxidative stress; while some act as endocrine disruptor, some are shown to suppress apoptosis in estrogen sensitive cell lines. Reports have shown an association of smoking (both active and passive) and pesticides with breast cancer risk. However, the issues have remained controversial. Different mutagenic substances that are generated in the cooking process e.g., heterocyclic amines and polycyclic aromatic hydrocarbons (PAHs) can be a threat to breast tissue. PAHs and dioxins exert their adverse effects through the aryl hydrocarbon receptor (AhR), which activates several genes involved in the metabolisms of xenobiotic compounds and endogenous estrogens. These chemicals also induce AhR-dependent mitochondrial dysfunction. Many of the environmental pollutants suppress the immune system, which are implicated to risk. A better understanding about the biological effects of different environmental carcinogenic compounds and determination of their impact on rising incidence of breast cancer will be beneficial in improving preventive policy against breast cancer.

Small group discussion followed by presentation as a revision exercise at the end of a teaching module in biochemistry.

BACKGROUND: We evaluated the effect of student-dominated small group discussion followed by faculty-moderated presentation as a revision exercise after completion of a teaching module in biochemistry. We assessed the understanding of graduate medical students on the topic and the gain in retention of information, if any, after 15 days. METHODS: Small group discussions involving 11-12 students in each group were conducted on 12 application-oriented problems in 'amino acid metabolism'. A group leader among the students helped to conduct the discussions. While two-thirds of the problems were taken up after the discussion during faculty- or student-moderated interactive presentations, the remaining were not. The effects on low-, medium- and high achievers were evaluated by a pre-test and post-test with multiple choice questions immediately after the session. A subjective feedback was also obtained. To test short-term memory, a post-test with the same multiple choice questions was conducted after 15 days. RESULTS: The exercise was effective and equally beneficial for low-, medium- and high achievers. The gain was maximum when faculty moderated the presentation session. The students' retention of their gain after 15 days was complete. All the students wanted more such sessions in future. CONCLUSION: Student-dominated small group discussion followed by a faculty-moderated presentation is an effective, revision exercise for undergraduate medical students.