The Impact of Pomegranate on Memory Dysfunction after Cardiac Surgery

Background: Studies have shown a decline in certain cognitive abilities in individuals diagnosed with heart disease of any type or etiology. This decline is observed as the disease progresses (Muller, Grobbee, Aleman, Bots & van der Schouw, 2006; Ernest et al., 2006), as well as after certain interventions, such as coronary artery bypass grafting (CABG) and heart valve surgery. In recent years, there has been a great deal of emphasis on the beneficial effects of pomegranate on health, including diseases of the brain and the heart. Few, however, have explored the impact of pomegranate on cognitive functions. Thus, the current pilot study is unique in its exploration of the effects of pomegranate on various health parameters and its possible effectiveness in reducing cognitive declines, specifically memory, after cardiac surgery. Methods: The sample consisted of 10 patients, who had undergone elective, on-pump, normothermic cardiac surgery (CABG and/or valve surgery). Participants in the treatment group were given two pomegranate (PomX) capsules (1000mg each). Participants in the placebo group were given two placebo capsules. These capsules were taken daily starting one week before and continued to 6 weeks after surgery. Subjects were administered a comprehensive battery of neuropsychological tests at each testing session (1 week before surgery, 2 weeks after surgery and 6 weeks after surgery); however, those tests only assessing memory functions were selected. Results: Results revealed that the treatment and placebo groups performed similarly at time 3; however, the critical time period of interpatient variability seems to be from time 1 to time 2 (with higher incidences of clinical impairments for the placebo group), particularly with visual memory measures. Conclusions: Results suggest that there are fewer incidences of memory impairments from time 1 to time 2 for individuals that supplemented their treatment with pomegranate suggesting that the contents contained in pomegranate may be targeting the factors associated with early postoperative dysfunction (i.e. hypoxia, ischemia)

Warfarin induced hematuria

Warfarin is an oral vitamin K antagonist prescribed to those patients for the treatment and prevention of thromboembolism. The major challenges to be faced during the therapy were a greater risk for both major as well as minor bleeding, which makes the regular monitoring of INR (international normalized ratio) mandatory. Herein, we reported a case of Warfarin induced hematuria which is serious and we concluded this causality as possible category according WHO-UMC causality category

Profile of ipilimumab and its role in the treatment of metastatic melanoma

Melanoma is an immunogenic cancer. However, the ability of the immune system to eradicate melanoma tumors is affected by intrinsic negative regulatory mechanisms. Multiple immune-modulatory therapies are currently being developed to optimize the immune response to melanoma tumors. Two recent Phase III studies using the monoclonal antibody ipilimumab, which targets the cytotoxic T-lymphocyte antigen (CTLA-4), a negative regulator of T-cell activation, have demonstrated improvement in overall survival of metastatic melanoma patients. This review highlights the clinical trial data that supports the efficacy of ipilimumab, the immune-related response criteria used to evaluate clinical response, and side-effect profile associated with ipilimumab treatment

Factors that Affect Performance on Executive Functioning after Coronary Artery Bypass Grafting

Research suggests that individuals who undergo coronary artery bypass grafting (CABG) experience declines in neuropsychological functioning post-operatively. This decline has been observed in up to 80% of patients early after surgery, and in up to 30% of patients after six months. Many studies have examined the potential effects of CABG on neuropsychological functioning in general, and numerous studies have found that executive functions are impaired in particular. However, none have examined what factors contribute to observed executive dysfunction after CABG. This study investigated the role of memory functions on executive functions in a selected sample of patients undergoing CABG. This study also examined the role of selected individual variables and surgical variables on executive functioning after CABG. Archival data were used for this study. The sample consisted of 42 patients who had undergone elective, on pump, normothermic CABG surgery. A battery of neuropsychological tests was administered 1-3 days before surgery and again approximately one week postoperatively, just before hospital discharge. It was hypothesized that there would be a significant decline on neuropsychological tests of executive functioning after CABG surgery. It was also hypothesized that impairment in executive functions would be impacted by performance on tests of long term memory as well as demographic and surgical factors including age, education, cardiopulmonary bypass time, anesthesia time and surgery time. Results revealed that there were significant declines in executive functions after CABG. Despite significant declines in long term memory functions after CABG, performance on long-term memory tests did not contribute significantly to performance on executive functioning tasks. Executive functioning was significantly impacted, however, by age, education, cardiopulmonary bypass time, anesthesia time and surgery time. Together, these results suggest that impairments in executive functioning after CABG may be due to demographic and perioperative factors and may exist independent of deficits in long term memory

Analysis of adverse drug reactions in a tertiary care emergency medicine department: prevalence, preventability and reporting

Background: Adverse drug reactions (ADRs) are negative consequences of drug therapy. ADR results in diminished quality of life, increased physician visits, hospitalizations, and even death. Hence a study was planned to detect and analyze ADR encountered in emergency medicine department.Methods: Data was collected over a period of 1 year after taking approval from IRB (Institutional Review Board) and written informed consent from patients. ADRs presenting as a cause of hospital admission or developed during hospitalization were analyzed.Results: A total of 229 ADRs were analyzed. Majority of ADRs were found in the age group of 40-60 Years. The M: F Ratio was 1.10:1. According to Wills and Brown Classification, majority of the ADRs belonged to Type A. According to Hartwig and Siegel classification of severity of ADRs, 18.78% of the ADRs were severe in nature. According to Schumock and Thornton preventability score, majority (64.19%) of the ADRs were not preventable, whereas 17.03% were definitely preventable. 120 (52.40%) of the ADRs were serious in nature Anti-infective were the most common drug class (30.13%) followed by CVS (24.03%) group of drugs. About (57.64%) ADRs fall in the category of probable/likely. Regarding their Outcome, 44.10% of the ADRs were recovered and 43.23% were recovering.Conclusions: Anti-infective were the most reported drug class to cause ADRs in a tertiary care emergency medicine department. Causality assessment according to WHO-UMC and Naranjo’s causality assessment criteria reported to be Probable. Whereas modified Schumock and Thornton scale preventability scale showed that majority were not preventable

Determinants of Helicobacter pylori density in the human stomach and implications in disease

Introduction and aims: Helicobacter pylori establishes a chronic infection in the stomach of almost half the world's population. A small proportion of patients go on to develop peptic ulcer disease and in some cases gastric cancer. Numerous factors influence the outcome of infection, including host, bacterial and environmental factors. The impact of bacterial colonisation density on the outcome of disease is poorly understood. The aim of this study was to investigate the determinants of bacterial density and the implications in disease. Methods: Gastric biopsies were collected from 50 H. pylori infected patients attending the Queen's Medical Centre, Nottingham for a routine upper GI endoscopy. Patient disease status was determined as having gastritis, duodenal ulcer disease (DUD), or gastric ulcer disease (GUD). Histological analysis for inflammation, activity, H. pylori density, atrophy and intestinal metaplasia were assessed according to the Sydney scoring system. Bacterial strains were cultured from gastric biopsies. Isolated bacterial DNA was used for genotyping strain virulence for CagA, VacA and DupA status. In order to determine accurate levels of colonisation in gastric tissue samples, a quantitative real-time PCR (qPCR) assay was developed based on the quantification of H. pylori 16S rRNA copy number, relative to the number of human GAPDH copy numbers. Quantification of IL8, ILIO, TGFß, FOXP3, h8, Dl and LL37 mRNA levels in gastric tissue were assessed by real-time RTPCR. The impact of host factors on bacterial density was assessed in vitro using H. pylori infected or uninfected AGS gastric epithelial cells, treated with recombinant cytokine. Colony forming units (CFUs) were enumerated in culture suspensions. The in vitro model was also used to examine the impact of cagA, cage, and vacA isogenic deletion mutant strains on bacterial density. Also, h, 8D1 expression levels were measured in culture suspensions, and IL-8 secretion levels in were assessed by ELISA. Results and conclusions: The pattern of colonisation in the gastric mucosa was found to be associated with the disease profile that develops, with an antral-predominant colonisation was associated with DUD, whereas corpus-predominant colonisation was associated with GUD. Bacterial factors that may drive the pattern of bacterial density in the stomach were then investigated, and strains expressing the dupA virulence factor were coincident with antral-predominant colonisation in the gastric mucosa. cagA and vacA were not found to be associated with bacterial density in vivo or in vitro. To assess the relationship between colonisation density and the host response, firstly IL8 mRNA expression levels were measured in gastric biopsies. An inverse relationship between bacterial load and expression of this pro-inflammatory cytokine was observed, but only at high IL8 expression levels and with higher H. pylori density. The inflammatory cytokines IL-10, TNFa, IL-17 and IL-22 did not impact CFU counts in vitro. No association was observed between bacterial load and expression levels of the immunosuppressive genes ILIO, TGFBI and FOXP3. However, increased CFU counts were found on treatment of H. pylori infected AGS cells with recombinant IL-10 and TGFß in vitro. Also, reduced expression of these immunosuppressive genes was associated with the presence of atrophy and intestinal metaplasia. In addition, ILIO and FOXP3 expression levels were negatively associated with mononuclear cell (MNC) infiltration. Reduced expression levels of the antimicrobial peptide (AMP) defensin hß, Dl were found with H. pylori infection in vivo and in vitro, and a negative association between hßDl expression and bacterial load was observed in vivo. A small increase in hßDl expression was observed in AGS cells infected with the cagPAI defective mutant strain in comparison to the wild type strain, suggesting a possible role for the CagPAI in modulating hßDl expression. In contrast, expression levels of the antimicrobial peptide LL37 were upregulated in the H. Mori infected gastric mucosa. In conclusion, the localisation of H. pylori in the gastric mucosa is associated with the disease profile that develops in the stomach. The patterns of colonisation observed may be influenced by the dupA virulence determinant. Host immune responses, were not associated with colonisation density. However, increased Treg response may be associated with protecting the host from the deleterious effects of inflammation. The direct modulation of bacterial load may be regulated by AMPs. In the H. pylori infected mucosa, reduced hßDl expression was observed which may assist persistent colonisation

A case series on drug induced hyponatremia: uncommon adverse effect of commonly used drugs

Older patients suffering from depression and psychosis have markedly increased since last decade. So, has the use of antidepressants and antipsychotics. The prevalence of hyponatremia due to these drugs is common in general as well as psychiatric practice. It may also lead to life threatening morbidity and mortality. Loss of renal function, polypharmacy, dementia and other conditions of advanced age can either exacerbate the severity of hyponatremia or mask its onset. In this case series, total four cases were reported of hyponatremia and drugs causing it were escitalopram, quetiapine, tianeptine and oxcarbazepine. Due to polypharmacy, a chance of hyponatremia was more in these patients. Patients received infusion of hypertonic saline with salt added diet to treat hyponatremia. Symptoms of hyponatremia were improved after the treatment. In all four cases, WHO and Naranjo’s causality assessment revealed ‘possible’ causal relationship with the prescribed drug. Prescribers should be aware of such adverse effect due to these drugs