Role of Bilastine in Allergic Rhinitis: A Narrative Review.

Allergic rhinitis (AR) is considered a trivial disease and is often self-treated with over-the-counter drugs and home remedies. However, AR is a contributing risk factor for asthma associated with complications, including chronic cough, eosinophilic esophagitis, and otitis media with effusion. In AR, inflammation is primarily mediated by histamines. Guidelines advise using second-generation oral H1 antihistamines as the primary treatment for AR. Second-generation H1 antihistamines strongly prefer the H1 receptor, limiting their ability to enter the central nervous system. Thus, they have minimal adverse effects. Among these H1 antihistamines, bilastine is highly specific for H1 receptors with a slight affinity for other receptors. It has a rapid and prolonged action, which reduces the need for frequent dosing and has better compliance. In the long term, bilastine is well-tolerated with minimal adverse effects. It is not associated with drug interactions, so dosage adjustment is unnecessary. Bilastine does not penetrate the brain and is nonsedating at 80 mg once daily. The low possibility of drug-drug interactions and pharmacokinetics of bilastine makes it suitable for elderly patients, even with compromised hepatic and renal function, without dose adjustment. This review comprehensively discusses the guidelines and the role of bilastine in treating AR. How to cite this article: Tiwaskar M, Vora A, Tewary K, et al. Role of Bilastine in Allergic Rhinitis: A Narrative Review. J Assoc Physicians India 2023;71(11):58-61.

Objective criteria for diagnosing high altitude pulmonary edema in acclimatized patients at altitudes between 2700 m and 3500 m.

BACKGROUND: The criteria used for diagnosing high altitude illnesses are largely based on Western literature. This study was undertaken to define objective, simple and reliable diagnostic criteria for high altitude pulmonary edema (HAPE) in Indian soldiers at altitudes between 2700 m and 3500 m. METHODS: Clinical data of 235 cases of HAPE that occurred between 2700 m and 3500 m were analysed. Receiver operator characteristic (ROC) curve analysis was used to select simple clinical parameters suitable for the diagnosis of HAPE at peripheral medical facilities. Cut-off values and their reliability for the diagnosis of HAPE were defined. RESULTS: HAPE occurred 2.8 ± 2.2 days after arrival at altitudes between 2700 m and 3500 m. Breathlessness, cough, chest discomfort and headache were the commonest symptoms. Low pulse oximetry (SPO2) values than normal for this altitude were seen in 89% of patients. ROC analysis of clinical parameters identified a heart rate more than 95 beats per minute (bpm), respiratory rate more than 21 per minute and SPO2 less than 86% while breathing ambient air at this altitude as diagnostic of HAPE. The sensitivity and specificity of these cut-offs was 0.66, 0.83 and 0.82 and 0.94, 0.95 and 0.93 respectively. CONCLUSION: A heart rate of more than 95 bpm, respiratory rate more than 21 per minute and SPO2 less than 86% breathing room air in individuals complaining of breathlessness, cough, chest discomfort or headache within the first 5 days of arrival at altitudes between 2700 m and 3500 m is highly suggestive of HAPE.

Coati optimization algorithm based Deep Convolutional Forest method for prediction of atmospheric and oceanic parameters.

Droughts and floods are examples of extreme weather events that can result from changes in ocean temperature. Ocean temperature is a key component of the global open sea system. Currently, real-time sea surface temperature (SST) forecasts are generated by numerical models based on physics principles and influenced by boundary and initial conditions. These models generally perform better over large areas than at specific locations. To address this and improve prediction accuracy, particularly in high-precision areas, the Coati Optimization Algorithm-based Deep Convolutional Forest (COA-DCF) method is proposed. This optimization approach is utilized to train the Deep Convolutional Forest (DCF) classifier, which then applies the prediction strategy. The COA-DCF method forecasts ocean surface temperature anomalies by considering key variables such as SST, Sea Surface Height (SSH), soil moisture, and wind speed, using historical data ranging from 1 to 10 days across six different locations. The proposed method achieves improved accuracy with low Root Mean Square Error (RMSE) and Mean Absolute Error (MAE) values, and a high Pearson's correlation coefficient (r) of 0.493, 0.487, and 0.4733, respectively, thereby enhancing the overall performance of the deep learning model.

Pneumatocele in an adult.

We report a case of 25-year-old male who presented with high grade fever with cough and expectoration. Chest examination revealed amphoric breath sounds on the right interscapular region. Chest X ray revealed multiple air fluid levels with collapse lung at places. Staph pneumonia with pneumatoceles is common in children but uncommon to in adult population.

SARS-CoV-2, Uncontrolled Diabetes and Corticosteroids-An Unholy Trinity in Invasive Fungal Infections of the Maxillofacial Region? A Retrospective, Multi-centric Analysis.

OBJECTIVES: Collate and analyse data of maxillofacial/rhino-cerebro-orbital fungal infections reported during the era of the Covid-19 pandemic, with the aim of investigating the common contributing factors leading to such infections and of highlighting the significance of this surge seen in patients infected with SARS-CoV-2. METHOD: This retrospective observational multi-centric study analysed patient data collected from clinicians belonging to different specialties in Bangalore, India. The data included the presentation and management of patients presenting with aggressive maxillofacial and rhino-cerebro-orbital fungal infections and explored the relationship between SARS-CoV-2, corticosteroid administration and uncontrolled diabetes mellitus. RESULTS: All 18 patients were Covid positive. Sixteen of the 18 patients received steroids for Covid treatment and 16 patients were diabetic (of whom 15 patients who were diabetics received steroids for Covid-19 treatment). Loss of vision was noted in 12 of the 18 patients and 7 of them underwent orbital exenteration. The fungi noted was mucormycosis in 16 patients, aspergillosis in 1 patient and a mixed fungal infection in 1 patient. Eleven of the patients survived, 6 died and 1 was lost to follow-up. There was a significantly higher incidence of diabetes (p = 0.03) amongst these cohort of patients who were Covid-19 positive with mucormycosis. A significantly higher number (p = 0.0013) of patients were administered steroids at some point during the treatment. CONCLUSION: Despite the limited sample size, it is evident that there is a significant increase in the incidence of angioinvasive maxillofacial fungal infections in diabetic patients treated for SARS-CoV-2 with a strong association with corticosteroid administration.

Targeting connexin 43 in diabetic wound healing: future perspectives.

The unknown mechanisms of impaired tissue repair in diabetes mellitus are making this disease a serious clinical problem for the physicians worldwide. The lacuna in the knowledge of the etiology of diabetic wounds necessitates more focused research in order to develop new targeting tools with higher efficacy for their effective management. Gap-junction proteins, connexins, have shown some promising results in the process of diabetic wound healing. Till now the role of connexins has been implicated in peripheral neuropathy, deafness, skin disorders, cataract, germ cell development and treatment of cancer. Recent findings have revealed that gap junctions play a key role in normal as well as diabetic wound healing. The purpose of this review is to provide the information related to etiology, epidemiology, clinical presentation of diabetic wounds and to analyze the role of connexin 43 (Cx43) in the diabetic wound healing process. The current control strategies and the future research challenges have also been discussed briefly in this review.

Synthesis of carbon nanotubes using Ni95Ti5 nanocrystalline film as a catalyst.

Carbon nanotubes (CNTs) were synthesized by low-pressure chemical vapour deposition (LPCVD) using N2:C2H2:H2 gas mixtures on nanocrystalline Ni95Ti5 film. This nanocrystalline film was deposited on silicon substrate using vapour condensation method. The growth temperature and growth time was kept at 800 degrees C and 30 mins, respectively and the pressure was maintained at 10 Torr. The growth mechanism of CNTs was investigated using FESEM, TEM, HRTEM, and Raman Spectroscopy. From FESEM image of Ni95Ti5 nanocrystalline film, it is clear that the particle size varies from 5-10 nm. EDX analysis suggests that Ni95Ti5 alloy contains Ni and Ti both. It is clear from TEM images that CNTs are multiwalled with the diameter varying from 10-30 nm and length of several micrometers. HRTEM image shows that the structure of these multi-walled nanotube (MWNTs) is bamboo-shaped and the catalyst exists at the tip of MWNTs. Fourier Transform Raman Spectroscopy confirmed that graphitic structure of as-prepared CNTs. Field emission measurements reveal that the carbon nanotubes grown for 30 mins showed a turn-on field of 7.2 V/microm, when the current density achieves 10 microA/cm2. The field enhancement factor was calculated to be 708.50 for carbon nanotubes grown for 30 mins.

Acanthamoebae presenting as primary meningoencephalitis in AIDS.

A rare case of Acanthamoebae meningoencephalitis is diagnosed in cerebrospinal fluid (CSF) of a 24 years old male suffering from acquired immunodeficiency syndrome (AIDS) patient on the basis of bright field microscopy and culture growth on non-nutrient agar with Escherichia coli. This case illustrates that Acanthamoebae should be considered in the differential diagnosis of meningoencephalitis in AIDS in addition to tuberculosis and cryptococcus infection in tropical areas.

RAD6 promotes DNA repair and stem cell signaling in ovarian cancer and is a promising therapeutic target to prevent and treat acquired chemoresistance.

Ovarian cancer (OC) is the most deadly gynecological cancer and unlike most other neoplasms, survival rates for OC have not significantly improved in recent decades. We show that RAD6, an ubiquitin-conjugating enzyme, is significantly overexpressed in ovarian tumors and its expression increases in response to carboplatin chemotherapy. RAD6 expression correlated strongly with acquired chemoresistance and malignant behavior of OC cells, expression of stem cell genes and poor prognosis of OC patients, suggesting an important role for RAD6 in ovarian tumor progression. Upregulated RAD6 enhances DNA damage tolerance and repair efficiency of OC cells and promotes their survival. Increased RAD6 levels cause histone 2B ubiquitination-mediated epigenetic changes that stimulate transcription of stem cell genes, including ALDH1A1 and SOX2, leading to a cancer stem cell phenotype, which is implicated in disease recurrence and metastasis. Downregulation of RAD6 or its inhibition using a small molecule inhibitor attenuated DNA repair signaling and expression of cancer stem cells markers and sensitized chemoresistant OC cells to carboplatin. Together, these results suggest that RAD6 could be a therapeutic target to prevent and treat acquired chemoresistance and disease recurrence in OC and enhance the efficacy of standard chemotherapy.

Anti oxidant potential of Metformin and Pioglitazone in Type 2 Diabetes Mellitus: Beyond their anti glycemic effect.

OBJECTIVE: Insulin sensitizers might influence oxidative stress to improve insulin resistance in diabetes mellitus. The present study was designed with the aim to study the effect of Metformin & Pioglitazone on markers of oxidative stress after 4 weeks of therapy in patients with type 2 diabetes mellitus (Type 2 DM). RESEARCH DESIGN AND METHODS: This was a prospective study with follow up of 4 weeks in patients with Type 2 DM. They were randomized into metformin treated group (N=20) and Pioglitazone treated group (N=20) and healthy age-matched control group (N=20). Data was presented as mean±S.D. Student "t" test, ANOVA and Pearson correlation co-efficient tests were performed to analyze the parametric data in this study. RESULTS: Baseline clinical characteristics of the two study groups were similar. There is a significant difference for Fasting plasma glucose (FPG) and 2h-Post Prandial Plasma Glucose (PPPG) after 30 days of metformin and pioglitazone treatment. Metformin significantly reduced MDA (p=0.041) and increased SOD (p<0.001). Pioglitazone significantly reduced MDA (p<0.001) but failed to raise SOD level (p=0.132). Mean MDA was 4.57±0.57µM/L in metformin and 2.91±0.66µM/L in pioglitazone treatment with a p-value of <0.001. Further, a similar significant difference was obtained for SOD value by metformin and pioglitazone treatment (7.87±0.72U/ml vs. 6.94±0.53U/ml; p<0.001). CONCLUSION: Pioglitazone was superior to Metformin to improve oxidative stress as reflected by reduction in MDA but the antioxidant effect i.e. increase in SOD was seen with metformin only. The differing mechanism of actions of the two drugs on oxidative stress favors co prescription of these drugs for better outcome in improving insulin resistance and diabetic complications.

Effect of glycaemic control on apoptosis in diabetic wounds.

OBJECTIVE: To study the effect of glycaemic control on apoptosis in chronic ulcers in diabetic patients and the differential roles of insulin and oral hypoglycaemic agents (OHAs). METHOD: Ten non-diabetic (group I) and 20 diabetic patients (groups II and III), with a wound of more than four weeks' duration, who were attending the wound clinic at University Hospital, Varanasi, India were recruited. The 10 patients in group 11 received insulin and the 10 in group III an oral hypoglycaemic agent; all had diabetic foot ulcers. Wound biopsy and other routine investigations were performed. Both DNA fragmentation and morphological changes under light microscopy (apoptotic index) were used as determinants of apoptosis. Different variables, including fasting and post-prandial blood sugar, serum low-density lipoprotein (LDL) and markers of microangiopathy, such as proteinuria and diabetic retinopathy, were compared with apoptosis. RESULTS: DNA fragmentation in groups I, II and III was 40.00 +/- 2.97, 45.26 +/- 3.21 and 60.8 +/- 3.13 respectively (p < 0.01). Near linear correlation was observed with blood sugar level, particularly post-prandial blood sugar (p < 0.05) and DNA fragmentation. DNA fragmentation was significantly correlated with serum LDL and proteinuria, and it was much greater in the OHA group than in the insulin group (p < 0.05). Similarly, in the diabetic patients with background retinopathy the DNA fragmentation was 46.50 +/- 3.42 (n=3) in the insulin group and 66.70 +/- 6.48 (n=4) in the OHA group (p < 0.05). CONCLUSION: There is a significant increase in apoptosis in diabetic wounds with poorly controlled blood sugar and microangiopathy. This increase was greater in patients on OHAs than those on insulin, and it contributes to delayed wound healing. Morphological markers do not appear to be a reliable index of apoptosis in the diabetic wound.

Primary amyloidosis presenting with predominant lymphnodal masses.

A 50 year young farmer presented with clinical features of bilateral carpal tunnel syndrome and generalized lymphadenopathy including paratracheal and retroperitoneal lymphodes. The histological diagnosis confirmed primary amyloidosis of lymphnodes. Presentation of primary amyloidosis as lymphnodal mass with deposition of amyloid in carpal tunnel is extremely rare and can only be diagnosed by histochemistry. The clinical response to drugs is variable and needs surgical intervention for decompressive therapy which can improve the symptoms of carpal tunnel syndrome.

Microorganisms as an alternative source of protein.

Demand for human food and animal feed proteins from nonconventional sources has increased, particularly in developing countries. Microbial protein is one such source. It is desirable because it is amenable to controlled intensive cultivation and is less dependent on variations in climate, weather, and soil. Microbial proteins must be evaluated for nutritive value, safety, and economic considerations before mass production is undertaken.

Resistance to treatment in Kala-azar: speciation of isolates from northeast India.

Kala-azar in India is becoming increasingly difficult to treat, which may be due to the presence of species other than Leishmania donovani; Leishmania tropica was reported to cause the same clinical syndrome in the area. Over the past 3 years, we have collected samples from 241 patients with visceral leishmaniasis from across the region. Of the 189 isolates that grew on diphasic medium, 159 were successfully transferred to liquid medium for typing. Clinically, 80% of these were resistant to antimony. Lipophosphoglycan-specific monoclonal antibodies were used to distinguish the 2 species by agglutination of promastigotes; all 159 were shown to be L. donovani. Eighty-three isolates were confirmed to be L. donovani by isoenzyme analysis, by amplification of kinetoplast DNA, or both, in comparison with multiple reference strains; none were L. tropica. Thus, the rising incidence of clinical resistance to treatment is unlikely to be due to a different species causing kala-azar in north Bihar.

Effect of strychnine on cardiac vagal inhibition.

Strychnine blocked the vagal-induced cardiac inhibition in both perfused frog heart and dog's heart in situ. This effect was antagonized by eserine. The present results are consistent with our previous findings that strychnine blocks the cholinergic inhibitory mechanisms both in the central nervous system as well as in the peripheral autonomic nervous system.

Modification by strychnine and D-tubocurarine of cardiac vagal inhibition in dogs.

Intravenous infusion of strychnine or D-tubocurarine chloride attenuated the cardiac depressant action and fall in blood pressure produced by electrical stimulation of the right vagus nerve in dogs anesthesized with pentobarbitone sodium. The effects of exogenous acetylcholine on the heart and blood pressure (B.P.) were not modified by strychnine or D-turbocurarine. Physostigmine sulphate potentiated the effects of injected acetylcholine without modifying the effects of strychnine and D-tubocurarine on vagal transmission. Dimethylphenylpiperazinium bromide also produced its characteristic effects on the heart and B.P. in the presence of strychnine and D-tubocurarine. The results indicate that strychnine and D-tubocurarine inhibition of vagal transmission is not a result of blockade of peripheral cholinergic receptors or cardiac vagal ganglia. This inhibition occurs presumably via a preganglionic presynaptic action.

Bacteriology of the cervix in cases of infertility: effect on human and animal spermatozoa and role of elastase.

Microorganisms such as Bacillus subtilis, Pseudomonas aeruginosa, Escherichia coli, and Candida albicans isolated from cervices of infertile human females inhibited motility and agglutinated human, cow bull, buffalo bull, and rat spermatozoa in vitro. Fifty percent of the infertile females studied carried elastase-positive microorganisms. Cell-free culture supernatants of 72-hr-old elastase-positive cultures were spermicidal within 60 min of contact with sperm, while elastase-negative cultures were spermicidal in 4-6 hr. Cultures of all the cervical isolates were spermicidal and agglutinated human, cow bull, buffalo bull, and rat spermatozoa, and these activities increased with age of the culture. Human sperm showed only tail-to-tail agglutination, while cow bull, buffalo bull, and rat spermatozoa showed mainly head-to-head agglutination. Spermicidal activity was also attributable to elastase, which was present more in 72-hr-old cultures than in 24-hr-old cultures.

Bacteriology of cervix in cases of infertility: effect on human sperm.

Microorganisms such as Escherichia coli, Pseudomonas aeruginosa, and Bacillus subtilis isolated from cervices of infertile females possessed spermicidal activity. They also agglutinated the human spermatozoa in vitro and showed tail-to-tail agglutination. Cell-free supernatant of these organisms was found to be spermicidal but did not agglutinate spermatozoa in vitro. Spermicidal activity was increased with increase in age of the culture.

A study on the vasopressin induced delay in the gastrointestinal transit in mice: possible mechanism of action.

The effect of arginine vasopressin (AVP) on the gastrointestinal (GI) transit and its possible mechanism were studied using charcoal meal test in mice. A dose related inhibitory effect was recorded. The effect appears to be independent of the time allowed between AVP administration and testing. The studies on the mechanism reveal that AVP acts without involving V1 and V2 vasopressin receptors. An almost complete reversal of the effect by physostigmine and potentiation by atropine indicate that AVP might act through an inhibition of the release of acetylcholine. However, the neural nicotinic receptors mechanisms do not seem to contribute since hexamethonium failed to modify the AVP action. Further, a partial antagonism by naloxone or prazosin pretreatment indicates that opioid and alpha 1 adrenergic systems also contribute to this action of AVP. However, the effect appears to be independent of alpha 2 and beta adrenergic systems since yohimbine and propranolol failed to modify the same.