Trends of humoral immune responses to heterologous antigenic exposure due to vaccination & omicron SARS-CoV-2 infection: Implications for boosting

Background & objectives: Vaccination and natural infection can both augment the immune responses against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but how omicron infection has affected the vaccine-induced and hybrid immunity is not well studied in Indian population. The present study was aimed to assess the durability and change in responses of humoral immunity with age, prior natural infection, vaccine type and duration with a minimum gap of six months post-two doses with either ChAdOx1 nCov-19 or BBV152 prior- and post-emergence of the omicron variant. Methods: A total of 1300 participants were included in this observational study between November 2021 and May 2022. Participants had completed at least six months after vaccination (2 doses) with either ChAdOx1 nCoV-19 or an inactivated whole virus vaccine BBV152. They were grouped according to their age (? or ?60 yr) and prior exposure of SARS-CoV-2 infection. Five hundred and sixteen of these participants were followed up after emergence of the Omicron variant. The main outcome was durability and augmentation of the humoral immune response as determined by anti-receptor-binding domain (RBD) immunoglobulin G (IgG) concentrations, anti-nucleocapsid antibodies and anti-omicron RBD antibodies. Live virus neutralization assay was conducted for neutralizing antibodies against four variants – ancestral, delta and omicron and omicron sublineage BA.5. Results: Before the omicron surge, serum anti-RBD IgG antibodies were detected in 87 per cent participants after a median gap of eight months from the second vaccine dose, with a median titre of 114 [interquartile range (IQR) 32, 302] BAU/ml. The levels increased to 594 (252, 1230) BAU/ml post- omicron surge (P<0.001) with 97 per cent participants having detectable antibodies, although only 40 had symptomatic infection during the omicron surge irrespective of vaccine type and previous history of infection. Those with prior natural infection and vaccination had higher anti-RBD IgG titre at baseline, which increased further [352 (IQR 131, 869) to 816 (IQR 383, 2001) BAU/ml] (P<0.001). The antibody levels remained elevated after a mean time gap of 10 months, although there was a decline of 41 per cent. The geometric mean titre was 452.54, 172.80, 83.1 and 76.99 against the ancestral, delta, omicron and omicron BA.5 variants in the live virus neutralization assay. Interpretation & conclusions: Anti-RBD IgG antibodies were detected in 85 per cent of participants after a median gap of eight months following the second vaccine dose. Omicron infection probably resulted in a substantial proportion of asymptomatic infection in the first four months in our study population and boosted the vaccine-induced humoral immune response, which declined but still remained durable over 10 months

The complication rate following Neodymium-doped Yttrium Aluminum Garnet laser posterior capsulotomy for posterior capsular opacification in patients with and without comorbidities

Purpose: To study the complication rate following Nd: YAG posterior capsulotomy posterior capsular opacification (PCO) in patients with and without comorbid conditions. Methods: This was a prospective, interventional, comparative, and observational study. A total of 80 eyes, consisting of 40 eyes without ocular comorbidities (group A) and 40 eyes with ocular comorbidities (group B) that were being treated with Nd: YAG capsulotomy for PCO, were included. Visual outcome and complications of Nd: YAG capsulotomy were studied. Results: The mean age of group A patients was 61.65 ± 8.85 years and that of group B patients was 63 ± 10.46 years. Of the total, 38 (47.5%) were men and 42 (52.5%) were women. In group B, the ocular comorbidities were moderate nonproliferative diabetic retinopathy (NPDR) (n = 14 eyes; 14/40 = 35%), subluxated intraocular lens (IOL; <2 clock hours of subluxation; n = 6), age?related macular degeneration (ARMD; n = 6), post?uveitic eyes (having old signs of uveitis, no episode of uveitis since the last 1 year; n = 5), and operated cases of traumatic cataract (n = 4). The mean energy required in groups A and B was 46.95 ± 25.92 and 42.62 ± 21.85 mJ, respectively (P = 0.422). The average energy requirement in Grade 2, Grade 3, and Grade 4 PCO was 22.30, 41.62, and 79.52 mJ, respectively. An increase in intraocular pressure (IOP) of >5 mmHg from pre?YAG levels was observed in one patient in each group on day 1 postprocedure, for which medical treatment was given to both patients for 7 days. One patient in each group had IOL pitting. No patient had any other complications attributable to ND:YAG capsulotomy. Conclusion: Nd:YAG laser posterior capsulotomy is a safe procedure for PCO in patients with comorbidities. Visual outcomes were excellent after Nd:YAG posterior capsulotomy. Although a transient increase in IOP was noted, the response to treatment was good and a long?term increase in IOP was not observed

A Clinical study of Hansen抯 Disease and Histopathological Correlation from a Tertiary Care Centre in East India

Background: Leprosy or Hansen抯 disease caused by Mycobacterium leprae is a chronic granulomatous disease characterized by hypoesthetic skin lesions and nerve involvement. The objective of the study was to find clinicohistopathological correlation of Hansen抯 disease diagnosed at a tertiary care centre of eastern India. Material and Methods: Hospital based retrospective study was conducted that included cases of leprosy diagnosed clinically and examined for histopathology at Indira Gandhi Institute of Medical Sciences, Patna from January 2021 to December 2021. Clinical diagnosis was correlated with that of histopathological diagnosis. Result: From this study, it was observed that, the commonest age group affected by leprosy was 20 to 40 years, males were more commonly affected than females (M:F = 1.83: 1) and commonest clinically diagnosed spectrum was Tuberculoid leprosy (TT) ( 48.03%). It was observed that there was complete agreement between clinical diagnosis and histopathological diagnosis in 84.3% cases and disagreement was observed in 15.7% cases. Conclusion: Combining clinical, and histopathological finding of leprosy is essential for accurate diagnosis and thus proper treatment of the patient and prevention of complications.

Measurement of change in angle kappa and its correlation with ocular biometric parameters pre- and post-phacoemulsification

Purpose: Angle kappa has been considered to play a role in causing glare and haloes despite accurate centration during implantation of multifocal intraocular lenses following phacoemulsification. There is a lack of substantial data regarding whether angle kappa is a constant entity or changes following ocular surgical procedures. To answer this question, in this prospective observational study, we measured change in angle kappa following phacoemulsification, and studied the ocular biometric parameters correlating with this change. Methods: Angle kappa was measured objectively using synoptophore. Ocular Biometric parameters (Anterior Chamber Depth, Corneal White?to?White measurement, Lens Thickness, and Axial Length) using LenStar LS 900 Haag Streit Anterior Segment imaging system. outcome measures were a quantitative change in angle kappa from the preoperative value by one degree or more and observation of correlation between change in angle kappa and ocular biometric parameters. The Wilcoxin Signed Rank Test was used to determine the difference between pre?operative and post?operative measurements for angle kappa. A p?value of less than 0.05 was considered statistically significant. Pearson's correlation coefficient was employed to find the relationship between preoperative ocular biometric parameters and a change in angle kappa. A linear regression model was used to derive an equation considering corneal white?to?white measurement as the predictor and change in angle kappa as the outcome measure. Results: A significant change in angle kappa was recorded, and a significant correlation was found with corneal white to white measurements. This change could be predicted preoperatively, for a known corneal white to white measurement using the standard equation y=mx+c. Conclusion: This study explains the possible cause of dissatisfaction among seemingly ideal patients who undergo multifocal IOL implantation and the potential for better decision? making during patient selection for multifocal IOL implantation.

Serum Vitamin D Level in Psoriasis: A Prospective Study in a Tertiary Care Centre of Eastern India

Background: Psoriasis is a systemic, inflammatory, chronic autoimmune disease characterized by multiple discoid plaques over body with silvery scales associated with cardiovascular diseases, obesity, diabetes mellitus, hypertension, and hyperlipidemia. Recently, association between psoriasis and Vitamin D level has also been reported. Our aim of study was to evaluate the association of vitamin D and its association with the severity of Psoriasis Materials and methods: 60 patients diagnosed with psoriasis, in our outpatient department from January 2021 to December 2021, were included the study. 58 age, gender- and skin phototype- matched healthy controls were included in the study. Results: The serum vitamin D level in patients and in the control group ranged from 7 to 24 ng/ml (mean: 13.04 �32 ng/ml) and from 16 to 65 ng/ml (mean: 23.91�08 ng/ml), respectively. The circulating vit D levels were less in patients compared to control. The analysis showed statistical significance (P< 0.05) between the two groups. Conclusion: Our results showed decreased level of vitamin D in patients suffering from psoriasis when compared to healthy controls. Vitamin D supplementation can be useful in psoriasis management.

Case Reports on Black Fungus of the Gastrointestinal Tract: A New Complication in COVID-19 Patients / 대한소화기학회지

Gastrointestinal mucormycosis is a rare disease with a significant mortality rate, even when promptly diagnosed and treated. An unusual complication was observed in India during the second wave of coronavirus disease 2019 (COVID-19). Two incidences of gastric mucormycosis were found. A 53-year-old male patient with a history of COVID-19 one month earlier came into the intensive care unit. After admission, the patient developed hematemesis, which was initially treated with blood transfusions and digital subtraction angiography embolization. Esophagogastroduodenoscopy (EGD) revealed a large ulcer with a clot in the stomach. During an exploratory laparotomy, the proximal stomach was necrotic. Histopathological examination confirmed mucormycosis. The patient was started on antifungals, but despite rigorous therapy, the patient died on the tenth postoperative day. Another patient, an 82-year-old male with a history of COVID-19, arrived with hematemesis two weeks earlier and was treated conservatively. EGD revealed a large white-based ulcer with abundant slough along the larger curvature of the body. Mucormycosis was verified by biopsy.He was treated with amphotericin B and isavuconazole. He was discharged after two weeks in a stable condition. Despite quick detection and aggressive treatment, the prognosis is poor. In the second case, prompt diagnosis and treatment saved the patient’s life.

Anorectal balloon cell melanoma: a rare variant

ABSTRACT Balloon cell melanoma is a rare presentation of malignant melanoma, usually on the skin, with less than 100 cases reported. Mucosal BCM is even rarer, with only one case of anorectal BCM reported in English literature. The diagnosis is based on the histopathologic findings of a tumor composed of large, foamy melanocytes, with or without pigmentation, and confirmed by immunohistochemical studies showing expression for melanocytic markers. The foam cell appearance of the tumor cells and the lack of melanin pigment lead to a diagnostic dilemma, mostly when presented at an unusual location. Herein, we report a case of balloon cell melanoma at the anorectal junction in a 73-year-old male patient complaining of constipation and bleeding per rectum. Surgical resection was performed with no evidence of recurrence after three years of close follow-up. We believe this case will raise awareness among the medical community to consider this tumor a differential diagnosis in rectal masses.

Histopathological Approach To The Diagnosis Of Benign Peripheral Nerve Sheath Tumors At Uncommon Location

PARIPEX - INDIAN JOURNAL F RESEARCH |O December - 202Volume - 11 | Issue - 12 | 2 | PRINT ISSN No. 2250 - 1991 | DOI : 10.36106/paripex ABSTRACT Peripheral nerve sheath tumors are relatively common lesions that exhibit a wide morphological and biological spectrum. In the presence of classical morphological and immunohistochemical features, the histological diagnosis is usually straightforward, but they may represent diagnostic challenges. Schwannoma is a slow growing encapsulated tumor of neuroectodermal derivation that originates from the Schwann cells of the neural sheath. Most commonly presents as cerebellopontine angle mass but extracranial sites are known and needs to be considered in the differential diagnosis. Intraparotid and penile schwannomas are extremely rare. Their diagnosis could be missed on cytology due to cystic changes. Isolated plexiform neurofibroma of the tongue is again a rare tumor. Plexiform pattern recognition is important for the pathologist as these varients might show malignant transformation. Overall Fine needle aspiration cytology though inconclusive at times, help a lot initially to delineate between benign Vs malignant lesions. Moreover its minimally invasive so can be performed easily at the uncommon locations. Histopathology remains the gold standard. Clinicopathological and imaging correlation is must for definite diagnosis and treatment.

Effect of COVID-19 Lockdown on Lifestyle Habits and Self-Care Practices of Diabetic and Hypertensive Patients in Rural Shimla and Udaipur – Findings from the HealthRise India program

Background: COVID-19 pandemic has increased the risk of mortality among patients with noncommunicable diseases. Maintaining a good metabolic control, lifestyle modification along with improved self?care practices are not only associated with less severe COVID?19 infections but also with a high recovery rate. Objectives: This research article explores the changes in lifestyle habits, self-care practices, and metabolic control among patients enrolled in the HealthRise program. The study compares behavioral changes, before COVID-19 pandemic and during COVID-19 pandemic, between intervention and control arms in Shimla and Udaipur. Methods: A quasi-experimental study design was employed for program implementation in select villages of Shimla district, and Udaipur district. A total of 459 patients from Shimla and 309 patients from Udaipur with diabetes mellitus or hypertension or with both were enrolled and followed for 1 year. Results: Metabolic control in Shimla intervention arm was 2.6 times higher than in control arm (P = 0.001) before COVID?19 pandemic. During COVID?19 pandemic, Odds of metabolic control in Shimla intervention was 1.5 times higher when compared with control arm (P = 0.03). In Udaipur, metabolic control before COVID-19 pandemic was comparable between control and intervention arms. During the pandemic, metabolic control in intervention arm of Udaipur was 5 times higher when compared to the control arm ((P = 0.001). Conclusion: Participants exposed to support, appreciate, learn, and transfer-community life competence process (SALT-CLCP) intervention maintained metabolic control during the COVID-19 pandemic with improved behavioral and self-care practices. Community-based interventions such as SALT-CLCP method bring ownership and empower community in achieving the better health outcomes.

Impact of an Alcohol-based hand sanitizer usage during COVID-19 pandemic on disulfiram treatment: A South Indian psychiatrist's practice experiences

Background: Alcohol-based hand sanitizer (ABHS) usage has become one of the COVID-19 pandemic-related adapted responses. Some disulfiram-ethanol reactions are reported in people who use alcohol-based hand rub/sanitizer and take Disulfiram as a treatment for their alcohol use disorders. Aim & Objective: To determine the practice experiences of psychiatrists on disulfiram prescription to alcohol use disorder victims. Methodology: A cross-sectional study on the psychiatrists to find the experiences of disulfiram prescription to their clients with alcohol use disorders during the COVID-19 pandemic. Results: Nearly 84 (51%) were reverted with a completed questionnaire. Among the respondents, 28 (33.3%) of the respondents decreased to prescribe Disulfiram, 48 (57.1%) reported that their patients stopped using ABHS due to fear of Disulfiram-Ethanol Reaction (DER), and 20 (23.8%) responders notified that their patients were expressed their worry on DER with Disulfiram and ABHS. Conclusion: Disulfiram prescribed for alcohol use disorders; treatment got peculiar experiences with the incidences of DER reported with Alcohol-based hand sanitizer. Many practitioners were scared to prescribe disulfiram due to DER with ABHS. The prevailing evidence that there is no possibility of cutaneous application of ABHS producing enough significant DER. Hence using ABHS is not a contraindication for disulfiram prescription.

“CLINICAL PRESENTATION OF HYPERTENSIVE EMERGENCY AND URGENCY PATIENTS”

Arterial hypertension affects approximately a billion people worldwide and approximately 30 % of them remain undiagnosed.1% - 2% of known hypertensive patients will have hypertensive emergency at some time in their life Though hypertensive crisis contributes one fourth of all emergency visits and trend is increasing in last few years still there is lack of data over the actual incidence of hypertensive crisis The present study aims to know the incidence and clinical presentation of the hypertensive crisis ( hypertensive emergency and urgency ) in a tertiary hospital and will help us to know the incidence and pattern of clinical presentation with respect to different aspects. This is a prospective Methods; observational study of 100 cases of hypertensive crisis (hypertensive emergency and hypertensive urgency) presenting to the emergency department. Study conduct during 2016 to 2018. The incidence of hypertensive crisis was found to be Results; 20%.Most of the patients were belonged to the 5th and 6th decades of life and Male patients were more than female patients Majority of the patients were known hypertensives for 6 to 10 years and 22% of the known hypertensive patients has discontinued their anti hypertensive medications Cardiovascular symptoms in the form of dyspnoea & chest pain were the most common accompanying symptoms Acute coronary syndrome was the most common clinical manifestation followed by neurological de?cit. As the trend of hypertensive crisis is increasing efforts should be made to reduce the Conclusion; occurrence of hypertension Preventive measures should be taken in the form of community education for dietary modi?cation and routine exercise Routine blood pressure check ups compliance to the anti hypertensive treatment and control of associated comorbidities is essential to reduce the risk of hypertensive crisis.

Normal and Abnormal Development of Left Vertebral Artery and Its Implications in Cervical Region Surgery

Aortic arch (AA) anomalies occur in approximately 3-5% of cadavers, but these atypical branches remain a point of discussion in cervical region surgery. This case report describes a 73-year-old Caucasian female who died of renal failure following a complicated urinary tract infection whose left vertebral artery (LVA) originated from the AA between the left common carotid and subclavian arteries. The preforaminal part of the LVA was 5 mm in diameter and entered the C6 transverse foramen while the right vertebral artery (RVA) arose from the right subclavian was 6.5 mm in diameter and entered the C5. Embryologically, VAs are formed during weeks four through eight by development of longitudinal anastomoses linking the cervical intersegmental arteries (ISA). The ISA regress except the seventh, which becomes the proximal subclavian artery, the point of origin of the adult VA. Persons with LVA that arises from the AA may be asymptomatic; however, secondary dilatation of the RVA may be implicated in the development of cerebrovascular disorders and atherosclerotic changes due to increased blood flow. Additionally, the anatomical positioning of a left vertebral artery is important when considering an anterior approach for cervical spine surgery and other head-neck procedures when soft structures arteries, veins and muscles are retracted to reach the cervical spine.

Effect of Integrated People-Centred Eye Care (IPEC) Model on Eye Care Seeking Behaviour of Community

Background: World report on vision makes integrated people-centered eye care as care model of choice. Integrating eye care with the existing public health system makes services available, accessible, affordable, and sustainable. Being from the community, Accredited Social Health Activists(ASHAs) are better suited to improve people’s eye health-seeking behavior. Objectives: This study aims to assess the eye care-seeking behavior of community and to understand their response toward the approach of integrated vision centers (VC) with ASHA involvement. Methods: A cross-sectional descriptive study was conducted in South Delhi district where integrated VC were functional for more than a year. These centers were supervised by medical officer in?charge, under whom ophthalmic assistants, ASHAs, auxiliary nurse midwives, and pharmacist work. ASHAs were trained in community-based primary eye care. The community survey was conducted on eye health-seeking behavior and utilization of VC services. Descriptive statistics were used for data analysis. Results: Out of 1571 study participants, 998 reported any ophthalmic illness in family in the past 6 months as against 1302 who reported nonophthalmic illness in family. The majority (1461, 90%) were aware about integrated VC and half of them (748, 51.2%) visited it. Of them, 64.2% were motivated through ASHAs. ASHAs spread awareness about eye diseases, eye treatment facility, and referred patients from the community. The majority (93%) were happy with the integrated VC and 87.8% were happy with ASHAs. Conclusion: Integrated VC with ASHA engagement could pave the way for universal eye health. Understanding people’s needs and engaging community would increase the demand for eye care.

Study of the Efficacy of Uptitrating Teneligliptin Dose from Standard Dose (20 mg) to High Dose (40 mg) in Patients with Type II Diabetes Mellitus

Purpose: To evaluate efficacy for an on-demand treatment of acute bleeding events, pharmacokinetics, safety, and tolerability of HemoRel-A® in severe hemophilia A. Methods: A total of 44 male subjects with severe hemophilia A with an annualized bleed rate of 12 while on-demand treatment with factor VIII (FVIII) were enrolled in the study and received HemoRel-A® for bleed treatment. The efficacy of HemoRel-A® was evaluated based on a four-point scale (excellent, good, moderate, or none). Six-point pharmacokinetic (PK) assessment was performed following a single dose of 50 IU/kg in 12 subjects after a 7-day wash-out period. Safety evaluations were performed at each visit and inhibitor testing was performed in all patients at screening and end of study. Results: Forty-four male subjects received at least a single dose of the study medication and were included in the intent-to-treat (ITT) analysis and safety outcome. In 23 (7.52%) out of the 306 bleeding events, HemoRel-A® efficacy was rated as excellent, in 272 (88.89 %) bleeds it was rated as good, and in 11 (3.68%) bleeding events it was rated as moderate. No failure of efficacy was noted in any of the bleeding events. Thus overall out of 306 bleeding events, 295 (96.41%) showed excellent or good efficacy. Pharmacokinetic assessment based on plasma FVIII activity measured by the chromogenic assay in 12 patients showed comparative results similar to FVIII preparations. A total of 12 adverse events (AEs) were reported in this study. There was no inhibitor development in this previously treated patients (PTP) cohort. Conclusion: HemoRel-A® was established to be efficacious and safe in the treatment of acute bleeding events in subjects with severe hemophilia A.

Correlation Of Core Muscle Strength and Lower Limb Muscle Strength With Lower Limb Functional Status In Healthy Middle Old Population

Background: Aging is a gradual, life-long process and highly variable, characterized by a progressive and cumulative generalized impairment of physiological functions which in turn reduces functional performance and disturbs ADL's & may lead to significant impact on core & lower limb muscles, which are important in functioning. Thus, the study aimed at assessing correlation amongst the core & lower limb muscles and functional status. Methods and procedures: 84 participants between 70-79 years of age (Male:Female = 1:1) were assessed for core strength, Lower limb strength and functional mobility using pressure biofeedback, five times sit to stand and timed up and go test respectively and data was tabulated & analyzed further in SPSS. Results: Spearman's correlation was used in this study which showed significant positive correlation between core strength and lower limb strength with lower limb functional status. (r(Core)=0.813, r(5SST) =0.893; p(Core)=0.00, p(5SST) =0.00) Discussion: Optimal core stability helps maintain the center of gravity within the altered base of support and this could be a reason for individuals with good core strength having better functional mobility. Also force of muscle contraction is directly proportional to velocity of movement which is seen reduced in lower limb musculature because of aging in this population. Conclusion: The present study concluded that strong correlation of core strength and lower limb strength with functional mobility exists among middle old elderly population.

Diagnosis and Management of Acquired Aplastic Anemia: Consensus Statement of Indian Academy of Pediatrics

Justification: In India, there is a lack of uniformity of treatment strategies for aplastic anemia (AA), and many children are managed only with supportive care due to non-availability of hematopoietic stem cell transplantation (HSCT). Process: Eminent national faculty members were invited to participate in the process of forming a consensus statement in Hyderabad in July, 2016. Draft guidelines were circulated to all members, and comments received in a online meeting in October, 2020 were incorporated into the final draft. These were approved by all experts. Objective: To facilitate appropriate management of children with acquired aplastic anemia. Recommendations: Key recommendations are: i) A bone marrow biopsy is must to make a diagnosis of AA; ii) Rule out inherited bone marrow failure syndromes (IBMFS), connective tissue disorders, viral infections, paroxysmal nocturnal hemoglobinuria (PNH), drug or heavy metal induced marrow suppression in all cases of AA; iii) Conservative approach to transfusions should be followed, with a target to keep hemoglobin >6 g/dL in children with no co-morbidities; iv) HLA-matched sibling donor HSCT is the preferred choice of treatment for newly diagnosed very severe/ severe AA; v) In absence of HLA-matched family donor, a matched unrelated donor (MUD) transplant or immunosuppressive therapy (IST) should be considered as alternate choice based on physician expertise; vi) Fludarabine, cyclophosphamide and anti-thymocyte globulin (ATG) based conditioning with cyclosporine and methotrexate as graft versus host disease (GvHD) prophylaxis is the preferred regimen; vii) Horse ATG and cyclosporine are the recommended drugs for IST. One should wait for 3-6 months for the response assessment and consideration of next line therapy.

Cytoprotective Effect of Dietary Squalene Supplementation on Experimentally Induced Cardiomyopathy in Rats

Background: Adriamycin is a broadspectrum, potent, older chemotherapy drug and antineoplastic agent used in the treatment of several cancers such as solid tumours, leukaemias, and lymphomas, playing a major role in cancer chemotherapy. Long-term use of this drug results in congestive heart failure and to overcome this effect dietary squalene intake reduces the adverse effects of adriamycin-mediated cardiotoxicity and cellular oxidative stress. Methods: The current study aims to investigate the cytoprotective effects of dietary squalene supplementation on adriamycin-induced cardiomyopathy in rats in terms of alterations in Troponin T, homocysteine, diagnostic marker enzymes, and cardiac tissue histology. Results: The findings show that a 1.5 percent dose of dietary squalene supplementation for 21 days reduced adriamycin-induced changes in homocysteine, troponin T, diagnostic marker enzymes, and lesions in cardiac tissues. Conclusion: The outcomes of the study specified squalene's cytoprotective action which stabilizes membranes against adriamycin-induced oxidative membrane degradation, which is primarily responsible for heart cell irreversible necrosis.