Renoprotective and antioxidative effects of methanolic Paederia foetida leaf extract on experimental diabetic nephropathy in rats.

ETHNOPHARMACOLOGICAL RELEVANCE: Paederia foetida Linn. (Family: Rubiaceae) is widely used as a natural remedy for diabetes mellitus by the Nepali and Lepcha tribes of Sikkim and Darjeeling Himalayan region. The plant is administered to a diabetic individual in the form of leaf infusion for 2-3 weeks. Therefore, we investigated the effects of methanolic leaf extract of Paederia foetida (MEPF) on alloxan (ALX) induced diabetic renal oxidative stress and NF-kB dependent renoinflammatory events in rat. Method Effects of MEPF on blood glucose, glomerular filtration rate (GFR), serum and oxidative stress markers were evaluated in ALX induced diabetic wistar rats. Enzyme linked immunosorbent assay (ELISA) was carried out to estimate serum IL-6, IL-1ß, TNF-α and renal tissue NF-kB p65 levels. MEPF treatment was given to the diabetic rats at a dose of 250 and 500mg/kg body weight (b.w.). RESULTS & DISCUSSION: MEPF treatment significantly reduced hyperglycaemia, serum creatinine, blood urea nitrogen (BUN), bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), triglycerides (TRIGs), and total cholesterol (TCHOL) levels in the diabetic rats, whereas it significantly restored GFR and serum albumin level. The activity of enzymatic and non-enzymatic antioxidant machineries was remarkably augmented by MEPF treatment. Likewise, it also significantly lowered lipid peroxidation which was evidenced by decreased concentration of thiobarbituric reactive substances (malondialdehyde, MDA) in the renal tissue of treated diabetic groups. Moreover, MEPF treated animals exhibited low serum concentrations of IL-6, IL-1ß and TNF-α compared to the diabetic control rats. It showed a dose dependent inhibition of NF-kB activation in the diabetic kidney, but the effects were more prominent at a dose of 500mg/kg. Histopathological examinations also confirmed its nephroprotective action during diabetes. CONCLUSION: MEPF treatment mitigates oxidative stress and suppresses renal inflammation via inhibition of NF-kB in diabetic kidney in early progressive diabetic nephropathy.

Nucleic acid testing for blood banks: an experience from a tertiary care centre in New Delhi, India.

INTRODUCTION: Blood safety is a challenging task in India; with a population of around 1.23 billion and a high prevalence rate of HIV (0.29%), HBV (2-8%) and HCV (≈ 2%) in general population. Nucleic acid testing (NAT) in blood donor screening has been implemented in many developed countries to reduce the risk of transfusion-transmitted viral infections (TTIs). NAT shortens this window period, thereby offering blood centers a much higher sensitivity for detecting viral infections. MATERIALS AND METHODS: Routine ID-NAT for HIV-1, HCV and HBV was started from June 2010 at AIIMS blood bank by the Procleix® Ultrio® Assay (Novartis Diagnostics, USA) a multiplex NAT, which allows the simultaneous detection of HIV-1, HCV, and HBV in a single tube. During the period of 27 months from June 2010 to August 2012, around 73,898 samples were tested for all the three viruses using both ELISA (by Genscreen Ultra HIV Ag-Ab(BIO-RAD), Hepanostika HCV Ultra & HBsAg Ultra(Biomerieux) and Nucleic acid testing. The comparative results of both the assays are being presented here in this study. RESULTS: Out of 73,898 samples, 1104 samples (1.49%) were reactive by NAT. out of these 1104 samples, 73 were reactive for HIV-1 (0.09%), 186 were reactive for HCV only (0.25%), 779 (1.05%) were reactive for HBV only, and around 66 (0.08%) were HBV-HCV co-infections. There was one HIV, 37 HCV, 73 HBV and 10 HBV-HCV co-infection cases that were not detected by serology but reactive on NAT testing, with a combined yield of 1 in 610 donations (total 121 NAT yields). CONCLUSION: NAT could detect HIV, HBV and HCV cases in blood donor samples that were undetected by serological tests. NAT can interdict a large number of infected unit transfusions and thus help in providing safe blood to the patients.

Individual donor nucleic acid testing for blood safety against HIV-1 and hepatitis B and C viruses in a tertiary care hospital.

BACKGROUND: In July 2010, we started universal individual donor nucleic acid testing (ID-NAT) at our blood bank. This test simultaneously detects human immunodeficiency virus-1 (HIV-1), hepatitis B virus (HBV) and hepatitis C virus (HCV) in samples of donor blood. We continued to do the enzymelinked immunosorbent assay (ELISA) test for these agents, as per the guidelines of the Drug Controller General of India. We assessed the impact of ID-NAT in preventing transfusionassociated transmission of viruses. METHODS: We used fourth generation ELISA to screen blood samples of all voluntary and replacement blood donors. ID-NAT was done by transcription-mediated amplification (TMA). RESULTS: Of the 18 356 donors, ID-NAT could not be performed on 2 samples which were inadequate. Of the 18 354 donors tested by both ID-NAT and fourth generation ELISA, 7 were found to be NAT-positive but ELISA-negative (NAT yield) for HBV and HCV. The prevalence of NAT yield cases among routine donors was 1 in 2622 donations tested (0.038%). Since we supply blood as components (packed red cells, fresh frozen plasma and platelet concentrate), these 7 units of blood would have yielded 21 components and hence 21 patients could have been infected with HBV and HCV viruses. CONCLUSION: In the vast majority of blood units tested, the results of ELISA and ID-NAT for HIV-1, HBV and HCV were concordant. ID-NAT did detect the presence of viruses missed by ELISA in some blood units. It widespread use in blood banks would ensure safer blood transfusion.

Adrenocortical carcinoma: An extremely uncommon entity and the role of Immunohistochemistry in its diagnosis.

Adrenocortcal carcinoma is an extremely uncommon entity with an incidence of two in one millionth population. Here we present a 60 year gentleman with pain in abdomen, nausea, and backache, and weight loss. Contrast enhanced computed tomography (CECT) abdomen revealed a heterogenous well defined mass measuring (15 × 10.3 × 13) cm(3) on the left suprarenal region with central necrosis which extended medially up to the midline. Locally, the growth infiltrated the upper pole of left kidney. Initially, the differential diagnosis included that of renal cell carcinoma arising from upper pole of left kidney involving adrenal gland. The patient underwent left radical nephrectomy and left adrenalectomy. Histological evaluation could not differentiate it from of malignant pheochromocytoma, but immunohistochemistry confirmed it as adrenocortical carcinoma. This case highlights the crucial role of immunohistochemistry in establishing the diagnosis like tumors.

Internal fixation of fractures of both bones forearm: Comparison of locked compression and limited contact dynamic compression plate.

BACKGROUND: The locking compression plate (LCP) with combination holes is a newer device in fracture fixation. We undertook a study comparing the LCP with limited contact dynamic compression plate (LC-DCP) in the treatment of diaphyseal fractures of both bones of the forearm. MATERIALS AND METHODS: This is a prospective comparative study, 36 patients (18 in each group) with fractures of both the forearm bones (72 fractures) were treated with one of the two devices. The average age of the patients was 30.5 years (range 16-60 years) with mean followup of 2.1 years (range 1.5-2.8 years). The patients were assessed for fracture union and function and complications and by Disabilities of the Arm, Shoulder and Hand (DASH) score for patient related outcome at the latest followup. RESULTS: There was no significant difference in two groups with respect to the range of movements or grip strength. One case had delayed union (LC-DCP group) and another had synostosis (LCP group). Plate removal was done in four cases within the study period with no refracture till the presentation of this report. CONCLUSION: LC plating is an effective treatment option for fractures of both bones of forearm. The present study could not prove its superiority over LC-DCP.