Jigna Shah

Necrotizing Enterocolitis in Very Low Birth Weight Infants: A Systemic Review

Necrotizing enterocolitis (NEC) is the most common serious gastrointestinal disorder affecting very preterm or very low birth weight infants. The risk is inversely proportional to gestational age and weight at birth. Fetal growth restriction and compromise may be additional specific risk factors. Despite extensive research and animal studies etiopathogenesis, preventive strategies and management options remain controversial. The present paper reviews the literature for recent advances and newer insights for changing epidemiological trends, pathogenesis, role of inflammatory cytokines, and various preventive and management strategies.

Association between altered thyroid state and insulin resistance

Objective: To determine the association between altered thyroid hormones and insulin resistance (IR). Materials and Methods: Eight euthyroid (EU), eight hypothyroid (HO), and eight hyperthyroid (HR) patients with no past medical history were studied in this cross-sectional study at the Care Institute of Medical Sciences, Ahmedabad, India, The fasting blood sample were analyzed for thyroid stimulating hormone (TSH), lipid profile, insulin, and glucose. Homeostatic model assessment (HOMA) was calculated for assessing IR. Results: HOMA values were significantly higher in HR and HO groups as compared to the EU group (P < 0.05). Insulin levels were also found to be significantly increased in HR and HO groups as compared to the EU group (P < 0.05). Cholesterol, triglycerides (TG), and low density lipoprotein (LDL) were significantly raised in HO as compared to EU and HR groups (P < 0.05) whereas high density lipoprotein levels (HDL) were lower. HOMA and insulin were found to be positively correlated with TSH in HO and negatively in HR. Conclusion: Thyroid disorder, including both hypo- and hyper have been associated with IR due to various mechanisms such as altered insulin secretion and lipid levels. IR was comparable in patients with both HO and HR. Although HO and HR constitute an IR state, more studies need to be done in order to clarify the underlying pathogenic mechanism. Thus, an altered thyroid state can lead to IR leading to glucose-related disorder such as diabetes dyslipidemia.

Dendrimer-mediated approaches for the treatment of brain tumor

Abstract Worldwide, the cancer appeared as one of the most leading cause of morbidity and mortality. Among the various cancer types, brain tumors are most life threatening with low survival rate. Every year approximately 238,000 new cases of brain and other central nervous system tumors are diagnosed. The dendrimeric approaches have a huge potential for diagnosis and treatment of brain tumor with targeting abilities of molecular cargoes to the tumor sites and the efficiency of crossing the blood brain barrier and penetration to brain after systemic administration. The various generations of dendrimers have been designed as novel targeted drug delivery tools for new therapies including sustained drug release, gene therapy, and antiangiogenic activities. At present era, various types of dendrimers like PAMAM, PPI, and PLL dendrimers validated them as milestones for the treatment and diagnosis of brain tumor as well as other cancers. This review highlights the recent research, opportunities, advantages, and challenges involved in development of novel dendrimeric complex for the therapy of brain tumor.

Role of Vitamin D in Amyloid clearance via LRP-1 upregulation in Alzheimer’s disease: A potential therapeutic target?

Amyloid beta (Aβ) deposition is considered to be one of the primary reason to trigger Alzheimers disease (AD). Literature clearly suggests decline in Aβ clearance to be accountable for progression of late onset AD as compared to augmented Aβ production. There may be several pathways for Aβ clearance out of which one of the major pathway is the vascular-mediated removal of Aβ from the brain across the blood-brain barrier (BBB) via efflux pumps or receptors. Among Aβ scavenger receptors, low density lipoprotein receptor related protein (LRP-1) has been most extensively studied. LRP-1, is highly expressed in neurons and located on abluminal side of the brain capillaries whose expression decreases in AD patients which give rise to increased cerebral Aβ deposition. Recent evidences reveal that post 1,25-(OH)2D3 treatment, LRP1 expression increases significantly for both in-vivo and in-vitro studies, since Vitamin D receptors (VDR) are broadly expressed in brain. Biological actions of Vitamin D are mediated via its nuclear hormone receptor vitamin D receptor (VDR) and is found to regulate many genes. Several lines of evidence suggest that VDR deficiency/inhibition can be a potential risk factor for AD and sufficient Vitamin D supplementation is beneficial to prevent AD onset/pathology or slow down the progression of disease. The present review establishes a strong correlation between Vitamin D and LRP-1 and their possible involvement in Aβ clearance and thereby emerging as new therapeutic target.

Anti-ulcer activity of Lucer against experimentally induced gastric ulcers in rats

The present study is designed to explore the mechanism of action of herbal formulation Lucer against experimentally induced gastric ulcers. The aqueous extract (120 and 180 mg/kg) of Lucer was tested against aspirin and ethanol-induced gastric ulcer model in rats. The drug has been found to be very effective in inhibiting gastric ulceration. This is evident from reduction in ulcer index parameters. Besides, significant reduction in acid secretory parameters such as total acidity, total acid output and volume of gastric secretion were also observed. It is concluded from this study that the drug possesses anti-ulcer activity in both the models. The anti-ulcer activity of the drug can be attributed to inhibition of acid secretary parameters and strengthening of gastric mucosal barrier.

Glucagon like peptide-1: A new therapeutic target for diabetes mellitus

Glucagon-like peptide-1 (GLP-1) is an endogenous peptide secreted from the gut in response to the presence of food. GLP-1 and its longer acting analog exendin-4 have multiple synergistic effects on glucose dependent, insulin secretion pathways of the pancreatic β-cell and on plasticity in neuronal cells. Recently the development of these peptides as a novel therapeutic strategy for non-insulin-dependent (type 2) diabetes mellitus and associated neuropathy has been the focus of much interest. Here we describe the biological actions of GLP-1 and its related analogs.

Identification of biomarkers for prediction of preterm delivery

Preterm birth is one of the most prevailing complications of pregnancy causing neonatal mortality and morbidity. Cervical length measurement has been the only criteria used till now for the prediction of preterm delivery (PTD). Research on many biomarkers in maternal serum, amniotic fluid, and cervicovaginal fluid (CVF) has been accomplished such as fetal fibronectin (FFN), α-fetoprotein, C-reactive protein (CRP), multiple members of the interleukin family (interleukin-6, interleukin 8, and interleukin 10), matrix metalloproteinases, pregnancy-associated plasma protein A, relaxin, lactate dehydrogenase (LDH), thyroid-stimulating hormone, adrenocorticotropic hormone, vascular endothelial growth factor (VEGF), ferritin, prolactin, ceruloplasmin, alkaline phosphatase (ALP), glucose, placental protein 13, corticotropin releasing hormone, tumor necrosis factor-α (TNF-α), tumor necrosis factor-β (TNF- β), estriol and human chorionic gonadotropin (hCG). Not a single biomarker has been evolved till date, which possesses sensitivity as well as reliability for the detection of spontaneous preterm birth. The variability in results across the studies may have arisen due to dissimilarities in study designs, different timings of collection of blood, and diversities in the study population. Study on a large sample size is needed for the confirmatory conclusion of use of biomarker in PTD. A single biomarker or even in combination, if found for the prediction of preterm labor (PTL), can decrease the hospital cost as well as restrict the treatment.

Determinants of overweight and obesity among school children in Mehsana District, India

Introduction: World Health Organization refers obesity as a global epidemic because of rapid increase in the number of overweight and obese individuals in last 20 years. Objective: To study the prevalence of overweight and obesity and determine their associated factors among school children aged 10-12 years in Mehsana district in India. Study Protocol: A single centric epidemiological study was conducted among 200 school children selected at random in Mehsana district school in the period from July 2011 to September 2011. Overweight and obesity were assessed using height, weight, waist circumference and hip circumference of each student in the class. A predesigned and pretested questionnaire was used to interview the students to elicit the information on family characteristics such as number of family members, education and occupation of parents, their usual physical activity, habit of watching TV and time spent with computer and for sleeping as well as the pattern of dietary intake. Results: Significant difference in body mass index for boys ( P P Conclusion: The present study attempts to highlights childhood obesity is an emerging health problem which need to be confirmed by large scale studies and effective preventive strategies should be developed to halt this epidemic at its beginning.

Ticagrelor: A new antiplatelet drug for acute coronary syndromes

Coronary heart disease and acute coronary syndrome (ACS) are a significant cause of morbidity and mortality all over the world. Antiplatelet agents play an essential role in the treatment of acute coronary syndrome (ACS), usually with aspirin and a thienopyridine. Currently, clopidogrel, a second generation thienopyridine, is the main drug of choice, and the combination of aspirin and clopidogrel is administered orally for the treatment of ACS. Clopidogrel, the most commonly used thienopyridine, is limited by a high degree of interpatient variability and inconsistent inhibition of platelets. Ticagrelor, a new, oral, direct-acting P2Y12 receptor antagonist, produces a more profound and consistent antiplatelet effect than clopidogrel. The U.S. Food and Drug Administration approved Ticagrelor on July 20, 2011. Furthermore, ticagrelor has at least one active metabolite, which has pharmacokinetics that are very similar to the parent compound. Therefore, ticagrelor has a more rapid onset and more pronounced platelet inhibition than other antiplatelet agents. The safety and efficacy of ticagrelor compared with clopidogrel, in an ACS patient, has been recently evaluated by the PLATelet inhibition and patient Outcomes (PLATO) trial. Clinical studies of patients with both ST-elevation and non-ST-elevation ACS have shown that ticagrelor, when compared with clopidogrel, reduces the rates of vascular death and myocardial infarction. The clinical data currently available indicate that ticagrelor is a promising option for the treatment of patients with ACS and may be of particular use in those at high risk for ischemic events or in those unresponsive to clopidogrel.

Usage trends for memory and vitality-enhancing medicines: A pharmacoepidemiological study involving pharmacists of the Gujarat region.

Objective: The aim of the study was to explore the trends and rationale of use of memory and vitality-enhancing medicines (MVEM) in the Gujarat region. Materials and Methods: A prospective pharmacoepidemiological study involving pharmacists of Gujarat region was carried out in the year 2005. Pharmacists (n = 351) working in general and Ayurvedic medical stores were selected from 12 districts of Gujarat region. The pharmacists were explained about the objective of the study and were given a pretested, validated questionnaire. Outcome Measures: The questionnaire included the questions regarding herbal MVEM used most commonly, percentage sale of herbal MVEM – sold with or without prescriptions – age group of patients and professional groups who used these drugs most commonly. Results: The number of individuals using MVEM was highest in the age group of 11–20 years (17.54%), followed by the 21–40 years group (17.12%), supporting the results that the professional group of students (17.29%) and the persons of business or service class (15.29%) are the highest users of these medicines. Evaluation of various constituents in the marketed polyherbal MVEM revealed that Brahmi (Bacopa monniera), Shankhpushpi (Evolvulus alsinoides), Ashwangandha (Withania somnifera), Jatamansi (Nardostychos jatamansi), Vacha (Acorus calamus) and Amla (Phyllanthus emblica) were the common ingredients in the polyherbal preparations. Conclusions: This study highlights commonly used Ayurvedic medicines that can be explored for safely enhancing memory and vitality performance. Hence, detailed and scientifically designed research on these drugs would help to identify safe and effective drugs for enhancing the same.