In-vitro Cytotoxicity Investigations for Phytoconstituents of Saudi Medicinal Plants With Putative Ocular Effects.

BACKGROUND: Metastatic secondary ocular tumors spread from systemic malignancies, including breast cancer. This study aimed to evaluate the cytotoxicity of extracts from 5 medicinal plants native to Saudi Arabia. METHODS: For preliminary activity screening, cytotoxicity using the MTT assay and selectivity index determinations were made for medicinal plant extracts against various cancer cell-lines. The most promising extract was subjected to GC-MS analysis to determine the phytochemical composition. Clonogenic assays were performed using the most promising extract to confirm the initial results. Finally, western blot analysis was used to determine the modulation in expression of survivin and P27 suppressor genes in the human breast adenocarcinoma (MCF7) cell-line to understand the potential mechanistic properties of the active plant extract. RESULTS: The 5 plant extracts showed various cytotoxic activity levels using IC50. The most active extract was found to be the leaves of Capparis spinosa L. (BEP-07 extract) against the MCF7 breast cancer cell-line (IC50 = 3.61 ± 0.99 µg/ml) and selectivity index of 1.17 compared to the normal human fetal lung fibroblast (MRC5) cells. BEP-07 extract showed a dose dependent clonogenic effect against the MCF7 colonies which was comparable with the effect of doxorubicin. BEP-07 extract caused a significant decrease of survivin and increase in P27 expression compared to control GAPDH at its highest dose (14 µg/ml). The GC-MS chromatogram of Capparis spinosa L. (BEP-07 extract) revealed the existence of 145 compounds, belonging to the diverse classes of phytoconstituents. Fatty acids and their derivatives represent 15.4%, whilst octadecanoic acid, 2,3-dihydroxypropyl ester was the principal component (7.9%) detected. CONCLUSION: Leaves of Capparis spinosa L. (BEP-07 extract) exhibited a significant cytotoxic effect particularly against breast cancer cells. It exhibited this effect through survivin inhibition and via P27 upregulation. The detected phytoconstituents in the plant extract might be involved in tested cytotoxic activity, while further investigations are required to complete the drug candidate profile.

Treatment of Steroid-Resistant Nodular Episcleritis With Tacrolimus: A Case Report.

A 46-year-old male, with no chronic medical illness, complained of pain, tearing, and redness for one-month duration, with no photophobia, discharge, or decrease in visual acuity. Examination revealed a small, painful, red swelling in the left sclera. Slit-lamp examination using a narrow bright slit beam revealed edema of the episcleral layer and injection of the superficial episcleral blood vessels. The rest of the anterior segment exam and fundoscopy were normal. The laboratory investigations and systemic workup were normal. The patient was initially treated with prednisolone acetate (Pred Forte) 1% every three hours per day for one week, and then four times per day for another week, and tapered gradually over eight weeks with systemic nonsteroidal anti-inflammatory drugs (NSAIDs) as diclofenac sodium for eight weeks with mild improvement of clinical symptoms, but the size of the lesion remained without any change and the patient started to have a relapse of symptoms at the end of the course. Topical tacrolimus drops of 0.1% concentration were prepared in the pharmacy under complete sterile precautions and were used four times per day for the following six weeks duration instead of the initial therapy (steroids and NSAIDs). Tacrolimus drops were then tapered gradually over another six weeks duration. The patient showed dramatic suppression of inflammation and exceptional remission of symptoms with complete resolution of the episcleritis. Topical tacrolimus is very effective in the treatment of nodular episcleritis, which is resistant to steroid therapy. Patients with nodular episcleritis suffer from prolonged bouts of inflammation that are characteristically more painful than the diffuse type and may be associated with other systemic diseases. The case is steroid-resistant nodular episcleritis, which did not respond to the usual treatment and showed a good response to treatment with tacrolimus, which was first introduced in episcleritis. Tacrolimus is being used in other ocular diseases, but its use in episcleritis is unique.

The use of medicinal plants in common ophthalmic disorders: A systematic review with meta-analysis.

Purpose: This study aimed to assess and compile the available research articles about medicinal plants used for ocular diseases. Principal results: A total of 2949 articles were retrieved, 35 full-text articles were assessed for eligibility, and seven studies (4 observational and three experimental) with low to moderate quality were eligible and involved in the systematic review, with a total of 600 plants from 4 countries. Among the 600 plants, only 24 (4%) were used to assess the status. Both the fixed and random models of the studies showed that the included studies tended to predict the results for the observational studies (OR = 0.062, CI = 0.043-0.090 OR = 0.039, CI = 0.012-0.122) for different plants used for ocular diseases. High heterogeneity (estimated as I2 = 87.078, Tau2 = 1.161 and Q-value = 23.217 with a p-value of 0.000), while for experimental studies (I2 = 94.928, Tau2 = 23.211 and Q-value = 39.434 with a p-value of 0.000) and publication bias were reported. Conclusion: Few articles representing approximately 600 plants of low to moderate quality reported using medicinal plants for ocular diseases. The meta-analysis confirmed the systematic review findings regarding the plants' traditional use with high heterogeneity and publication bias. A considerable gap was proven in the use of medicinal plants in ocular diseases requiring intensive research.

Optimal Steps for designing and implementing the extracurriculars through the integrative medical approach.

Extracurriculars are those that fall outside the scope of the academic curriculum. The purpose of the work is to outline the steps of planning extracurriculars, practice these steps in the medical program, and evaluate these steps. Methods: Using Kern's steps with some modifications, we did some extracurricular reforms. Assessment of the current situation/needs and identification of gaps have been occurred by a questionnaire that revealed low students' satisfaction (36.1%) about the current extracurriculars with points of weakness that have been addressed in the improvement plan. A list of extracurriculars was prepared and aligned with modules and learning outcomes. Allocation of resources and implementation of these extracurriculars were performed. The evaluation was done through a questionnaire that was fulfilled by 404 students. Results: Students' satisfaction was 66.8% in the second questionnaire compared to 36% in the initial questionnaire with a significant association. Further analysis of the respondents who revealed satisfaction showed that 95 out of 140 (67.8%) were high-grade achievers, 88 out of 134 (65.7%) for moderate, and 87 out of 130 (66.9%) in low-grade achievers. A comparison of the student's satisfaction in the three phases revealed a significant p-value (0.004), but no significance in students' satisfaction within phases of the program between males and females. Conclusion: Well-structured extracurriculars might contribute to the achievement of the mission, vision, and goals of the program. Extracurricular activities might be flexible and undergo periodic changes related to the nature of the curriculum. Following the cycle of developing extracurricular activities in designing, implementing, monitoring, evaluating, and reporting, the extracurricular activities will be more efficient in enhancing the learning climate and making the learning process more enjoyable, especially in a solid medical integrated curriculum.

The efficacy of self-directed learning versus problem-based learning for teaching and learning ophthalmology: a comparative study.

INTRODUCTION: Self-directed learning (SDL) and problem-based learning (PBL) are fundamental tools to achieve lifelong learning in an integrated medical curriculum. However, the efficacy of SDL in some clinical courses is debated. AIM: The aim of the study was to measure the effectiveness of SDL for an ophthalmology course in comparison with PBL. METHODS: A cross-sectional study was conducted with fifth-year medical students enrolled in an ophthalmology course. SDL comprised four case-based scenarios guided by several questions. PBL comprised three sessions. An ear, nose, and throat (ENT) course was selected for comparison as a control. At the end of the course, 30 multiple-choice questions (MCQs) for both SDL and PBL were assessed and analyzed against their counterparts in the ENT course by an independent t-test. RESULTS: For the SDL component of the ophthalmology course, the number and percentages of students attaining high (n = 6/60, 10%) and moderate (n = 15/60, 28.3%) scores on an MCQs written exam were evaluated. For the PBL component, high scores were seen for 23.3% (n = 14/60), and moderate scores for 33.3% (n = 20/60) of the participants. For the SDL component of the ENT course, the number and percentages of students attaining high (n = 14/60, 23.3%) and moderate (n = 17/60, 28.3%) scores were recorded. For the PBL component, high (16/60, 26.6%) and moderate (17/60, 28%) scores were recorded. Significant p-values were obtained between the results for SDL and PBL in the ophthalmology course (p = 0.009), as well as between SDL results for both courses (p = 0.0308). Moreover, differences between the SDL results of ophthalmology and the PBL results of ENT (p = 0.0372) were significant. CONCLUSION: SDL appears to be less valuable for promotion of self-readiness. Periodic discussions in small groups or by panel discussion are strongly recommended for students to enhance readiness with SDL.

Absorbance and Light Scattering of Lenses Organ Cultured with Glucose.

Purpose/Aim: Diabetes is one of the major factors related to cataract. Our aim is to determine if the attenuation of light through glucose treated lenses was due to light scattering from structural changes or absorbance from metabolic changes. MATERIALS AND METHODS: Human and rat lenses were cultured in a medium with and without 55 mM glucose for a period of 5 days. Absorbance and light scattering were measured using a ultraviolet spectrometer. Aldose reductase and catalase activity, RAGE, and glutathione were measured using classical assays. RESULTS: Almost all of the glucose related attenuation of light through the human lens was due to light scattering from structural changes. Glucose treatment caused three absorbance band to appear at 484, 540 to 644 and 657 nm in both the rat and human lens. The optimum time point for equilibration of human lenses was found to be between 2 and 3 days in organ culture. Glucose caused a more significant effect on the opacity of human lenses compared with rat lenses. Since the levels of glutathione, catalase, and aldose reductase were reduced in glucose treated rat lenses compared with untreated lenses, glucose may have caused oxidative stress on the rat lens. CONCLUSIONS: The absorbance and light scattering of glucose treated lenses in organ culture were quantitated for the first time which could be important for future studies designed to test the efficacy of agents to ameliorate the opacity. Almost all of the glucose related attenuation of light through the human lens was due to light scattering from structural changes and not absorbance from metabolic changes. Glucose caused a more significant effect on the opacity of human lenses compared with rat lenses. The lens model employed could be used to study the efficacy of agents that potentially ameliorate lens opacity.