Effect of Weekly Text Messaging Reminders on Medication Adherence in Hypertension and Type 2 Diabetes Mellitus at a Tertiary Care Center in Eastern Nepal.

Background The short-message service (SMS) reminder techniques are found to be important in increasing medication adherence in non-communicable diseases. Objective To assess the effect of SMS on medication adherence in hypertension and/or type 2 diabetes mellitus. Method An observational study was conducted in the outpatient department using a semistructured questionnaire. Patients having hypertension and/or type 2 diabetes mellitus and taking at least one medication and having low to medium adherence were enrolled and short-message service was sent to them twice a week for up to two months reminding them to take medications as prescribed. At the end of two months, medication adherence was assessed using SPSS at P-value less than 0.05. Result Out of 105 patients, 64 (60.95%) were females. The mean age (±SD) was 51.15 ± 11.01 years. After two months of the short-message service reminders, majority of the patients were graded as having high adherence (73.33%) followed by medium adherence (20.0%) and low adherence (6.67%). The mean medication adherence scores on day one and after two months were 5.50 ± 1.14 and 7.50 ± 0.93 respectively (P-value=0.000). A high medication adherence was seen in individuals aged above 45 years (75.7%), males (78.0%) and those using a basic mobile phone (76.7%) after two months of follow-up; however it was statistically not significant (P-value > 0.05). Conclusion The SMS reminders had significantly improved the medication adherence in patients with hypertension and/or type 2 diabetes mellitus. However, none of the baseline variables were significantly associated with improvement in the adherence.

Synthesis, anti-inflammatory and anticancer activity evaluation of some novel acridine derivatives.

Condensation of 9-chloro-2,4-(un)substituted acridines (1a-c) with various amines (2a-e) and 9-isothiocyanato-2,4-(un)substituted acridines (4a,b) with different amines (2a,b,d,e) gave condensed products 3a-o and 5a-g respectively. Compounds 3a-o and 5a-g were screened for anti-inflammatory activity at a dose of 50mg/kg p.o. Compound 3e exhibited 41.17% anti-inflammatory activity which is better than most commonly used standard drug ibuprofen which showed 39% anti-inflammatory (at 50mg/kg p.o.) activity. Anticancer activity evaluation of compounds 3a-o and 5a-g was carried out against a small panel of human cancer cell lines and compounds 3g, 3m and 5g exhibited good anticancer activity against breast (MCF-7), liver (HEP-2), colon (COLO-205, 502713, HCT-15), lung (A-549) and neuroblastoma (IMR-32) cancer cell lines at a concentration of 1 x 10(-5)M.

Synthesis, anticancer, and anti-inflammatory activity evaluation of methanesulfonamide and amidine derivatives of 3,4-diaryl-2-imino-4-thiazolines.

Condensation of 3,4-diaryl-2-imino-4-thiazoli-nes 1a-j with methanesulfonyl chloride gave methanesulfonamide derivatives 2a-j. Condensation of 2-cyanopyrazine, 4-cyanopyridine, and 2-cyanopyridine with 3,4-diaryl-2- imino-4-thiazolines 1h-m in the presence of sodium methoxide afforded amidine derivatives 3a-j. Compounds 2a-j and 3a-j were screened against various human cancer cell lines (COLO-205, HEP-2, A-549, IMR-32) and their percentage growth inhibition profile determined at 1 x 10(-5)M. The anti-inflammatory activity of these compounds was assessed using the carrageenan-induced paw edema model. Compound 2i exhibited 34.7% anti-inflammatory activity at 50 mg/kg p.o., which is comparable to standard care drug phenyl butazone (37% activity at 50 mg/kg p.o.).

High-resolution computed tomography features in patients with chronic obstructive pulmonary disease.

INTRODUCTION: In recent years, there has been increasing interest in diagnosing various components of chronic obstructive pulmonary disease (COPD) using high-resolution computed tomography (HRCT). The present study was undertaken to evaluate HRCT features in patients with COPD. METHODS: 40 male patients with COPD (age 40 years or older) and with a significant smoking history (20 pack-years or more) were included in the study. They were evaluated for HRCT features including vascular attenuation and distortion, mosaic attenuation pattern, directly visible small airways, low attenuation areas of emphysema and measures of hyperinflation of the lungs: tracheal index, sterno-aortic distance, thoracic cage ratio and thoracic cross-sectional area. RESULTS: The tracheal index ranged from 0.46 to 0.94; Saber-sheath trachea was found in 14 patients. The mean thoracic cage ratio at two levels, carina and 5 cm below carina, were 0.69 (range 0.61-0.78) and 0.73 (range 0.62-0.83), respectively. Sterno-aortic distance at carinal level ranged from 1.43 to 4.55 cm, with a mean of 3.00 cm. Directly visible small airways was the commonest finding (36 patients), followed by vascular attenuation (25 patients), mosaic attenuation pattern (16 patients) and vascular distortion (8 patients). Among various subtypes of emphysema, centriacinar emphysema was commonest (16 patients), followed by paraseptal (13) and panacinar emphysema (11). CONCLUSION: There are certain specific HRCT features of emphysema and it is possible on HRCT to identify the subtypes of emphysema, such as centriacinar, panacinar and paraseptal emphysema. Various features of hyperinflation can also be well identified and quantified on HRCT.

Synthesis of amidine and amide derivatives and their evaluation for anti-inflammatory and analgesic activities.

A number of amidine derivatives (2a-i) have been synthesized by condensation of 2-cyanopyridine with various 3,4-diaryl-2-imino-4-thiazolines. Various amide derivatives (3a-h) were synthesized by condensation of orotic acid and hydantoin-5-acetic acid with a number of 3,4-diaryl-2-imino-4-thiazolines using microwave irradiation. All the compounds i.e. (2a-i) and (3a-h) synthesized were characterized by spectroscopic means and elemental analysis. Compounds (2a-i) and (3a-h) at 50 mg/kg p.o. were screened for anti-inflammatory activity whereas 2a-d, f, g, i and 3a, b, d, f at 50 mg/kg p.o. were evaluated for analgesic activity. Compounds 2e and 3g exhibited good anti-inflammatory activity (49% and 34%, respectively) and 2f, g showed interesting (50% in each case) analgesic activity.

Multiple foreign bodies in a neonate.

We report a rare instance of nine foreign bodies in a neonate that included a coin, safety pin, screw, cotton piece, polythene piece, and four glass pieces. Of these, six foreign bodies were removed by esophagoscopy and endoscopy, two glass pieces were passed in feces and one could not be removed. The child died 5 days after admission.

Subclinical peripheral neuropathy in stable middle-aged patients with chronic obstructive pulmonary disease.

INTRODUCTION: Presently, there are few studies addressing the subject of peripheral neuropathy in patients with chronic obstructive pulmonary disease (COPD). Consequently, there is a dearth of evidence and awareness of subclinical neuropathy in stable COPD patients with no significant hypoxaemia, particularly in the age group of 40-60 years. The present study was designed to evaluate the subclinical peripheral neuropathy in this study group. METHODS: 60 subjects were included in the study. The COPD group comprised 30 male smokers with stable COPD, aged between 40 and 60 years and with no clinical neuropathy; and 30 age-matched healthy male volunteers served as the control group. The following nerves were evaluated for latency, amplitude and conduction velocity: for motor nerve conduction - median nerve, ulnar nerve, and common peroneal nerves; and for sensory nerve conduction - median nerve, ulnar nerve, and sural nerves. RESULTS: Five out of 30 COPD patients had peripheral nerve impairment on electrophysiological evaluation. In these patients, we found decreased amplitude and conduction velocity in all examined sensory nerves; however, the conduction velocity was found to be more than 70 percent of the predicted value. These findings were suggestive of predominantly sensory (with milder involvement of motor nerves) axonal polyneuropathy. CONCLUSION: We observed five out of 30 COPD patients to have predominantly sensory axonal peripheral neuropathy. These five COPD patients had significantly higher consumption of cigarettes, longer duration of illness and advanced airflow obstruction when compared to COPD patients with no peripheral neuropathy.

Drug resistant tuberculous osteomyelitis of small bones of foot.

Drug resistant tubercular osteomyelitis of small bones of foot is not reported frequently. The case described here had isoniazid resistant tuberculous osteomyelitis of small bones of foot. The probable mechanism was endogenous reactivation of previously disseminated foci of drug resistant bacilli from the primary site in the lung.

Awareness about the disease in asthma patients receiving treatment from physicians at different levels.

Morbidity and mortality due to asthma continue to increase worldwide. One of the reasons is an inadequate patient awareness regarding the disease and its treatment. One thousand four hundred patients with reversible airflow obstruction due to bronchial asthma were included in this study and assigned to one of the four groups depending on whom they had consulted before. The patients were asked to complete a questionnaire which included questions regarding the disease, its course, understanding of treatment schedules, correct use of inhaler devices, use of peak flow meter and when to take emergency actions. The awareness regarding the disease, avoidance of trigger factors, treatment adherence, and correct use of inhaler devices was found to be greater in patients who had received initial treatment from a qualified physician and was best among those treated at the Institute level. The use of peak flow meter by the patients for objective assessment of asthma and the awareness regarding use of emergency care services was found to be poor among all the groups. To improve patient awareness and quality of asthma care delivery, private practitioners as well as Institute doctors must be included in continuing medical education programmes and various methods of communications with patients should be used along with separate clinics for asthma at the Institute level.

Comparative functional characterization of mouse bone marrow-derived mast cells and peritoneal mast cells in response to non-immunological stimuli.

The cultured mouse mast cells that are dependent on spleen-derived factor for their proliferation and maintenance and have been shown to be similar to mucosal mast cells in terms of their T-cell dependence and histochemical staining characteristics. Mast cell heterogeneity has been confirmed by functional characterization of mouse bone marrow-derived mast cells (MBMMC) and mouse peritoneal mast cells (MPMCs). MPMCs released around 30% of histamine when stimulated with compound 48/80 whereas MBMMC were almost unresponsive to the same stimulus. Calcium Ionophore A23187 on the other hand, released histamine in dose-dependent manner from MBMMC. The study was undertaken to investigate the effect of antiallergic drug, disodium cromoglycate (DSCG), a synthetic cromone and quercetin, a plant-derived flavonoid on Ca ionophore A23187 induced histamine release from MBMMC. MBMMCs were almost unresponsive to DSCG whereas Ca Ionophore induced histamine release was blocked by Quercetin. The results indicate that response of mast cells at one anatomic site to a given stimulus does not necessarily predict the response of mast cells at a different anatomic location to the same stimulus. It shows functional heterogeneity within a single species. So, it cannot be assumed that antiallergic compounds stabilizing mast cells in one tissue site or organ will be equally efficacious against mast cells in other sites.

Antiallergic/antiasthmatic effect of novel antiallergic hexapeptide-95/220 in various experimental models.

The effects of newly synthesized antiallergic hexapeptide 95/220 was investigated on various allergic and asthmatic test models. This newly developed peptide was found to be more potent than clinically used drug disodium cromoglycate (DSCG). Hexapeptide 95/220 inhibited immediate hypersensitivity reactions such as passive cutaneous anaphylaxis (PCA) and mast cell degranulation in rats, antigen-induced bronchoconstriction in actively sensitized guinea pigs in dose dependent manner like DSCG. Antigen-induced contraction of guinea pig ileum was also markedly inhibited by this newly developed hexapeptide in the same fashion as ketotifen and DSCG did but at comparatively lower dose. Egg albumin-induced histamine release was also blocked by this hexapeptide from chopped lung tissues of sensitized guinea pigs. These results suggest that hexapeptide' 95/220 has potent inhibitory effect on immediate hypersensitivity reactions thereby inhibiting mediator release from mast cell. Moreover, this newly synthesized peptide is orally active and effective at lower doses as compared to standard drugs.

Effect of immunosuppression on the clinicopathological changes in experimental zygomycosis in rabbits.

A study was undertaken to investigate the effect of immunosuppression by cyclophosphamide or methylprednisolone on the clinicopathological alterations in respiratory absidiosis in rabbits. Infected rabbits showed respiratory distress that was more severe in immunosuppressed groups. Leukocytosis due to neutrophilia was observed in the non-immunosuppressed group in the initial stages, whereas leukopenia was observed in both the immunosuppressed groups initially, owing to polymorphopenia in the cyclophosphamide-treated group and to lymphopenia in the methylprednisolone-treated group, followed by leukocytosis in both groups. Total serum proteins increased significantly in the non-immunosuppressed group but were significantly decreased in the immunosuppressed groups. Serum creatinine increased significantly in all the infected groups from 20 days post inoculation (DPI) onwards. Blood urea nitrogen increased significantly in the initial stages only in the methylprednisolone-treated group. AST and ALT also showed significant increases in the infected animals. Total serum immunoglobulins and circulating immune complexes increased gradually in all three infected groups, except for an initial significant drop in the immunosuppressed rabbits. Re-isolation of fungus was only achieved from the lungs of infected rabbits up to 15 DPI in the non-immunosuppressed group and 30 DPI in the immunosuppressed groups. Pathological lesions in all the infected groups were found mainly in the lungs and consisted of pyogranulomas. The lesions were most severe in the cyclophosphamide-treated group and least severe in the non-immunosuppressed group.

Immunomodulatory effect of albizzia lebbeck.

The immunomodulatory effect of the bark of Albizzia lebbeck (Sirisha) was evaluated by studying humoral and cell mediated immune responses. The hot aqueous extract and its butanolic fraction were administered once daily for one week in mice, immunised previously with sheep red blood cells (SRBC). At the dose levels tested (6.25, 12.5 and 25 mg/kg, p.o.), A. lebbeck treated mice developed higher serum antibody titres compared to the vehicle treated group and the effect was comparable to the standard drug muramyl dipeptide (MDP). Delayed type hypersensitivity response was suppressed in SRBC immunised mice treated with A. lebbeck extract. The macrophage migration index remained unaltered in both mice and rats. These results are discussed in the light of possible immunopotentiating effects of A. lebbeck.

Sequential clinical, haematological, biochemical, immunopathological and histopathological alterations in buffalo calves (Bubalus bubalis) intravenously infected with Absidia corymbifera.

Absidiosis was produced experimentally in 18 buffalo calves by intravenous inoculation of spores of Absidia corymbifera. Infected animals exhibited dullness, depression, partial anorexia and an initial pyrexia and coughing during the first week and two animals died on each of 9, 13 and 16 days post infection (DPI). The haemoglobin concentration and total erythrocyte count showed no appreciable change from their basal values at any stage of the experiment. However, the erythrocyte sedimentation rate and total leukocyte count increased significantly in the infected animals. The differential leukocyte count revealed a relative neutrophilia from 5 to 20 DPI. There was a significant increase in the serum total proteins, blood urea nitrogen, creatinine, alanine aminotransferase, aspartate aminotransferase, serum alkaline phosphatase, total immunoglobulins and circulating immune complexes in the infected animals as compared to the controls. In the sera of the infected animals, specific Absidia corymbifera IgM and IgG antibodies were detected from 3 DPI to 6 DPI respectively by Dot-EIA. Type I and type III skin hypersensitivity were detected from 10 DPI and type IV hypersensitivity from 15 DPI onwards. The gross and microscopic pathological lesions were seen mainly in the lungs, in all except one of the affected animals. This animal died 9 DPI and mycotic granulomas were also seen in its heart and kidneys. The microscopic lesions in the lung took the form of well-developed granulomas.

Evaluation of antiallergic activity (type I hypersensitivity) of Inula racemosa in rats.

Alcoholic extract of root of Inula racemosa, was studied for its antiallergic effect in experimental models of type I hypersensitivity, viz. egg albumin induced passive cutaneous anaphylaxis (PCA) and mast cell degranulation in albino rats. The alcoholic extract was prepared by the process of continuous heat extraction. LD50 of this extract was found to be 2100 +/- 60 mg/kg, i.p. Assessment of protection against egg albumin induced passive cutaneous anaphylaxix by different doses of Inula racemosa was done by giving drug intraperitoneally or orally for seven days or once only. Mast cell degranulation studies were done by using compound 48/80 as degranulation agent with same dosage schedule. Inula racemosa (i.p. as well as p.o.) showed significant protection against egg albumin induced PCA. Protection against compound 48/80 induced mast cell degranulation by alcoholic extract of Inula racemosa (single dose) was similar to that of disodium cromoglycate. The seven days drug treatment schedule showed greater protection than disodium cromoglycate intraperitoneally. The results suggest that Inula racemosa possesses potent antiallergic properties in rats.

Effect of immunosuppression on the pathogenesis of respiratory zygomycosis in rabbits intranasally infected with Absidia corymbifera.

The study was envisaged for elucidating the effect of immunosuppression on the pathology and pathogenesis of experimental respiratory absidiomycosis in rabbits. Seventy rabbits used in the experiment were divided into different groups viz. non-immunosuppressed, immunosuppressed with cyclophosphamide and immunosuppressed with methylprednisolone respectively, and a control group. The experiment was continued for 50 days during which all the infected animals exhibited clinical signs of respiratory distress but no mortality. The infected rabbits showed gross lesions mainly in the form of pneumonic consolidations in the lungs in antero-ventral lobes initially followed by spread to the other lobes. Similarly, microscopic lesions were restricted to lungs and consisted of early pyogranulomas dominated by fungal invasion and spread, followed by chronic granulomatous reaction and a recovery during the later stages. Fungus was demonstrated and re-isolated only from lung lesions up to 15 days postinfection (DPI) in non-immuno-suppressed group and up to 30 DPI in both the immunosuppressed groups suggesting no systemic dissemination. The findings of the present study indicated that immunosuppression increased the extent, duration and severity of the pathological lesions associated with absidiomycosis in the lungs. Moreover, an assessment based on gross and histopathological lesions revealed cyclophosphamide to be a more potent immunosuppressant than methylprednisolone.

Antiallergic/antiasthmatic activity of oligopeptide related to IgE.

In spite of continuous research in the field of bronchial asthma, still no satisfactory drug is available. Recently a new class of oligopeptide exhibited antiallergic activity by inhibiting the synthesis of IgE antibody. The analogue of ADSDGK (94-335) has shown antiallergic activity in experimental models. The 94-335 inhibited the passive cutaneous anaphylaxis (PCA) reactions in rats in a dose-dependent manner (0.5-10 mg kg-1 p.o.) by 47-90%. There was a 70-87% protection of mast cell degranulation induced by compound 48/80 with peptide 94-335 at 0.5-1.5 mg kg-1 p.o. in rats. This peptide also inhibited antigen- induced contraction in sensitised guinea pig ileum. There was 18 and 72% protection to bronchoconstriction induced by histamine and egg albumin, respectively, in an aerosol test in guinea pigs. These effects of compound 94-335 were comparable with that of the clinically-used antiallergic drug disodium cromoglycate (DSCG). The results suggest that peptide 94-335 possesses potent antiallergic activity.