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   Table of Contents - Current issue
May-June 2021
Volume 41 | Issue 3
Page Nos. 107-160

Online since Thursday, June 10, 2021

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Burden of Coronavirus Disease-19 on cardiovascular system p. 107
Amit Goel, Amit Madaan, Satbir Singh, Subhash Chandra
The rapid emergence and spread of coronavirus disease-19 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) into a worldwide pandemic has caused unprecedented crisis on already overwhelmed healthcare system and global economy leading to healthcare and social emergency. Since its outbreak, the disease prognosis has largely been influenced by multisystem involvement. Comorbid conditions such as cardiovascular diseases have been the most common risk factor for its severity and outcome. Although the exact mechanism of myocardial involvement in patients with COVID-19 is unknown, several plausible mechanisms have been proposed, of which uncontrolled and dysregulated immune response is most implicated in its causation. In the present article, an attempt has been made to summarize the literature available on COVID-19 and its impact on the cardiovascular system.
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Lycopene abrogates ifosfamide-induced fanconi syndrome in albino rats p. 116
Elias Adikwu, Bonsome Bokolo, Dorcas Okayo Okoroafor
Background: Treatment modalities for Fanconi syndrome caused by ifosfamide (IFO) are very limited. This study assessed the protective effect of lycopene (LYP) against IFO-induced Fanconi syndrome in albino rats. Methods: Forty adult male albino rats randomized into eight groups of n = 5 were used. Group A (Control) was treated intraperitoneally (IP) with normal saline (0.2 mL), whereas groups B–D were treated orally with LYP (10, 20, and 40 mg/kg) daily for 5 days, respectively. Group E was treated IP with IFO (80 mg/kg) daily for 5 days, whereas groups F–H were pretreated orally with LYP (10, 20, and 40 mg/kg) before IP treatment with IFO (80 mg/kg) daily for 5 days. After treatment, the rats were anesthetized; blood samples were collected and evaluated for serum biochemical biomarkers. Kidneys were excised, weighed and evaluated for oxidative stress markers and histology. Results: Significant (P < 0.001) increases in serum creatinine, urea, and uric acid levels with significant (P < 0.001) decreases in glucose, phosphate, magnesium, calcium, potassium, sodium, chloride, and bicarbonate levels were observed in IFO-treated rats when compared to control. Significant (P < 0.001) decreases occurred in kidney superoxide dismutase, catalase, glutathione (GSH), and GSH peroxidase levels with significant (P < 0.001) increases in malondialdehyde levels in IFO-treated rats in comparison to control. Glomerulus with sclerosis, lipid accumulation, and tubular necrosis were observed in the kidneys of IFO-treated rats. The aforementioned changes were significantly abrogated in rats pretreated with LYP 10 mg/kg (P < 0.05), 20 mg/kg (P < 0.01), and 40 mg/kg (P < 0.001) when compared to IFO-treated rats. Conclusions: LYP may be useful as treatment for Fanconi syndrome caused by IFO.
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Impaired pulmonary function in patients with chronic neck pain p. 123
Mohamed Fawzi Awadallah, Eman Sobh, Mohamed Abdelhalim Shendy, Abdullah M Al-Shenqiti, Talal M Al-Jeraisi, Reda S Eweda
Background: Neck pain is a common problem in the medical practice, and the limited movement of the neck muscles can result in impaired chest movement. This study aimed to investigate the relationship between neck pain and pulmonary function using spirometry. Methods: We included 75 patients with chronic neck pain and 75 age- and sex-matched healthy controls. We performed spirometry and recorded forced-vital capacity (FVC), forced expiratory volume in the first second of FVC (FEV1), forced expiratory flow at 25%–75% (FEF 25–75), and peak expiratory flow rate (PEFR). We also measured the neck active range of motion in all positions (flexion, extension, lateral flexion, and rotation) and administered the Neck Disability Index (NDI) and Visual Analog Scale (VAS) for pain. Results: Neck movements were significantly limited in all directions in patients with chronic neck pain. Pulmonary function (FVC, FEV1, FEF25–75, and PEFR) was significantly lower, and FEV1/ FVC was significantly higher in the neck pain group compared with the control group. In the neck pain group, restrictive pattern in spirometry was found in 39 participants (52%). The pulmonary function parameters (FVC, FEV1, FEF25–75, and PEFR) had a significant positive linear relationship with neck movement and a significant negative linear relationship with VAS and NDI scores. Conclusions: Patients with chronic neck pain had limited pulmonary function, which was related to a limited range of cervical movement.
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Vitamin D supplementation in the prevention of recurrent acute respiratory tract infections in children aged <5 years p. 129
Sujata Jadhav, Chitra Khanwelkar, Abhay Jadhav, S Seshla
Background: Children with Vitamin D deficiency are at an increased risk for acute respiratory tract infections (ARTIs). Till now, few studies have been conducted on the use of Vitamin D against ARTIs, but the findings are conflicting and not conclusive. Aim: The aim was to study the effect of Vitamin D supplementation in the prevention of recurrent ARTIs in under-five children. Methods: In this prospective study, a total of 310 children aged between 1 and 5 years diagnosed with ARTI were included. They were randomized into two groups: Group A (oral Vitamin D 120,000 IU with standard treatment; n = 155) and Group B (placebo with standard treatment only; n = 155). Follow-up of the patient was done every month for a period of 6 months to document the recurrence of acute attacks of ARTI. R version 3.6.0 software was employed to analyze the data. Results: Twelve children (3.9%) in Group B were unable to follow-up, and hence, 143 were considered for statistical analyses in that group. Among the 298 children, 63.7% were males and majority (25.5%) of them were in the age group of 11–20 months. Cough (96%), fever (93%), and rhinitis (85.2%) were the commonly encountered symptoms. On day 4th (after Vitamin D supplementation), majority in Group A (40%) had recovered completely compared to Group B (5.6%). Within 5 days, Group A patients were 7 times (odds ratio: 6.97, Confidence interval: 3.5–13.8; P < 0.0001) more likely to have a high recovery rate compared to Group B patients. The proportion of patients with minimal attacks (three or four) of ARTI was significantly less in Group A (7.7%) compared to Group B (32.4%; P < 0.001). Conclusions: Children with Vitamin D supplementation had better and rapid recovery from ARTIs and reduced frequency of ARTI attacks.
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Production of mosquito cell-derived Zika virus-like particles using BacMos system p. 134
Hui-Tsu Lin, Der-Jiang Chiao, Szu-Cheng Kuo
Background: Zika virus (ZIKV) is a mosquito-borne flavivirus which has been conclusively linked to Guillain-Barré syndrome and microcephaly. The worldwide emergence of ZIKV has greatly increased the demand for vaccines that reduce or prevent disease transmission. Neutralizing human antibodies which target ZIKV E proteins have been shown to prevent ZIKV replication. Virus-like particles (VLPs) lacking viral genetic material comprise self-assembled multi-subunit protein structures that are capable of strongly activating humoral and cellular immunity. Flavivirus prM and E proteins are both necessary and sufficient for the production of VLPs. Thus, it appears that ZIKV VLPs are an ideal target for vaccine design and serological detection. Methods: In this study, the BacMos (baculovirus/mosquito) method was used to introduce the ZIKV prME gene into mosquito cells. Immunofluorescence assays (IFAs), dot blot (DB) analysis, and Western blot (WB) analysis were used to evaluate the expression and secretion of ZIKV glycoproteins. VLP formation was confirmed using transmission electron microscopic (TEM) and dynamic light scattering (DLS) analysis. Results: IFA presented intense signals from ZIKV E-positive cells in BacMos-ZIKV prME-transduced cells. DB and WB detected abundant ZIKV glycoproteins in the culture medium of BacMos-ZIKV prME-transduced cells. TEM observation and DLS analysis revealed that ZIKV VLPs comprised spherical particles, with an average diameter of 30 nm. Conclusions: Mosquito cell-derived ZIKV VLPs are promising candidates for the development of safe, efficacious vaccines and diagnostic antigens in the future.
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Association between serum homocysteine levels and methylene-tetrahydrofolate-reductase gene polymorphism in patients with stroke: A study from a tertiary care teaching hospital from Central India p. 140
Dinesh Chouksey, Hashash Singh Ishar, Rahul Jain, Sunil Athale, Ajoy Sodani
Background: Hyperhomocysteinemia (HHcy) is a well-established risk factor for vascular thrombosis leading to stroke. Homocysteine (Hcy) is mainly synthesized in the methionine cycle, and it is an intermediate during the conversion of methionine to cysteine. HHcy can develop by polymorphism of several enzymes like methylene-tetrahydrofolate-reductase (MTHFR) mutation and due to deficiency of co-factor Vitamins such as B12, B6, and folic acid. This study was planned to see the association between HHcy and MTHFR gene polymorphism in patients with stroke in populations from central India. Methods: Seventy-two patients diagnosed with stroke aged 18 years and above who met the inclusion criteria were selected. Hcy level and MTHFR mutation were identified among patients of stroke. Results: Forty-two patients (58.33%) were diagnosed with acute ischemic stroke as compared to cerebral venous thrombosis (30, 41.66%) from a total of 72 patients. The statistical analysis projected that the HHcy diagnosed among more (45, 62.5.0%) cases with stroke who had aged ≤45 years as compared to cases who had aged >45 years (17, 23.6%). None of our patients tested positive for either CT (Heterozygous) or TT(Homozygous) genotypes. Conclusions: HHcy is not associated with MTHFR gene mutation in our study group, and this possibly is related to the deficiency of co-factors in Hcy metabolism. Young age group stroke patients have higher Hcy levels.
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Estrogen deficiency accompanied by oxidative stress sustains heme oxygenase 1 expression in cardiomyocytes of ovariectomized rats p. 146
Zheng-Zong Lai, Hsiang-Yu Yang, Ping-Nan Chen, Wei-Jou Shih, Hsin-Hsueh Shen, Yen-Mei Lee
Background: Estrogen deficiency is one of the main causes of cardiovascular diseases (CVDs) after menopause, accompanied with the upregulation of oxidative stress. Two isoforms of heme oxygenase (HO), HO-1 and HO-2, have been implicated in the cytoprotective effects via the antioxidant and anti-inflammatory capacities. Aims: This study aimed to investigate the time-course of HO-1 and HO-2 expression in the cardiac tissue of ovariectomized rats and whether oxidative stress is involved in the regulation of HO alteration. Methods: Adult female rats were ovariectomized bilaterally to induce estrogen deficiency and randomly divided into (1) Sham, (2) ovariectomy (Ovx), (3) Ovx + E2 (17β estradiol, 50 μg/kg/day, intramuscular), and (4) Ovx + tempol (1 mM in drinking water, a superoxide dismutase [SOD] mimetic). Rats were sacrificed 12 weeks after Ovx; blood and myocardium samples were collected. Results: Showed that plasma E2 levels of Ovx and Ovx + tempol groups were significantly reduced as compared to Sham group after 4 weeks of Ovx. Superoxide anion in the cardiac tissue was significantly elevated 2 weeks after Ovx, and the increase was drastically reversed by the treatment with E2 and tempol. In addition, Ovx rats showed significantly higher levels of oxidized glutathione (GSSG) than those of Sham group, which were also significantly reduced by E2 and tempol administration. Western blot analysis indicated that HO-1 expression was significantly induced 1 week after Ovx and sustained at high levels until 12 weeks. E2 replacement did not immediately reverse HO-1 until treatment for 4 weeks as well as tempol administration for 5 weeks. Expression of the constitutive enzymes HO-2 did not show significant differences between Sham and Ovx groups, and E2 or tempol administration had no effect on cardiac HO-2 protein expression. Conclusion: E2 deficiency induced upregulation of superoxide anion in the myocardium, which might be the major contributor to the sustained HO-1 expression as adaptive responses to oxidative stress. This study provides new insight into the pathogenesis of CVDs after menopause.
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Soft palatal pleomorphic adenoma with dystrophic calcifications and upper airway obstruction p. 153
Ayodele Moses Akinola, Oluwapelumi O Olusoga-Peters, Omotayo F Salami, Adekunle Moses Adetayo, Taiwo O Solaja
Pleomorphic salivary adenoma (PSA) is a benign tumor composed of epithelial and mesenchymal elements. Approximately 10% of pleomorphic adenomas occur in the minor salivary glands, with the palate being the most common site. Mesenchymal elements in PSA are capable of giving rise to various components that are usually seen in the tumor. Still, the presence of calcifications either from degenerations or the mesenchymal elements is rare. We are reporting a case of giant pleomorphic adenoma of the soft palate with dystrophic calcification and significant upper aerodigestive obstruction in a 49-year-old Nigerian. Surgical excision was done under general anesthesia via oral route.
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Relationship between severity of asthma attacks and Vitamin D levels in children p. 157
Mahmood Dhahir Al-Mendalawi
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Extracorporeal membrane oxygenation and awake fiberoptic intubation for the anesthetic management in a patient with a large intrathoracic goiter-induced severe tracheal stenosis p. 158
Po-An Lin, Zhi-Fu Wu, Jih-Chin Lee, Tsai-Wang Huang, Bo-Feng Lin, Hou-Chuan Lai
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