The effect of proton pump inhibitors on glycaemic control in diabetic patients.

OBJECTIVE: This study aimed to evaluate the effect of proton pump inhibitors on glycaemic control amongst diabetic patients taking anti-diabetic medications. METHODS: This randomised interventional clinical study was conducted in Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi. Eighty patients of either sex (aged 30-60 years) with type 2 diabetes mellitus and without any known comorbidities were equally divided into two groups (i.e., n = 40 for each group) and were included in this study. Group A received metformin and glimepiride, while Group B, metformin and glimepiride plus omeprazole. The efficacy of the combination medications was evaluated based on fasting blood sugar (FBS) and glycosylated haemoglobin (HbA1c) levels. Serum creatinine and liver function tests were reviewed to evaluate patients' safety profile at the initial visit and after 12 weeks. RESULTS: After 12 weeks of omeprazole therapy, we observed a more significant improvement in glycaemic control in group B compared to group A based on the patients' FBS (108 ± 2.37 vs. 126 ± 2.9, P = 0.001) and HbA1c levels (7.29 ± 0.07 vs. 7.47 ± 0.04, P = 0.030). CONCLUSION: The addition of a proton pump inhibitor along with anti-diabetic medications was considered effective in achieving better glycaemic control.

Assessment of anti-coagulant activity of Nelumbo nucifera fruit.

The herbal agents rich in flavonoids are progressively becoming popular these days as they are considered to have anti-oxidant effects and also lack bothersome effects. That's why existing research was encircled around the anti-coagulant effect of Nelumbo nucifera fruit (NNF) as it is also a rich source of flavonoids and cultivated in abundance especially in tropical regions of Asia but its usefulness as anti-coagulant agent was never determined pharmacologically. Anticoagulant assessment was done in thirty five male Wister rats which were separated equally in 5 groups. Results of the current study revealed that NNF 200mg/kg significantly prolonged prothrombin time and thrombin time, whereas fibrinogen level was highly significantly reduced as compared to control. Fibrinogen level was also reduced highly significantly with NNF 100 mg/kg as compared to control without affecting other parameters of coagulation i.e. activated partial thromboplastin time, prothrombin time and thrombin time. NNF exhibited strong anti-coagulant activity which may be due to the inhibitory effects on platelet activation, adhesion and aggregation along with inhibitory effects on thromboxane A2 formation. Presence of alkaloid i.e. neferine and flavonoids in it may be a reason of its anti-coagulant activity but more pre-clinical and clinical evaluation needs to be conducted to establish these findings.

Correlation of CD24 expression with histological grading and TNM staging of retinoblastoma.

OBJECTIVE: Correlation of CD24 expression with histological grading and TNM staging of retinoblastoma. METHODS: This cross-sectional study was conducted in the Department of Pathology, BMSI, JPMC and NICH from 1(st) January 2009 to 31(st) December 2013. A total 68 diagnosed cases of retinoblastoma were selected for CD24 immuno staining. The data was analyzed by using SPSS version 22. RESULTS: Out of 68 cases 7.35% showed grade 1 followed by 11.76% in G2, 26.47% in G3 and 54.41% in G4. Majority of cases i.e. 60.29% in stage IV followed by 19.11% in stage I, 10.29% each in stage II and stage III. CD24 immuno staining positivity was seen in majority of grade 3 and grade 4. In grade 3, 38.88% showed moderate and 22.22% strong immuno reaction. Amongst grade 4, 40.54% showed moderate and 13.51% strong positive. Variable immuno pattern was observed according to TNM staging. In stage I, 46.15% showed moderate and 7.69% strong positivity, while in stage II, 57.14% were negative for saining. In stage III, 42.85% were negative while 28.57% each showed moderate and strong staining. Majority of cases in stage IV i.e. 48.78% were negative for staining while 34.14%, 17.07% showed moderate and severe CD24 immuno staining. CONCLUSION: Majority of grade I retinoblastoma were in TNM stage I & II and mostly were immuno negative. Lymph node and distant metastatic cases were 75% in G4 and 25% in G3, all of them showed moderate to strong immunoreactivity. These results showed that CD24 expression may be a marker of poor prognosis in retinoblastoma. Whereas TNM staging of retinoblastomas with CD24 expression had varying pattern and showed no significant correlation between them.

Immune profiling of leprosy and tuberculosis patients to 15-mer peptides of Mycobacterium leprae and M. tuberculosis GroES in a BCG vaccinated area: implications for development of vaccine and diagnostic reagents.

Mycobacterium leprae (ML) GroES has been shown to induce strong T cell responses in tuberculoid as well as in exposed healthy contacts of leprosy patients, and therefore this antigen has been the focus of study as a potential vaccine candidate. Paradoxically, we have shown that ML GroES also induces extremely high titres of IgG1 antibody in leprosy patients across the disease spectrum, a response associated with disease progression. IgG1 antibodies in leprosy also show a negative association with interferon-gamma, a critical T cell cytokine responsible for macrophage activation and intracellular killing of mycobacteria. We therefore queried if antibody and T cell responses were being evoked by different epitopes in ML GroES proteins. To address the issue of epitope recognition in mycobacterial diseases, we have analysed 16 peptides (15-mer peptides) spanning the entire ML and M. tuberculosis GroES protein in leprosy (n = 19) and tuberculosis (n = 9) patients and healthy endemic controls (n = 8). Our analysis demonstrates clearly that the dominant peptides evokingT cell and IgG subclass antibodies were different. The target of both T and B cell responses were cross-reactive epitopes in all groups. Differences in disease and healthy states related to the strength (mean intensity) of the T cell and antibody response. IgG1 and IgG3 antibodies were associated with disseminated disease and IgG 2 and IgG4 with disease limitation. Such comprehensive immune profiling of antigen-specific responses is critical to understanding the disease pathogenesis and also if these reagents are to be exploited for either diagnostic or vaccine purposes.