Journal of Acute Disease

357–363

Authors: Wissem Aidi Wannes, Brahim Marzouk

The use of the medicinal plants in treating diabetes is frequent in Africa, especially in Tunisia, and it is ritually transmitted from generation to generation within cultures. Many of Tunisian medicinal plants have been experimentally validated. A comprehensive review was conducted to pile up information from scientific journal articles, including indigenous knowledge researches, about Tunisian medicinal plants used for the treatment of diabetes. The aim of this review article is to provide the reader with information concerning the importance of Tunisian medicinal plants in the treatment of diabetes and to draw attention of the health professionals and scientists working in the field of pharmacology and therapeutics to develop new drug formulations to cure different kinds of diabetes. 1. Introduction

382–385

Authors: Nan-Bin Yu

Objective: To investigate the effect of anisodamine combining with conventional therapy on the degree of lung injury and inflammatory reaction of patients with acute pulmonary contusion. Methods: A total of 48 patients with acute pulmonary contusion treated in our hospital emergency department from April 2011 to October 2015 were enrolled as the research object and were divided into experimental group and control group by using a method of random number table. Experimental group received anisodamine combining with conventional therapy and control group received conventional therapy. In the process of the treatment, the mechanical ventilation time, hospital stays in intensive care unit and the number of cases developed into acute respiratory distress syndrome and multiple organ dysfunction syndromes of patients in two groups were observed. Oxygenation indexes of patients were respectively calculated on Days 1, 2 and 3 after treatment. The contents of inflammatory mediators in serum were detected on Day 3 after treatment. Results: The mechanical ventilation time and hospital stays in intensive care unit [(9.52 ± 1.41) vs. (14.57 ± 2.51) days] of patients in experimental group were significantly shorter than those in control group, and the number of cases developed into acute respiratory distress syndrome [1 (4.17%) vs. 9 (37.50%)] and multiple organ dysfunction syndrome [1 (4.17%) vs. 7 (29.17%)] was significantly less than those in control group. Oxygenation indexes (294.52 ± 41.26 vs. 257.63 ± 38.52; 357.74 ± 47.74 vs. 279.87 ± 31.46; 396.71 ± 55.12 vs. 279.87 ± 31.46) of patients were respectively calculated on Days 1, 2 and 3 after treatment, which were significantly higher than those in the control group. On Day 3 after treatment, the contents of serum C-reactive protein [(7.94 ± 1.05) vs. (14.49 ± 2.97) mg/L], tumor necrosis factor a [(264.69 ± 41.58) vs. (417.87 ± 64.51) ng/L], interleukin-6 (IL-6) [(147.72 ± 21.36) vs. (257.68 ± 41.54) ng/L], IL-8 [(93.68 ± 12.52) vs. (145.62 ± 22.65) ng/L], IL-10 [(205.64 ± 31.56) vs. (336.62 ± 51.38) ng/L] and myeloid cells-1 (73.32 ± 10.39 vs. 114.45 ± 18.51) of patients in experimental group were significantly lower than those in the control group. Conclusions: The anisodamine combining with conventional therapy can relieve the degree of lung injury caused by acute pulmonary contusion, improve ventilatory function, lower the incidence of acute respiratory distress syndrome and multiple organ dysfunction syndrome and inhibit the activation of inflammatory reaction and the release of inflammatory mediators.

393–396

Authors: Xiao-Yan Zhu, Rong-Yao Hou, Shun-Chang Sun, Xi-Yan Zhou

Objective: To analyze the serum levels of miR-126, miR-146a and its relationship with infarction area, severity of disease and inflammatory reaction degree in patients with acute cerebral infarction (ACI). Methods: A total of 75 cases with ACI treated in our hospital from April 2014 to October 2015 and 80 healthy cases were respectively selected as ACI group and control group for retrospective study. Patients' clinical data were collected, and the serum levels of miR-126, miR-146a, tumor necrosis factor-a (TNF-a), interleukin-1b (IL-1b) and IL-6 were detected. Results: Serum contents of miR-126 (0.286 ± 0.078 vs. 1.000 ± 0.169) and miR-146a (0.337 ± 0.084 vs. 1.000 ± 0.158) in patients of ACI group were significantly lower than those of control group. Contents of IL-1b [(68.4 ± 10.3) vs. (22.7 ± 5.8) ng/L], TNFa [(126.9 ± 22.4) vs. (49.6 ± 8.4) ng/L] and IL-6 [(89.3 ± 14.7) vs. (34.8 ± 5.9) ng/L] were obviously higher than those of control group. The bigger the infarction area was, the more severer the degree of nerve defect could be. The lower the serum levels of miR-126, miR-146a were, the higher the levels of TNF-a, IL-1b, IL-6 could be. Levels of miR-126 and miR-146a were negative correlation with levels of TNF-a, IL-1b and IL-6. Conclusions: An abnormal decrease in serum levels of miR-126 and miR-146a in patients with ACI was closely related to the severity of disease. Through regulating the generation of inflammatory factors TNF-a, IL-1b and IL-6, miR-126 and miR-146a may get involved in the changes of cerebral infarction condition.

402–407

Authors: Chiedozie Onyejiaka Ibegbulem, Paul Chidoka Chikezie, Agwu Igwe Ukoha, Chinwe Ngozi Opara

Objective: To study the effects of diet containing monosodium glutamate on visceral organ weights, acute blood steroidal sex hormone levels, serum lipid profile (SLP) and erythrocyte antioxidant enzymes activities of Wistar rats. Methods: The Wistar rats were grouped into two groups of six rats each. The ones in Group 1 (control group) were placed on water and pelletized standard guinea feed ad libitum, whereas Group 2 was regarded as test group [Wistar rats (WR)-monosodium glutamate (MSG) group] and the Wistar rats received water, compounded diet of MSG and pelletized standard guinea feed ad libitum. After 33 days of feeding study, rat body weight was obtained. Rats were sacrificed and the incisions were made into the thoracic cavity and blood samples were drawn by cardiac puncture as a terminal event. Plasma was assayed for estradiol and testosterone concentrations, SLP and erythrocyte peroxidase and catalase activities. Visceral organ weights were also measured. Results: WR-MSG exhibited marginal alterations in blood estradiol and testosterone concentrations. Elevation of serum triacylglycerol concentration inWR-MSGwas corresponded to 77.7%. Increases in serum concentrations of very low-density lipoprotein cholesterol and low-density lipoprotein cholesterol in WR-MSG were corresponded to 70.6% and 41.0% respectively. Erythrocyte peroxidase and catalase activities showed marginal alterations. Alterations in visceral organs-to-body weights ratios were not profound. Conclusions: Blood testosterone and estradiol concentrations were not significantly (P > 0.05) altered, which may not be connected with the low dose of MSG in the diet. Marginal alterations of SLP did not indicate atherogenicity in WR-MSG. The visceral organs were not atrophic or hypertrophic because of the comparatively low dose of MSG consumed by WR-MSG and the duration of the feeding experiment.

413–418

Authors: Mallikarjuna Rao Talluri, Rajananda Swamy Tadi, Ganga Rao Battu

Objective: To evaluate the antioxidant and thioacetamide induced liver toxicity using extracts of aerial parts of Balanites roxburghii (B. roxburghii). Methods: The in-vitro antioxidant activity was estimated for different extracts on superoxide, hydroxyl and 1,1- diphenyl-2-picrylhydrazyl free radicals and the hepatoprotective activity of the selected plant extracts was evaluated by using thioacetamide-induced liver intoxication in rats model. Results: There were no visible signs of toxicity, mortality and no behavioral changes were observed for the selected plant extracts (hydroalcoholic, ethyl acetate and hexane) at 2000 mg/kg body weight. The plant extracts showed dose-dependent effectiveness in the inhibition of free radicals generation and hepatoprotective nature. The hydroalcoholic extract showed more scavenging activity as compared to other extracts with IC50 values of (332.50 ± 1.30) mg, (302.00 ± 1.50) mg and (230.40 ± 1.10) mg on superoxide, hydroxyl and 1,1- diphenyl-2-picrylhydrazyl free radicals. Aerial parts of B. roxburghii at three dose levels such as 125 mg/kg, 250 mg/kg and 500 mg/kg showed dose dependent percentage protection as standard drugs and on enhancement activities of serum biomarker enzymes (aspartate aminotransferase, alanine transaminase, alkaline phosphatase, total bilirubin and total protein) observed in thioacetamide-induced hepatotoxicity. The hydroalcoholic extract showed significant results at 500 mg/kg body weight as compared to other extracts (P < 0.05) with 65.65%, 62.39%, 59.89%, 55.90% and 54.61% on aspartate aminotransferase, alanine transaminase, alkaline phosphatase, total bilirubin and total protein levels. Conclusions: It was observed that the B. roxburghii plant extracts are non-toxic and have capacity to restore the physiological changes caused by the hepatotoxic compounds.

423–429

Authors: Basiru Olaitan Ajiboye, Oluwafemi Adeleke Ojo, Oluwatosin Adeyonu, Oluwatosin Imiere, Isreal Olayide, Adewale Fadaka, Babatunji Emmanuel Oyinloye

Objective: To investigate the in vitro antioxidant activity of ethanolic extract of Artocarpus heterophyllus (A. heterophyllus) stem bark and its inhibitory effect on a-amylase and a-glucosidase. Methods: The A. heterophyllus stem bark was extracted using methanol and tested for antioxidative activity. Results: The results revealed that the ethanolic extract has polyphenolics and free radical scavenging compounds which were significantly higher (P < 0.05) than their respective standard, at concentration dependent manner. The ethanolic extract of A. heterophyllus stem barkwas observed to showinhibitory activities on a-amylase and a-glucosidase with IC50 of (4.18 ± 0.01) and (3.53 ± 0.03) mg/mL, respectively. The Lineweaver-Burk plot revealed that ethanolic extract of A. heterophyllus stem bark exhibited non-competitive inhibition for a-amylase and uncompetitive inhibition for a-glucosidase activities. Also, gas chromatography– mass spectrometry showed the presence of different bioactive compounds in extract. Conclusions: Therefore, it can be inferred from this study that ethanolic extract of A. heterophyllus stem bark may be useful in the management of diabetes mellitus probably due to bioactive compounds observed in the extract.

434–436

Authors: Ebisa Bekele, Bethel Shiferaw, Alexandra Sokolova, Arpan Shah, Phillip Saunders, Alida Podrumar, Javed Iqbal

Thrombotic thrombocytopenic purpura (TTP) is a rare blood disorder with an estimated incidence of 4–5 cases per million people per year. It is characterized by small-vessel platelet-rich thrombi that cause thrombocytopenia, microangiopathic hemolytic anemia and organ damage. There are reports in literature that TTP and acute pancreatitis are associated, indicating each can be the cause of the other. However, acute pancreatitis triggering TTP is very rare. A 71 years old female presented with abdominal pain of 3 days, followed by dark urine. She had icteric sclera, petechial rash and mild epigastric tenderness. Lab findings were significant for hemolytic anemia, thrombocytopenia and elevated lipase. CT of abdomen showed evidence of pancreatitis and cholelithiasis. After admission, patient developed symptoms of stroke. Further investigation showed elevated lactate dehydrogenase and normal coagulation studied with peripheral blood smear showed 5–6 schistocytes/high power field. Disintegrin and metalloproteinase with thrombospondin motifs-13 (ADAMTS13) activity showed less than 3% with high ADAMTS13 inhibitor 2.2. Patient required 6–7 weeks of daily plasmapheresis until she showed complete response. Our patient presented with clinical features of pancreatitis prior to having dark urine and petechial rash. Therefore, we strongly believe that our patient had pancreatitis which was followed by TTP. Patient's ADMTS13 activity was 6% after 10 plasma exchanges, signifying refractory TTP and higher risk for morbidity and mortality. There are limited data and consensus on the management of refractory TTP. TTP and acute pancreatitis are associated. However, refractory TTP following acute pancreatitis is rarely mentioned in the literature. We would like to emphasize the importance of having higher clinical suspicion of the association of both disease entities.

439–441

Authors: Yuen Keat Gan, Syed Shoeb Ahmad, Sheena Mary Alexander, Amir Samsudin

Necrotizing scleritis is an uncommon but potential disastrous infection to the eye. It is commonly caused by vaso-occlusive autoimmune diseases such as rheumatoid arthritis or surgically-induced, and rarely due to infections. In this article, we presented a rare case of necrotizing scleritis caused by herpes infection in an immunocompromised patient. A 49 years old, retroviral positive gentleman presented to our clinic with a painful, red right eye associated with watering, photophobia and blurring of vision. His right eye rapidly deteriorated leading to an impending perforation of the sclera despite intensive antimicrobial therapy. The patient was started on acyclovir ointment and subsequently improved remarkably salvaging the eye from the need of an evisceration. Although the visual prognosis was poor, structural integrity of the eye was achieved.