Systemic evaluation of patients with central serous chorioretinopathy: A case-control study.

OBJECTIVE: To investigate the systemic associations of central serous chorioretinopathy (CSCR) with help of clinical and biochemical investigations. DESIGN: Case-control study. PARTICIPANTS: Eighty seven CSCR patients (case) and 82 Asian-Indian patients with primary non-traumatic rhegmatogenous retinal detachment (control) were recruited between July 2017 and December 2018 at a tertiary eye-care center in North India. METHODS: The patients underwent ophthalmological examination and systemic evaluation based on history and biochemical investigations. Logistic regression was performed to identify the associations of CSCR. RESULTS: The age was similar between cases and controls (36.9 ± 7.8 years vs 35.7 ± 10.8 years, p = 0.38). On univariate analysis, the significant factors with higher odds of CSCR were alcohol use (odds ratio, OR: 3.4; 95% confidence interval: 1.36-8.53), sleep disturbance (OR: 5.44; 1.76-16.8), gastroesophageal reflux (OR: 9.34; 1.15-75.50), psychological disorder (OR: 5.78; 1.24-26.97), tuberculosis history (OR: 8.2; 1.0-67.10), serum albumin: globulin ratio (AGR) > 2 (OR: 10.43; 2.33-46.57), and serum hemoglobin (per unit increase; OR: 1.35; 1.14-1.61). Although the mean blood pressure was significantly higher in cases, the distribution among various hypertension categories was not significantly different. Exogenous steroid use and morning 8 am serum cortisol levels were not significantly different between the groups. On multivariable analysis, alcohol use (OR: 4.72; 1.33-16.76), sleep disturbances (OR: 5.04; 1.36-18.70), dysthyroid state (OR: 3.02; 1.04-8.74), serum AGR > 2 (OR: 14.28; 2.33-87.28), and serum hemoglobin (per unit increase; OR: 1.43; 1.13-1.81) were significant independent associations. CONCLUSION: Other than the previously described associations of CSCR like alcohol use and sleep disturbances, this study reports possible association with deranged serum protein and thyroid hormone profile. Further large-scale prospective studies need to validate these results.

Effect of intracameral human cord blood-derived stem cells on lasered rabbit trabecular meshwork.

BACKGROUND: This study aimed to investigate the effect of intracameral human cord blood stem cells on lasered rabbit trabecular meshwork. METHODS: Immediately following diode laser application to the trabecular meshwork, human cord blood stem cells were injected intracamerally, in one eye of 12 albino rabbits. The other eye of ten rabbits was lasered controls and two eyes were normal controls. Rabbits were killed after 4, 8 and 12 weeks. RESULTS: Lasered control rabbit eyes showed significant disruption of trabecular architecture, loss and pleomorphism of trabecular endothelial cells and progressive narrowing of trabecular spaces till 12 weeks. In contrast, lasered eyes, concurrently injected with human cord blood stem cells, showed relatively preserved endothelial cellularity and structure of the trabecular meshwork, at all time points. Human CD34- and CD44-positive cells were identified in 7/8 eyes treated with stem cells, at 4 and 8 weeks, and 2 of 3 at 12 weeks. Many PKH26-labeled human cord blood cells were visible throughout the trabecular area at 4 weeks. They gradually decreased in number by 8 weeks, and at 12 weeks, they appeared to be oriented along trabecular beams. CONCLUSIONS: There was a relative preservation of cellularity and architecture of the trabecular meshwork in eyes injected with human cord blood stem cells, as compared to lasered control eyes up to 12 weeks, without significant inflammation. This suggests a probable role for such stem cells in eyes with glaucoma, having trabecular dysfunction.

Tear inflammatory mediators and protein in eyes of post allogenic hematopoeitic stem cell transplant patients.

AIM: To analyze tear cytokines levels and their correlation to ocular surface parameters in allogenic hematopoietic stem cell transplants (allo-HSCT) patients. METHODS: Prospective longitudinal study of allo-HSCT patients and controls for ocular surface evaluation (OSDI, TBUT, Schirmer's test, staining scores), tear biochemical analysis for protein, cytokines [IL-10, IL-12, IL-2, IL-4, IL-6, IL-17, interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha, VEGF], MMPs [MMP 2, 9, 7, 13, 10 and chemokine (IL-8)], & VEGF on three consecutive follow up visits (at three monthly interval) was done. RESULTS: Of 24 post allo-HSCT patients (19 males, 5 females) & 12 controls (mean age 34.3 + 5.8 years) enrolled, 20 patients [mean age 33.4 + 7.77 years; mean time of recruitment of 5.2 + 2.12 months following alloHSCT] who completed three consecutive follow up visits were included for analysis. Ocular GVHD (oGVHD) was seen in 8 patients (33.3%). Tears biochemical analysis showed elevated levels of interferon γ, IL 6, IL 8, IL 10, IL 12AP70, IL 17A, MMP 9 and VEGF in oGVHD eyes as compared to non-oGVHD & control eyes. Non-oGVHD eyes showed elevated tear MMP 7 and MMP 9 as compared to healthy controls. Tear protein levels were significantly decreased in oGVHD eyes and were equivocal in nonGVHD and control eyes. TBUT and ocular staining scores to correlate best with tear interleukins and MMPs. CONCLUSION: Evaluation of levels of tear VEGF, total protein & MMP 9 can be of significance in identifying oGVHD in post alloHSCT patients.

Microcystin Biosynthesis and mcyA Expression in Geographically Distinct Microcystis Strains under Different Nitrogen, Phosphorus, and Boron Regimes.

Roles of nutrients and other environmental variables in development of cyanobacterial bloom and its toxicity are complex and not well understood. We have monitored the photoautotrophic growth, total microcystin concentration, and microcystins synthetase gene (mcyA) expression in lab-grown strains of Microcystis NIES 843 (reference strain), KW (Wangsong Reservoir, South Korea), and Durgakund (Varanasi, India) under different nutrient regimes (nitrogen, phosphorus, and boron). Higher level of nitrogen and boron resulted in increased growth (avg. 5 and 6.5 Chl a mg/L, resp.), total microcystin concentrations (avg. 1.185 and 7.153 mg/L, resp.), and mcyA transcript but its expression was not directly correlated with total microcystin concentrations in the target strains. Interestingly, Durgakund strain had much lower microcystin content and lacked microcystin-YR variant over NIES 843 and KW. It is inferred that microcystin concentration and its variants are strain specific. We have also examined the heterotrophic bacteria associated with cyanobacterial bloom in Durgakund Pond and Wangsong Reservoir which were found to be enriched in Alpha-, Beta-, and Gammaproteobacteria and that could influence the bloom dynamics.

Effect of Low-Intensity Microwave Radiation on Monoamine Neurotransmitters and Their Key Regulating Enzymes in Rat Brain.

The increasing use of wireless communication devices has raised major concerns towards deleterious effects of microwave radiation on human health. The aim of the study was to demonstrate the effect of low-intensity microwave radiation on levels of monoamine neurotransmitters and gene expression of their key regulating enzymes in brain of Fischer rats. Animals were exposed to 900 MHz and 1800 MHz microwave radiation for 30 days (2 h/day, 5 days/week) with respective specific absorption rates as 5.953 × 10(-4) and 5.835 × 10(-4) W/kg. The levels of monoamine neurotransmitters viz. dopamine (DA), norepinephrine (NE), epinephrine (E) and serotonin (5-HT) were detected using LC-MS/MS in hippocampus of all experimental animals. In addition, mRNA expression of key regulating enzymes for these neurotransmitters viz. tyrosine hydroxylase (TH) (for DA, NE and E) and tryptophan hydroxylase (TPH1 and TPH2) (for serotonin) was also estimated. Results showed significant reduction in levels of DA, NE, E and 5-HT in hippocampus of microwave-exposed animals in comparison with sham-exposed (control) animals. In addition, significant downregulation in mRNA expression of TH, TPH1 and TPH2 was also observed in microwave-exposed animals (p < 0.05). In conclusion, the results indicate that low-intensity microwave radiation may cause learning and memory disturbances by altering levels of brain monoamine neurotransmitters at mRNA and protein levels.

Stability of latanoprost in generic formulations using controlled degradation and patient usage simulation studies.

PURPOSE: To evaluate the stability of latanoprost in generic formulations by using controlled degradation and patient usage simulation studies METHODS: Standard latanoprost was subjected to controlled degradation studies. Latanoprost content was assessed by using MRM, and generated Degradation Products (DP) were analysed by using the Information Dependent Acquisition (IDA) protocol of positive ESI-LC-MS/MS. Latanoprost content and formation of DP were assessed in generic formulations and were compared with Xalatan(®) in a controlled patient usage simulation studies. The last few drops of latanoprost, present in containers used by patients were also evaluated. RESULTS: Extreme pH conditions, oxidation, light and heat were found to be the significant factors for high degree of latanoprost degradation. Systematic analysis of 7 selected generics revealed that the latanoprost content varied from 90-330%. Concentration of the latanoprost in Xalatan was found to be 97% of the label claim. Degradation studies showed the formation of 3 novel and 3 already known impurities. Upon simulated patient usage, 2 of the generic formulations showed significant degradation of latanoprost. Generic formulations having thermally sealed gas tight packing showed good stability during patient usage. Overage of latanoprost was observed in generics with other than thermal sealing. Latanoprost bottles used by patients showed concentrations ranging from 20 to 250% of label claim (144% median). CONCLUSION: This study revealed the presence of overage of latanoprost in some generic formulations and formation of degradation products. Packaging with gas tight containers may be one of the important factors for latanoprost stability, along with its storage at low temperature during patient usage.

Temporal variations in microcystin-producing cells and microcystin concentrations in two fresh water ponds.

The relationship between microcystin production, microcystin-producing cyanobacteria, including Microcystis spp., and various biological and physicochemical parameters in Sankuldhara and Lakshmikund, situated in the same geographical area was studied over a period of 1.5 years. Seasonal variation in cyanobacterial 16S rRNA, Microcystis spp. 16S rRNA, mcyA and mcyB genes were quantitatively determined by real-time PCR. Microcystis was the dominant microcystin producer in both study sites constituting 67% and 97% of the total microcystin-producing cyanobacteria at Sankuldhara and Lakshmikund, respectively. Microcystin concentrations were 2.19-39.60 µg/L and 15.22-128.14 µg/L at Sankuldhara and Lakshmikund, respectively, as determined by LC-MS. Principal component analysis revealed a strong positive correlation between microcystin concentration and the copy number of mcyA and mcyB, chlorophyll a and cyanobacterial biomass at both sites. The higher microcystin concentrations in Lakshmikund pond were attributed to the high copy number of mcy genes present coupled with the pond's eutrophication status, as indicated by high total algal biomass, high chlorophyll a content, high nutrient load and low DO. Therefore, a significant difference in microcystin concentrations, correlating with these various biological and physicochemical parameters, confirms the importance of local environmental variables in the overall regulation of microcystins production.

Development and validation of a LC-MS/MS method for homocysteine thiolactone in plasma and evaluation of its stability in plasma samples.

The present study demonstrates the development and validation of a sensitive method for the quantification of homocysteine thiolactone (HCTL) in human plasma using the technique of LC-MS/MS. The gradient elution of HCTL was achieved within 5min using ZIC HILIC column having acetonitrile with 0.1% formic acid and water with 0.1% formic acid. The method was validated for the linearity, sensitivity, accuracy, precision, recovery, matrix effect and stability. A good linearity was found within a range of 0.5-32.5nmol/ml. Quantification was performed using multiple reaction monitoring (MRM) mode based on the molecular/fragment ion transitions for HCTL (118/56) and homatropine (276.1/142.2) as internal standard. Generally, HCTL levels in plasma were found to be highly unstable. In order to verify the stability of the HCTL levels in plasma for a longer period, the samples were extracted immediately and stored at -86°C. Using the above method it was found to be stable for a period of 1 month. The method was well applied for quantification of HCTL in plasma of healthy human volunteers.

Evaluation of pharmacological activities and assessment of intraocular penetration of an ayurvedic polyherbal eye drop (Itone™) in experimental models.

BACKGROUND: The polyherbal eye drop (Itone™) is a mixture of aqueous distillates of nineteen traditionally used ingredients that sum up to impart potency to the formulation and make it a useful adjunct in various ocular pathologies. However, as there have been no controlled experimental studies accounting to the above claim, therefore, the present study was designed to evaluate the polyherbal formulation (PHF) for antiangiogenic, anti-inflammatory, anticataract, antioxidant and cytotoxicity in addition to the evaluation of intraocular penetration of PHF in rabbit eyes using LC-MS/MS. MATERIALS AND METHODS: Antiangiogenic activity of the PHF was evaluated using in ovo chick chorio-allantoic membrane (CAM) assay and in vivo cautery induced corneal neovascularization assay in rats. Anticataract potential was evaluated using steroid induced cataract in developing chick embryos, sodium selenite induced cataract in rat pups and galactose induced cataract in rats. The antioxidant activity was evaluated using di-phenyl picryl hydrazyl (DPPH) radical scavenging assay. Anti-inflammatory activity was evaluated in vitro using inhibition of LTB4 formation in human WBCs and in vivo using carrageenan induced paw edema assay in rats. The cytotoxicity was evaluated against HeLa cancer cell lines using (3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Furthermore evaluation of the intraocular penetration of the PHF was carried out in rabbit eyes via aqueous humor paracentesis and further analysis using LC-MS/MS. RESULTS: PHF significantly inhibited VEGF induced proliferation of new blood vessels in CAM assay and inhibited the cautery induced corneal neovascularization in rats. Additionally, PHF showed noticeable delay in the progression of cataract in the selenite and galactose induced cataract models whereby the PHF treated lenses were graded for stages II and III respectively. However, the PHF did not show any anticataract activity in the hydrocortisone induced cataract model. Moreover, PHF exhibited anti-inflammatory activity whereby it showed 39.34% inhibition of LTB4 formation and significantly inhibited carrageenan induced paw edema in rats. Eight compounds of PHF viz. camphor, casticin, curcumin-II, quercetin, rosmarinic acid, γ-terpinene, ß-pinene and dipentene exhibited transcorneal penetration in rabbit eyes. CONCLUSION: The significant antiangiogenic and anti-inflammatory activities evinced by the PHF merits further investigation for ocular neovascular and inflammatory diseases in humans.

Dynamics of microcystin production and quantification of potentially toxigenic Microcystis sp. using real-time PCR.

Cyanobacterial blooms in eutrophied water body are generally composed of various genotypes with or without microcystin-producing genes (mcy gene cluster). Thus there is a need for quantification of potent toxin producing strains. The present study aimed at identifying microcystin variants and its producer strains in Durgakund pond, Varanasi, India, based on quantification of cpcBA-IGS and mcyA (condensation domain) genes using real-time PCR and LC-MS. Increase in microcystin concentrations was correlated with increase in mcyA copy number and the level of pigments (chlorophyll a, phycocyanin and carotenoids). Also, selected environmental factors (water temperature, light irradiance, rainfall, pH, N and P) and the concentration of microcystin variants (MC-LR, -RR and -YR) were also assessed in samples during May 2010 to April 2011 to establish the possible correlation among these parameters. Nutrients favored cyanobacterial bloom but it could not be correlated with the levels of microcystin variants and seemed to be geographically specific. Microcystis sp. dominant in the pond comprised potentially toxigenic cells. The ratio of potentially toxigenic Microcystis sp. to that of total Microcystis sp. ranged from 0% to 14%. Such studies paved the way to identify and quantify the most potent microcystin producer in the tropical aquatic body.

Regional variation in the levels of macular xanthophylls and carotenoids in dietary components: comparing North and South India.

Multiple epidemiological studies have emphasized the intake of dark green leafy vegetables rich in xanthophylls in reducing the risk of developing age-related macular degeneration (AMD). Therefore, the present study was undertaken to quantify the levels of major carotenoids in commonly consumed fruits and vegetables of Indian origin and of xanthophylls in the macula of Indian human donor eyes. Fresh fruits (n=20) and vegetables (n=51) collected from two zones of India were tested for the estimation of xanthophyll, lycopene and ß-carotene by using HPLC with Photodiode Array Detection. Lutein and zeaxanthin were quantified from macula and in selected vegetables collected from both southern (SI) and northern (NI) regions of India. Xanthophylls, ß-carotene and lycopene were found in many affordable vegetables commonly available for consumption in India. Higher content of lutein and zeaxanthin was confirmed in many economical leafy vegetables and fruits. Surprisingly, the mean macular levels of lutein and zeaxanthin of SI donor eyes (n=13) were found to be significantly (p<0.001) four times less than in NI donor eyes (n=15) and the macular levels of Northern India were comparable with reported levels in western populations. The present study showed considerable levels of xanthophylls in many of the commonly consumed fruit and vegetable sources in both parts of India. However, SI donor eyes showed lower levels as compared to NI donors and this warrants further investigation about the bioavailability of xanthophylls in their blood and food intake. The relevance of these findings with prevalence of AMD in South India needs to be explored.

Retinal toxicity of intravitreally injected plain and liposome formulation of fluconazole in rabbit eye.

PURPOSE: Candidal endophthalmitis is a sight-threatening ocular infection that most frequently occurs as a complication of candidemia. Fluconazole has been effective against Candida albicans in various animal models. Our objective was to evaluate retinal toxicity of plain and liposome formulation of fluconazole at various dose levels after intravitreal injection. MATERIALS AND METHODS: Twelve New Zealand albino rabbits weighing 2-2.5 kg were used. Two rabbits were used for every dose level. Liposome formulation containing 100 and 200 microg of fluconazole in sterile phosphate buffer solution and plain fluconazole at concentrations of 100, 200, 400 and 800 microg in 0.1 ml of sterile normal saline were injected intravitreally into the right eyes. The left eyes received 0.1 ml normal saline or 0.1 ml of liposome formulation without fluconazole. One week later, the animals were sacrificed, their eyes enucleated and processed for light microscopy and scanning electron microscopy. RESULTS: It showed that plain fluconazole at a concentration of 100 microg and above caused retinal changes, with disorganization of the photoreceptor outer segments. However, liposome formulation of fluconazole (200 microg/0.1 ml) did not show any significant microscopic changes of the retina. CONCLUSION: The liposome formulation decreased the retinal toxicity of fluconazole up to the studied concentration of 200 microg/0.1 ml.

Detection of 16S rRNA gene in round bodies isolated from polyps of rhinosporidiosis.

Polyps of rhinosporidiosis contain microscopic round bodies, believed to be causative agents of the disease. The source and identity of these round bodies has been debated ever since the first case was described in the year 1900. Most patients have a history of exposure to pond water. Collection and microscopic analysis of pond water samples where patients had been dipping led to the idea that a cyanobacterium could possibly develop into round bodies after entering the patient's nose. Molecular genomic studies based on PCR, cloning, and sequencing were, therefore, carried out using purified DNA, extracted from individually separated round bodies from polyp samples. Parallel investigations were also conducted on DNA extracted from cyanobacterium Microcystis isolated from pond water samples. The results of these experiments presented here provide evidence of the presence of 1458 bp 16S rRNA gene in round bodies. This is the first molecular study indicating the prokaryotic identity of round bodies in rhinosporidiosis.

Comparative evaluation of Prostina and terazosin in the treatment of benign prostatic hyperplasia.

The objective of the present study was to evaluate the efficacy and safety of Prostina, a multi-ingredient herbal formulation in benign prostatic hyperplasia (BPH) in comparison with terazosin. A randomised, open, parallel, controlled clinical trial was carried out in ambulatory men aged between 40-80 years suffering from BPH, with American Urological Association (AUA) symptom index score of at least 8 or more at recruitment. One group received 2 Prostina capsules twice daily for 12 weeks; the other received terazosin 2 mg at bedtime for 12 weeks. Urodynamic parameters, AUA score, biochemical and clinical adverse effects were assessed. Twenty subjects completed the study in Prostina group and 20 in terazosin group. The groups were comparable at baseline in age and assessment criteria. Majority of urodynamic parameters showed improving trends in both the groups. AUA symptom score declined significantly from 19.50 +/- 1.40 (mean +/- standard error) to 1.04 +/- 0.68 in Prostina group and from 16.95 +/- 1.23 to 4.14 +/- 0.88 in terazosin group. The AUA symptom score in 12 weeks follow-up was significantly lower in Prostina group than terazosin group (p = 0.005). Other laboratory-parameters remained unaltered in both the groups. Prostina is as effective as terazosin in providing symptomatic relief in BPH.

Evaluation of the stability of extemporaneously prepared ophthalmic formulation of mitomycin C.

Mitomycin C (MMC) is a cytostatic agent topically used in conjunctival neoplasms, secondary to glaucoma filtering, pterygium, and strabismus surgery to increase the success rate. The topical formulation of MMC for ocular use is always extemporaneously prepared. Our study evaluated the stability of extemporaneously prepared formulations of MMC at different concentrations (150, 300, & 600 microg/mL) kept at different temperatures (25 degrees , 4 degrees , and -70 degrees C) and at different pH range (6, 7, and 8). Aliquots from the above formulations were subjected for quantification of MMC on days 0, 7, 14, 21, and 28 using high-performance liquid chromatography. MMC stored at 25 degrees C for 6 months was also subjected to flow cytometry and compared to freshly prepared MMC. The results indicated that the degradation of MMC is very high in acidic pH at room temperature. Increasing the pH to 7 or 8 and keeping MMC at low temperatures significantly decreased the degradation of MMC. Interestingly, the flow cytometry data revealed that the 6-month-old MMC showed an antiproliferative effect compared to that of freshly prepared MMC. To conclude, the extemporaneously prepared MMC at pH between 7 and 8 and stored in the refrigerator can increase the duration of its stability. However, the antiproliferative study using flow cytometry revealed that degraded MMC retained its activity even after degradation.