PHYTOCHEMICAL EVALUATION OF ELEUSINE CORACANA IN CORRELATION WITH ITS NUTRITIONAL VALUE

Eleusine coracana, a tropical cereal, commonly known as finger millet found in region of India and Africa contains large source of phytochemicals. The nutrient content of finger millet is high and can be further enhanced by processing, the hypoglycemic, anti-ulcer properties and hypo-cholesterolic effect of finger millet are among its health benefits. Scientific proof of the existence of phenolics and flavonoids in finger millet, however, is lacking. Additionally, analytical methods to calculate the amounts of gallic acid and quercetin have not been developed. The present investigation includes phytochemical screening, estimation of total phenolic and flavonoid content, determination of calcium content, as well as analytical method development for two bio-actives using High-Performance Thin Layer Chromatography (HPTLC). The final method was optimized using Toluene: Ethyl acetate: Methanol: Formic acid (3:3:0.8:0.4 v/v/v/v) and densitometric scanning of the plate was performed in absorption mode at 271 nm. Validation of the developed method was done according to the ICH guidelines. Linearity range was found to be 200-600 ng/spot with R2 value 0.988 and 0.9976 for quercetin and gallic acid, respectively. Other validation parameters like precision, repeatability, and accuracy were performed and the results were found according the specifications. The quantification of quercetin and gallic acid in the sample was found to be 0.61% and 0.55% w/w, respectively. Despite the widespread use of synthetic antioxidants, calcium determination, estimates of quercetin and gallic acid in the present investigation provided assurance of health benefits & quality and purity of finger millet. However, there is growing evidence that consumers prefer natural antioxidants due to their potential for lower toxicity

PHYTOCHEMICAL EVALUATION OF ELEUSINE CORACANA IN CORRELATION WITH ITS NUTRITIONAL VALUE

Eleusine coracana, a tropical cereal, commonly known as finger millet found in region of India and Africa contains large source of phytochemicals. The nutrient content of finger millet is high and can be further enhanced by processing, the hypoglycemic, anti-ulcer properties and hypo-cholesterolic effect of finger millet are among its health benefits. Scientific proof of the existence of phenolics and flavonoids in finger millet, however, is lacking. Additionally, analytical methods to calculate the amounts of gallic acid and quercetin have not been developed. The present investigation includes phytochemical screening, estimation of total phenolic and flavonoid content, determination of calcium content, as well as analytical method development for two bio-actives using High-Performance Thin Layer Chromatography (HPTLC). The final method was optimized using Toluene: Ethyl acetate: Methanol: Formic acid (3:3:0.8:0.4 v/v/v/v) and densitometric scanning of the plate was performed in absorption mode at 271 nm. Validation of the developed method was done according to the ICH guidelines. Linearity range was found to be 200-600 ng/spot with R2 value 0.988 and 0.9976 for quercetin and gallic acid, respectively. Other validation parameters like precision, repeatability, and accuracy were performed and the results were found according the specifications. The quantification of quercetin and gallic acid in the sample was found to be 0.61% and 0.55% w/w, respectively. Despite the widespread use of synthetic antioxidants, calcium determination, estimates of quercetin and gallic acid in the present investigation provided assurance of health benefits & quality and purity of finger millet. However, there is growing evidence that consumers prefer natural antioxidants due to their potential for lower toxicity

Prevalence of childhood asthma and its immediate outcome - At tertiary care rural hospital

Introduction: Asthma is a chronic inflammatory disorder of the airways resulting in episodic airway obstruction. Globally, childhood asthma is increasing in the prevalence, despite improvements in investigation and treatment. Childhood asthma seemed more prevalent in urban population and now even in rural areas of India. Objectives: To know the prevalence, assess the risk factors, severity, and immediate outcome of the treatment offered to asthmatic children in a tertiary rural hospital. Materials and Methods: All the diagnosed asthmatic children up to 18 years were enrolled in the study. All the patients of pulmonary Koch’s, congenital heart disease and chronic lung disease were excluded from the study. Clinical profile was noted in recruited patients. Results: The prevalence of childhood asthma among children visiting to our department was 3.93%. 58 (48.33%) had age of onset before the age of 6 years. Asthma was more prevalent in boys. 116 (96.66%) children presented with complain of cough, and 118 (98.33%) children had associated breathlessness. Common precipitating factors were change in season (71.66%), pollen allergy (58.33%), air pollutieon (45.00%), and passive smoking (23.33%). Exercise-induced asthma was seen in 55% cases, diurnal variation in 60% and 28.33% children had family history of atopic disease. Majority of the patient was undernourished. The average duration of stay in persistent asthma is 1.8 times more than in intermittent asthma. Conclusion: Significant number of patient becomes symptomatic before the 6 years of age. Prevention of child from exposure to passive smoking, environmental improvement, and allergen avoidance are major aspects for prevention of asthma exacerbations

Expansion Thoracoplasty Affects Lung Growth and Morphology in a Rabbit Model: A Pilot Study

Background: Thoracic insufficiency syndrome represents a novel form of postnatal restrictive respiratory disease occurring in children with early-onset scoliosis and chest wall anomalies. Expansion thoracoplasty improves lung volumes in children with thoracic insufficiency syndrome; however, how it affects lung development is unknown. Questions/purposes: Using a rabbit model of thoracic insufficiency syndrome, we evaluated the effect of expansion thoracoplasty on the response of biologic mechanisms in the alveolar microstructure. Methods: Using archived material from a previous experiment, 10 4-week-old New Zealand rabbits were divided into three groups: normal (n = 3), disease (n = 3), and treated (n = 4). Left ribs four to eight were tethered in seven rabbits at age 5 weeks to induce hypoplasia of the left hemithorax (disease). At age 10 weeks, four of these rabbits were treated by expansion thoracoplasty (treated). At age 24 weeks, lungs were excised and processed. Alveolar density and parenchymal airspace were measured on histologic sections. Immunohistochemistry was performed for vascular endothelial growth factor receptor 2 (angiogenesis), KI-67 (cell proliferation), and RAM-11 (macrophages). Results: Alveolar walls were poorly perfused and airspace fraction was larger (emphysematous) in disease rabbits than normal or treated rabbits. Immunohistochemistry provided inconclusive evidence to support the concept that pulmonary hypoplasia is induced by thoracic insufficiency syndrome and controlled by expansion thoracoplasty. Conclusions: Treatment of thoracic insufficiency syndrome by expansion thoracoplasty may prevent emphysematous changes in the alveolar microstructure, thereby enhancing gas exchange

Outcomes of Over 40,000 Eyes Treated for Diabetic Macula Edema in Routine Clinical Practice: A Systematic Review and Meta-analysis

Introduction: We investigated effectiveness and safety outcomes of diabetic macula edema (DME) treatment in routine clinical practice. Methods: A literature search was conducted of peer-reviewed articles published from January 2011 to September 2021. Studies of DME treatment in real-world practice of at least 6 months with at least 50 eyes at baseline were included. Randomized controlled trials (RCTs) were excluded. The primary outcome for this meta-analysis was change in visual acuity (VA) 12 months after starting treatment. Results: Of 3034 initially identified studies, 138 met selection criteria, representing more than 40,000 eyes. The mean 12-month VA gain was 4.6 letters (95% CI 3.7, 5.4; baseline 58.6) for vascular endothelial growth factor inhibitors (anti-VEGF), 4.4 (2.5, 6.3; baseline 54.2) for steroids, and 2.1 (- 1.2, 5.3; baseline 63.6) for macular laser. Australian and New Zealand studies had better baseline VA when initiating treatment compared with Asia, Europe, and North America, translating to better VA at 12 months. Fewer anti-VEGF injections were delivered in real-world practice than registrational RCTs. Neither systemic nor ocular safety was consistently reported. Conclusions: Intravitreal anti-VEGF or steroids for DME generally led to visual gains in real-world practice but these were less impressive than RCTs, with undertreatment and differences in baseline characteristics likely contributing factors. Keywords: Diabetic macula edema; Meta-analysis; Observational; Outcomes; Real-world data; Systematic review; Treatment

Changes in 12-month outcomes over time for age-related macular degeneration, diabetic macular oedema and retinal vein occlusion

OBJECTIVES To identify whether the outcomes of neovascular age-related macular degeneration (nAMD), diabetic macular oedema (DMO) and retinal vein occlusion (RVO) in routine clinical practice have changed over time. METHODS We analysed 12-month outcomes in treatment-naïve eyes that started aflibercept or ranibizumab for nAMD (3802 eyes), DMO (975 eyes), Branch RVO (BRVO, 357 eyes), Central RVO (CRVO, 371 eyes) and Hemi-RVO (HRVO, 54 eyes) from 2015 and 2019 tracked in the prospectively designed observational Fight Retinal Blindness! Registry. RESULTS The mean VA change at 12-month for each year between 2015 and 2019 remained stable or otherwise showed no discernible trends over time in eyes with nAMD (+3.3 to +6 letters), DMO (+3.6 to +6.7 letters) and RVO (+10.3 to +11.7 letters for BRVO, +5.9 to +17.7 letters for CRVO and 10.2 to 20.7 letters for HRVO). The median number of VEGF-inhibitor injections in eyes that completed 12-month follow-up also remained stable at 8-9 for nAMD, 6-7 for DMO, 7-9 for RVO. Fewer eyes (<one-fourth) that started treatment between 2015 and 2018 and more eyes starting in 2019 did not complete 12-month's follow-up visit. The mean VA in non-completers at their last visit was higher than that of their baseline visit. CONCLUSIONS Treatment patterns and outcomes for nAMD, DMO and RVO in routine clinical practice have stabilised over the past 5 years at levels inferior to those reported by the pivotal phase 3 studies. A conscious effort to treat these conditions more intensively, or with longer lasting agents, would likely improve outcomes further in our patients

Importance of Anatomical Efficacy for Disease Control in Neovascular AMD: An Expert Opinion

BACKGROUND: Neovascular age-related macular degeneration (nAMD) presents a significant treatment burden for patients, carers and medical retina services. However, significant debate remains regarding how best to manage nAMD when assessing disease activity by optical coherence tomography (OCT), and particularly the significance of different types of fluid and how the understanding of anatomical efficacy can influence treatment strategies. This article provides opinion on the practical implications of anatomical efficacy and significance of fluid in the management of nAMD and proposes recommendations for healthcare professionals (HCPs) to improve understanding and promote best practice to achieve disease control. METHODS: An evidence-based review was performed and an expert panel debate from the Retina Outcomes Group (ROG), a forum of retinal specialists, provided insights and recommendations on the definition, role and practical implications of anatomical efficacy and the significance of fluid at the macula in the management of nAMD. RESULTS: The ROG has developed recommendations for achieving disease control through a zero-tolerance approach to the presence of fluid in nAMD as patients who avoid fluctuations in fluid at the macula have better visual outcomes. Recommendations cover five key areas: service protocol, training, regimen, multidisciplinary teams and engagement. This approach facilitates more standardised protocol-based treatment strategies. CONCLUSIONS: Targeting a fluid-free macula and aiming for disease control are essential to improve outcomes. As new therapies and technologies become available, drying the macula and maintaining disease control will become even more achievable. The outlined recommendations aim to promote best practice among HCPs and medical retina services to improve patient outcomes

Three-year treatment outcomes of Aflibercept versus Ranibizumab for diabetic macular edema:: Data from the Fight Retinal Blindness! Registry

PURPOSE Compare the 3-year outcomes of ranibizumab versus aflibercept in eyes with diabetic macular edema in daily practice. METHODS This was a retrospective analysis of naive diabetic macular edema eyes starting intravitreal injections of ranibizumab (0.5 mg) or aflibercept (2 mg) from January 1, 2013 to December 31, 2017 that were collected in the Fight Retinal Blindness! Registry. RESULTS We identified 534 eyes (ranibizumab-267 and aflibercept-267) of 402 patients. The adjusted mean (95% confidence interval) visual acuity change of +1.3 (-0.1 to 4.2) letters in the ranibizumab group and +2.4 (-0.2 to 5.1) letters (P = 0.001) in the aflibercept group at 3 years was not clinically different. However, the adjusted mean CST change seemed to remain significantly different throughout the 3-year period with higher reductions in favor of aflibercept (-87.8 [-108.3 to -67.4] µm for ranibizumab vs. -114.4 [-134.4 to -94.3] for aflibercept; P < 0.01). When baseline visual impairment was moderate (visual acuity ≤68 Early Treatment Diabetic Retinopathy Study letters), we found a faster improvement in visual acuity in eyes treated with aflibercept up until 18 months of treatment than eyes treated with ranibizumab, which then stayed similar until 36 months of treatment, whereas there was no apparent difference when baseline visual impairment was mild (visual acuity ≥69 Early Treatment Diabetic Retinopathy Study letters). The rate of serious adverse events was low. CONCLUSION Aflibercept and ranibizumab were both effective and safe for diabetic macular edema over 3 years

Outliers of Treatment Frequency in Retinal Vein Occlusion: 24‐Month Comparative Analysis of Fight Retinal Blindness! Practitioners

Background We aimed to describe a 2‐year outcome of eyes managed by practitioners benchmarked using a funnel plot by their frequency of treatment using vascular endothelial growth factor (VEGF) inhibitors for naive retinal vein occlusion (RVO). Methods A multicentre, international, observational study of 29 doctors in 12 countries managing 1110 eyes with RVO commencing VEGF inhibitors between 1 January 2012–2022 tracked in the Fight Retinal Blindness! registry. Results We identified 3 outlying ‘intensive’ practitioners (managing 350/1110 eyes [32%]), 22 ‘typical’ practitioners (604/1110, [54%]) and 4 outlying ‘relaxed’ practitioners (156/1110, [14%]) with respective 24‐month outcomes in Branch and Central RVO including the primary outcome, mean adjusted change in visual acuity (VA) in BRVO: +16.2, +13.6, +9.3 letters (p  68 letters in BRVO 90, 78, 68 weeks (p < 0.01) and CRVO 69, 60, 54 weeks (p = 0.04); median injections 18, 13 and 10; median final injection intervals, BRVO 6, 9, 10 weeks and CRVO 6, 9 and 12 weeks; with no significant difference in adverse outcomes. Conclusions At 24 months, the intensive practitioners were treating RVO using VEGF inhibitors with twice the frequency of the relaxed practitioners; however, their patients had gained twice (BRVO) to three times (CRVO) more letters of VA

Central retinal vein occlusion 36-month outcomes with anti-vascular endothelial growth factors: the Fight Retinal Blindness! registry

PURPOSE To analyze the 3-year outcomes in a broad population of patients starting vascular endothelial growth factor (VEGF) inhibitors for central retinal vein occlusion (CRVO) in routine clinical practice. DESIGN Observational database study PARTICIPANTS: 527 treatment-naïve CRVO eyes that commenced VEGF inhibitors between December 1, 2010-2018 tracked in the Fight Retinal Blindness! registry. METHODS Longitudinal models were used to plot changes in visual acuity (VA) and central subfield thickness (CST). MAIN OUTCOME MEASURES Mean change in VA from baseline to 36 months, injections, visits, completion, switching and suspensions of therapy >180 days at final review. RESULTS Overall (527 eyes) mean VA change (95% CI) was +10 (7, 12) letters, 37% had final VA ≥70 and 30% ≤35 letters, mean CST changed -306μm. Completers (257/527, 49%) had mean 36-month changes in VA and CST of +12 letters and -324μm with a median of 18 injections at 26 visits. The adjusted mean VA change was similar with each VEGF inhibitor (mean, +11.4 letters) despite a greater reduction in CST with aflibercept (-310μm) vs. ranibizumab (-258μm) vs. bevacizumab (-216μm; P 73 letters, 42/527, 8%) lost 7 letters. Switching (160/527, 30%) was most often to aflibercept (79 eyes). Using suspensions and discontinuation reasons we identified similar proportions had ceased therapy (154/527, 29%) as were still receiving it at 36 months (165/527, 31%). Only 62/527 eyes (12%) had resolution of macular edema without treatment for over 6 months. CONCLUSIONS Patients with CRVO that commenced VEGF inhibitors in routine care for whom follow-up was available had VA improvements of around 12 letters at three years, but with more than 50% lost to follow the VA outcome for the entire group is likely worse. The choice of VEGF inhibitor influenced CST but not VA outcomes. We estimate that around half of eyes were still receiving injections after 36 months