VITEX NEGUNDO EXTRACTS PROTECT HUMAN CORNEAL EPITHELIAL CELLS FROM ULTRAVIOLET C-INDUCED PHOTOTOXICITY

Objective: The objective of the study was to investigate the protective effects of Vitex negundo (VN) extracts against ultraviolet (UV) light C-induced oxidative stress in human corneal epithelial cells (HCEC) in vitro. Methods: The VN extracts were checked for their antioxidant activities by biochemical tests. The preliminary phytochemical analysis was done to check the presence of secondary metabolites. To trigger oxidative stress, the HCEC were exposed to UVC irradiation (200 J/m2). Then, different concentration of VN extracts was administered after 1 h of UVC irradiation. The effects of UVC irradiation and the extracts on the HCEC viability, morphology, cell migration by scratch assay, and reactive oxygen species (ROS) production by dichlorofluorescein diacetate method were measured. Results: VN ethanol (VNE) extract showed the highest antioxidant activity than the aqueous extract. Phytochemical screening shows the presence of alkaloids, carbohydrates, proteins, phenolics, and tannins. The extracts showed no cytotoxicity on the HCEC and also the VNE extract did not alter the morphology of the cells. Results suggest that the VNE extract enhanced the proliferation and migration of HCEC. The VNE extract significantly decreased UVC-induced oxidative toxicity by inhibiting the intracellular ROS production and maintained cell viability. Conclusion: VN extracts with its strong antioxidant potential protects HCEC from UVC-induced oxidative stress. The results suggest that these extracts can be used as prophylactic agents or as a therapeutic agent in overcoming UV light-induced damage in various ocular surface diseases such as pterygium and photokeratitis

PROTECTIVE EFFECT OF CASSIA FISTULA EXTRACTS AGAINST ULTRAVIOLET C INJURY IN HUMAN CORNEAL EPITHELIAL CELLS

Objective: The objective of this study was to investigate the antioxidant activity of Indian laburnum (Cassia fistula L. [CF]) leaf extracts and their impact on ultraviolet C (UVC) radiation-induced damage on human corneal epithelial (HCE) cells. Methods: The antioxidant activity and free radical scavenging ability of CF leaf extracts were determined by in vitro methods such as 1,1-diphenyl- 2-picrylhydrazyl radical scavenging capacity, Total antioxidant capacity (TAC), and reducing power. The total phenolic content (TPC), total flavonoid content (TFC), and preliminary phytochemical screening were done to ensure the pharmacological effects of the extracts. The UVC radiation at wavelength 254 nm was used to irradiate HCE cells and cell viability was assessed by methyl thiazolyl tetrazolium assay. Results: Extracts at the concentration of 200 μg/ml did not affect the cell viability of HCE cells. Almost 50% cell death was observed after UVC irradiation at a dose of 200 J/m2. Both extracts showed a protective effect by increasing the cell viability of irradiated cells up to 57.28% and 62.39%. A dose-dependent increase in the TAC and reducing power of the extract was observed. The TPC in aqueous and ethanol extracts of CF leaves was 18.8 and 27.80 mg gallic acid equivalent/g sample while TFC was 8.47 and 16.5 mg quercetin equivalent per/gsample, respectively. Conclusions: CF leaves are a potent source of bioactive compounds with good antioxidant potential. Exposure to UVC radiation cause harmful effects on HCE cells and the extracts have shown to have potent protective effects on UV light-induced oxidative stress in HCE cells

Prevalence and pattern of dyslipidemia in newly detected type 2 diabetes mellitus and its correlation with anthropometric parameters

Background: Globally 425 million people have diabetes mellitus (DM) of which 90% are type 2 DM. India carries nearly 70 million cases of DM. India is called the diabetes capital of the world. The escalating epidemic of type 2 diabetes has been attributed to increasing obesity and longevity. Due to the additive cardiovascular risk of hyperglycemia and hyperlipidemia, lipid abnormalities should be aggressively detected and treated as a part of comprehensive diabetic care. The study aimed at detecting the occurrence and pattern of dyslipidemia in newly-detected type 2 diabetic patients in a tertiary care hospital in South India.Methods: This cross-sectional study was conducted over a period of eighteen months. It comprised of 50 newly detected diabetics above the age of 18 years who satisfied the inclusion and exclusion criteria.Results: Fifty patients were included in the study which included 18 males and 32 females. The body mass index (BMI) was abnormal in 62% (as per the Asian criteria) and in 42% (as per the WHO criteria). The waist circumference (WC) was found to be high in 82% and 70% as per the Asian and the WHO criteria, respectively. Forty six percent of the population was found to have elevated total cholesterol levels. LDL was increased in 70% of the study population while triglycerides were elevated in 40%, total cholesterol in 46% and low HDL in 76% of the patients.Conclusions: A significant correlation was found between the fasting blood sugars (FBSs) and serum triglycerides. There was a positive correlation noted between the dyslipidemia and the anthropometric parameters recorded

Central corneal thickness changes in bevel-up versus bevel-down phacoemulsification cataract surgery: study protocol for a randomised, triple-blind, parallel group trial.

INTRODUCTION: Corneal endothelial damage following phacoemulsification is still one of the major concerns of modern day cataract surgery. Although many techniques have been proposed, the risks of posterior capsular rupture and corneal endothelium damage persist. In theory, damage to the corneal endothelium is minimised by delivering the lowest phaco energy only in the direction necessary to emulsify the lens nucleus. Hence, it is believed that the bevel of the needle should be turned towards the nucleus or the nuclear fragment (ie, bevel-down. However, there is a difference of opinion among ophthalmologists with reference to the phaco tip's position (bevel-up vs bevel-down) during phacoemulsification. This subject has not been extensively studied earlier. METHODS AND ANALYSIS: This is a prospective, triple-blinded (trial participant, outcome assessor and the data analyst), randomised controlled trial with 2 parallel groups and with an allocation ratio of 1:1. It will be conducted in a tertiary care hospital, Mangaluru, India. The objective is to compare the postoperative central corneal thickness changes between the bevel-up and bevel-down techniques of phacoemulsification. Patients aged >18 years with immature cataract undergoing phacoemulsification will be selected for the study. The important exclusion criteria are the history of previous significant ocular trauma or intraocular surgery, corneal pathology, pseudoexfoliation syndrome, intraocular inflammation, a preoperative fully dilated pupil 4. After randomisation, patients will undergo phacoemulsification surgery either by a bevel-up or bevel-down procedure. With an estimated power of 80%, the calculated sample size is 55 patients in each group. The recruitment will start from April 2016. ETHICS AND DISSEMINATION: Yenepoya University Ethics Committee, India has approved the study protocol (YUEC/148/2016 on 18 February 2016). It complies with the Declaration of Helsinki, local laws and the International Council for Harmonization-good clinical practices. TRIAL REGISTRATION NUMBER: CTRI/2016/02/006691; Pre-results

Does the phaco TIp position during clear corneal Phacoemulsification Surgery adversely affect corneal endothelium? TIPS study protocol for a randomised, triple-masked, parallel-group trial of bevel-up versus bevel-down phacoemulsification

Introduction: Globally, at least 30 million cataract surgeries are required annually to prevent cataract-related blindness. Corneal endothelial decompensation is one of the most common causes of poor visual outcome following cataract surgery, particularly in those with predisposing factors. The increasing ageing population and reduced visual impairment threshold for cataract surgery have resulted in rising cataract surgical rates and hence, an increase in corneal endothelial decompensation is expected. The role of phaco tip position on corneal endothelial damage is ambiguous. Previous studies have reported contradictory results and were also underpowered to detect a significant difference due to small sample sizes. With no consensus regarding the most cornea-friendly phaco tip position (bevel-up versus bevel-down) during phacoemulsification, we propose a randomised clinical trial with a robust design using direct chop phaco-technique. Objective: To compare the effect of phaco tip position (bevel-up vs. bevel-down) on corneal endothelial cell count during phacoemulsification. Methods: A randomised, multicentre, parallel-group, triple-masked (participant, outcome assessor, and statistician) trial with 1:1 allocation ratio is proposed. By adopting stratified randomisation (according to cataract grade), we will randomly allocate 480 patients aged >18 years with immature cataract into bevel-up and bevel-down groups at two centres. History of significant ocular trauma, previous intraocular surgery, shallow anterior chamber, low endothelial cell count, pseudoexfoliation syndrome, intraocular inflammation, and corneal endothelial dystrophy are the key exclusion criteria. The primary outcome is postoperative endothelial cell count at one month. Secondary outcomes are central corneal thickness on postoperative days 1, 15, and 30, and intraoperative complications. Trial registration: Clinical Trial Registry of India CTRI/2019/02/017464 (05/02/2019)

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified