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Background The short synacthen test (SST) is the most commonly performed investigation to assess adrenal function. Appropriate criteria for when an SST is performed are subject to debate. We investigated how random serum cortisol levels relate to SST response. Methods We examined random cortisol measurements taken between 04.40–23.55 p.m. results of SST baseline and 30-/60-min cortisol performed over 12 months (225 SSTs) at Salford Royal Hospital. Serum cortisol was measured on the Siemens Centaur Analyser. A 30–60-min cortisol concentration of ≥450 nmol/L defined a pass; 350–449 nmol/L defined borderline. Results Patients only proceeded to SST if random cortisol was

Neurodegenerative disorders are one of the most terrible consequences of aging and damage due to unbalanced biochemical reactions occur in the body. Numbers of research has been conducted to digout the reason and possible therapeutic strategies against the neurodegenerative damage and many more are on the way to be studied. There are many commercial drugs available in the market to cure neurodegenerative disorders but with many side effects. Therefore, researchers are searching for key therapies with minimum side effects. Many phytochemicals attract the researchers due to promising therapeutic effects and least side effects. Nigella sativa is one among many herbal plants. The chemical constituents of the plants are also studied against many diseases like inflammatory, bacterial/fungal disease, oxidative stress, and neurodegenerative disorders. In this chapter, the authors have focused the therapeutic role of N. sativa and its chemicals against neurodegenerative disorders.

The important aspect of light environment is to provide time-of-day and time-of-year information to the endogenous machinery that measures time. In a 24 h day there are conspicuous alterations in light intensity and spectrum. VIBGYOR is the visible portion of spectrum covering the light wavelength range from 380-760 nm. Each wavelength can activate the select class of photoreceptors, and hence a specific colour is experienced. Photoreceptors have opsin-based molecules that can trap light and thus play a key role in the perception of light and dark signals of the day. Eyes are the main photoreceptive structure but non-mammalian vertebrates such as birds have both retinal (eyes) and extra-retinal (e.g. lateral eyes, pineal, parapineal organs and deep brain photoreceptors) structures for photoreception. These opsin-based molecules found in different regions of the eyes and brain are sensitive to different wavelengths of light, hence play an important role in regulating the circadian and seasonal rhyt...

Cardiovascular disease is the leading cause of death worldwide, despite the growing advances that have been made in the development of therapeutics. Almost all aspects of the pathogenesis underlying a cardiac injury are critically influenced by the inflammatory response. Over the past two decades, researchers have shown that the myocardium triggers an intense innate immune response that activates various immune effectors including the pattern recognition receptors.

Correlation between midnight and post dexamethasone salivary cortisone and cortisol and post dexamethasone serum cortisol concentrations in patients with unilateral and bilateral adrenal incidentalomas Background: The commonest functional abnormality in adrenal incidentalomas (AI) is autonomous cortisol secretion. Most guidelines recommend a 1 mg overnight dexamethasone suppression test (ONDST) as a screening test for this abnormality. This requires either a short stay or attendance to hospital as well as the inconvenience of venepuncture. Aim: To investigate the utility of using salivary samples in an ONDST by correlating post dexamethasone salivary cortisol (SaC) and cortisone (SaCn) and midnight salivary cortisol (MSaC) and cortisone (MSaCn) concentrations with post dexamethasone cortisol (SC). Methods: Using linear regression analysis we correlated post SC with SaC and SaCn and with MSaC and MSaCn. Results: We examined the results of 57 patients with unilateral or bilateral adrenal incidentalomas who underwent a 1 mg dexamethasone suppression test on our unit. The SC range

Background: The most common functional abnormality in adrenal incidentalomas (AI) is autonomous cortisol secretion. Most guidelines recommend a 1 mg overnight dexamethasone suppression test (ONDST) as a screening test for this abnormality. There is some evidence that simultaneous measurement of post dexamethasone serum dexamethasone (SD) with serum cortisol (SC) improves the accuracy of the ONDST. We have therefore been routinely measuring SD in our unit to ensure adequate concentrations when interpreting the results of this test. Aim: To measure the correlation between SD and SC concentrations and SD with the decrement in serum cortisol levels from baseline (9 am the day before the test) to the post dexamethasone level (DSC) in the ONDST. Method: We examined the results of 57 patients with unilateral or bilateral adrenal incidentalomas who underwent a 1 mg ONDST on our unit. Using linear regression analysis, we correlated SC and SD concentrations and serum SD concentration with the DSC. We also examined whether lower levels of SD were associated with adequate suppression of SC following ONDST. Results: SD levels range 16, median 7.656 nmol/L. SC range

Laser therapy, recently renamed as photobiomodulation, stands as a promising supportive treatment for oral mucositis induced by oncological therapies. However, its mechanisms of action and, more importantly, its safety in cancer patients, are still unclear. Here we explored the anti-cancer effect of 3 laser protocols, set at the most commonly used wavelengths, in B16F10 melanoma and oral carcinogenesis mouse models. While laser light increased cell metabolism in cultured cells, the in vivo outcome was reduced tumor progression. This striking, unexpected result, was paralleled by the recruitment of immune cells, in particular T lymphocytes and dendritic cells, which secreted type I interferons. Laser light also reduced the number of highly angiogenic macrophages within the tumor mass and promoted vessel normalization, an emerging strategy to control tumor progression. Collectively, these results set photobiomodulation as a safety procedure in oncological patients and open the way to its innovative use for cancer therapy., Highlights • Laser light reduces tumor progression while increasing metabolism of cultured cells • Laser-treated tumors contain mature vessels and less pro-angiogenic macrophages • Tumors treated by photobiomodulation are surrounded by lymphocytes and dendritic cells • Laser light promotes secretion of type I interferons in vitro and in vivo Laser therapy, also named photobiomodulation, is recommended to heal mucositis induced by oncological treatments, raising concerns on its safe use in cancer patients. Ottaviani et al. showed that laser light inhibits tumor progression, induces tumor vessel normalization and stimulates the immune system to produce type I interferons, proving the safety and extending the use of laser-based therapies to cancer.

Background: The incidence of Tuberculosis (TB) in renal transplant recipients in Pakistan is 15%. Following findings of our randomized controlled trial 1 showing an overwhelming benefit of Isoniazid (INH) prophylaxis, from June 2009 every transplant recipient receives INH for one year post transplant in our unit. Aims and objectives: To find out incidence, risk factors and complications of tuberculosis in renal transplant recipients receiving INH prophylaxis. Methods: We reviewed the records of all renal transplant recipients on INH prophylaxis from June 2009 to December 2011, followed up till June 2015. We noted details of transplantation and immunosuppression, Tuberculosis including occurrence after transplantation, site, methods of diagnosis, treatment, drugs side effects and other complications, and outcome. Results: Out of 910 recipients, 91% completed one year of INH. Forty six (5%) developed TB, incidence higher in later than 2 years post transplantation than earlier. Majority were pulmonary (48%); most were diagnosed on cultures. Out of 14 positive cultures, only one (7%) was INH resistant. Out of 46 patients with TB, majority (84%) were cured, 6 (13%) died while one suffered graft failure. Incidence of hepatotoxicity was 1.42%. Conclusion: INH prophylaxis is effective in preventing TB in post renal transplant recipients. Late development of TB still remains a challenge. 1 Use of isoniazid chemoprophylaxis in renal transplant recipients. Rubina Naqvi et al. Nephrol. Dial. Transplant. (2010) 25 (2): 634-637.

Background Wiskott-Aldrich syndrome (WAS) is a rare primary immunodeficiency caused by mutations in Wiskott-Aldrich syndrome protein (WASp), a key regulator of cytoskeletal dynamics in hematopoietic cells. A high proportion of patients experience autoimmunity caused by a breakdown in T- and B-cell tolerance. Moreover, excessive production of type I interferon (IFN-I) by plasmacytoid dendritic cells (pDCs) contributes to autoimmune signs; however, the factors that trigger excessive innate activation have not been defined. Objective Neutrophil extracellular traps (NETs) emerged as major initiating factors in patients with diseases such as systemic lupus erythematosus and rheumatoid arthritis. In this study we explored the possible involvement of aberrant neutrophil functions in patients with WAS. Methods We evaluated the expression of a set of granulocyte genes associated with NETs in a cohort of patients with WAS and the presence of NET inducers in sera. Using a mouse model of WAS, we analyzed NET release by WASp-null neutrophils and evaluated the composition and homeostasis of neutrophils in vivo . By using depletion experiments, we assessed the effect of neutrophils in promoting inflammation and reactivity against autoantigens. Results Transcripts of genes encoding neutrophil enzymes and antimicrobial peptides were increased in granulocytes of patients with WAS, and serum-soluble factors triggered NET release. WASp-null neutrophils showed increased spontaneous NETosis, induced IFN-I production by pDCs, and activated B cells through B-cell activating factor. Consistently, their depletion abolished constitutive pDC activation, normalized circulating IFN-I levels, and, importantly, abolished production of autoantibodies directed against double-stranded DNA, nucleosomes, and myeloperoxidase. Conclusions These findings reveal that neutrophils are involved in the pathogenic loop that causes excessive activation of innate cells and autoreactive B cells, thus identifying novel mechanisms that contribute to the autoimmunity of WAS.