Mecanismos moleculares de los efectos benéficos de la alicina sobre la enfermedad cardiovascular / Molecular mechanisms of the beneficial effects of allicin on cardiovascular disease

Resumen Las enfermedades cardiovasculares (ECV) comprenden un grupo de enfermedades cuyo denominador común es la afectación de vasos sanguíneos, corazón y ritmo cardiaco. El tratamiento de las ECV representa costos muy altos para los sistemas de salud y está enfocado en el control de los factores de riesgo. A pesar de existir una gran variedad de fármacos para el tratamiento de las ECV, estas continúan siendo las principales causas de mortalidad, posiblemente debido a que su origen es multifactorial y por ello se requiere de más de un fármaco. En este contexto, la alicina, un compuesto derivado del ajo, ha mostrado regular la expresión de vías de señalización y factores de riesgo asociados a la progresión de las ECV. Por ello el objetivo del presente trabajo es revisar los mecanismos celulares y moleculares por medio de los cuales la alicina ejerce sus efectos terapéuticos y describir las evidencias científicas del porqué la alicina podría representar un potencial candidato para coadyuvar en el tratamiento de las ECV.

Abstract Cardiovascular diseases (CVD) include a group of diseases whose common denominator is the affection of the blood vessels, heart, and heart rate. The treatment of CVD represents high costs to the health systems and is focused on the control of risk factors. Despite the existence of a great variety of treatments of the CVD, these continue as the main cause of mortality mainly due to the multifactorial origin, and therefore more than one drug is required. In this context, allicin, a compound derived from garlic, has shown regulate the expression of signaling pathways and risk factors associated with the progression of CVD. Therefore, the objective of this work is to review the cellular and molecular mechanisms through which allicin exert its therapeutic effects and to describe the scientific evidences why allicin represents a potential candidate to assist in the treatment of CVD.

Tratamiento de la púrpura fulminans neonatal. Reporte de caso y revisión de la literatura / Treatment for neonatal fulminans purpura. Case report and literature review

Resumen La púrpura fulminans (PF) neonatal es un estado de hipercoagulabilidad poco frecuente pero grave. Su presentación clínica es súbita con lesiones purpúricas-necróticas que pueden dejar secuelas permanentes o incluso tener una evolución fatal. Se caracteriza por trombosis en la microcirculación de la piel acompañada de hemorragia perivascular. Los sitios más afectados son las extremidades pélvicas, torácicas o las zonas de presión. La alteración funcional más común es el defecto de la proteína с que fisiológicamente regula la coagulación, el defecto puede ser de causa primaria o secundaria. Caso clínico: Recién nacido varón con 8 días de vida extrauterina que presenta súbitamente rechazo a la vía oral, irritabilidad y fiebre de 39 °С. Dos días después es hospitalizado por deshidratación y rechazo a la vía oral. Al ingreso no se documentó fiebre o foco infeccioso. A las 24 horas presentó lesiones purpúricas-necróticas en el pie derecho. Se realizó un ultrasonido Doppler que confirmó trombosis venosa y arterial. Los dímeros Deran positivos. Se dio tratamiento con plasma fresco congelado (PFC), anticoagulante y antiplaquetario con buena respuesta. Conclusión: La PF es un estado protrombótico grave que requiere un diagnóstico y tratamiento oportunos para mejorar el pronostico.

Abstract Neonatal Purpura Fulminans (PF) is an infrequent hypercoagulable state but very severe. Its clinical manifestation is sudden with purpuric-necrotic injuries. It can leave permanent sequels oreven have a fatal evolution. It is characterized by thrombosis in the skin's microcirculation, accompanied with perivascular hemorrhage. The most affected areas are the pelvic and thoracic limbs, and pressure zones. The most common molecular alteration is the protein с defect, which physiologically regulates coagulation; the defect can be of a primary or secondary cause. Case report: A male newborn with 8 days of extrauterine life suddenly presents oral rejection, irritability and a 39° с fever. Two days later, he was hospitalized for dehydration and oral rejection. He didn't show signs of fever or infection at the time of his admission. Twenty-four hours after his entry, he presented purpuric-necrotic injuries in the right foot, hence, he was diagnosed with purpura fulminans. D-dimer studies and doppler ultrasound were taken. They confirmed venous and arterial thrombosis. The treatment was initiated with fresh frozen plasma, an anticoagulant and an antiplatelet, with a good response. Conclusion: PF is a serious hypercoagulable state that requires an early diagnosis and therapy to improve the outcome.

Usos de membrana amniótica en patología ocular pediátrica / Use of amniotic membrane in childhood ocular disease

Introducción: La membrana amniótica (MA) posee varias propiedades clínicas que la hacen útil en el tratamiento de diferentes patologías. El principal efecto clínico es que permite la epitelización de los tejidos, favorece el crecimiento, adhesión y diferenciación de las células epiteliales, además de prevenir su apoptosis, reduciendo la cicatrización. Objetivo: Describir la utilidad de la membrana amniótica como alternativa en el tratamiento de la superficie ocular. Son abordados tópicos como las diferentes formas de obtención, preparación y conservación de la misma, así como sus mecanismos de acción y aplicaciones. Resultados: En el Servicio de Oftalmología del Hospital de Pediatría J. P. Garrahan se usaron 429 membranas amnióticas en 294 pacientes desde el año 2002 hasta octubre 2014 para el tratamiento de distintas patologías oculares. Los pacientes estudiados presentaron reducción de la inflamación, vascularización y mejor cicatrización. Conclusión: la MA es en la actualidad una alternativa en el tratamiento de patologías de difícil manejo que no responden a las terapias médicas convencionales. Sin embargo, su empleo deberá ser racional, para evitar falsas expectativas de considerarla como panacea en toda patología corneal o conjuntival (AU)

Introduction: Amniotic membrane has several clinical properties rendering it useful in different pathologies. Its main clinical effect is the epithelization of tissue, favoring growth, adhesion and differentiation of epithelial cells as well as prevention of apoptosis and reduction of scarring. Objective: To determine the usefulness of amniotic membrane as an alternative for ocular surface treatment. Issues such harvesting techniques, preparation, and storage of the amniotic membrane, as well as mechanisms of action and use are discussed. Results: At the Department of Ophthalmology of the Pediatric Hospital J. P. Garrahan 429 amniotic membranes were used in 294 patients between 2002 and October 2014 for the treatment of different eye pathologies. The patients studied presented with reduced inflammation and better vascularisation and scarring. Conclusion: Amniotic membrane is currently a treatment option in difficult-to-treat pathologies that do not respond to conventional therapies. Nevertheless, it should be used rationally to avoid unrealistic expectations considering it the panacea for all corneal or conjunctival pathologies (AU)

Disability adjusted working life years (DAWLYs) of leprosy affected persons in India.

Background & objectives: Disability-adjusted life years (DALYs) have been accepted as a useful method to estimate the burden of disease, and can be adapted to determine the number of productive years lost due to the disability. DALY has been reported for many studies but not for leprosy. Hence this study was carried out in three States of India. In view of the fact that in this study, productive working years are used, the term is modified as DAWLY. Methods: A representative random sample of 150 leprosy affected persons, 50 from each States of Uttar Pradesh, West Bengal and Chhattisgarh, was chosen, and data were collected on detailed work-life history, occupation, time when leprosy was discovered, reported and treatment started, break of job/loss of income due to leprosy. The loss of wages and durations were used to compute the life-years lost due to leprosy, and summarized over the average total duration of 42 years of productive work-life from 18 to 60 years. The percentage losses were determined and differences tested for statistical significance. Results: The overall mean (± SE) disability adjusted working life years was 28.6 (±0.67), a reduction of 13.4 yr from the ideal productive working life period of 42 yr. The youngest patients with disability had a reduction of 41.4 per cent, as compared to the oldest patients. There was a significant increase in loss based on year for those whose disability started earlier (P=0.0024). Interpretation & conclusions: On an average, 30 per cent of the leprosy affected person’s work life is lost due to disability.

Totally implantable venous access ports: Retrospective review of long-term complications in 81 patients.

Aim of The Study: A totally implantable venous access port (TIVAP) has become an essential prerequisite for many chemotherapy protocols. It is serving its purpose very well, but its use is not without complications. We are presenting our experience with these devices (TIVAPs). Subjects and Methods: We retrospectively reviewed the totally implantable venous access ports in 81 patients at our hospital between January 2009 and March 2011 for long-term problems which include postoperative and follow-up problems, excluding the immediate complications which occur at the time of insertion. Results: Catheter malfunction was the most common complication (9.87%, 0.40/1000 device-days of use/observation). Catheter-related bloodstream infections were present in 5 (6.17%) patients (0.25/1000 device-days of use/observation). The mean life of the catheter was 246 days. Only 11.1% ports required removal during the treatment period. Overall, patients either completed treatment (82.8%) or died (6.1%) while receiving treatment. Conclusion: TIVAPs provide safe and reliable vascular access for patients on chemotherapy but require utmost care by a dedicated team of trained medical professionals and paramedics experienced with the use of such ports, in order to minimize the complications and their continued use while administering treatment.

Hantaviruses: an emerging public health threat in India? A review.

The emerging viral diseases haemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS) are a cause of global concern as they are increasingly reported from newer regions of the world. The hantavirus species causing HFRS include Hantaan virus,Seoul virus, Puumala virus, and Dobrava-Belgrade virus while Sin Nombre virus was responsible for the 1993 outbreak of HCPS in the Four Corners Region of the US. Humans are accidental hosts and get infected by aerosols generated from contaminated urine,feces and saliva of infected rodents. Rodents are the natural hosts of these viruses and develop persistent infection. Human to human infections are rare and the evolution of the virus depends largely on that of the rodent host. The first hantavirus isolate to be cultured, Thottapalayam virus,is the only indigenous isolate from India,isolated from an insectivore in 1964 in Vellore, South India. Research on hantaviruses in India has been slow but steady since 2005. Serological investigation of patients with pyrexic illness revealed presence of anti-hantavirus IgM antibodies in 14.7% of them. The seropositivity of hantavirus infections in the general population is about 4% and people who live and work in close proximity with rodents have a greater risk of acquiring hantavirus infections. Molecular and serological evidence of hantavirus infections in rodents and man has also been documented in this country. The present review on hantaviruses is to increase awareness of these emerging pathogens and the threats they pose to the public health system.

Management of patients with fibromyalgia using biofeedback: a randomized control trial.

OBJECTIVE: Fibromyalgia syndrome (FMS) is a chronic rheumatological condition which could be characterized by generalized pain and fatigue. Cognitive and behavioral therapy has been found to be a suitable technique in the management of FMS. This study intends to evaluate the efficacy of electromyography (EMG) biofeedback to reduce pain in patients with FMS. MATERIALS AND METHODS: A randomized controlled trial involving two groups of FMS patients, one receiving EMG biofeedback and the other a sham biofeedback, was carried out. The assessment tools included in the study were fibromyalgia impact questionnaire (FIQ), visual analogue scale (VAS), six-minute walk test (SMWT) and number of tender points; and tenderness of each tender point was done for both the groups. STATISTICS: A Student's 't' test was used to study the test for significance. RESULTS: After using biofeedback, the mean VAS scores and the mean number of tender points were found to be 3 out of 10 and 6 out of 18 respectively. Subjective analysis from both groups showed improvement in physical and psychological realms. Statistical significance. CONCLUSION: Biofeedback as a treatment modality reduces pain in patients with FMS, along with improvements in FIQ, SMWT and the number of tender points.

Perceptions about suicide: a qualitative study from southern India.

BACKGROUND: Studies from India have reported high rates of suicide. We aimed to understand the social and cultural factors that modulate the risks related to suicide. METHODS: Focus group discussions were conducted with community health workers (1 group) and members of the public (6 groups). In-depth interviews were also conducted with 5 people who had attempted suicide and survived. The interviews were tape-recorded and transcribed verbatim. The results were summarized and analysed using standard procedures. RESULTS: The most common causes for suicide were interpersonal and family problems, and financial difficulties. Mental illness was also reported as causal. All 5 subjects who had attempted suicide mentioned marital and family discord as the cause. The majority of the general population and all the subjects who had attempted suicide were not aware of any community and support services for the prevention of suicide. CONCLUSION: Our study reveals that people perceived suicide as an option to overcome interpersonal, family and financial stress among normal individuals as well as those with mental illness. Healthcare providers should place greater emphasis on educating the general public regarding the policies and services available for suicide prevention.

Cultivation of human corneal limbal stem cells in Mebiol gel--A thermo-reversible gelation polymer.

BACKGROUND & OBJECTIVES: Cultivated limbal stem cell transplantation is being used as a current treatment modality for limbal stem cell deficiency. However, use of allogenic biological material as substrate is associated with risks of transmission of certain diseases and allograft rejection. Therefore development of non-toxic biodegradable synthetic polymers is important. We undertook this study to evaluate the use of a synthetic polymer Mebiol gel as a substrate for the growth of limbal phenotype cells and cornea phenotype cells from limbal explants. METHODS: Human cadaveric limbal explants cells were cultivated on Mebiol gel. The proliferative capacity of cultivated cells was analyzed with thymidine incorporation studies. Immunostaining for presumed limbal stem cell association markers and cornea differentiation markers was performed and confirmed with reverse transcription (RT-PCR). RESULTS: The limbal explants underwent proliferation in vitro. The cultivated cells expressed the presumed limbal stem cell association markers (ABCG2 and p63), the transient amplifying cell markers (connexin 43, integrin alpha9) and the cornea differentiation marker (K3). RT PCR confirmed the immunohistochemical data. INTERPRETATION & CONCLUSION: Our findings showed that the synthetic polymer Mebiol gel was able to support limbal explant proliferation. The cultured cells expressed presumed limbal stem cell association markers, transient amplifying cells and cornea phenotype markers. Mebiol Gel can be used as a scaffold for growing limbal explants.

Erythrocyte antioxidant enzymes in Parkinson's disease.

BACKGROUND & OBJECTIVES: Oxidative stress is incriminated to play a central role in the pathogenesis of Parkinson's disease (PD). Oxidative stress, to which neurons are highly susceptible, is also known to induce oxidative changes in human red blood cells (RBCs), in vivo and in vitro. Earlier studies on oxidative stress in RBCs in patients with PD have yielded controversial results claiming unaltered activity to reduced activity. Using RBC as a model, we have undertaken this study to ascertain the possibility of oxidative damage to the RBCs in PD by measuring the cytosolic antioxidant enzymes viz., superoxide dismutase (SOD), catalase (CAT) glutathione peroxidase (G-Px) and glucose-6-phosphate dehydrogenase (G6PD). METHODS: Activities of antioxidant enzymes were measured in erythrocytes of 115 PD patients and 37 normal age-matched healthy persons as controls. Enzymes activities were correlated with age of patients, age of onset of disease, duration of disease, United Parkinson's Disease Rating Scale (UPDRS) and Hoehn and Yahr stage. RESULTS: The SOD, CAT, G-Px and G6PD activities were significantly lower in patients with PD compared to the control. A significant (P<0.05) negative correlation of enzyme activities with Hoehn and Yahr stage of the disease and also with UPDRS score was found. INTERPRETATION & CONCLUSION: Results of the present study showed involvement of oxidative stress as one of the risk factors, which can initiate and/or promote neurodegeneration in PD and was correlated to the severity of the disease.

Tomato and garlic by gavage modulate 7, 12-dimethylbenz[a]anthracene-induced genotoxicity and oxidative stress in mice

Chemoprotection by dietary agents is a promising strategy for cancer prevention. The aim of the present study was to evaluate the combined effect of tomato and garlic against 7,12-dimethylbenz- [a]anthracene (DMBA)-induced genetic damage and oxidative stress in 12-14-week-old male Swiss albino mice. The animals were randomized into experimental and control groups and divided into eight groups of five animals each. Group 1 animals were injected intraperitoneally with 35 mg/kg body weight DMBA suspended in peanut oil as a single dose. Groups 2-4 animals received tomato (500 mg/kg body weight), garlic (125 mg/kg body weight) and a combination of tomato and garlic for 5 days by gavage, respectively, followed by DMBA 1.5 h after the final feeding. The doses of tomato and garlic correspond to the average human daily consumption. Animals in groups 5, 6 and 7 received tomato alone, garlic alone and tomato + garlic combination, respectively, for 5 days. Group 8 animals received the same volume of water and served as control. The incidence of bone marrow micronuclei and the extent of lipid peroxidation and the concentrations of antioxidants glutathione, glutathione peroxidase and glutathione-S-transferase were measured in the liver, 48 h after DMBA exposure. Increased frequency of micronuclei and enhanced lipid peroxidation accompanied by compromised antioxidant defenses were observed in DMBA-treated animals. Although pretreatment with tomato or garlic significantly reduced the frequency of DMBA-induced bone marrow micronuclei, the combination of tomato and garlic exhibited more profound effect in inhibiting DMBA-induced genotoxicity and oxidative stress. We suggest that a broad spectrum of antimutagenic and anticlastogenic effects can be achieved through an effective combination of functional foods such as tomato and garlic.

Symptoms related to the reproductive tract and mental health among women in rural southern India.

BACKGROUND: Symptoms related to the reproductive tract and symptoms of psychological distress are commonly seen in women living in South Asia. This study aimed to determine the association, if any, between symptoms related to the reproductive tract and mental health among women in rural southern India. METHODS: The study was conducted in a community setting of a comprehensive community health programme in a development block in rural southern India. It was a cross-sectional survey with a nested case-control study. The main outcome measure was the probability of mental distress as assessed by the Tamil version of the General Health Questionnaire-12 (GHQ). RESULTS: Of the 622 subjects recruited, 150 (24.4%) complained of at least one symptom related to the reproductive tract. The commonest symptom was vaginal discharge (17.5%). Significantly higher scores on the GHQ were associated with the presence of many current and past symptoms related to the reproductive tract, and receiving treatment for the same, even after adjusting for age, education, current marital status and type of house, using multiple regression analysis. GHQ scores were positively correlated with a higher number of current and past symptoms. Significantly higher scores were also associated with greater knowledge about prevention of sexually transmitted diseases and reproductive tract infections. Being currently married and educated were significant protective factors. A nested case-control study was done with the presence of a current common mental disorder as the outcome. Symptoms and other factors dated prior to this outcome were considered potential risk factors. Logistic regression models were developed. The presence of a symptom related to the reproductive tract for more than one month (OR 3.6; 95% CI 1.8, 7.2) and a history of similar symptoms over the past year (OR 2.2; 95% CI 1.3, 3.7) were risk factors for the development of common mental disorders. Higher education (OR 0.5; 95% CI 0.3, 0.7) and being currently married (OR 0.2; 95% CI 0.1, 0.6) were protective factors. CONCLUSION: The cross-sectional data suggest an association between symptoms pertaining to the reproductive tract and psychological distress. The results of the nested case-control study suggest that symptoms related to the reproductive tract are risk factors for common mental disorders, while education and being currently married are protective factors.

Symptomatic congenital syphilis presenting at birth.

We report here a case of congenital syphilis presenting in a newborn infant at birth. A negative infant VDRL test, pseudoparesis and more notably, joint swellings (arthritis) were features seen uncommonly. Florid skeletal involvement, which is rarely seen in the early neonatal period, prompted us to draw attention to the varied presentation of this disease, rightly referred to as the "master masquerader".

Antibody response to a single tetanus toxoid booster in young women in rural south India.

BACKGROUND: Tetanus toxoid immunization is an integral part of the maternal and child health programme in developing countries. It is likely that many women may have had childhood immunization and so already have antitetanus antibodies at the time of their first antenatal visit. A single dose of tetanus toxoid injection can boost the levels of antitetanus antibodies in these women. This study was undertaken to assess the previous immunization status by verbal history and assess the effect of a single tetanus toxoid injection in young women. METHODS: Ninety-nine unmarried women between 18 and 22 years of age were enrolled for the study. The history of childhood immunization was obtained from their mothers. Blood samples were collected to measure IgG antibody levels to tetanus using ELISA. Antibody levels were also measured on day 14 after a dose of tetanus toxoid injection. RESULTS: Of the 99 women studied, 81 had a history of childhood immunization while 18 did not. Overall, 92% of the women had protective levels of antibodies at the time of first testing and 99% of the women were protected with a single dose of tetanus toxoid. CONCLUSION: In areas with good maternal and child health services, a single booster dose of tetanus toxoid can be considered adequate for primigravidae with a history of childhood immunization.