Case Presentation of a Patient with Systemic Lupus Erythematous, A Tour through the More Unusual Presentationss

                                                   http://austinpublishinggroup.com/arthritis/

We presentthe case of a 23 year old female with Systemic Lupus Erethematosus [SLE] from diagnosis followed for 7 years. She presented unusually, with acute autoimmune hepatitis that has not recurred. Subsequently she developed significant haematological involvement with complications of profound thrombocytopenia and neutropenia. Ultimately she developed a rare malignancy-namely CD8+ epidermotropic T-cell lymphoma. We discuss the complications of SLE and the development of the cutaneous T cell lymphoma.

A twentythree year old female with no past medical history was referred to the Rheumatology clinic in 2009 following an acute illness managed by the Hepatologists. She presented with jaundice and diarrhoea. She had no risk factors for acute hepatitis and was not taking any hepatotoxic medication. Her liver enzymes were significantly elevated, suggestive of acute hepatic injury. Her bloods showed Bilirubin 300umol/L (0-20), ALT 1500IU/L (10-35), ALP 150IU/L (35-104 INR 1.5 and Albumin was 35g/L (34-50). Further investigations demonstrated a strongly positive anti-nuclear antibody (titre >1:5120). Anti-smooth muscle and anti-mitochondrial antibodies were negative. IgG was elevated at 23.18g/L (7.0-16.0 g/L). HIV and Hepatitis B&C serology was negative for previous infection. Subsequently a liver biopsy demonstrated evidence of acute hepatitis, with associated portal and lobular inflammation. She was treated with a tapering dose of oral prednisolone in combination with Azathioprine 75mg daily. Shortly thereafter she developed a macular rash, arthralgia and alopecia with an associated thrombocytopenia and lymphopenia.Further investigations revealed positive antibodies to Ro and double stranded DNA 208IU/ml (0-50). C3 was low at 0.77g/L (0.90- 1.80). The ESR was elevated at 66mm/hr. The anti-phospholipid screen was negative with the exception of an IgM anti-cardiolipin antibody. A diagnosis of Systemic Lupus Erythematosus (SLE) was made with associated lupus hepatitis.

She responded well to the initial treatment for several months with evidence of both clinical and serological remission. In early 2010 she presented again with mucosal bleeding and a petechial rash. Profound pancytopenia was noted with a platelet count of 0 (150-400 x10⁹/l), haemoglobin 54 (115-155 g/l) with positive direct antiglobulin test. This flare was complicated by a retinal haemorrhage resulting in central vision loss. She underwent a diagnostic Bone Marrow Aspirate and Trephine (BMAT) which demonstrated red cell aplasia with normal megakaryocytic suggesting periphera destruction. She was treated with intravenous methyl prednisolone, Cyclophosphamide and Rituximab for lupus-related pancyopenia. After several weeks her blood counts normalized. Over the next four years she remained relatively well although she required annual Rituximab infusions predominantly for mild flares comprising of arthritis, rash and constitutional symptoms.

In late December 2014, she developed serositis manifesting as pleuritic chest pain (pleurisy). An echocardiogram demonstrated associated pericarditis with a small pericardial effusion noted. She was again treated with high dose intravenous corticosteroids and Rituximab and made a good clinical recovery.

Fifty Years in the Development of a Glutaminergic- Dopaminergic Optimization Complex (KB220) to Balance Brain Reward Circuitry in Reward Deficiency Syndrome: A Pictorial

                                        http://austinpublishinggroup.com/addiction-sciences/

Dopaminealong with other chemical messengers like serotonin, cannabinoids, endorphins and glutamine, play significant roles in brain reward processing. There is a devastating opiate/opioid epidemic in the United States. According to the Centers for Disease Control and Prevention (CDC), at least 127 people, young and old, are dying every day due to narcotic overdose and alarmingly heroin overdose is on the rise. The Food and Drug Administration (FDA) has approved some Medication-Assisted Treatments (MATs) for alcoholism, opiate and nicotine dependence, but nothing for psychostimulant and cannabis abuse. While these pharmaceuticals are essential for the shortterm induction of “psychological extinction,” in the long-term caution is necessary because their use favors blocking dopaminergic function indispensable for achieving normal satisfaction in life. The two institutions devoted to alcoholism and drug dependence (NIAAA & NIDA) realize that MATs are not optimal and continue to seek better treatment options. We review, herein, the history of the development of a glutaminergic-dopaminergic optimization complex called KB220 to provide for the possible eventual balancing of the brain reward system and the induction of “dopamine homeostasis.” This complex may provide substantial clinical benefit to the victims of Reward Deficiency Syndrome (RDS) and assist in recovery from iatrogenically induced addiction to unwanted opiates/ opioids and other addictive behaviors.

In 1968,Blum and Geller received a grant from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) to do animal research into the role of neurotransmitters in stress and aberrant alcohol drinking. Funded by this grant, their laboratory was the first to look into darkness induced drinking based on the effect of pineal gland melatonin. They discovered that drinking was increased because there was an increase in the synthesis of melatonin in darkness which is inversely proportional to a reduction in serotonin. In fact, injecting melatonin during the light phase also induced high alcohol intake. From 1968-1972, the research focused on the role of stress-induced changes in brain neurochemistry. One finding that influenced the development of KB220 was the discovery that reduced serotonin in the brain of rodents resulted in intense stress-related behavior.

In 1972, at the Department of Pharmacology, University of Texas Health Science Center, at San Antonio, Texas (UTHSCSA), Blum’s group continued research on alcoholism. During this time, the concept of shared neurochemical mechanisms between alcohol and opiates was developed and presented to the scientific community. The research was the first to show that the narcotic antagonist naloxone could, not only, block alcohol induced sleep-time in mice (Figure 2), but that naloxone could also block alcohol dependence. These controversial early findings led to the clinical development of Vivitrol (Naltrexone) and Suboxone/Zubsolve (buprenorphine/ naloxone) used currently as FDA approved pharmaceuticals to treat both alcoholism as well as opiate addiction. Along these lines, it was shown that both dopamine and morphine could reduce alcohol withdrawal symptoms in a similar fashion.

Liposomes as Delivery System of Chondroitin Sulfate to the Arthritic Joint by Intra-articular Administrations

                                                  http://austinpublishinggroup.com/arthritis/

Osteoarthritisis the most prevalent rheumatic disorder affecting the musculoskeletal system; osteoarthritis is a degenerative form of arthritis that results in gradually breakdown of joint cartilage; osteoarthritis can be also viewed as an inflammatory disease. Currently applied therapies consist of physical therapy, oral medication, intra-articular injections and surgical interventions, their main goal being to reduce pain and improve function and quality of life. Intra-articular administration of drugs has potential benefits in osteoarthritis treatment because it minimizes systemic bioavailability and side effects associated with oral administration of drugs and enhances their therapeutic effect in the joint. However, the residence time of the drug is short and several drug delivery systems were explored to obtain a sustained release. This review is focused on the use of chondroitin sulfate as bioactive molecule in the treatment of osteoarthritis and the liposome ability as suitable drug delivery system for chondroitin sulfate.

Osteoarthritis (OA) is a degenerative disease, but not a systemic one, characterized by progressive loss of articular cartilage, subchondral bone sclerosis and osteophyte formation, changes in the synovial membrane and increased volume of synovial fluid with altered coefficient of friction. In some aspects, it can be also viewed as an inflammatory disease, leading to chronic pain and decrease of life quality. Presently, there is no prevention or efficient treatment that can stop the pathological processes involved in OA progression, since available treatments are directed to symptoms, pain relieve and function regain. The administration of nonsteroidal Anti-Inflammatory Drugs (NSAIDs), analgesics compounds and corticosteroids is achieved through oral, parenteral or intra-articular (i.a.) route, targeting to reduce or revise joint damage and inflammation.

The oral drug administration has major disadvantages, such as limited bioavailability and risk of side effects. As OA has a localized nature, i.a. administration of drugs provides the opportunity to improve the treatment by local depot formation and prolonged drug action. To treat local diseases, like joint disorders, i.a. route is very useful. However, the efficacy of i.a. administration of different anti-inflammatory bioactive molecules (e.g., glycoproteins, proteoglycans) is limited due to their poor stability and delivery in the harmful biological milieu. Several delivery systems, including liposomes, microparticles, nanoparticles and hydrogels have been investigated for the sustained drug delivery and for prolonged drug release in the joints. In vitro studies have demonstrated that the phospholipidic layer acting as a boundary lubricant was missing from the articular surface of osteoarthritic degenerated cartilage and changes in the structure of Chondroitin Sulfate (CS) occurred in case of OA

This review highlighted the advantages offered by liposomes as i.a. delivery system in treatment of OA. Data regarding the physico-chemical properties, biocompatibility, anti-inflammatory and regenerative potential of the liposomal formulations of CS are summarized. It is also discussed the trend in i.a. therapy of arthritis using this promising technology.

Intra-articular (i.a.) therapy improves drug delivery to joint cartilage and thus, it can increase the therapeutic efficacy in OA treatment by minimizing systemic bioavailability and side effects associated with oral administration. A very well structured review of Evans et al. presented the progress, clinical performances and advantages of i.a. therapy of arthropaties. Being discrete cavities, most diarthrodial joints are well suited for the local drug delivery via i.a. injection. The advantages offered by i.a. delivery of therapeutics in diarthrodial joints are also presented by Chen & Yang. They have noticed the importance of delivering drugs not just on the surface of the articular cartilage, but also into its matrix, in order to obtain a deeper zone treatment. Moreover, it should be fully considered that the drug biodistribution following delivery is quite different in i.a. administration from systemic administration or local injection into other tissues or organs. Many corticosteroid formulations are available for i.a. injection in OA and several studies have compared their effectiveness in OA. The conclusion was that they offer a shortterm solution for a chronic problem, reducing pain in the knee for at least 1 week. An alternative treatment for joints affected by OA that have not responded to NSAIDs or analgesics is the i.a. administration of natural bioactive substances that can influence the pathophysiology of OA joints, such as lubricin, also known as proteoglycan and hyaluronate, a component of the cartilage extracellular matrix

Fifty Years in the Development of a Glutaminergic- Dopaminergic Optimization Complex (KB220) to Balance Brain Reward Circuitry in Reward Deficiency Syndrome: A Pictorial

                http://austinpublishinggroup.com/addiction-sciences/fulltext/aas-v1-id1006.php

Dopaminealong with other chemical messengers like serotonin, cannabinoids, endorphins and glutamine, play significant roles in brain reward processing. There is a devastating opiate/opioid epidemic in the United States. According to the Centers for Disease Control and Prevention (CDC), at least 127 people, young and old, are dying every day due to narcotic overdose and alarmingly heroin overdose is on the rise. The Food and Drug Administration (FDA) has approved some Medication-Assisted Treatments (MATs) for alcoholism, opiate and nicotine dependence, but nothing for psychostimulant and cannabis abuse. While these pharmaceuticals are essential for the shortterm induction of “psychological extinction,” in the long-term caution is necessary because their use favors blocking dopaminergic function indispensable for achieving normal satisfaction in life. The two institutions devoted to alcoholism and drug dependence (NIAAA & NIDA) realize that MATs are not optimal and continue to seek better treatment options. We review, herein, the history of the development of a glutaminergic-dopaminergic optimization complex called KB220 to provide for the possible eventual balancing of the brain reward system and the induction of “dopamine homeostasis.” This complex may provide substantial clinical benefit to the victims of Reward Deficiency Syndrome (RDS) and assist in recovery from iatrogenically induced addiction to unwanted opiates/ opioids and other addictive behaviors.

The bigquestion is - “what is the best way, based on scientific evidence, to provide a balanced brain in people involved in addiction treatment and recovery”? While the answer may not be simple, because of the enormous efforts made by our national institutes (NIAAA and NIDA) we are making progress. The fifty-year journey began in the late 60’s and 70’s with the investigation of neurotransmitters in 1969 [1,2] that revealed that dopamine could control tremors in the periphery of cats.

In 1968,Blum and Geller received a grant from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) to do animal research into the role of neurotransmitters in stress and aberrant alcohol drinking. Funded by this grant, their laboratory was the first to look into darkness induced drinking based on the effect of pineal gland melatonin. They discovered that drinking was increased because there was an increase in the synthesis of melatonin in darkness which is inversely proportional to a reduction in serotonin. In fact, injecting melatonin during the light phase also induced high alcohol intake. From 1968-1972, the research focused on the role of stress-induced changes in brain neurochemistry. One finding that influenced the development of KB220 was the discovery that reduced serotonin in the brain of rodents resulted in intense stress-related behavior.

Before Old Age-A Rare Case of Werner Syndrome

                     http://austinpublishinggroup.com/austin-anesthesiology/online-first.php#

Werner syndrome or adult progeria is the most common of the premature ageing disorders. Patients usually present with all the symptoms and signs of old age very early in life, the most common being cataract, development of type II diabetes mellitus, osteoporosis, atherosclerotic changes in the blood vessels, non healing ulcers etc. Secondary complications may necessitate various surgical procedures in these patients subjecting the patient to high risks under anesthesia.

The anesthetic implications in these patients are very challenging as the airway is more often difficult owing to the morphological changes of the oral anatomy. Coexisting diseases like hypertension and ischaemic heart disease may also pose a greater threat to anaesthetize these patients.

A complete knowledge of the anesthetic challenges and preparedness for the management of complications is essential in patients with Werner syndrome coming for elective or emergency surgeries.

A 32 yr old male patient with a diagnosis of Werner syndrome is posted for debridement of non healing ulcer in the left lower limb. He was diagnosed with Werner syndrome 10 yrs back when he had developed cataract bilaterally and surgery under local anaesthesia was done for the same and vision was restored. Six years back he was diagnosed with type II diabetes mellitus and he has been on oral hypoglycemic agents since then. No history of chest pain or breathlessness. The patient has been having multiple ulcers on the lower limbs and frequently visits the dermatology clinic for regular dressings. These ulcers have been painful and so the patient was confined to the bed. Patient gives history of loss of molar teeth on either side. History obtained from the parents revealed that the patient’s sister had the same disease and died of ischaemic heart disease at the age of 25 yrs.

On examination, patient appeared to be 60 yrs of age, cooperative but unable to articulate his speech correctly. The head was large, there was loss of hair extensively over the scalp with premature greying, absent outer eyebrows and pale conjunctiva. The skin appeared to be non-elastic with decreased fat in the subcutaneous tissue and thin extremities. The chest was deformed with prominent lower ribs. Chest was clear on auscultation and cardiac sounds were well heard. Multiple small ulcers were seen on the upper and lower extremities. A large ulcer measuring 7x8 cms was seen in the left ankle which needed debridement under anaesthesia.

Older Person Research in Ireland

                          http://austinpublishinggroup.com/aapd/fulltext/aapd-v2-id1018.php

Irelandhas rapidly changing demographics. The 2006 Irish Census indicated that there was 468,000 people aged 65 or over resident in the country. By 2021 this is projected to rise to approximately 751,000 or 16% of the population. Allied with these figures is the estimation that dependency rates among the elderly population will also grow sharply to 52.8% in 2021. In relation to dependency, Barry indicates that older people in Ireland would prefer to live and be supported in their own homes. The resultant outcome of this is the need for quality and integrated community, health and social care services. A further outcome of home and community based care is that many older people experience care provided by family or neighbors. In Ireland more needs to be known about all types of community care for older people.

Two studies completed through CARDI will be used to highlight the wide spectrum of medical, physical and social research being undertaken with older people populations in Ireland.First, according to Scarlett et al. older people in Northern Ireland are up to three times more likely to be frail than those in the Republic of Ireland. Furthermore, this study found that females and those from lower socio economic groups were more likely to be frail than those in the general older person population. Among people aged 60-64, the rates of limiting disability range from 43% in Northern Ireland to 25% in the Republic of Ireland [3]. In the 80 years plus age group, Northern Ireland has a 54% rate of limiting disability whilst in the Republic of Ireland this figure is 29%. This research also showed that the prevalence of frailty rises with age, for example, in Northern Ireland 16% of people aged 60-64 are frail whilst in the Republic of Ireland this figure is 3%. These researchers conclude that the reasons for differences in North and South data in frailty merit further investigation and discussion.

Research by Parsons et al. examined medication use in people with dementia at end of life. This study was carried out within the context that there are currently around 41,740 people with dementia in the Republic of Ireland, with the numbers expected to grow to between 141,000 and 147,000 by 2041. Approximately 19,000 people have dementia in Northern Ireland. It is expected there will be 23,000 people with dementia by 2017 and 60,000 by 2051 in Northern Ireland.

Behavioral Intervention for Feeding Disorders

                               http://austinpublishinggroup.com/autism/fulltext/autism-v3-id1036.php

Individualswith autism are often poor eaters which may put them at risk for a variety of health problems including, poor bone density, vitamin deficiencies, obesity, and constipation among other medical problems. Behavioral intervention has been well validated in the literature as evidence-based treatment of pediatric feeding disorders and has been increasingly applied to those individuals with autism and other disabilities who are poor eaters. This paper highlights some of the latest behavioral intervention shown effective in increasing food consumption and may serve as a guide for professional and families.

As many as 90% of children with autism have feeding problems ranging from consuming a small variety of foods (i.e., food selectivity) to rejecting most or all foods (i.e., food refusal). Some families report their child consumed a large variety of foods in toddlerhood and over time consumption of these very same foods diminished significantly. Many of these children eat only starchy foods, specific brands, pureed foods, and/or little to no vegetables. A diet high in snacks and low in vitamins, minerals, and vegetables may lead to long-term health issues including poor bone growth, constipation, and obesity.

Behavioral interventions have increasingly been shown effective in the treatment of feeding disorders for some children with autism and other developmental disabilities. These interventions typically involve structured meal schedules, repeated exposure to non preferred foods, reinforcement in the form of verbal praise or tangible items for food acceptance, and ignoring inappropriate mealtime behaviors, for example. Some of these interventions have been implemented by parents while others were more complex and required a trained professional and/or inpatient hospitalization. Following is a summary highlighting some of the previously published case studies on feeding disorders that have been shown effective in increasing food consumption and in some cases food variety.

Presenting both non preferred and preferred foods together may be a simple option for some children with mild food selectivity. For example, Ahearn increased vegetable consumption in an adolescent with autism and mild food selectivity by placing a preferred condiment (i.e., ketchup, BBQ sauce, or mustard) on top a non preferred vegetable (i.e., carrots, broccoli, or corn). Preferred condiments were determined by a preference assessment and the top three were selected for intervention. Food consumption immediately increased from zero at baseline to 100% during intervention. A choice board was added at the conclusion of the study giving the participant the opportunity to choose a condiment for his vegetables from a selection. The author reported that one year later this participant continued to eat vegetables with condiments and requested them with an augmentative communication system. The author also noted that neither positive reinforcement in the form of verbal praise nor tangible items were used and may not be necessary when using a simultaneous presentation intervention for some children with mild food selectivity.

Seasonal Variations of Zooplankton Diversity in a Perennial Reservoir at Thoppaiyar, Dharmapuri District, South India

http://austinpublishinggroup.com/aquaculture-marine-biology/fulltext/ajamb-v1-id1001.php

Zooplanktoncommunity is cosmopolitan in nature and they inhabit all freshwater habitats of the world. The zooplankton diversity is one of the most important ecological parameters in water quality and biodiversity assessment because they are strongly affected by environmental conditions and respond quickly to changes in water quality. Zooplankton is the intermediate link between phytoplankton and fish. The qualitative and quantitative study of zooplankton is very importance in the plankton diversity. Hence the present investigation was carried out in the Thoppaiyar reservoir (Lat. 11°57'21"N and Long. 78°6'28"E) at Dharmapuri District, South India. The physico-chemical characteristics and zooplankton diversity were studied for a period of one year from December-2010 to November-2011. A total of 55 species of zooplankton were recorded, which includes 19 species of Rotifera, 13 species of Cladocera, 15 species of Copepoda and 8 species of Ostracoda. The population abundance of zooplankton was noticed in the following order: Rotifera > Copepoda > Cladocera > Ostracoda. The present study revealed that the zooplankton productivity was found to be rich in Thoppaiyar reservoir. Further it is concluded that the Thoppaiyar reservoir could be continuously utilized for aquaculture, if proper water quality management measures are adopted.

The zooplankton (microscopic drifting or wandering animals) occupies a vital role in the tropic structure of an aquatic ecosystem and plays a key role in the energy transfer. Unlike algae or phytoplankton, zooplanktons are microscopic animals that do not produce their own food. Freshwater zooplanktons play an important role in ponds, lakes and reservoirs ecosystem and food chain. They are responsible for the eating millions of little algae that may otherwise grow to an out-of-control state. However, not all algae are edible and oftentimes it's the blue green algae that we would like to see disappear that cannot be eaten. In fact, as mostly filter feeders, a community of zooplankton can filter through the volume of an entire lake in a matter of days. The zooplankton community is composed of both primary consumers (which eat phytoplankton) and secondary consumers (which feed on the other zooplankton). The zooplankton forms a major link in the energy transfer at secondary level in aquatic food webs between autotrophs and heterotrophs [1]. Nearly all fish depend on zooplankton for food during their larval phases and some fish continue to eat zooplankton in their entire lives.

Negative Pressure Pulmonary Edema: A Rare Complication Following Extubation

                   http://austinpublishinggroup.com/anesthesia-analgesia/fulltext/ajaa-v5-id1052.php

We describe a case of Negative PressurePulmonary Edema (NPPE) followed by laryngospasm occurred immediately after extubation. A 24-year-old man underwent a surgical correction of unilateral inguinal hernia by laparoscopy. The tracheal intubation was easy with grade 1 of Cormack-Lehane classification. Anesthesia was maintained with sevoflurane 2, 5%. After fully awake extubation, nearly total upper airway obstruction due to severe laryngospasm was observed by a decrease in oxygen saturation and the presence of large amount frothy pink sputum, suggestive of acute pulmonary edema. A nasal airway was inserted, but face mask ventilation was difficult. Oxygenation of the airway was maintained with support of non invasive ventilation for twenty four hours, with SpO₂ of 92-96 %. 48 hours later, the pulmonary edema disappeared and the patient was discharged without complications.

 Negative pressure pulmonary edema (NPPE) is a non common complication of general anesthesia. The incidence of NPPE is 0.05 to 0.1% in healthy adults who underwent general anesthesia. It is even less common with the use of a laryngeal mask airway. It is usually seen during emergence from anesthesia having a multi factorial pathogenesis. The most common causes of NPPE are upper airway infection, tumor and laryngospasm. In adults about 50% of NPPE occurrences are due to postoperative laryngospasm. The implications of acute NPPE can be severe with mortality as high as 11 to 40%. However, if diagnosed and treated early, these rates decrease. Previous recognition and institution of appropriate Non- Invasive Mechanical Ventilation (NIMV) is important to ensure successful outcomes. We report a case of a previously healthy male who developed NPPE secondary to laryngospasm shortly after extubation following general anesthesia.

He was monitored with electrocardiogram, non-invasive blood pressure, oxygen saturation (SpO₂) and a peripheral vein was catheterized for infusion and drug administration. Anesthesia was induced with intravenously propofol (150mg), fentanyl (250mcg) and atracurium (35mg). The endotracheal intubation using tube 8.0mm was easy with grade 1 of Cormack-Lehane classification. Anesthesia was maintained with sevoflurane (2.0-2.5%). Surgery lasted about one hour and during that time vital signs were normal. Patient recovered from surgery and was extubated successfully.

Implementation of a Solution for the Remote Monitoring of Subjects Affected of Metabolic Diseases: The Metabolink Project

                                            http://austinpublishinggroup.com/aging-research/

Diabetesrepresents one of most serious public health disease. The aim of the Metabolink project was to develop a smart solution for elderly people with diabetes and obesity, in order to promote a healthier style of life, improve diabetic control trying to reduce overall cost for the community.

It consists of an app for Smartphone linked to a system and a process of data collection based on bi dimensional barcode (qr code) and NFC-tag technologies.

Thesystem was accepted by all the patients and they learned efficaciously in a few hours to use it. Unfortunately we observed a drop-out of about 50% in the first month. Patients remaining in the study refer a slight improvement in the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and General Satisfaction Questionnaire (GSQ) and they decided to continue to use it after the end of the follow-up.

The diabetes represents one of most serious public health disease for the planet. The WHO estimated about 60 million of subjects are affected in Europe. In Italy the rough prevalence is 5.8%. The prevalence of disease in the next years will grow both as a result of the aging of the population and to the increase of the risk factors such as overweight and obesity, sedentary lifestyle and lack of proper nutrition education. Milestone studies have shown that an intensive glycemic treatment significantly reduces microvascular complications with a moderate positive long-term effect on macrovascular complications. The health care systems are called to face this disease that it has not only direct cost linked to pharmacological and complications treatment but also an indirect significant social cost. It is therefore essential for the diabetic patient to carry out a continuous and accurate monitoring of clinically relevant parameters (as blood glucose, blood pressure) and to follow a health life style in order to reduce disease complications permitting to live better maintaining independence for much more longer time. Moreover the majority of patients with diabetes is older and frequently present significant comorbidity making the integrated management of the disease more complex. 

The aim of the Metabolink project was to develop a smart solution for elderly people with diabetes and obesity, in order to promote a healthier style of life, improve diabetic control (glcaemic control, blood pressure, adherence to a specific diet and treatment) trying to reduce overall cost for the community. The approval of the study for experiments using human subjects was obtained from the local Ethics Committees on human experimentation. Written informed consent for research was obtained from each patient or from relatives/legal guardian in the case of critically disabled demented patients prior to participation in the study.

Effect of Ginseng on the Testis of Subclinical Hypothyroidism Model in Adult Male Albino Rat

               http://austinpublishinggroup.com/anatomy/fulltext/Anatomy-v4-id1065.php

Hyperstimulation of follicular cells using a goitrogen Propylthiouracil (PTU) caused Subclinical Hypothyroidism (SCH) that was associated with disturbances in adult male testicular functions. This work was carried out to study the probable relationship between follicular cells in drug-induced hypothyroidism caused by PTU and consequently its effect on testicular tissue and the possible modulating effect of ginseng. The present work was carried out on 40 adult male albino rats divided into four groups. Group I was the control group; Group II (Ginseng treated); Group III (SCH group) rats and Group IV was the treated group. Testes and thyroid glands were studied. Our results revealed the protective role of Ginseng on testis and thyroid tissue of experimentally induced hypothyroidism rat model.

Thyroid hormone plays an important role in testicular development and function. It has been established that Triiodothyronine (T3) regulates the maturation and growth of the testis, controlling Sertoli cells and Leydig cell proliferation and differentiation during testicular development in rats and other species. Subclinical Hypothyroidism (SCH) could be considered as an elevated serum thyrotropic stimulating hormone (TSH) level associated with normal Thyroxine (T4) and Triiodothyronine (T3) levels with no clinical symptoms of hypothyroidism. This thyroid dysfunction occurs in 4-20% of the adult population, the possibility of SCH progression to clinical hypothyroidism is around 7% [2]. Hypothyroidism extremely affects reproductive functions including fertility, pregnancy and postnatal development in human and rat [3]. Rat SCH model was induced mostly by administration of antithyroid drug mostly Propylthiouracil (PTU) and Methimazole (MMI). PTU is a thiouracil-derived drug which can be used to treat hyperthyroidism through lowering the amount of thyroid hormone produced by the thyroid gland [5]. PTU inhibits conversion of T4 to T3 causing hypothyroidism [6]. Ginseng is considered as an aromatic herb that is commonly used in herbal medicine. It contains saponins and high iodine content. Ginseng saponins, which are known as ginsenosides, have been studied to be responsible for its medicinal effects, specifically anticancer, antihypertensive, antidiabetic, and antistress effects. Ginseng benefits all the endocrine system, and therefore the thyroid gland. As ginseng markedly increased epididymal sperm count, motility and hyperactivation in mice. So, we studied its effect on the testis and thyroid of SCH model.

Forty adult Westar male albino rats were used in this experiment, each weighting 150-200gm. Food and water were provided ad libitum and the rats were left for 7 days for acclimatization before use in the Anatomy Department, Faculty of medicine, Menoufia University. All aspects of animal care and treatment were carried out according to the local guidelines of the ethical committee for animal research.

Small-Molecule Inhibitors of the Mcl-1 Oncoprotein

http://austinpublishinggroup.com/analytical-pharmaceutical-chemistry/fulltext/ajapc-v1-id1015.php

Mcl-1, an anti-apoptotic member of the Bcl-2 protein family, has emerged as an especially attractive target for the development of next generation antineoplastics owing to its direct involvement in tumor genesis as well as its role in the resistance of many cancers to current anti-cancer therapies. The efficacy of Navitoclax against a range of different cancer models that are dependent on Bcl-x_L and Bcl-2, two relatives of Mcl-1, indicates that the inhibition of Mcl-1 with small-molecules might also be a viable strategy to kill cancer cells by inducing apoptosis. Herein, we provide a comprehensive review of the most potent, Mcl-1 selective small-molecule inhibitors reported in the literature to date.

The Bcl-2 (B cell lymphoma 2) family of proteins, whose anti-apoptotic members include Bcl-2, Bcl-x_L, Bcl-w, A1 and Mcl-1 (myeloid cell leukemia 1), are critical regulators of apoptosis, or programmed cell death. A hallmark of cancer is the evasion of apoptosis, and many cancers are resistant to apoptosis due to overexpression of one or more of the Bcl-2 family members. ABT-263 (Navitoclax), the clinical analogue of ABT-737, is a potent, dual inhibitor of Bcl-x_L and Bcl-2, and is an effective killer of cancer cells over expressing these proteins. However, Navitoclax exhibits limited activity against Mcl-1, such that cancer cells overexpressing Mcl-1 or both Bcl-x_L and Mcl-1 are resistant to the drug. Over expression of the Mcl-1 protein and/or amplification of the Mcl-1 gene have been linked to a variety of human cancers, including lung, breast, pancreatic, cervical and ovarian cancers, as well as leukemia and lymphoma. Mcl-1 overexpression is directly responsible for the emerging resistance of various FDA-approved anti-cancer therapies, including vincristine, Taxol, gemcitabine and cisplatin. Importantly, down regulation of Mcl-1 by RNAi decreases tumor-igenicity in mouse xenograft models. Taken together, these observations suggest that the inhibition of Mcl-1 by small-molecules might provide an alternative strategy to kill cancer cells by inducing apoptosis. With this in mind, the focus of this mini-review is on selective small-molecule inhibitors of the Mcl-1 protein; small-molecule inhibitors of Bcl-2, Bcl-x_L and dual Bcl-x_L/Mcl-1 inhibitors are reviewed elsewhere.

Like the other anti-apoptotic Bcl-2 proteins, there is a hydrophobic grove on the surface of Mcl-1 that engages the BH3 “death” domains of the pro-apoptotic Bcl-2 proteins, such as Bim, Bak and Bad. The BH3 domain is an amphipathic α-helix whose hydrophobic face recognizes four hydrophobic sub-pockets, p1, p2, p3 and p4, in the BH3-binding groove on Mcl-1, while a critical Asp on the polar face of the BH3 helix binds Arg263 of Mcl-1. Figure 1A shows the crystal structure of the Bim-BH3–Mcl-1 complex, and Figure 1B is the BH3-binding groove on the surface of Mcl-1 with key binding regions and residues highlighted. Through this protein–protein interaction (PPI), Mcl-1 (and the other anti-apoptotic Bcl-2 proteins) “neutralizes” the cell-killing function of the pro-apoptotic Bcl-2 proteins. In this way, overexpression of Mcl-1 leads to the evasion of apoptosis and, hence, cancer. Small-molecules that can block this PPI through binding the hydrophobic groove on Mcl-1 are expected to counter this neutralization and allow the pro-apoptotic proteins to kill the cancer cell through restoring apoptosis. Dual Bcl-x_L/ Mcl-1 inhibitors have been reported for about ten years, and these compounds are predicted and/or known to bind in some or all of these sub-pockets. Although Bcl-x_L-selective inhibitors, such as ABT- 737, have been identified, there have been limited advances towards the development of Mcl-1-selective inhibitors. In the last 18 months, however, some exciting advances have been made. This mini-review reports the recent progress in the discovery of small-molecules that selectively inhibit the Mcl-1 oncoprotein.

Clinical Asthma Phenotypes; A Challenging but Promising Spectrum

                                    http://austinpublishinggroup.com/allergy/all-issues.php

Asthma is a common, chronic and heterogeneous syndrome, affecting people of all ages, all races and both sexes. In recent years, it has become clearly apparent that asthma management must be individualized and tailored not only to the severity of the disease but also, importantly, to the phenotypic characteristics of the patient. Researchers have tried to define asthma phenotypes based on its clinical, physiologic and cellular parameters. Interestingly, tailoring asthma therapy according to the clinical phenotype is particularly crucial since asthma diagnosis is based mainly on clinical basis. Classification methods based on clinical features included those defined by symptoms (age at onset, natural history, severity), triggers (allergic versus non-allergic, exercise, viral), and treatment response. Other clinical asthma phenotypes included cough variant asthma and obese asthma phenotype.The addition of a genetic or blood biomarker could move a phenotype towards the evolving term of “endotype”, defined as a sub grouping of disease associated with distinct functional or pathologic mechanisms. Thus, verification of clinical asthma phenotypes by correlating them with their underlying genotypes and certain airway inflammatory biomarkers is extremely pivotal.

We have previously hypothesized an approach to classify asthma phenotypes based on validated symptomatology [Shortness of Breath (SOB), cough, wheezy phenotypes] in correlation with cytokine profile and airway inflammatory biomarkers aiming to detect their impact on asthma treatment. Our study described a wide variability in the baseline characteristics of the proposed clinical phenotypes in which the SOB phenotype group were found to have significant increase of total sIgE, soluble interleukin-2 receptor serum concentration and decrease in FEV1 in comparison to both cough and wheezy groups. Other characteristics included older age (>10 years), male gender, and longer disease duration with negative family history of asthma. Whereas, cough phenotype group was found to have an eosinophilic pattern, younger age (<10 years), female gender, and shorter disease duration, with positive family history of Asthma. On the other aspect, a mixed IgE and eosinophilic pattern were noticed in the wheezy phenotype group. This wide variation in the features of each clinical asthma phenotype had its implication on treatment response where the SOB group responded to fluticasone alone, the cough group responded to montelukast alone, and the wheezy group responded to both medications.

Numerous studies suggested that genetic factors may mediate a large part of heterogeneity in response to asthma medications among asthmatics. Further, Cytokine gene polymorphisms were found to affect the serum levels of cytokines by influencing transcriptional regulation. Thus in another recent study, we explored the genetic profile of the proposed clinical asthma phenotypes, in addition to their cytokine profile and other airway biomarkers. The proposed clinical phenotypes included cough phenotype, SOB phenotype, and cough with SOB phenotype. Single nucleotide polymorphism of IL4RA 175V and IL4C-590T were studied in the different clinical phenotypes. We found that asthma as a group had AGheterozygosity genotype of IL4RA 175V, whereas, cough with SOB group showed AA and GGhomozygosity genotype. Further, cough with SOB group showed significant elevated serum levels of IL-9 among those with IL- 4RA AA and GG genotypes in comparison to the other phenotypes with similar genotypes. In addition, this group showed significant increase in serum IL-9 and peripheral eosinophilic percentage compared to cough group.

Annals of Yoga and Physical Therapy

                                    http://austinpublishinggroup.com/yoga-physical-therapy/

Annals of Yoga and Physical Therapy is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Yoga, Physical Medicine and Rehabilitation.

The journal aims to promote latest information and provide a forum for doctors, researchers, physicians, and healthcare professionals to find most recent advances in the areas of Yoga, Physical Medicine and Rehabilitation. Annals of Yoga and Physical Therapy accepts research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of Yoga, Physical Medicine and Rehabilitation.

Annals of Yoga and Physical Therapy strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.

Austin Journal of Women’s Health

                                              http://austinpublishinggroup.com/womens-health/

Austin Journal of Women’s Health is an open access, peer reviewed, scholarly journal dedicated to publish articles in all areas of women's healthcare including gynecology, obstetrics, and breast cancer and policies.

Austin Journal of Women's Health is committed to improving the health and health care of all women throughout the lifetime and in diverse communities with focus on the prevention, diagnosis and administration of fertility.

Austin Journal of Women's Health accepts original research articles, review articles, case reports, commentaries, clinical images and rapid communication on all the aspects of Women’s Health.

Austin Journal of Vector Borne Diseases: Open Access

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Austin Journal of Vector Borne Diseases: Open Access is an open access, peer reviewed, scholarly journal dedicated to publish articles in all areas of vector borne diseases including existing or new policy in the relevant areas, impact of all types of vector borne diseases and related medical research methodologies.

Vector-borne diseases are the infections transmitted by the bite of infected arthropod species, such as mosquitoes, ticks, triatomine bugs, sandflies, and blackflies. Arthropod vectors are cold-blooded (ectothermic) and thus especially sensitive to climatic factors. Or Vectors are organisms that transmit pathogens and parasites from one infected person (or animal) to another, causing serious diseases in human populations. These diseases are commonly found in tropical and sub-tropical regions and places where access to safe drinking-water and sanitation systems is problematic.

Austin Journal of vector borne diseases welcomes research manuscripts, review articles, case reports, editorials, letters to the editor, and innovations relating to all aspects of vector borne diseases.

Austin Virology and Retrovirology

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Austin Virology and Retrovirology is an international scholarly peer reviewed Open Access journal, aims to promote the research in the field of Virology.

Austin Virology and Retrovirology is a comprehensive Open Access peer reviewed scientific Journal that covers multidisciplinary fields. We provide limitless access towards accessing our literature hub with colossal range of articles. The journal aims to publish high quality varied article types such as Research, Review, Case Reports, Short Communications, Perspectives (Editorials), Clinical Images

Austin Virology and Retrovirology supports the scientific modernization and enrichment in virology research community by magnifying access to peer reviewed scientific literary works. Austin also brings universally peer reviewed member journals under one roof thereby promoting knowledge sharing, collaborative and promotion of multidisciplinary science.

Austin Journal of Veterinary Science & Animal Husbandry

                           http://austinpublishinggroup.com/veterinary-science-research/index.php

Austin Journal of Veterinary Science & Animal Husbandry is an open access, peer reviewed, scholarly journal dedicated to publish articles in all areas of Veterinary Science.

The aim of the journal is to provide a forum for researchers, physicians, academicians and other Veterinary professionals to find most recent advances in the areas of diagnosis and treatments in Veterinary sciences.

Austin Journal of Veterinary Science & Animal Husbandry accepts original research articles, review articles, case reports, clinical images and rapid communication on all the aspects of Veterinary Science.

Austin Journal of Vascular Medicine

                                         http://austinpublishinggroup.com/vascular-medicine/

Austin Journal of Vascular Medicine is an open access, peer review journal publishing original research & review articles in all the fields of Vascular Medicine. Austin Journal of Vascular Medicine provides a new platform for all researchers, scientists, scholars, academicians to publish and find latest research information in the field of Vascular Medicine.

Austin Journal of Vascular Medicine ]is a comprehensive Open Access peer reviewed scientific journal that covers multidisciplinary fields. We provide limitless access towards accessing our literature hub with colossal range of articles. The journal aims to publish high quality varied article types such as Research, Review, Short Communications, Case Reports, Perspectives (Editorials) and Clinical Images.

Austin Journal of Vascular Medicine supports the scientific modernization and enrichment in Vascular Medicine research community by magnifying access to peer reviewed scientific literary works. Austin also brings universally peer reviewed member journals under one roof thereby promoting knowledge sharing, collaborative and promotion of multidisciplinary science.