Recurrent aseptic meningitis: A rare clinical presentation of Sjogren's syndrome.

Sjogren's syndrome most commonly presents with dry eyes, dry mouth, joint pain and fatigue. However, recurrent aseptic meningitis, reported as the most uncommon initial symptom, was the presenting feature in our case. We present the case of a 19-year-old female with recurrent episodes of aseptic meningitis. She presented with fever, headache, vomiting and photophobia. Neurological examination showed neck stiffness. Fundoscopy was normal. On two previous occasions her cerebrospinal fluid analysis was consistent with meningitis; however, it was normal at this presentation. Review of system revealed history of fatigue and sicca symptoms since early childhood. Autoimmune workup showed antinuclear antibodies with a titer of 1:400 and positive anti SSA (Ro) antibodies that led to the diagnosis of Sjogren's syndrome. She responded well to intravenous steroids, followed by oral prednisolone and hydroxychloroquine. To conclude, diagnosis of Sjogren's syndrome may also be considered in a patient presenting with recurrent aseptic meningitis.

Comparison of Microscopy, Card Agglutination Test for Trypanosoma Evansi, and Real-time PCR in The Diagnosis of Trypanosomosis in Dromedary Camels of The Abu Dhabi Emirate, UAE.

Introduction: Trypanosomosis is an important disease of dromedary camels caused by the pathogenic protozoan Trypanosoma evansi. This study aimed to compare three different tests for its diagnosis in this species: conventional microscopy, the card agglutination test for trypanosomosis/T. evansi (CATT/T. evansi) and real-time PCR. Material and Methods: Whole blood and serum samples collected from 77 dromedary camels of Abu Dhabi, United Arab Emirates, were analysed with the test methods stated. Statistical analysis was done using McNemar's chi-squared test, and Cohen's kappa index (κ) was calculated. Results: We obtained results with positivity of 18% (14/77) by microscopy, 22% by CATT (17/77) and 60% (46/77) by real-time PCR, with the chain reaction detecting at a respectively three- and two-fold greater rate than the other techniques. Analysis of the data revealed a relative sensitivity of 30.4% and 37.0% for microscopy and CATT, respectively, compared to real-time PCR. The difference between the real-time PCR's sensitivity and those of the other methods was statistically significant, with X2 values of 30.03 and 20.1, respectively (df = 1 and P = 0.05 in both cases). Agreement of microscopy results with those of with CATT was good (κ = 0.72; 95% CI = 0.62-0.82). Cohen's kappa index showed fair agreement of real-time PCR with microscopy (κ = 0.26; 95% CI = 0.16-0.36) whereas it was in poor agreement with CATT (κ = 0.09; 95% CI = 0.02-0.15). Conclusion: Real-time PCR was found to be more sensitive than microscopy and CATT.

2,2-Bis(hy-droxy-meth-yl)-2,3-dihydro-1H-pyrrolizin-1-one.

The title compound, C(9)H(11)NO(3), was prepared by an Aldol reaction of 2,3-dihydro-1H-pyrrolizin-1-one with formaldehyde. The asymmetric unit contains six mol-ecules. The pyrrolizine ring system in each mol-ecule is planar, the maximum atomic deviation being 0.066 (2) Å. In the crystal structure, mol-ecules are liked together by an extensive O-H⋯O hydrogen-bonding network.

Systematic evidence of health economic evaluation of drugs for postmenopausal osteoporosis: A quality appraisal.

This paper systematically and critically reviewed all published economic evaluations of drugs for the treatment of postmenopausal osteoporosis. A systematic search was conducted using relevant databases for economic evaluations to include all relevant English articles published between January 2008 to January 2020. After extracting the key study characteristics, methods and outcomes, we evaluated each article using the Quality of Health Economic Studies (QHES) and the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) instruments. A total of 49 studies met the inclusion criteria. Majority of studies were funded by the industry and reported favorable cost-effectiveness. Based on the QHES total scores, studies (n = 35) were found to be industry-funded with higher QHES mean 82.44 ± 8.69 as compared with nonindustry funding studies (n = 11) with mean 72.22 ± 17.67. The overall mean QHES scores were found to be higher 79.06 ± 11.84, representing high quality (75-100) compared to CHEERS scores (%) 75.03 ± 11.21. The statistical pairwise comparison between CHEERS mean (75.03 ± 11.21) and QHES mean (79.06 ± 11.84) were not statistically significant (P = 0.10) whereas, QHES score showed higher means as compared to CHEERS. This study suggests the overall quality of the published literatures was relatively few high-quality health economic evaluation demonstrating the cost-effectiveness of drugs for postmenopausal osteoporosis, and the majority of the literature highlights that methodological shortcoming.

Antimicrobial activity of various parts of Polyalthia longifolia var. pendula: isolation of active principles from the leaves and the berries.

Methanol extracts of leaves, stem, twigs, green berries, flowers, roots, root-wood and root-bark of Polyalthia longifolia var. pendula, were tested for their antibacterial and antifungal potentials. Bioassay monitored isolation work on the methanol extract of leaves and berries which possess promising antibacterial activity led to the isolation of seven clerodane diterpenoids, 16(R and S)-hydroxy-cleroda-3,13(14)Z-dien-15,16-olide (1), 16-oxo-cleroda-3,13(14)E-dien-15-oic acid (2), methyl-16-oxo-cleroda-3,13(14)E-dien-15-oate (3), 2-oxo-kolavenic acid (4), 16 (R and S)-hydroxy-cleroda-3,13(14)Z-dien-15,16-olide-2-one (5), (4-->2)-abeo-16(R and S)-hydroxy-cleroda-2,13(14)Z-dien-15,16-olide-3-al (6), 3beta,16alpha-dihydroxy-cleroda-4(18), 13(14)Z-dien-15,16-olide (7), while kolavenic acid (8) and solidagonal acid (9) were obtained from the root-wood. Diterpenoids 1 and 8 were also obtained from the root-bark. It is the first report of the isolation of 7 and 9 from this source, and clerodane 3 was obtained as a natural product for the first time. Clerodanes 1, 2, 5, 6 and 7 were found to be active antimicrobial agents with MIC values ranging between 7.8 and 500 microg/mL. Diterpenoid 1 emerged as the most active antimicrobial agent. The acetyl derivative (10) of 1 and the methyl derivative (3) of 2 were found to be less active than the parent compounds. A complex of allantoin was also obtained from the berries, which on hydrolysis furnished pure allantoin (11).

Effect of anti-diabetic drugs on bone metabolism: Evidence from preclinical and clinical studies.

Diabetes mellitus is associated with abnormal bone health and an increased risk of fracture even though patients have normal or higher BMD. The mechanisms behind diabetes mellitus- induced various skeletal disorders remain unclear. Anti-diabetic drugs may have negative or positive impact on bone metabolism. For instance, thiazolidinediones increases the bone loss and risk of fracture possibly through PPARγ activation in bone marrow cells and hamper osteoblastogenesis via decreasing Runx2 transcription factor, IGF-1 and Wnt signalling pathways. In contrast, metformin and sulfonylureas have a neutral or positive effect on bone health and reduced risk of fracture. Results from the preclinical and clinical studies convey conflicting findings over insulin safety profile on bone health. Incretin-based therapy (GLP-1 receptor agonist and DPP-4 inhibitors) and SGLT2 inhibitors are currently marketed anti- diabetic drugs. While evidence from animal studies suggest that incretin-based therapy have anabolic effect on bone, limited clinical data of DPP-4 inhibitors and GLP-1 receptor agonist indicated a neutral effect on the bone health and risk of fracture. SGLT2 inhibitors may cause bone loss or increase fracture risk due to altered calcium, phosphate and sodium concentration. Therefore, safety concerns of anti-diabetic drugs are crucial for the management of diabetes mellitus. In this review, analysis of the available evidence for effect of anti-diabetic drugs on the bone metabolism and fracture risk in diabetes mellitus is described.

Neuroprotective Role of Steroidal Sex Hormones: An Overview.

Progesterone, estrogens, and testosterone are the well-known steroidal sex hormones, which have been reported to have "nonreproductive "effects in the brain, specifically in the neuroprotection and neurotrophy. In the last one decade, there has been a surge in the research on the role of these hormones in neuroprotection and their positive impact on different brain injuries. The said interest has been sparked by a desire to understand the action and mechanisms of these steroidal sex hormones throughout the body. The aim of this article was to highlight the potential outcome of the steroidal hormones, viz. progesterone, estrogens, and testosterone in terms of their role in neuroprotection and other brain injuries. Their possible mechanism of action at both genomic and nongenomic level will be also discussed. As far as our knowledge goes, we are for the first time reporting neuroprotective effect and possible mechanism of action of these hormones in a single article.

Nematicidal natural products from the aerial parts of Buddleja crispa.

Studies on the aerial parts of Buddleja crispa yielded 13 known compounds, nonyl benzoate, hexyl p-hydroxy-cinnamate, ginipin, gardiol, 1-heptacosanol, steroidal galactoside (22 R)-stigmasta-7,9 (11)-dien-22 beta-ol-3beta-O-beta-D-galactopyranoside, 3-methoxy benzoic acid, beta-sitosterol and ursolic acid. Besides this two iridoid galactosides buddlejosides A, buddlejosides B and a benzofuran-type sesquiterpene buddlejone have been isolated from the ETOAC fraction of B. crispa. Together with the above compounds, methyl benzoate (1) and 3-methoxy-4-hydroxy benzoic acid (2) were also isolated. Compound 2 (C(8)H(8)O(4)) was identified by comparison of its data with those reported earlier, which was originally isolated from Onosma hispidum, and this is the first report of its isolation from this species. For compounds 1 and 2, the total alcoholic soluble extract, methanol soluble, chloroform soluble, ethyl acetate soluble and petroleum ether soluble extract of the aerial parts of B. crispa were screened for nematicidal activity against nematodes of freshly hatched second-stage juveniles of Meloidogyne incognita (root-knot nematode), exhibiting 92%, 40%, 88%, 83%, 82% and 50% mortality, respectively, of eloids M. incognita at 0.5% concentration. Compound 1 was more potent than the nematicide Azadirachta indica at the same concentration. Negative results were obtained for the nematicidal activity of petroleum ether extract of B. crispa leaves.

Hypotensive activity and toxicology of constituents from root bark of Polyalthia longifolia var. pendula.

A defatted extract of Polyalthia longifolia var. pendula root bark (PRB) in 50% methanol showed a significant ability to reduce blood pressure. It caused a 22% and 47% fall in mean arterial blood pressure (MABP) in rats at doses of 3 mg/kg and 30 mg/kg, respectively. Compounds purified from this extract include kolavenic acid (3), clerodane (1) and its isomer (2), liriodenine (4), lysicamine (5) and bisclerodane imide (6) and its isomer (7). Of these, only kolavenic acid produced a 22% fall in MABP, at a dose of 30 mg/kg. PRB showed a decrease in blood pressure of normotensive and egg yolk induced hypertensive rats. The LD50 of PRB was determined as 100 mg/kg in mice.

New antimicrobial alkaloids from the roots of Polyalthia longifolia var. pendula.

Bioassay-guided isolation studies on the root extract of Polyalthia longifolia var. pendula possessing significant antibacterial activity led to the isolation of three new alkaloids pendulamine A (1), pendulamine B (2) and penduline (3) along with stigmasterol 3-O-beta-D-glucoside, allantoin, the known diterpenoid kolavenic acid, and the azafluorene alkaloid isoursuline. The structures of these compounds have been elucidated with the help of spectroscopic studies including 2D NMR experiments. Compounds 1 and 2, which are the only protoberberine alkaloids having a monosubstituted A ring with a hydroxy group at C-3, were found to be the active antibacterial principles of the roots. Their MIC values ranged between 0.02-20 microg against the tested bacteria.

Evaluation of the antimicrobial property of Polyalthia longifolia var. pendula: isolation of a lactone as the active antibacterial agent from the ethanol extract of the stem.

Bioassay guided fractionation of the ethanolic extract of Polyalthia longifolia var. pendula stem, which showed promising antibacterial activity against thirteen Gram-positive and nine Gram-negative organisms, furnished (3S,4R)-3,4,5-trihydroxypentanoic acid-1,4-lactone (1) as the active principle. The structure of (1) was established by UV, IR, mass, 1H and 13C NMR as well as 2D NMR spectral studies and the formation of its acetate (1a). On acetylation activity of (1) was markedly reduced. It is synthetically well known and only recently isolated from two plants, however, its antimicrobial activity was not reported earlier. The extract, fractions and pure compounds did not show any remarkable activity against fungi and Mycobacterium fortuitum, and M. smegmatis.