Metabolic effects of oral vitamin D supplementation as an adjuvant therapy on subjects with type 2 diabetes

Background: It is common for patients with type 2 diabetes mellitus (T2DM) to have vitamin D deficiency. Aim of the study is to determine the metabolic effects of oral vitamin D supplementation in a cohort of T2DM subjects.Methods: Subjects with T2DM were divided into two groups. Group A (Control) included subjects who received the standard treatment (conventional antidiabetic drugs). Group B (Intervention), apart from the standard treatment (conventional antidiabetic drugs), was also supplemented with Vitamin D3. All the patients were followed up at baseline, 6 months, 12 months and 18 months.Results: Vitamin D deficiency was noted down in all the study subjects. Even after 18 months of supplementation, all subjects remained vitamin D deficient. There was a significant improvement in the circulating levels of 25-hydroxyvitamin D. Improvement in the lipid profile of subjects was observed as evidenced by a decrease in total cholesterol (5.0±0.92 mmol/l) as compared to baseline (5.5±1.6 mmol/l). HOMA-IR changed significantly after 18 months of supplementation from baseline (7.0±1.06 vs 10.8±1.96 nmol/l).Conclusions: Supplementation to achieve higher levels of vitamin D remains a promising adjuvant therapy for T2DM patients. Additionally, the intervention brought out a favourable change in HDL/LDL ratio among study subjects.

A case report on sorafenib induced adverse reaction

Sorafenib is an oral multi-kinase inhibitor used primarily in the treatment of hepatic cellular carcinoma, renal cell carcinoma, and thyroid carcinoma. Hand-foot syndrome also is known as palmar-plantar erythrodysesthesia causes reddening, numbness, swelling of palms of hands and soles of feet. In this report, a known case of renal cell carcinoma, post right nephrectomy patient on treatment with tab sorafenib had developed the hand-foot syndrome

Social dilemma and vitamin D deficiency: a cross-sectional study of nutritional rickets in children ages 6 months to 24 months

Background: In developing countries, malnutrition's is one of the challenges that still need to be addressed. Undernutrition is usually a result of the unavailability of food and/or repeated infections in children. Countries with comparatively lower per-capita incomes as well as those with middle per-capita income have its increased prevalence in younger age. Social dilemma of mothers, like exclusively breastfeeding, heavy clothing's and practice of keeping babies inside the doors, lead vitamin D deficiency and ultimately into nutritional rickets. The objective of this study was to determine the frequency of factors leading to nutritional rickets in children ages 6 months to 24 months.Methods: This cross-sectional study was conducted at Department of Pediatrics, Ayub Teaching Hospital, Abbottabad, Pakistan from March to December 2017. After inclusion/exclusion criteria, total 160 patients of rickets were observed. Detailed history followed by vitamin D level (<15 ng/ml) was measure. Data was analyzed by SPSS-22 and all documents were locked with principal author.Results: Present study showed that 62% children were in age ranged 6-12 months and 38% children were in age range 13-24 months. Mean age was 12 months with SD'2.16. Seventy nine percent children were male, and 21% children were females. More over 52% children had exclusive breast feeding, and 48% children did not have exclusive breast feeding. Similarly, 15% children had limited sun-light exposure and 85% children did not have limited sun-light exposure.Conclusions: Present study concluded that a lack of health education and sunlight exposure and exclusive breastfeeding were the significant risk factors contributed to nutritional rickets among children of Abbottabad, Pakistan.

Association of Posterior Reversible Encephalopathy Syndrome with Renal Failure.

Background: Posterior reversible encephalopathy syndrome is a clinico-radiological entity that is characterized by variable associations of seizure activity, consciousness impairment, headaches, visual abnormalities, nausea, vomiting and focal neurological signs. No large data exists on the association of posterior reversible encephalopathy syndrome with renal failure. Materials and Methods: This case series of five patients was collected to examine the association of two conditions and evaluate outcome. All these patients were enrolled in a tertiary care hospital over a period of two years. No informed consent was sought because the study was merely observational and did not demand deviations from standard. Results: Four patients presented with acute renal failure and one patient had established End- Stage Renal Disease. All the patients had hypertension at presentation besides other risk factors. All the patients had Magnetic Resonance Imaging documented posterior reversible encephalopathy syndrome. Despite intensive management, two patients did not show any improvement of blood pressure control and died. This observation raises the possibility that renal failure increases mortality in patients with posterior reversible encephalopathy syndrome. However, our series is limited by small number of enrollees and hence no definite conclusions can be drawn from this observation. Conclusion: Posterior reversible encephalopathy syndrome should be considered in all those patients who have renal failure and associated neurological abnormalities. The association needs to be taken urgently and seriously.

Assessment of Thrombolytic Activity of Five Bangladeshi Medicinal Plants: Potential Source for Thrombolytic Compounds.

Aim: The aim of our project work was to assess the thrombolytic activity of five common Bangladeshi plant extract in different solvent. Five plants are Geodorum densiflorum (Shankhamul), Pistia stratiotes (Topa Pana), Smilax zeylanica (Kumarilata), Pandanus foetidus (Keya) & Tabernaemontana coronaria (Tagar). Plants were collected and air dried separately for three weeks. They were ground into a coarse powder. Cold extractions were performed for all plants by using different solvents. Place and Duration of Study: Department of Pharmacy, University of Chittagong and University of Science and Technology Chittagong, November, 2013. Methodology: Fresh blood was collected from healthy individuals ten volunteers (n=10). Blood was allowed to form clots in a pre-weighed sterile micro-centrifuge eppendorf tubes. After clot serum was removed and blood clot was weighed then blood clot was allowed to lysis by streptokinase. After lysis fluid was removed and the remaining of blood clot was again weighed along with the tube. Percentage of blood clot lysis was calculated on the basis of the weight difference. Weight difference of tubes obtained by weighing before and after clot lyses of blood. % clot lysis=(Weight after clot lysis/ Weight of clot before lysis)×100. This method was repeated for all extracts. Result: Among the herbs studied Pandanus foetidus (C), Pandanus foetidus (PE), Smilax zeylanica (E) and Pistia stratiotes-Root (M) showed significant % of clot lysis 47.54% 41.49%, 43.35% and 35.85% respectively with reference to standard, streptokinase (70.24%). Conclusion: These extracts lyse the blood clots In-vitro, however, we need to know In-vivo clot dissolving property. Further systemic research on these plants and may be a potential source of thrombolytic agent in future.

‘WhatsApp’ as an adjunct to home based pin tract care: a case report.

Mobile based technology can be a cheap and handy adjunct to a home based programme for managing pin tract care in chronic orthopaedic cases. The text message and image based mobile platforms may serve as an evaluation tool relieving patient of agony of long and painful commutes on simple health issues like wound dressings. A case report depicting versatility of the idea with regard to its efficacy in clinical scenario is presented here.

Clinical presentation of various thyroid lesions in a study population attending a teaching hospital in North India.

The present study is undertaken to evaluate the different clinical presentations of thyroid lesions in Northern Indian population. Clinical examination, although very accurate in most cases of thyroid lesion, is inadequate in some areas especially, in staging of thyroid malignancies and in detecting the multi-nodularity of the gland. Methods: The study was conducted in the postgraduate department of pathology of a teaching hospital for a period of 1 year. It was a prospective hospital based Study. In each case, a brief clinical history and physical examination along with evaluation of relevant investigation was carried out. Patient was explained about whole of the procedure & the consent for the procedure was taken in all patients. FNAC of thyroid gland was done and the results of FNAC were correlated with histopathology, wherever available. The final results were correlated with different clinical presentations using SPSS 11.5 software. Results: Out of the 139 patients, 134 presented with swelling in the neck, 3 patients presented with pain in the neck while as 2 patients came with discomfort in the neck. 74 patients have duration of swelling more than 2 years, 51 patients have duration upto 1 year, 10 patients have duration between 1 to 2 years and 4 patients have less than one month. Out of 139 patients, 110 patients have solitary swelling, 87 have swelling on right side, 119 presented with regular margins, 91 presented with firm consistency, 130 were mobile and 135 presented with non-tender. Conclusion: Majority of the patients presented after 2 years of illness i.e. 74. Only 4 patients presently acutely within 1 month of illness. The major complaint was swelling in neck i.e. in 134, rest presented with local pain and discomfort.

Clinical evaluation of efficacy and safety of α-keto analogs of essential amino acids supplementation in patients of chronic kidney disease.

Background: The objective was to evaluate the efficacy and safety of α-keto analogs of essential amino acids (KAA) as a supplement in chronic kidney disease (CKD). Methods: A prospective comparative study was conducted in patients of CKD of a tertiary care center of North India. Patients were randomly divided into two interventional groups. Group I (control) was advised conservative management and placebo while Group II (KAA) given conservative management along with KAA (600 mg, thrice daily) for 12 weeks. Hemogram, renal function tests, lipid profiles were done, and adverse effects were recorded at 0, 4, 8, and 12 weeks of treatment. Results: There was progressive improvement in clinical features in both groups after 12 weeks of treatment, but KAA group showed more marked improvement as compared with the control group. Both groups showed gradual improvement in the biochemical parameters as compared to their pre-treated values, which was more marked in KAA supplemented group. There was a reduction in blood glucose, blood urea, serum creatinine, and 24 h total urine protein. There was an increase in hemoglobin, 24 h total urine volume and glomerular filtration rate. KAA group showed significant (p<0.05) improvement in lipid profiles as compared with the control group. There was no statistical difference in two groups with respect to side-effects (p>0.05). Conclusion: KAA supplementation along with conservative management is efficacious and safe in preventing the progression of disease in patients of CKD.

In-vitro antibacterial properties and pre-liminary phtytochemical analysis of amomum subulatum roxburg (Large Cardamom).

The efficacy of methanolic seed extracts of Amomum subulatum Roxb. activity against bacterias such Staphylococcus aureus, Streptococcus pneumoniae, Bacillus subtilis, Salmonella typhi, Klebsiella pneumoniae, Pseudomonas aerugenosa and Candida albican senegalensis was studied. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of the extracts was determined using standard methods. Results obtained showed considerable inhibition against the bacteria tested except Salmonella pyrogenes and Escheria Coli which showed considerable resistance at all concentrations of the extract. It can also observe that the extract exhibited greater inhibition on Klebsiella pneumonia and Pseudomonas aerugenosa (18±0.2 and 17±0.3). However the standard antibacterial drug tetracycline exhibit superior activity than the extract. Both the MICs and MBCs of the extract ranges from 50 to 200 mg/ml. Its further reveals that Bacillus subtilis, Klebsiella pneumonia and Staphylococcus aureus exhibit broadest activity at MIC and MBC concentrations of 50mg/ml. While the rest Salmonella typhii and Pseudomonas aerogunosa and candida albicans of the bacteria shows negative turbidity and resistance at MIC and MBC of 100mg/ml. This activity was indicative of the possible means of finding pure active principles from natural source with possible high potency that could serve as a lead to the pharmaceuticals. The low concentration (MIC and MBC) activity of the methanolic extracts give credence and scientific base for the claim therapeutic capabilities of Amomum subulatum as an anti-bacterial agent. The extract concentrate yield of the methanolic extracts was estimated to be 9.8%w/w which is brown in colour and oily in texture. Preliminary screening analysis of the powdered methanolic seed extracts showed the presence of Carbohydrate, tannins, cardioactive glycosides, tepenes, flavonoids, alkaloids and saponins. Anthraquinone was not found in the extract. The study provides the basis of use of this plant Amomum subulam in treatment of infections caused by pathogens (bacteria) and the phytochemical found are implicated in having anti-bacterial properties.

The Effects of Ethanolic Extract of Vitex Doniana Stem Bark on Peripheral and Central Nervous System of Laborotory Animals.

This study evaluated the depressant effects V. doniana stem bark ethanolic extract. The stem bark of V. doniana (2kg) was macerated for five days with 95% ethanol, filtered and evaporated in vacuo and the extracts concentrate yields was calculated to be 14.8%w/w. The intraperitoneal LD50 in rats estimated with 95% confidence limit was 2154.06mg/kg while no mortality was recorded with the oral route even on administration of 5000mg/kg extract. Thus the extract can be administered with a certain degree of safety. Pre-liminary phytochemical analysis was conducted to ascertain the primary and secondary metabolites present in the extract using standard procedures. The results revealed the presence of tannins, phlobatannins, saponins, carbohydrates, cardioactive glycoside, flavonoids, steroids and terpenes. Alkaloids and anthracenosides were absent in the extract. The administration of doses of 50 mg/mL and 100 mg/mL of the extract produced 70% and 80% local anesthesia respectively on rabbits. Xylocaine exerted local anesthetic effect of 35% and 50% at a concentration of 0.3 and 1.0 mg/ml respectivel. The result shows that the extract has significant (P< 0.01) local anesthetic effect when compared to xylocaine. Antinociceptive activity of the ethanolic extract was evaluated using acetic acid induced pain and heat. The extract demonstrated significant antinociceptive activities dose dependently when compared to control .The activity being more pronounced at highner dose of 600mg/kg which gave the high percentage protection of the abdominal constriction induced by acetic acid . About 80 and 100% of the treated rats with 400mg/kg and 600mg/kg of the extracts slid down the board. Effect of the extract of pentobarbitone sleep time in Albino Wister rats was also evaluated. The ethanolic stem bark extract of V. doniana increase the sleeping time together with the pentobarbitone from 72.3±3.07 at a doses(100mg/kg of extract and 35 mg/kg of the pentobarbitone) to 181±0.35 at a dose of 400mg/kg and 35 mg/kg) respectively.

Assessment of Thrombolytic & Cytotoxic Activity of Herbal Preparations Originated from Botanical Source of Bangladesh.

An in vitro thrombolytic model was used to check the clot lysis effect of four herbal extracts viz., Honey, Nigella sativa, Capsicum frutescens, Brassica oleracea, combination of Honey & Nigella sativa and Honey & Capsicum frutescens along with Streptokinase as a positive control and water as a negative control. And also brine shrimp lethality bio-assay was done using brine shrimp Nauplii and 5% of DMSO as a solvent for the ethanol extracts of Nigella sativa & Capsicum frutescens and Honey. Using an in vitro thrombolytic model, Honey, Nigella sativa, Capsicum frutescens, Brassica oleracea, combination of Honey & Nigella sativa and Honey & Capsicum frutescens showed 26.82%, 47.13%, 57.40%, 62.44%, 56.58% and 44.54% clot lysis effect respectively. From our study we found that Brassica oleracea, Capsicum frutescens, and combination of Honey & Nigella sativa showed significant % of clot lysis effect with reference to Streptokinase. Again from in vitro brine shrimp lethality bio-assay, we found that the LC50 of Honey, Capsicum frutescens & Nigella sativa were 129.62 μg/ml, 83.33 μg/ml & 45.45 μg/ml respectively.

In-vitro interaction of verapamil hydrochloride with magnesium sulphate (anhydrous) and its influence on protein binding of verapamil hydrochloride.

The interaction between Verapamil Hydrochloride and Magnesium Sulphate (anhydrous) has been studied in an aqueous system at pH 7.4 and 2.4. From spectrophotometric study, it has been found that Verapamil Hydrochloride form 1:1 complex with Magnesium Sulphate (anhydrous). Spectral studies helps to detect the initial complexation between drug and metal. Job’s plot at 7.4 and 2.4 provides same type of information. The Ardon’s spectrophotometric method confirmed the 1:1 complexation and the value of stability constants was calculated using Ardon’s plot. An in vitro study of protein binding of Verapamil Hydrochloride and their 1:1 mixture with Magnesium Sulphate (anhydrous) has been conducted by equilibrium dialysis method at (37 ± 0.5)0C and at pH 7.4. The Scatchard plots were prepared to reveal the number of binding sites and the affinity for protein binding. It has been found that interaction of the drug with Magnesium Sulphate (anhydrous) results into increasing the affinity and increasing the protein binding of Verapamil Hydrochloride.

Effect of precocene on development of ovarian follicles in flesh fly, Sarcophaga ruficornis F.

Administration of precocene II (6,7-dimethoxy-2, 2-dimethyl chromene) to freshly emerged virgin female flies of S. ruficornis adversely affected the development and differentiation of ovarian follicles leading to a number of morphological abnormalities. Precocene treatment resulted into suppression of development of egg chamber, differentiation of follicular epithelium, degeneration of nurse cells, growth of oocyte and uptake of yolk granules by oocytes. The results suggest that precocene induced effects are due to deficiency of juvenile hormone.

Heterochrony in cotton bollworm, Earias vitella (Fb) following ethoxyprecocene administration.

Administration of a synthetic precocene analogue, 7-ethoxy-6-methoxy-2,2-dimethyl chromene to fourth and last instar larvae of E. vitella results into heterochrony, viz. prothetely and metathetely. These disturbances are due to interference with the endocrine system and application of juvenile hormone to treated larvae abolishes the effect of ethoxyprecocene.