Orbital foreign body- Study of a case series.

BACKGROUND: Orbital foreign bodies (OFBs) may remain in the orbital cavity for considerable time and manifest with secondary complications. OBJECTIVE: To report five consecutive cases of orbital trauma with OFBs, who presented at our institute from Jan 2010 to Dec 2013. CASES: The first case of our series with a non-specific history of injury had a chronic granulomatous discharging sinus in the left upper eyelid and an intact globe. The second case, with an injury to the left lower eyelid following an assault, presented late and the manifestations were similar to that of the first case. The third case, of a road traffic accident, had sustained multiple facial and periocular injuries. The nature of all of three OFBs was uncertain by CT- scan, till surgical exploration. The fourth case had sustained injury to his left eye by a flying metal object. X-ray was sufficient to detect the OFB, but as scleral penetration was associated, management was complex. The fifth case had a nonspecific history of injury and the manifestation was similar to that of the first case. The surgical exploration revealed multiple OFB (wood). CONCLUSION: The OFBs pose difficult diagnostic and therapeutic challenges. Management of such cases, at times, calls for innovation in decision making and formulation of strategies.

Chlamydia trachomatis: TLR4-mediated recognition by human dendritic cells is impaired following oestradiol treatment.

Genital Chlamydia trachomatis infection creates a substantial reproductive health burden in women. The high incidence of asymptomatic infection often precludes timely antibiotic therapy to control the sequelae of infection, and therefore a vaccine is required. Dendritic cells (DC) are now being used as an adjuvant for vaccine development; however, the fate of C. trachomatis in human DC and differential regulation of cytokine secretion remains unclear. Hence, an in vitro study was performed using C. trachomatis (serovar D) elementary body (EB)-pulsed, monocytederived DCs co-cultured with autologous CD4+ T cells. Secreted cytokines were measured to assess the protective/pathogenic immune response. The effect of (beta-oestradiol in the modulation of DC function and on Toll-like receptor (TLR) gene expression was also studied. Elementary body-pulsed DCs showed induction of protective Th1 immune response with upregulation of TLR4 expression, secretion of interleukin (IL)-6, IL-12 and interferon (IFN)-y, together with upregulation of major histocompatibility complex (MHC) class II, CD83 and CD86. When co-cultured with autologous CD4+T cells, DCs presented chlamydial antigens efficiently, as shown by proliferation of T cells and secretion of IL-2 and IFN gamma, which provide a protective immune response. However; pretreatment of cells with oestradiol significantly reduced TLR4 expression and upregulated IL-10 secretion, modulating the Th1 immune response to a Th2-type response, which may lead to pathogenesis.

Linguistic validation of the N-QOL (ICIQ), OAB-q (ICIQ), PPBC, OAB-S and ICIQ-MLUTSsex questionnaires in 16 languages.

OBJECTIVE: Overactive bladder (OAB) is a highly prevalent condition with a negative impact on both health-related quality of life and sexual functioning. We aimed to create and validate conceptually equivalent tools to assess OAB for use in diverse cultural and linguistic settings. RESEARCH DESIGN AND METHODS: To evaluate the linguistic validity of harmonised translations of the Nocturia Quality of Life (N-QOL) questionnaire, Overactive Bladder Questionnaire (OAB-q) family, Patient Perception of Bladder Condition (PPBC) questionnaire, Overactive Bladder Satisfaction Questionnaire (OAB-S) and International Consultation on Incontinence Questionnaire (ICIQ) Male Sexual Matters associated with Lower Urinary Tract Symptoms Questionnaire (ICIQ-MLUTSsex), bilingual (target language and English) interviewers cognitively debriefed subjects to assess their ability to paraphrase and understand the instructions, questions and responses within each questionnaire. RESULTS: Overall item comprehension rates were 96% for the N-QOL, 98.9% for the OAB-q, 92% for the PPBC, 98.5% for the OAB-S and 94.3% for the ICIQ-MLUTSsex. DISCUSSION: We found that the translations were well-understood by subjects, although a number of minor changes were made to the N-QOL, OAB-q, OAB-S and ICIQ-MLUTSsex translations in an effort to improve clarity and cultural appropriateness. In a few instances, the majority of subjects in a language were unable to paraphrase a specific term or phrase prior to the revisions. In several cases, problems arose from the wording of the question in the source language. CONCLUSIONS: The translated instruments in this study demonstrated a high level of overall linguistic validity.

Recruitment of myeloid and plasmacytoid dendritic cells in cervical mucosa during Chlamydia trachomatis infection.

The mobilization of myeloid dendritic cells (mDCs) and plasmacytoid dendritic cells (pDCs) to the cervix during chlamydial infection is not fully understood, and the role of these cells in immunopathogenesis is largely unknown. As an effective vaccine to control chlamydial infection is currently unavailable, understanding the regulation of the local immune response becomes a necessity. Therefore, mDC and pDC populations were analysed in peripheral blood and cervical samples of controls and Chlamydia-positive women, with or without mucopurulent cervicitis (MPC). Cervical cytokines and C-reactive protein levels in serum were quantified by ELISA and the chlamydial infectious load by culture. Chlamydia trachomatis infection mobilized both mDCs and pDCs to the cervical mucosa. pDCs were recruited more often in women with MPC (p <0.05) and they correlated significantly with the chlamydial load, C-reactive protein levels and cervical interleukin-8 (IL-8) levels. Upregulation of surface expression of co-stimulatory molecules (CD80, CD83 and CD86) on cervical mDCs and pDCs was observed during chlamydial infection but was significant only for mDCs. Significantly higher levels of IL-1 beta, IL-6 and IL-8 were observed in Chlamydia-positive women with MPC; however, after therapy, IL-8 levels decreased significantly. Median numbers of mDCs after therapy were significantly higher in the cervix and blood of infected women as compared to the numbers of pDCs, which were found to be lower in the cervix after therapy. These results thus suggest that during chlamydial infection, both mDCs and pDCs are recruited to the cervix, but their number and possible immunological functions may differ with the pathological condition. pDCs were associated more often with MPC and inflammatory factors, suggesting that they may possibly be involved in the immunopathogenesis of infections due to Chlamydia.

Mucosal and peripheral immune responses to chlamydial heat shock proteins in women infected with Chlamydia trachomatis.

Most of the studies on 60-kDa and 10-kDa chlamydial heat shock proteins (HSPs) to date have been carried out with blood lymphocytes or serum antibody responses, which do not provide a clear picture of the actual pathogenesis as they do not differentiate primary infection from recurrent infection. Thus, in the present study induction of the immune response was evaluated by studying lymphoproliferation of both cervical and peripheral lymphocytes to synthetic peptides of cHSP60, cHSP10 and major outer membrane protein (MOMP) antigen. In addition, cervical antibody prevalence to MOMP antigen, cHSP60 and cHSP10 and cytokine levels in cervical washes was also determined. Positive proliferative responses of cervical lymphocytes to cHSP10 peptide were significantly higher (P < 0.05) in women with recurrent infections and that to MOMP antigen were significantly higher in primary infection. On proliferation of PBMCs with the above antigens, no significant difference was observed between primary and recurrent infection. Prevalence of cervical IgG and IgA antibodies to Chlamydia trachomatis was significantly higher (P < 0.05) during primary infection than recurrent infections. In contrast, prevalence of IgG and IgA antibodies to cHSP10 and IgG antibodies to cHSP60 was higher during recurrent infections than primary infections. Interferon (IFN)-gamma levels were significantly higher in cervical washes of women with recurrent infection and correlated strongly with cHSP60 antibody titres. Our data thus suggest that mucosal responses are more appropriate in understanding the pathogenesis of chlamydial infection and IFN-gamma could be involved in the modulation of immune responses towards chlamydial infection directly, by causing acute inflammation, or indirectly through modulation of HSP expression.

Pterocarpus marsupium extract (Vijayasar) prevented the alteration in metabolic patterns induced in the normal rat by feeding an adequate diet containing fructose as sole carbohydrate.

Insulin resistance (hyperinsulinaemia) is now recognized as a major contributor to the development of glucose intolerance, dyslipidaemia and hypertension in non-insulin-dependent diabetes mellitus (NIDDM) patients. Sedentary lifestyle, consumption of energy-rich diet, obesity, longer lifespan, etc., are important reasons for this rise (J. R. Turtle, Int J Clin Prac 2000; 113: 23). Aqueous extracts of Pterocarpus marsupium Linn bark (PM), Ocimum sanctum Linn leaves (OS) and Trigonella foenumgraecum Linn seeds (FG) have been shown to exert hypoglycaemic/antihyperglycaemic effect in experimental as well as clinical setting. As no work has been carried out so far to assess the effect of PM, OS and FG on fructose-induced hyperglycaemia, hyperinsulinaemia and hypertriglyceridaemia, we undertook this study to assess whether these extracts attenuate the metabolic alteration induced by fructose-rich diet in rats. Five groups of rats (eight each) were fed chow diet, 66% fructose diet, 66% fructose diet + PM leaves extract (1 g/kg/day), 66% fructose diet + OS leaves extract (200 mg/kg/day) and 66% fructose diet + FG seeds extract (2 g/kg/day) for 30 days. Fructose feeding to normal rats for 30 days significantly increased serum glucose, insulin and triglyceride levels in comparison with control. Treatment with all the three plants extract for 30 days significantly lowered the serum glucose levels in comparison with control group. However, only PM extract substantially prevented hypertriglyceridaemia and hyperinsulinaemia, while OS and FG had no significant effect on these parameters. Results of this study, in addition to previous clinical benefits of PM seen in NIDDM subjects, are suggestive of usefulness of PM bark (Vijayasar) in insulin resistance, the associated disorder of type 2 diabetes; however, OS and FG may not be useful. Though several antidiabetic principles (-epicatechin, pterosupin, marsupin and pterostilbene) have been identified in the PM, yet future studies are required to certify their efficacy and safety before clinical scenario.

Anti-cataract activity of Pterocarpus marsupium bark and Trigonella foenum-graecum seeds extract in alloxan diabetic rats.

Long-term complications are frequently encountered in diabetes mellitus and are difficult to treat. This study was undertaken to assess the effect of three antidiabetic plants on the development of cataract in rats. An aqueous extract of Pterocarpus marsupium Linn bark (PM, Hindi name: Vijaysar) (1 g kg(-1) day(-1)), Ocimum sanctum Linn leaves (OS, Hindi name, Tulsi) (200 mg kg(-1) day(-1)) and alcoholic extract of Trigonella foenum-graecum Linn seeds (FG, Hindi name, Methi) (2 g kg(-1) day(-1)) were given to alloxan (120 mg kg(-1)) diabetic rats until the development of cataract. Serum glucose and body weight were monitored at regular intervals while cataract was examined through naked eye as well as slit lamp at 75, 100 and 115 days after alloxan administration. Administration of all the three plant extracts exerted a favorable effect on body weight and blood glucose, the effects were best with PM followed by FG and OS. On the course of cataract development, PM followed by FG exerted anti-cataract effect evident from decreased opacity index while OS failed to produce any anti-cataract effect in spite of significant antihyperglycemic activity.

Brassica juncea (Rai) significantly prevented the development of insulin resistance in rats fed fructose-enriched diet.

Brassica juncea (BJ; Hindi name: Rai) seeds and Murraya koenigii (MK; English names: Curry leaves) leaves, used as food ingredients and also by diabetics in India, were assessed in a fructose-mediated non-genetic model of insulin resistance. Feeding of fructose rich diet for 30 days resulted in rise in blood glucose by 29.4%, insulin by 101.2% and cholesterol by 26.7% indicating development of insulin resistance. However, feeding of a fructose diet containing 10% Brassica juncea seeds powder for 30 days significantly decreased fasting serum glucose, insulin and cholesterol levels but did not normalize them. On the other hand, a diet containing 15% Murraya koenigii leaves powder failed to exert any effect on these parameters. Results of the present study suggests that BJ can play a role in management of pre-diabetic state of insulin resistance and should be promoted for use in patients prone to diabetes.

Ethanolic extract of Ocimum sanctum leaves partially attenuates streptozotocin-induced alterations in glycogen content and carbohydrate metabolism in rats.

Ocimum sanctum (OS) has been mentioned in Indian system of traditional medicine to be of value in the treatment of diabetes mellitus. We have previously shown that OS shows a dose-dependent hypoglycemic effect and prevented rise in plasma glucose in normal rats. It also showed significant antihyperglycemic effect in STZ-induced diabetes. The present study was undertaken to assess the effect of OS on three important enzymes of carbohydrate metabolism [glucokinase (GK) (EC 2.7.1.2), hexokinase (HK) (EC 2.7.1.1) and phosphofructokinase (PFK) (EC 2.7.1.11)] along with glycogen content of insulin-dependent (skeletal muscle and liver) and insulin-independent tissues (kidneys and brain) in STZ (65 mg/kg) induced model of diabetes for 30 days. Administration of OS extract 200mg/kg for 30 days led to decrease in plasma glucose levels by approximately 9.06 and 26.4% on 15th and 30th day of the experiment. Liver and two-kidney weight expressed as percentage of body weight significantly increased in diabetics (P<0.0005) versus normal controls. OS significantly decreased renal (P<0.0005) but not liver weight. Renal glycogen content increased by over 10 folds while hepatic and skeletal muscle glycogen content decreased by 75 and 68% in diabetic controls versus controls. OS did not affect glycogen content in any tissue. Activity of HK, GK and PFK in diabetic controls was 35, 50 and 60% of the controls and OS partially corrected this alteration.

Cyclo-oxygenase 2 inhibitors: emerging roles in the gut.

BACKGROUND AND AIMS: Discovery of an isoform of Cyclo-oxygenase (COX) 1, the inducible COX-2, has made it possible to avoid some side effects of non-specific COX inhibitors. The COX-2 gene is over-expressed in reflux oesophagitis, Barrett's oesophagus, gastric and colon cancer, familial adenomatous polyposis, pancreatic cancer, hepatocellular carcinoma, hepatotoxicity, cirrhosis, and inflammatory bowel disease, and specific COX-2 inhibitors have been tried experimentally and clinically and found effective. METHODS: A Medline search was performed of English-language experimental studies and controlled clinical trials from January 1980 to January 2002, and relevant citations were noted. RESULTS: Review of available literature shows that sulindac and COX-2 inhibitors are effective in preventing as well as regressing familial adenomatous polyposis. However, they have not been shown to prevent cancer in these patients. Studies evaluating NSAIDs and COX-2 inhibitors in carcinogen-induced and genetically manipulated animal models of various cancers have been promising especially in conditions such as Barrett's oesophagus, oesophageal and hepatocellular carcinoma and pancreatic cancer. COX-2 inhibitors may be of value in the treatment of reflux oesophagitis, pancreatitis and hepatitis, although carefully planned randomized controlled clinical trials demonstrating their efficacy need to be conducted. At present NSAIDs and COX-2 inhibitors cannot be recommended for average-risk individuals or for those with sporadic colorectal neoplasia (or other forms of cancers) as chemo-preventive agents. CONCLUSION: COX-2 inhibitors may open up a new therapeutic era in which these drugs can be used for chemo-prophylaxis. However, COX-2 selective inhibitors retain renal adverse effects of the non-selective inhibitors and the concern regarding the pro-thrombotic potential of COX-2 inhibitors will limit their value as chemo-preventive agents.

Effect of T. foenumgraecum on glycogen content of tissues and the key enzymes of carbohydrate metabolism.

The Indian traditional system of medicine prescribed plant therapies for diseases including diabetes mellitus called madhumeh in Sanskrit. One such plant mentioned in Ayurveda is Trigonella foenumgraecum (FG). In the present study, FG (1g/kg PO) was assessed for its effect on glycogen levels of insulin dependent (skeletal muscle and liver), insulin independent tissues (kidneys and brain) and enzymes such as glucokinase (GK), hexokinase (HK), and phosphofructokinase (PFK). Administration of FG led to decrease in blood glucose levels by 14.4 and 46.64% on 15th and 30th day of the experiment. Liver and 2-kidney weight expressed as percentage of body weight was significantly increased in diabetics (P<0.0005) versus normal controls and this alteration in the renal weight (P<0.0005) but not liver weight was normalized by feeding of FG. Renal glycogen content increased by over 10 folds while hepatic and skeletal muscle glycogen content decreased by 75 and 68% in diabetic controls versus controls and these alteration in glycogen content was partly prevented by FG. Activity of HK, GK and PFK in diabetic controls was 35, 50 and 60% of the controls and FG partially corrected this alteration in PFK, HK and GK.

Effect of feeding Murraya koeingii and Brassica juncea diet on [correction] kidney functions and glucose levels in streptozotocin diabetic mice.

Purpose of the study was to investigate the effects of daily oral feeding 15% of powdered leaves of Murraya koeingii (MK) (commonly called as Curry patta) and 10% powder of seeds of Brassica juncea (BJ) (commonly called as Rai) for 60 days on serum glucose concentrations and kidney functions in streptozotocin (STZ; 100mg/kg) diabetic rats. Serum glucose levels, body weight, urine volume, serum creatinine, and urinary albumin (UAE) levels were monitored on day 0, 10, 25, 40, and 70 of the experiment. After 60 days of STZ administration, urine volume per day and UAE levels were significantly higher (P<0.0005) in diabetic controls (DC) as compared to normal controls (NC). Although feeding of the MK/BJ showed a trend towards improvement in most of the parameters, results were not statistically different from the DC except in serum creatinine values in BJ-fed rats on day 70. Thus, these plants can be best utilized by promoting them as preferable food adjuvants for diabetic patients.

Hypoglycemic and antihyperglycemic activity of Murraya koenigii leaves in diabetic rats.

The commonly used spice curry patta (Murraya koenigii) is traditionally consumed by diabetics in southern part of India. Feeding of diet containing various doses of curry leaves (5, 10 and 15%) to normal rats for 7 days as well as mild diabetic (blood glucose levels >175 mg/dl induced by alloxan 35 mg/kg IP) and moderate diabetic rats (blood glucose levels >250 mg/dl induced by STZ 60 mg/kg IP) for 5 weeks showed varying hypoglycemic and anti-hyperglycemic effect. In normal rats, reduction in blood glucose was almost negligible (approximately 4% with 10 and 15% diet). In mild and moderate diabetic rats, feeding of 5, 10 and 15% diet caused a maximal reduction in blood sugar by 13.1, 16.3 and 21.4% (NS, P<0.05 and 0.005) and 3.2, 5.58, 8.21% (NS), respectively. The mechanism of action is further discussed in light of results of previous and the present study.

The effect of Momordica charantia and Mucuna pruriens in experimental diabetes and their effect on key metabolic enzymes involved in carbohydrate metabolism.

The Indian traditional system of medicine prescribed traditional plant therapies. Two such plants, i.e. Momordica charantia (MC) and Mucuna pruriens (MP), earlier shown to reduce hyperglycaemia, were assessed for their anti hyperglycaemic effect on varying degrees of hyperglycaemia and diabetic complications. Alcohol and aqueous extracts of MC (50, 100 and 200 mg/kg/day) and only an alcohol extract of MP (100, 200 and 400 mg/kg/day) were evaluated in a pilot study (plasma glucose >180 mg/dL, 21 days), a chronic study in alloxanized rats (plasma glucose >280mg/dL, 120 days) and streptozotocin (STZ) mice (plasma glucose >400 mg/dL, 60 days). In the pilot study, the maximum antihyperglycaemic effect occurred with an aqueous extract of MC at week 3 and an alcohol extract of MP at week 6 at a dose of 200 mg/kg/day. In chronic alloxanized rats, the selected dose of MC led to a significant fall of 64.33%, 66.96%, 69.7% and 70.53% in plasma glucose levels at 1, 2, 3 and 4 months, respectively. MP showed a decrease of 40.71%, 45.63%, 50.33% and 51.01% at the same time period. In chronic STZ diabetic mice, MC led to a mean reduction of 15.37%, 18.68% and 22.86% in plasma glucose levels on days 40, 50 and 60 of sampling while MP had no significant effect. The alteration in hepatic and skeletal muscle glycogen content and hepatic glucokinase, hexokinase, glucose-6-phosphate and phosphofructokinase levels in diabetic mice were partially restored by MC but not by MP. The mechanism of action of MC and MP is discussed.

Medicinal plants of India with anti-diabetic potential.

Since ancient times, plants have been an exemplary source of medicine. Ayurveda and other Indian literature mention the use of plants in treatment of various human ailments. India has about 45000 plant species and among them, several thousands have been claimed to possess medicinal properties. Research conducted in last few decades on plants mentioned in ancient literature or used traditionally for diabetes have shown anti-diabetic property. The present paper reviews 45 such plants and their products (active, natural principles and crude extracts) that have been mentioned/used in the Indian traditional system of medicine and have shown experimental or clinical anti-diabetic activity. Indian plants which are most effective and the most commonly studied in relation to diabetes and their complications are: Allium cepa, Allium sativum, Aloe vera, Cajanus cajan, Coccinia indica, Caesalpinia bonducella, Ficus bengalenesis, Gymnema sylvestre, Momordica charantia, Ocimum sanctum, Pterocarpus marsupium, Swertia chirayita, Syzigium cumini, Tinospora cordifolia and Trigonella foenum graecum. Among these we have evaluated M. charantia, Eugenia jambolana, Mucuna pruriens, T. cordifolia, T. foenum graecum, O. sanctum, P. marsupium, Murraya koeingii and Brassica juncea. All plants have shown varying degree of hypoglycemic and anti-hyperglycemic activity.

Pharmacological studies on Myristica fragrans--antidiarrheal, hypnotic, analgesic and hemodynamic (blood pressure) parameters.

Recurrent diarrhea is prevalent in developing countries, particularly in tropical regions. A natural based antidiarrheal home remedy can serve as an ideal health tool to limit diarrhea-related morbidity and mortality. In the traditional Indian medical science of Ayurveda, nutmeg is one such plant said to possess antidiarrheal activity. A study was therefore planned to assess the various pharmacological effects (antidiarrheal, sedative, analgesic and blood pressure) of nutmeg. Both Nutmeg crude suspension (NMC) and petroleum ether (PE), but not aqueous extract (Aq), decreased the mean number of loose stools or increased the latency period. NMC increased intestinal tone while PE had no such effect. PE had no effect on guinea pig ileum, but inhibited the contraction produced by acetylcholine, histamine and prostaglandin. NMC but not PE extract showed a significant but weak analgesic effect. While PE effectively potentiated both phenobarbitone and pentobarbitone-induced sleeping time, NMC was considerably less effective. NMC administered intraduodenally did not produce much effect on blood pressure (BP), but potentiated the action of exogenously administered adrenaline and nor-adrenaline. On the other hand, PE in higher, but not lower, doses caused a precipitous fall in BP not blocked by atropine. Thus, overall extracts of nutmeg showed a good antidiarrheal effect, with a significant sedative property. The extracts possessed only a weak analgesic effect, with no harmful effects on blood pressure and ECG.

Amelioration of experimental diabetic neuropathy and gastropathy in rats following oral administration of plant (Eugenia jambolana, Mucuna pruriens and Tinospora cordifolia) extracts.

Extract of M. charantia (200 mg/kg), E. jambolana (200 mg/kg), M. pruriens (200 mg/kg) and T. cordifolia (400 mg/kg) was administered for 50 days in STZ induced diabetic mice, the plasma glucose concentration was reduced by 24.4, 20.84, 7.45 and 9.07% respectively. Tail flick latency (TFL) and gastric transit percentage were significantly higher in diabetic controls versus normal controls. M. charantia and E. jambolana modified it favorably while M. pruriens and T. cordifolia did not exert any favorable change.

Evaluation of anti-hyperglycemic and hypoglycemic effect of Trigonella foenum-graecum Linn, Ocimum sanctum Linn and Pterocarpus marsupium Linn in normal and alloxanized diabetic rats.

The hypoglycemic effect of the aqueous (Aq) extract of the bark of Pterocarpus marsupium (PM) and alcoholic (Alc) extract of seeds of Trigonella foenum-graecum (FG) and leaves of Ocimum sanctum (OS) was investigated in both normal and alloxan-induced diabetic rats. The Aq extract of PM (1 g/kg PO) significantly (P<0.001) reduced the blood sugar levels from 72.32+/-5.62 to 61.35+/-1.2 mg% 2 h after oral administration of the extract and also significantly lowered the blood glucose in alloxan diabetic rats from 202.91+/-5.44 to 85.22+/-11.28 mg% 21 days after daily oral administration of the extract (P<0.001). Similarly, reduction was seen with Alc extract of FG (74.33+/-4.77 to 60.56+/-1.9 in normal rats and 201.25+/-7.69 to 121.25+/-6.25 in diabetic rats) (P<0.001) and OS (204.48+/-11.0 to 131.43+/-7.86 in normal rats and 73.54+/-3.7 to 61.44+/-2.3 in diabetic rats) (P<0.001). In addition, the extract also showed a favorable effect on glucose disposition in glucose fed hyperglycemic rats.