Chronic administration of cannabis extract (14 mg/kg body wt for 90 days) caused testicular lesions resulting in mass atrophy of the spermatogenic elements. RNA, protein and sialic acid contents of the testes and epididy-mides were reduced; whereas the alkaline phosphatase and cholesterol contents of the testes were elevated. Liver glycogen and adrenal ascorbic acid contents were low. Degranulation and vacuolization of hepatocytoplasm was conspicuous which was further reflected in elevated transaminases, bilirubin, NEFA, phospholipids, free and total cholesterol. Serum protein, alkaline and acid phosphatase, triglycerides, blood sugar, blood urea and creatinine phosphate levels were in normal range. Hematological studies did not reveal any deviation from the normal range except a rise in leucocyte counts.
The efficacy of interferon monotherapy in dialysis patients with chronic hepatitis C remains unclear, although a number of small clinical trials have been published addressing this issue.We evaluated the efficacy and safety of initial interferon monotherapy in dialysis patients with chronic hepatitis C by performing a systematic review of the literature with a meta-analysis of clinical trials. The primary outcome was sustained virological response (as a measure of efficacy); the secondary outcome was drop-out rate (as a measure of tolerability). We used the random effects model of Der Simonian and Laird, with heterogeneity and sensitivity analyses.We have identified 14 clinical trials (269 unique patients); two were controlled studies. The mean overall estimate for sustained virological response (SVR) and drop-out rate was 37%[95% confidence interval (CI) 28-48] and 17% (95% CI 10-28), respectively. The most frequent side-effects requiring interruption of treatment were flu-like symptoms (17%), neurological (21%) and gastrointestinal (18%). The overall weighted estimate for SVR in patients with hepatitis C virus genotype 1 was 30.6% (95% CI 20.9-48). In the sub-group of clinical trials (n = 5) with standard interferon administration (3 million units [MUI] thrice weekly, subcutaneous route, 24-week treatment), the overall mean estimate of SVR was 39% (95% CI 25-56). The studies were heterogeneous with regard to SVR and drop-out rate.Tolerance to initial interferon monotherapy was lower in dialysis than nonuremic patients with chronic hepatitis C. However, more than one-third of haemodialysis patients with chronic hepatitis C have been successfully treated with interferon. Longer duration of interferon monotherapy does not appear to have a beneficial effect on the response rate. Further studies are warranted to define the optimal anti-viral regimen for chronic hepatitis C in dialysis population.
Gentamicin-Eudragit RS100 microspheres were prepared by modified double emulsion method. A 32 full factorial experiment was designed to study the effects of the composition of outer aqueous phase in terms of amount of glycerol (viscosity effect) and sodium chloride (osmotic pressure gradient effect) on the entrapment efficiency and % yield and microsphere size. The results of analysis of variance test for responses measured indicated that the test is significant (p>0.05). The contribution of sodium chloride concentration was found to be higher on entrapment efficiency and % yield, whereas glycerol produced significant effect on the mean diameter of microspheres. Microspheres demonstrated spherical particles in the size range of 33.24—60.43 μm. In vitro release profile of optimized formulation demonstrated sustained release for 24 h following Higuchi kinetics. Finally, drug bioactivity was found to remain intact after microencapsulation. Response surface graphs are presented to examine the effects of independent variables on the responses studied. Thus, by formulation design important parameters affecting formulation characteristics of gentamicin loaded Eudragit RS100 microspheres can be identified for controlled delivery with desirable characters in terms of maximum entrapment and yield.
The efficacy and safety of antiviral therapy in patients with acute hepatitis C on long-term dialysis remains unclear, although a number of small clinical studies have been published addressing this issue. We evaluated the efficacy and safety of interferon therapy in chronic dialysis patients with acute hepatitis C by performing a systematic review of the literature with a meta-analysis of clinical studies. The primary outcome was sustained virological response (SVR, as a measure of efficacy); the secondary outcome was dropout rate (as a measure of tolerability). We used the random effects model of DerSimonian and Laird, with heterogeneity and sensitivity analyses. We identified eight clinical studies (173 unique patients), three (37.5%) being controlled clinical trials (CCTs). Among CCTs, the viral response was much more common in study (patients on antiviral therapy) than control (patients who did not receive therapy) groups; the pooled odds ratio of SVR being 27.06, 95% Confidence Intervals (95% CI), 9.26; 79.1 (P = 0.00001). No difference in the dropout rate between study and control patients was shown, odds ratio = 0.920 (95% CI, 0.367; 1.92), NS. Pooling all study results (n = 8 studies) demonstrated that the summary estimate for SVR and dropout rate was 58% (95% CI, 38; 77) and 9% (95% CI, 4; 14), respectively. The most frequent side-effects requiring interruption of the treatment were flu-like symptoms (n = 4, 18%), followed by haematological changes and loss to follow-up. A strong relationship between increasing age and reported dropout rate was recognized (P = 0.001). The studies were heterogeneous with regard to SVR but not to dropout rate. Our meta-analysis of CCTs showed that the viral response after antiviral therapy was more common than the spontaneous viral clearance in dialysis patients with acute hepatitis C. Pooled analysis demonstrated that IFN-based therapy of acute hepatitis C in dialysis populations gives SVR in around one half of patients. These results support IFN-based therapy for acute hepatitis C in patients on maintenance dialysis.
Ulcerative colitis (UC) is a form of inflammatory bowel disease (IBD) and is often confused with Irritable bowel Syndrome (IBS). Ulcerative colitis is treated as an autoimmune disease. A number of cytokines have been implicated in chronic inflammatory lesions of UC. It has been reported that inflammatory cytokines play important role in the development of the disease. Macrophage migration inhibitory factor (MIF) is important pro inflammatory cytokine and plays a critical role in regulating broad range of immune and inflammatory activities. Higher levels may be related to the pathogenesis and induction of inflammation in UC. Aim of the present study was to evaluate the serum concentration of MIF in patients with ulcerative colitis, Irritable Bowel Syndrome (IBS), colon cancer and healthy control. Study was carried out in the Department of Gastroenterology, IMS, BHU, Varanasi, India. A total of 275 subjects age sex matched (59 UC, 127 IBS, 28 colon cancer and 61 Healthy controls) were enrolled for the study fulfilling inclusion and exclusion criteria. Blood samples were obtained after informed consent for serum separation. Enzyme linked immune sorbent assay (ELISA) was performed using Bioassay Technology Laboratory kit for human macrophage migration inhibitory factor following the manufacturers protocol. A p value of less than 0.05 was considered significant. Statistical analysis was conducted by using SPSS 16.0 (SPSS, Chicago, IL). MIF level in UC was found to be significantly higher (P < 0.0003) having mean SD 3.55 ± 1.3 (Z score = 3.36) when compared with healthy control having mean SD 0.89 ± 0.48 whereas in IBS patients MIF level was found to be significantly elevated (p < 0.0006) having mean SD 3.96 ± 1.39 (Z score = 3.19) when compared to healthy control and that of colon cancer was also found to be high (P < 0.00471) having mean SD 3.02 ± 1.76 (Z score = 2.59) when compared to healthy control. MIF concentration significantly elevated in UC, colon cancer and IBS in respect to control subject which may immobilize macrophages and can lead to production of several inflammatory cytokine which supports the claim that inflammation could be an effective factor in the pathogenesis of disease.
EDITOR: We read with interest the paper by Francksen and colleagues [1] comparing the LMA Unique, Ambu laryngeal mask and Soft Seal laryngeal mask. In a randomized controlled study, we compared the performance of the LMA Unique with the Soft Seal laryngeal mask and the Cobra Perilaryngeal Airway [2]. We studied 320 consecutive patients in the three groups and found that the LMA Unique and Soft Seal laryngeal mask were of equal clinical performance. Ease of insertion between the two devices was very similar using a partially inflated cuff. In the Unique LMA group, a successful primary airway was established in 96% of patients on the first attempt, and in 4% of patients insertion failed at the second attempt. In the Soft Seal laryngeal mask group, a successful primary airway was established in 99% of patients on the first attempt, and in 1% of patients insertion failed at the second attempt. In agreement with the authors, the effective airway time was similar for the two devices and the oropharyngeal leak pressure was higher in the Soft Seal laryngeal mask group. The endoscopic score of the larynx was significantly better with the Soft Seal laryngeal mask group than with the Unique LMA group. The changes in cuff pressures and airway morbidity were similar in both groups. In an observational study, we inserted the Soft Seal laryngeal mask with the cuff inflated at atmospheric pressure [3] in 100 patients and achieved 97% success in the first attempt and 3% in the second attempt. Regarding insertions, 85% were graded as very easy and 12% as easy and were achieved within 20 s. The mean intra-cuff pressure in vivo was 40 mmHg (53 cm H2O). The leak pressure was at a mean pressure of 24.8 cm H2O, in agreement with the authors. Only six patients complained of mild-to-moderate sore throat in the first 2 h after operation. We agree with the authors' conclusion that the LMA Unique and the Soft Seal laryngeal mask are of equal clinical suitability. We believe that inserting the Soft Seal laryngeal mask with the cuff inflated at atmospheric pressure can achieve excellent conditions for insertion and removal.
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