*This blog post is in collaboration with iHerb*
As a former Nanny (and former Nursery Nurse in a Private Day Nursery) of 14 years I have cared for numerous babies & toddlers, and it is safe to say that no one skin type is the same.
Each child is unique and therefore has individual likes, dislikes, allergies and needs.
Both of my children have Eczema, Emmy had it rather severely as a baby/toddler but out-grew it around 3 years old and it hasn’t returned. Harry developed his at the age of about 1 and still suffers now, aged 4 and a half.
What is Eczema?
The word eczema comes from the Greek word “ekzein” which means “to boil.”
Eczema (also known as dermatitis) is a dry skin condition. It is a highly individual condition which varies from person to person and comes in many different forms. It is not contagious so you cannot catch it from someone else.
In mild cases of eczema, the skin is dry, scaly, red and itchy. In more severe cases there may be weeping, crusting and bleeding. Constant scratching causes the skin to split and bleed and also leaves it open to infection. – www.eczema.org
Although Eczema is mainly seen on children it can of course affect anyone of any age, and those who have once out-grown it, as Emmy has, could see it return out of the blue in adulthood. With 1 in 5 children in the UK having this and 1 in 12 adults.
Signs of Eczema
- redness of affected areas of skin
- generally dry skin, which is often thickened in the areas that have been scratched
- lumps or blisters in affected areas
- signs of superficial infection, such as weeping or crusty deposits.
Top Tips for dealing with Eczema and dry skin
Avoid hot baths or showers
I’m not saying don’t bath your baby, however water can dry out their skin so daily bathing probably isn’t best. Stick with every other day or so (we all know just how messy babies get and will need it). Use warm water instead of hot. Water will help to soothe the itching although if the skin is broken through scratching it may hurt a little.
Avoid bubble baths and shampoos which contain Parabens
Parabens are a chemical compound of para-hydroxybenzoic acid and are used in shampoos, deodarants, moisturisers, soft drinks, processed meats and many other every day items to give them a longer shelf life
Our doctor always used to refer to it as ‘Slippery Baby’ – one of the key factors in keeping dry skin and Eczema at bay and under control is to keep the skin moisturised. When the moisturiser has been applied and then been absorbed into the skin, reapply often. With a good moisturiser you can not apply TOO MUCH.
I have used Aveeno Baby with Harry for years, we have tried various other creams and lotions however, for us this was the one which suited us best and comes in such a wide range of creams, bath treatments and shampoos that can be used for the whole family.
I often have a bath with the kids, it’s an easy way of them getting in fuss free and while in that bath I ensure they both wash their hair. I use the Aveeno Baby Wash and Shampoo with them as using a different product on Emmy while in the bath with Harry will irate his skin. This can also be used as a soap replacement, traditional soaps can dry the skin out too much, if not washing hair I use Aveeno Soothing Relief Creamy Wash which is very moisturising for Harry’s skin but also great for mine too. I use the Aveeno Baby Eczema Soothing Bath Treatment when Harry has a very bad flare up, it is made of oats and helps to relieve dry, itchy and irrated skin, and is good for taking on holidays to avoid taking a heavy bottles of liquid as it comes in handy one use sachets.
After the bath I pat dry and try my hardest to avoid rubbing the affected areas, then I use either the Aveeno Baby Soothing Moisturizing Cream all over or their Eczema Therapy Moisturizing Cream. All Aveeno products are Paediatrician recommended. These moisturisers are fragrance free and suitable for use daily and have been clinically shown to moisturise for up to 24 hours. It is hypoallergenic and this soothing cream is non-greasy and absorbs into the skin quickly while also being gentle enough for sensitive skin.
Keep nails short
Young babies and toddlers will scratch at the sore areas both in the day and at night while sleeping. Scratching can make Eczema infected and bleed, making the situation far worse.
Many baby sleep suits come with scratch mitts, if your child is prone to scratching then make sure you put these on before bed. For older children where this isn’t an option socks work well.
Baby your babies skin
Remember that young skin is delicate, don’t be tempted to use products designed for adults for ease, let it breathe – include nappy free time into your day and dress in breathable fabrics.
Light layers over heating
Central heating can dry out skin so try to limit the use if you can, using baby sleeping bags at night time instead of putting on the heating on.
Keep a food diary
If your little one has very bad Eczema it may be worth keeping a food diary for a few weeks to see if certain foods may trigger a flare up – foods which can be links to such flare ups include: Milk, Eggs, Peanuts, Wheat, Fish, Shellfish and Soy. If you notice a connection try cutting that food type out and speaking with your doctor to see if you can get food allergy testing or advice.
This won’t get rid of the Eczema but may help to keep flare ups to a minimal
Be vary of washing powders etc
Contact Eczema can get worse by changing washing powders/liquids, fabric softeners etc. It is recommended you use non-bio versions for children’s clothes however if you are cuddling a small child you’ll want to wash your clothes in that too. I have always found Harry has a rather bad flare up if I run out of our usual washing liquid and I’ve just grabbed a bottle in a local shop as a stop gap – it’s easy to forget when he’s not had a flare up for a while. I also have to re-wash clothes given to him by friends when their children have out-grown them and new clothes need a wash too.
I was given a voucher code to purchase my recent Aveeno products from iHerb which a Google Trusted Store, there are lots of different products available from household items to baby products, pet products and supplements. They ship internationally to over 160 countries and their Customer Service Team provides support in 10 different languages. Although my purchased items were being shipped overseas to me I was pleasantly surprised to find they took less than one week to arrive safe and sound and ordering was very easy once I had created an online account.
Currently customers will get 10% off Aveeno Baby Products by clicking on this link – this offer ends on 30th June 2017.
*Post contains affiliate links*
This is part of a Blog Series called Top Tips from a Former Nanny, please click the picture below to read my other posts in this series:


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EVERYTHING YOU NEED TO KNOW ABOUT THIS YEAR’S FLU SEASON
Canada is in the midst of a challenging flu season: cases are spiking across the country, particularly among the elderly and in long-term care facilities, and experts predict a surge in infections in the coming weeks.
Why is this season shaping up to be so rough? And what should Canadians be doing to protect themselves?
“The flu” refers to a range of influenza A and B viruses that typically circulate in North America from early November to April. People can contract the virus if they are in close proximity to an infected person or if they touch a surface contaminated with virus particles. Most cases are never confirmed in a laboratory and symptoms may be difficult to distinguish from a nasty cold. But the Public Health Agency of Canada says there are a few telltale signs you may be suffering from the flu rather than a cold, such as a fever, headache, severe aches and pains and extreme fatigue. People who are young, old, suffer chronic health conditions, are pregnant, live in nursing homes or are aboriginal are among those at highest risk of developing complications from the flu. During the week of Dec. 11 to 17 (the most recent data available), there were 692 lab-confirmed flu cases in Canada and 18 reported outbreaks, mainly in long-term care homes.
Each year, the dominant viruses in circulation change – and so must the influenza vaccine.
The flu shot
Around February each year, the World Health Organization issues recommendations on which flu viruses are most likely to be in circulation and should therefore be protected against in that year’s vaccine. In the current flu season, the vaccine protects against two influenza A strains, H1N1 and H3N2 and a B strain (Brisbane/60/2008-like virus). The vaccine contains inactivated versions of the circulating viruses, which help the body create antibodies that will be ready in the event the body has to fight off the real thing. Infectious disease experts report that H3N2 is causing the lion’s share of flu infections across the country. It’s known to be a nasty virus linked to an increase in hospitalizations and deaths. To make matters worse, it’s also notoriously difficult for vaccine makers to produce a shot that offers a high level of protection against H3N2.
Why isn’t the flu shot 100-per-cent effective?
Flu viruses are constantly mutating and changing, meaning that it’s virtually impossible to make a vaccine that is a perfect match for the circulating strain, said Danuta Skowronski, epidemiology lead for influenza and emerging respiratory pathogens at the B.C. Centre for Disease Control. Dr. Skowronski used colours as an analogy to explain the challenge public health officials face: Imagine the H3N2 virus is the colour orange. A vaccine containing an inactivated version of the virus might be a lighter shade of the same colour. Perfectly matching the two is extraordinarily challenging.
That helps explain why the flu shot isn’t 100-per-cent effective. In the case of H3N2, Dr. Skowronski said she’d be happy if the vaccine turns out to be 40- to 50-per-cent effective. Compare that with two years ago, when the H3N2 vaccine offered less than 10-per-cent protection from the virus. During years when H1N1 is the dominant virus in circulation, effectiveness rates tend to be higher because officials are better able to match the vaccine to the virus. Data on effectiveness rates for this year are currently being collected and should be available in the coming weeks.
Given the flaws and the fact I’m a healthy adult, why should I get a flu shot?
The flu vaccine is by far the best means available to protect against the flu. As more people get vaccinated, the chances of them contracting the virus and passing it onto others, particularly those who might be vulnerable to the flu, decreases. This is a particularly important message for anyone who will be in contact with higher-risk individuals.
The flu shot gave me the flu, so I don’t want to get it again.
No, it didn’t. It’s not possible for the flu shot to cause the flu because it uses an inactive form of the virus. It is still possible to get sick with a cold or flu after getting a shot. The flu shot isn’t always effective and there are a number of respiratory viruses circulating this time of year.
My sister-in-law wrote on Facebook that the flu shot causes pretty serious childhood illnesses
Conspiracy theories and scare-mongering messages linked to the flu and other routine vaccinations continue to be commonplace, despite the fact they have all been debunked by leading scientists and infectious-disease experts. But for the record, vaccines, including those that protect against the flu, have been studied intensely and safety is continuously monitored. The vast majority of vaccine side effects are mild, such as soreness at the injection site or a mild fever. According to the Public Health Agency of Canada, it received 639 reports of adverse events after immunization in the first quarter of 2016. Of those, 52 were classified as serious.
About 43 per cent of reports were linked to reactions at or near the injection site; 14 per cent were linked to allergic reactions; another 14 per cent of reports were linked to rashes; 5 per cent were linked to neurological events, which may include seizures and Guillain-Barré syndrome.
There is no credible evidence linking vaccines to autism or other chronic illnesses.
P.S. Don’t forget the flu can often mask dental symptoms, call us with any questions at 519-305-9100!


Caring for our community
Located on the campus of Prisma Health North Greenville Hospital, we offer same-day care for patients of all ages in the Travelers Rest community.
Our team is here to provide care for adults experiencing minor illnesses and injuries such as: allergy symptoms, colds, flu, fever, sore throats, rashes, ear pain, simple infections, minor burns, minor cuts, scrapes, bruises, bug bites/stings, and minor sprains and strains. No appointment is needed for our walk-in care services.
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Prisma Health is a not-for-profit health company and the largest healthcare system in South Carolina. Our goal is to improve the health of all South Carolinians by enhancing clinical quality, the patient experience and access to affordable care, as well as conducting clinical research and training the next generation of medical professionals.


Pimple On Roof Of Mouth Dizziness Mayo Clinic
Vertigo, also called lightheadedness, is a family member term to the extra familiar vertigo, also known as nausea. A sensation that your whole body is dizzy and also relocating a strange way. The lightheadedness comes on unexpectedly, without warning and also is generally for short amount of times. Vertigo, like dizziness, is really frightening and also is the primary symptom of many different problems that affect the brain, from high blood pressure to fainting. Pimple On Roof Of Mouth Dizziness Mayo Clinic
Benign positional vertigo (BPV) is most likely the most typical root cause of vertigo, the sensation that the interior of your head or that your whole body is turning strangely. Normally this is accompanied by light-headedness, queasiness, throwing up, collapsing, as well as a sensation of detachment from your surroundings. BPV typically triggers only brief episodes of lightheadedness, generally no more than 10 mins. It is usually caused by muscle spasms or by an absence of blood flow to the nerves in the internal ear. Some people have no signs at all. Pimple On Roof Of Mouth Dizziness Mayo Clinic
Pimple On Roof Of Mouth Dizziness Mayo Clinic
Most instances of lightheadedness are brought on by several of the problems that affect the mind as well as interfere with its ability to function properly. If you are experiencing symptoms that you believe are vertigo, your medical professional will certainly most likely recommend antihistamines or tricyclic antidepressants as therapies for these problems. Antihistamines reduce the task of the chemicals in the body that create the reaction that creates vertigo. Tricyclic antidepressants are used to deal with allergic reactions, anxiousness, and other comparable conditions. Pimple On Roof Of Mouth Dizziness Mayo Clinic
Certain medicines may additionally create vertigo. For example, doxycycline can decrease the toughness of your muscle mass that support your balance. This decreases the quantity of liquid in your mind that creates your wooziness. Various other drugs that may consist of doxycycline are Prednisone, Acetylcholine, Phenytoin, and also NSAIDs (nonsteroidal anti-inflammatory medications).
Vertigo that does not enhance with non-prescription therapy can be treated by your doctor. These therapies include prescription medicines, surgery, as well as antihistamines. If your wooziness is serious, your physician might suggest you to have a dedicated echocardiography system or VASER (vesicular stentibular shutoff excitement) treatment. This procedure makes use of a laser to open the narrowed capillary that trigger the dizziness. The laser may additionally reduce the quantity of liquid accumulation in your brain that triggers wooziness.
Some individuals have problems with dizziness without treatment. In these situations, it is very important to determine why you experience the symptoms. Your medical professional may require to carry out examinations such as an MRI or CT scan to identify the underlying trouble. He might also perform some simple laboratory tests in order to eliminate or confirm the medical diagnosis.
Some of the causes that may result in wooziness include a condition called sensorineural hearing loss. This problem occurs when there is damage to the inner ear. This can be caused by an ear infection, an injury, or an adverse effects of certain medicines. Other reasons can be high fevers, ear infection, meniere’s illness, Meniere’s disorder, or vestibular neurons.
If you are experiencing dizziness, you need to make note of where your lightheadedness is influencing your equilibrium. You need to additionally recognize if the adjustments in balance are occurring for a long period of time or if they are just taking place in a brief period of time. This will aid your doctor to establish the cause of vertigo as well as likewise the correct therapy. If you assume that your dizziness is due to a lack of balance, you should consult your medical professional. Your health care specialist will have the ability to provide you with important info regarding vertigo and how you can manage the symptoms.
In order to establish the precise cause of vertigo, your healthcare expert will certainly probably have you go through a thorough exam to eliminate any underlying physical causes. Among the most typical causes of wooziness is low blood pressure or hypertension. If you have actually been identified with either of these conditions, you ought to follow your medical professional’s orders and also stick to your routine medicine. By reducing your blood pressure, your lightheadedness could be eliminated. Your problem may require treatment to reduce your blood pressure naturally.
One more common reason for vertigo is experiencing hearing loss. As we age, our hearing ends up being much less reliable, which might result to vertigo. If you have been experiencing dizziness with no other signs and symptoms, it might be tough to identify the issue. As soon as you start experiencing any type of kind of audio or noise in your ear, you should immediately call your medical professional.
Some symptoms that could suggest the presence of a vestibular migraine include: queasiness, throwing up, faintness, and also fainting. Because these signs and symptoms can be incorporated, your doctor might do examinations to confirm the presence of vertigo. If your signs are consistent, your physician may execute extra examinations such as catheterizations, magnetic vibration imaging (MRI), as well as computerized tomography (CT) check.


XF-73 in being developed as a new treatment for diabetic foot ulcer infections (DFUs) to target a market which is estimated to be a $0.5 billion global sales opportunity based on the incidence of such infections, the costs of the associated medical care and a realistic product pricing of XF-73 in this new market. Driven by the growing number of diabetics and associated complications such as infected DFUs, this represents a significant market opportunity for XF-73. As with all anti-infectives, AMR is also a concern within this market. There is no dominant treatment for DFUs and specialist physicians are therefore working to find better treatment options, including topical formulations. In addition, the target product profile of XF-73 tested favourably with dermal clinicians looking for better treatments for the smaller market for burns/wound infections and venous leg ulcers.
Our China partner CMS are also running a programme for XF-73 in superficial skin infections.


Getting Rid of the Fat that Exercise and Diet Just Won’t Touch
Even if you eat healthy and exercise, over time your body will likely develop stubborn fat that just doesn’t want to go away, regardless of the fat-burning method you use. What’s worse, as our metabolism slows, these fat deposits accumulate, creating everything from double chins to love handles. Because this type of fat can be very difficult to get rid of – regardless of your diet or your number of daily crunches – more and more people in the Greater Atlanta area are turning to liposuction as a popular body contouring surgery.
Is Liposuction Right for Me?
Liposuction surgery is not an alternative to diet and exercise, or to be used as an answer for obesity. Liposuction provides the best, long-lasting results for those who are healthy, but struggling to lose areas of unwanted fat despite exercise and eating healthy. Liposuction can be used to treat a variety of problem areas including:
- Love handles and hips
- Upper arms
- Buttocks and back
- Thighs and knees
- Bra rolls
- Male chest (gynecomastia)
If you are relatively healthy and traditional fat-burning methods haven’t worked, then liposuction is a safe and effective method that can reshape your body and restore a healthier appearance that matches your inner health.
What to Expect with Your Liposuction
Our liposuction procedures are performed on an outpatient basis using general or local anesthesia. You might also be given a sedative, typically through an IV injection, to help you relax. Most surgeries are completed in less than two hours, depending on the extent of fat removal.
After the procedure, most patients experience swelling and mild bruising and discomfort. Downtime varies, but most patients return to work in two days.
You will be given medication for pain and antibiotics for a few days. You will likely be required to wear a compression garment for a few weeks following surgery. This garment helps reduce swelling.
Dr. Marc Klein has performed thousands of liposuctions with a variety of techniques, ranging from the standard tumescent liposuction, ultrasound-assisted liposuction (VASER and Lysonix), Smartlipo, laser-assisted liposuction, power-assisted liposuction, and others. Dr. Klein has a large experience with liposuction using local anesthesia.
Scheduling a Liposuction Consultation in Atlanta or Alpharetta
To schedule a complimentary and confidential liposuction consultation with one of our board-certified plastic surgeons in our Atlanta or Alpharetta office, call 770.475.3146 or complete and submit the consultation request form.


Indexed on: 07 Nov '13Published on: 07 Nov '13Published in: European Journal of Human Genetics
Myosin myopathies comprise a group of inherited diseases caused by mutations in myosin heavy chain (MyHC) genes. Homozygous or compound heterozygous truncating MYH2 mutations have been demonstrated to cause recessive myopathy with ophthalmoplegia, mild-to-moderate muscle weakness and complete lack of type 2A muscle fibers. In this study, we describe for the first time the clinical and morphological characteristics of recessive myosin IIa myopathy associated with MYH2 missense mutations. Seven patients of five different families with a myopathy characterized by ophthalmoplegia and mild-to-moderate muscle weakness were investigated. Muscle biopsy was performed to study morphological changes and MyHC isoform expression. Five of the patients were homozygous for MYH2 missense mutations, one patient was compound heterozygous for a missense and a nonsense mutation and one patient was homozygous for a frame-shift MYH2 mutation. Muscle biopsy demonstrated small or absent type 2A muscle fibers and reduced or absent expression of the corresponding MyHC IIa transcript and protein. We conclude that mild muscle weakness and ophthalmoplegia in combination with muscle biopsy demonstrating small or absent type 2A muscle fibers are the hallmark of recessive myopathy associated with MYH2 mutations.


Pediatric pulmonary hypertension in the Netherlands: epidemiology and characterization during the period 1991 to 2005
SourceCirculation, 124, 16, (2011), pp. 1755-64
Article / Letter to editor
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Paediatrics - OUD tm 2017
SubjectIGMD 1: Functional imaging
Background- Incidence and prevalence rates for pediatric pulmonary hypertension (PH) and pulmonary arterial hypertension (PAH) are unknown. This study describes the nationwide epidemiological features of pediatric PH in the Netherlands during a 15-year period and the clinical course of pediatric PAH. Methods and Results- Two registries were used to retrospectively identify children (0-17 years) with PH. Overall, 3263 pediatric patients were identified with PH due to left heart disease (n=160; 5%), lung disease/hypoxemia (n=253; 8%), thromboembolic disease (n=5; <1%), and transient (n=2691; 82%) and progressive (n=154; 5%) PAH. Transient PAH included persistent PH of the newborn and children with congenital heart defects (CHD) and systemic-to-pulmonary shunt, in whom PAH resolved after successful shunt correction. Progressive PAH mainly included idiopathic PAH (n=36; iPAH) and PAH associated with CHD (n=111; PAH-CHD). Pulmonary arterial hypertension associated with CHD represented highly heterogeneous subgroups. Syndromes were frequently present, especially in progressive PAH (n=60; 39%). Survival for PAH-CHD varied depending on the subgroups, some showing better and others showing worse survival than for iPAH. Survival of children with Eisenmenger syndrome appeared worse than reported in adults. For iPAH and PAH-CHD, annual incidence and point prevalence averaged, respectively, 0.7 and 4.4 (iPAH) and 2.2 and 15.6 (PAH-CHD) cases per million children. Compared to studies in adults, iPAH occurred less whereas PAH-CHD occurred more frequently. Conclusions- Pediatric PH is characterized by various age-specific diagnoses, the majority of which comprise transient forms of PAH. Incidence of pediatric iPAH is lower whereas incidence of pediatric PAH-CHD is higher than reported in adults. Pediatric PAH-CHD represents a heterogeneous group with highly variable clinical courses.
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Medical staffing expert calls nurse shortage 'perfect storm'
An aging nurse workforce, a graying baby boomer population and millions more insured patients entering America's health care system as Obamacare is phased in means the already high need for nurses is going to skyrocket in the next few years, says Janet Elkin, president and CEO of Chicago-based Supplemental Health Care.
"We're entering what I call the perfect storm," Elkin told me in an interview.
Supplemental Health Care helped Parkland Memorial Hospital in Dallas, Texas, add nurse staff fast after state and federal inspections determined a severe nursing shortage was contributing to inferior patient care. The firm interviewed more than 1,700 candidates and hired more than 600 full-time health care professionals — mostly registered nurses, but also patient care assistants, medical coders, physical therapists, occupational therapists, social workers, administrators and others.
The shortage isn't isolated to Parkland, Elkin said. Far from it.
"Given that you'll have more patients and you don't want to increase (nursing) ratios, the only way you're going to do that is with more personnel," Elkin said. "But finding them is not easy. With an average age of a nurse being 48 years old, it's going to be much more difficult."
The Affordable Care Act could inject as many as 30 million new patients into the system at the same time many nurses hit retirement.
"Outsourcing the recruitment process has been used in many industries for a long time, but is relatively new to the health care industry,” Elkin said.
Supplemental Health Care partners with clients’ human resources departments. The firm's approach seeks to cut costs by reducing the time to fill positions, decreasing cost-per-hire, reducing staff overtime and contingent labor and increasing revenue by focusing on priority positions that have direct impact on hospital performance, Elkin said.
Bill covers health care, law and education.
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A medical license is required for a doctor to practice medicine in a particular state. Requirements vary by state but most require, at a minimum, post-graduate training in the doctor’s specific specialty. An NPI number is a national identifier unique to an individual health care provider and is managed by the Center for Medicare & Medicaid Services (CMS).
Learn more about Dr. Parul Patel:
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Specialties & Research
Dr. Parul Patel, MD, MPH is board certified in Pediatrics and Pediatric Emergency Medicine.
- She has special expertise in 5 areas:
- Acute Coronary Syndrome (ACS)
- Heart Block
- High Blood Pressure (Hypertension)
- High Cholesterol (Hypercholesterolemia)
- Unstable Angina
Education & Awards
Dr. Patel graduated from St. George's University, Bay Shore.
Dr. Patel has 9 hospital affiliations:
- Temple University Hospital
- Frankford Hospital
Accepted Insurance Plans
Dr. Patel accepts these health insurances in at least one office:
- Unicare - 12 plans
- Cigna - 9 plans
- United Healthcare - 14 plans
Similar doctors nearby
- Additional Information
- Where does Dr. Parul B. Patel practice?
Dr. Parul Patel practices Pediatrics, Pediatric Emergency Medicine, Anesthesiology, Emergency Medicine, Pediatric Emergency Medicine, and Cardiology near Chicago, IL.
Additional practice locations include: Philadelphia, PA.
See Chicago Pediatricians, Chicago Anesthesiologists, Chicago Emergency Physicians, and Chicago Cardiologists.


The New England Journal of Medicine is hardly a tool of the plaintiffs’ bar. So when the Journal criticizes the lack of complete disclosures in reports concerning clinical trials people should stand up and take notice.
The editor of the Journal says that some companies “are meeting the letter but not the spirit of the law.” Read the study of the compliance rate of drug manufacturers with the federal law that governs clinical trials here.
Here is an editorial written by the Journal staff on the subject. An excerpt: “In our opinion, it is unacceptable for a trial sponsor not to register its trial in a complete, meaningful, and timely fashion. We call for all clinical investigators and patients to participate only in fully registered trials.”
There is another editorial on the subject as well; read it here. Here is a sample of it: “The ultimate goal should be to make trial protocols publicly available in their entirety, including any financial arrangements and agreements with regard to publication, so that patients can be sure that the results will become available. At the same time, it is the responsibility of those who set the rules and establish the registries to make them practical to use and understandable for all kinds of research groups, both small and large.”


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Holistic chiropractic rebalancing
During your treatment, Dr Tako looks for and corrects potential imbalances of the nerve receptors and nerve routes that affect muscles, ligaments, and soft tissues in the pelvic and abdominal area. This is accomplished through a series of muscular resistance tests and stimulations to the body (using neuro-receptor modulation or P-DTR®). This allows the nerves to function normally again, restores balance in muscles and ligaments and help pain decrease and stop. It is completely non-invasive and painless. If need be, some gentle traditional chiropractic adjustments are made.
Restoring balance in the body also allows for the thirty-six muscles and ligaments that surround the uterus to be relaxed and for the uterus to be in an optimal shape which can facilitate the baby’s engagement in the pelvis, along with a more spontaneous start and progression of labor.


Rheumatologists want to be the best clinicians possible, provide consistently exceptional care to patients and serve as role models for colleagues and trainees. In the Lessons from a Master Clinician series, we offer insights from clinicians who have achieved a level of distinction in the field of rheumatology.
Michael H. Weisman, MD, is a professor of medicine in the Division of Rheumatology at Cedars-Sinai Medical Center, Los Angeles. Dr. Weisman’s academic and research interests involve the genetic risk, epidemiology, treatment and outcome of rheumatic diseases, including clinical trials, outcomes research, and health services research and genetic
susceptibility/severity studies of patients with chronic rheumatic disease.
Dr. Weisman has published more than 400 peer-reviewed papers and six books, and he serves as a reviewer and editor for many journals in the field of rheumatology, including the New England Journal of Medicine, Arthritis & Rheumatology, the Journal of Rheumatology, Annals of the Rheumatic Diseases and Osteoarthritis and Cartilage.
In 2005, he served as president of the ACR’s Rheumatology Research Foundation and was named a Master of the ACR that year.
TR: In your opinion, what makes for a master clinician?
Dr. Weisman: It is easiest to answer this question by defining the role of the master clinician as a consultant.
As a consultant, [you must] always [consider] two needs—that of the patient and that of the consulting doctor who sent the patient to you, usually a primary care physician or another rheumatologist, who wants your opinion. The patient need is usually straightforward: What is the problem (wrong diagnosis, wrong treatment, etc.)? But the doctor issue takes experience and learned skills. You have to figure out exactly why that patient was sent to you. What were the barriers that prevented the referring physician from figuring out what’s going on: Was it his/her attitude on a personal level, was he/she too busy, were the patient’s real concerns not being addressed in spite of adequate disease control, etc.?
You cannot always take over the patient’s care in every one of these situations, so you have to figure out what is in the best interests of the patient and communicate it in a meaningful way to the referring doctor.
It is like every collaboration you do, even in research—the ultimate success is figuring out other peoples’ needs and not your own.
Indeed, treating the disease and managing the patient are two separate issues, and understanding this concept is important in working well with colleagues.


Managing diabetes requires careful monitoring of blood sugar levels, and one essential tool for assessing long-term glucose control is the A1c test. By understanding your A1c levels, you can make informed decisions about your diabetes management plan. In this article, we’ll explore the significance of A1c levels, how to use an A1c calculator, and why it’s crucial for diabetes management. Additionally, we’ll ensure the content is SEO-friendly to help individuals easily find information about A1c online.
1. What is A1c? A1c, or hemoglobin A1c, is a blood test that measures the average blood sugar level over the past 2-3 months. It provides valuable insight into long-term glucose control, offering a snapshot of how well diabetes is being managed. A1c levels are expressed as a percentage, with higher percentages indicating poorer glucose control.
2. Importance of A1c Levels: Monitoring A1c levels is essential for individuals with diabetes to assess their overall health and adjust their management plan accordingly. Maintaining A1c levels within target ranges can reduce the risk of diabetes-related complications, such as heart disease, kidney disease, nerve damage, and vision problems.
3. Using an A1c Calculator: An A1c calculator is a useful tool for estimating average blood sugar levels based on A1c values. It allows individuals to input their A1c percentage and receive an estimated average glucose (eAG) level in either mg/dL or mmol/L. This information provides additional insight into daily blood sugar trends and helps individuals gauge their diabetes management progress.
4. How to Use an A1c Calculator: Using an A1c calculator is straightforward. Start by entering your A1c percentage into the designated field. Then, select the appropriate unit of measurement (mg/dL or mmol/L) for the estimated average glucose level. Once the information is entered, the calculator will generate the corresponding eAG value, providing insight into your average blood sugar levels.
5. Benefits of Using an A1c Calculator: A1c calculators offer several benefits for individuals with diabetes. They provide a convenient way to estimate average blood sugar levels between doctor visits, allowing for more proactive management. Additionally, A1c calculators can help individuals set realistic goals for improving glucose control and track their progress over time.
6. Incorporating A1c Results into Diabetes Management: A1c results should be discussed with a healthcare professional to develop an individualized diabetes management plan. Based on A1c levels, adjustments may be made to medication, diet, exercise, and lifestyle factors to achieve optimal glucose control. Regular monitoring of A1c levels helps track progress and identify areas for improvement.
7. Conclusion: A1c levels are a valuable tool for assessing long-term glucose control in individuals with diabetes. Using an A1c calculator can provide additional insight into average blood sugar levels, empowering individuals to take proactive steps towards better management. By incorporating A1c results into diabetes management plans, individuals can reduce the risk of complications and improve overall health.
In summary, understanding A1c levels and using an A1c calculator are essential components of diabetes management. By optimizing content for search engines, individuals seeking information about A1c can easily find reliable resources to empower themselves in managing their diabetes effectively.


Novita Regional Services
Disability services in Murray Bridge
Our facilities in Murray Bridge offer a one-stop-shop for therapy, family support, and the latest in Assistive Technology and equipment. And depending on the services you need, our Murray Bridge team can also come to you for therapy services at school and kindy, in your home, and in the community.Call now Enquire now
Novita’s professional and dedicated Murray Bridge staff offer a range of tailored therapy services to support kids, young people and adults living with disability to achieve their goals.
Occupational Therapy supports people living with disability with physical and life skills such as movement, vision, sensory processing, sleep and personal care, as well as the skills needed for school and work. Novita’s Occupational Therapists can also provide advice, prescription and training for the assistive technology and equipment that can support people living with disability to lead a fulfilling life. Our Occupational Therapists also offer aquatic and hydrotherapy services.About Occupational Therapy
Orthotics support people living with physical disability with everyday skills such as walking, running, jumping, and climbing stairs. They can also assist with support for positioning and comfort. Novita’s specialist Orthotics Van will be visiting Murray Bridge regularly throughout the year to provide orthotics services using the latest technology and techniques.About Orthotics
Physiotherapy supports people who have difficulty with their movement skills due to living with physical disability such as cerebral palsy or brain injury, intellectual disability, or developmental disability. Our Physiotherapists can tailor a range of therapies to support movement and pain management, as well as providing advice, prescription and training for mobility equipment such as wheelchairs and walking aids. Our Physiotherapist can also provide aquatic and hydrotherapy services.About Physiotherapy
Assistive Technology and equipment can support people living with disability to achieve their goals at home, at school, in the workplace and in the community. Novita’s Murray Bridge office has access to a full range of Assistive Technology through Novitatech in Adelaide. Appointments can be made with the team in Adelaide, or via Novita’s telehealth communication system. Novita can provide assessment and prescription for Assistive Technology, as well as helping with funding applications.About Assistive Technology
Speech Pathology supports people who have difficulty communicating as a result of living with developmental delay, brain injury, stroke, learning and intellectual disability, cerebral palsy and hearing loss. Our Speech Pathologists can support kids, young people and adults with a range of communication skills including speaking, listening, using the voice, reading, writing, stuttering, and understanding language. They can also support people who have difficulty swallowing and eating safely.About Speech Pathology
Novita’s suites on Sturt Reserve Road offer great facilities for kids, adults and families. Our Murray Bridge therapy hub enables us to provide high-quality services to the Murray Bridge region, with industry-standard equipment and facilities to support local people living with disability.
Novita’s Murray Bridge team provides services and support to Murray Bridge and surrounding areas. The team can also come to you. Depending on the service and support required, we can offer therapy in the family home, at school, at work, and at other appropriate locations through our mobile services. We also offer telehealth facilities to connect you with our Adelaide and SA clinical, equipment and Assistive Technology experts.
How we work
Novita works using the Life Needs Model of service delivery. This is a flexible approach that focuses on community-based and specialised services that match your goals, whatever your stage of life. With you and your family at the centre of our thinking, we provide services across all areas of life, including:
- Your home – we work in partnership with families and significant others to support skill development, as well as home modifications, technology and equipment.
- Education – working in partnership with school staff and providing access to technology and equipment as well as training and support.
- Community – liaising with health professionals and partnering with community groups to provide linked up services, education and training.
Working for Novita in Murray Bridge
Our Novita therapists work alongside a supportive and collaborative team in a multi-disciplinary service and primarily support kids, teens and young adults living with physical disability, autism, acquired brain injuries and other conditions.
Through our broader work with families and communities, Novita’s life-changing services have a direct impact on thousands of South Australians. Working with Novita is not only rewarding, you will also benefit from unparalleled PD opportunities and professional support. Novita offers generous regional incentives and is always looking for locally-based therapists to work in Murray Bridge.
To find out more about working for Novita and our current vacancies visit our Careers page.


Dr. Tonya W. Robinson graduated from the Indiana University School of Medicine in 1985. She works in Louisville, KY and specializes in Neonatal-Perinatal Medicine and Obstetrics & Gynecology. Dr. Robinson is affiliated with Baptist Health Louisville, Norton Hospital and University Of Louisville Hospital.
Neonatal-Perinatal Medicine, Obstetrics & Gynecology
Medical School: Indiana University School of Medicine; Graduated 1985
503 S Jackson St
Louisville, KY 40202


Selecting the good weight loss supplement to meet your needs will be a daunting task.It is very true and natural if you don’t have any experience in selecting a diet supplement, you may get into trouble. The happy news is that there are number of excellent supplements available in the market. First of all, you need to know the weight loss reasons. Only then you will be able to choose the right weight loss supplement. Some people may not consume more food, even then they gain more fat. This is due to the increase in calories. When you are starving or craving for food, your stomach secretes some acid fluid. This acid fluid builds ulcer, gastric problems and calories in the body. You need to select the right fat burner like lipo 6. This weight loss supplement helps in burning the fat in the body as well as it will improve your physical performance.
There are millions of ways available to lose weight. Either it may be traditional or manual, you will have to put lots of effort in it. Slimming is not very easy by following such traditional methods. It will take more time, as well as it will make you physically tired. Excessive physical exercise or workouts may lead you into aches or pains. By using the energy plus weight loss supplements can give you good feel and results. You will feel active and lovely. Once your excess fat is burnt or reduced, you will be able to feel energetic. Also you can do a little muscle work every day along with your lipo 6 supplements. This will help you to enjoy quick and visible results in weight loss.
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You might wonder, how it can help you in weight loss. Also you may have disbelief in using it if you have tried other failure supplements. First, it is a reputed and proven supplement. This will have no side effects in your body. It burns our excess adipose tissue or it reduces the excessive adipose tissue. This tissue is a cause for laziness and dizziness. When this tissue is reduced your body will become active and activeness can naturally help you in reducing weight. In addition, this lipo 6 supplement consists of components like caffeine, synephrine, theobromineanhydruous, rauwolscine and yohimbine. Each component has its properties of making your body healthily active.


Participants must complete and submit the evaluation for the activity in order to receive a continuing education certificate or a certificate of completion. Physicians must also pass a post-test QUIZ with 80% or higher score to receive a continuing education certificate. Certificates can be printed or downloaded from this site and upon request can be issued via email. Who is the Accrediting Organization? The Medical College of Wisconsin.
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of The Medical College of Wisconsin and Chronic Pain Partner. The Medical College of Wisconsin is accredited by the ACCME to provide continuing medical education for physicians.
The Medical College of Wisconsin designates this Enduring Material for a maximum of 1 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
The Medical College of Wisconsin designates this activity for up to 1 hours of participation for continuing education for allied health professionals.


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- Research article
- Open Access
Antibacterial and cytotoxic cytochalasins from the endophytic fungus Phomopsis sp. harbored in Garcinia kola (Heckel) nut
BMC Complementary and Alternative Medicine volume 16, Article number: 462 (2016)
The continuous emergence of multidrug-resistant (MDR) bacteria drastically reduced the efficacy of our antibiotic armory and consequently, increased the frequency of therapeutic failure. The search for bioactive constituents from endophytic fungi against MDR bacteria became a necessity for alternative and promising strategies, and for the development of novel therapeutic solutions. We report here the isolation and structure elucidation of antibacterial and cytotoxic compounds from Phomopsis sp., an endophytic fungus associated with Garcinia kola nuts.
The fungus Phomopsis sp. was isolated from the nut of Garcinia kola. The crude extract was prepared from mycelium of Phomopsis sp. by maceration in ethyl acetate and sequentially fractionated by column chromatography. The structures of isolated compounds were elucidated on the basis of spectral studies and comparison with published data. The isolated compounds were evaluated for their antibacterial and anticancer properties by broth microdilution and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide methods respectively. The samples were also tested spectrophotometrically for their hemolytic properties against human red blood cells.
The fractionation of the crude extract afforded three known cytochalasins including 18-metoxycytochalasin J (1), cytochalasins H (2) and J (3) together with alternariol (4). The cytochalasin compounds showed different degrees of antibacterial activities against the tested bacterial pathogens. Shigella flexneri was the most sensitive microorganism while Vibrio cholerae SG24 and Vibrio cholerae PC2 were the most resistant. Ampicillin did not show any antibacterial activity against Vibrio cholerae NB2, Vibrio cholerae PC2 and Shigella flexneri at concentrations up to 512 μg/mL, but interestingly, these multi-drug resistant bacterial strains were sensitive to the cytochalasin metabolites. These compounds also showed significant cytotoxic properties against human cancer cells (LC50 = 3.66–35.69 μg/mL) with low toxicity to normal non-cancer cells.
The three cytochalasin compounds isolated from the Phomopsis sp. crude extract could be a clinically useful alternative for the treatment of cervical cancer and severe infections caused by MDR Shigella and Vibrio cholerae.
Endophytic fungi are organisms that live inside the plant tissues and behave as plant hosts . They have proven to be a rich source of novel organic compounds with interesting biological activities and a high level of biodiversity [2, 3]. Natural products from endophytic fungi have been observed to inhibit or kill a wide variety of harmful microorganisms including phytopathogens, as well as bacteria, fungi, viruses, and protozoans that affect humans and animals . As one of the most frequently isolated secondary metabolites from endophytic fungi cultures, cytochalasins are produced by Phoma , Hormiscium , Helminthosporium , Phomopsis  and Curualuriu  genera. They have been identified as contaminants of potato , tomato , pecan , rice , millet  and litchi fruit . The cytochalasins A, B, C, D, and E are highly toxic to the chick, rat, mouse, and guinea pig [11–14] and are teratogenic to both chick and mouse [13, 15–17]. In recent years, most works on endophytic fungi have been centered on plants in the temperate and tropical regions of the world .
Plants of the genus Garcinia (family Clusiaceae), widely distributed in tropical Africa, Asia, New Caledonia and Polynesia, have yielded an abundance of biologically active and structurally intriguing natural products . Garcinia species are known to contain a wide variety of oxygenated and prenylated xanthones, as well as polyisoprenylated benzophenones such as the guttiferones .
Garcinia kola (Clusiaceae) is a plant of West and Central African origin . In Nigeria, the seed (Bitter kola) is chewed for the relief of cough, colds, colic, hoarseness of voice, and throat infections. The plant is also used for the treatment of liver disorders, jaundice, fever, and as a purgative and chewing sticks . We focused on Garcinia kola nut because it is one of the most commercialized fruits in West and Central Africa, its highly valued perceived medicinal attributes, and the consumption of large quantities does not cause indigestion. However, several management strategies have been employed for their conservation, but the growth of the molds due to their moisture during that conservation remains a serious problem . Moreover, further studies by Austin  attributed the loss of viability of kola nut seeds to reduction in moisture content.
During our investigation, the fungus Phomopsis sp. associated with that nut was found to be a producer of diverse secondary metabolites, including cytochalasins from its mycelium in potato dextrose agar (PDA) medium. Attracted by the potential production of this class of compounds, a so-called OSMAC (one strain-many compounds)  approach was carried out to find compounds. Following the application of the OSMAC principle, we found out that when the culture conditions were changed from PDA medium to solid state medium (rice), fermentation significantly changed and based on high-performance liquid chromatography (HPLC) monitoring, 18-metoxycytochalasin J (1), cytochalasins H (2) and J (3) and alternariol (4) were isolated. In this report, we evaluate the cytotoxic activities of cytochalasins against bacterial species and human cervical cancer cell lines, with emphasis on MDR Shigella flexneri and Vibrio cholerae.
General experimental procedures
High resolution mass spectra were obtained with an LTQ-Orbitrap Spectrometer (Thermo Fisher, USA) equipped with a HESI-II source. The spectrometer was operated in positive mode (1 spectrum/s; mass range: 100–1000) with nominal mass resolving power of 60 000 at m/z 400 with a scan rate of 1 Hz). It was equipped with automatic gain control to provide high-accuracy mass measurements within 2 ppm deviation using an internal standard; Bis (2-ethylhexyl) phthalate: m/z = 391.28428. The spectrometer was attached with an Agilent (Santa Clara, USA) 1200 HPLC system consisting of LC-pump, PDA detector (λ = 260 nm), auto sampler (injection volume 5 μL) and column oven (30 °C). Following parameters were used for experiments: spray voltage 5 kV, capillary temperature 260 °C, tube lens 70 V. Nitrogen was used as a sheath gas (50 arbitrary units) and auxiliary gas (5 arbitrary units). Helium served as the collision gas. The separations were performed by using a Nucleodur C18 Gravity column (50 × 2 mm, 1.8 μm particle size) with a H2O (+0.1% HCOOH) (A) / acetonitrile (+0.1% HCOOH) (B) gradient (flow rate 300 μL/min). Samples were analyzed using a gradient program as follows: 80% A isocratic for 1 min, linear gradient to 100% B over 18 min, after 100% B isocratic for 5 min, the system returned to its initial condition (80% A) within 0.5 min, and was equilibrated for 4.5 min. The separation was carried out by preparative HPLC run for 20 min on a Gilson apparatus with UV detection at 220 nm using a Nucleodur C18 Isis column (Macherey-Nagel, Düren, Germany), 5 μm (250 × 16 mm) with a H2O (A) / CH3OH (B) gradient (flow rate 4 mL/min). Samples were separated by using a gradient program as follows: 60% A and 40% B isocratic for 2 min, linear gradient to 100% B over 18 min, after 100% B isocratic for 5 min, the system returned to its initial condition (60% A) within 0.5 min, and was equilibrated for 4.5 min. The NMR spectra were recorded on a Bruker DRX-500 MHz spectrometer. Chemical shifts (δ) were quoted in parts per million (ppm) from internal standard tetramethylsilane and coupling constants (J) are in Hz. Silica gel [Merck, Kieselgel 60 (0.063–0.200 mm)] was used for column chromatography. Melting points were determined on a BÜCHI melting point b-545 apparatus. UV spectra were measured with the earlier described spectrometer.
Isolation of endophytic fungus
The fungus was isolated from the nut of Garcinia kola bought at Mokolo local market in Yaounde (Cameroon). The plant material was identified at the Cameroon National Herbarium, Yaoundé, where a voucher specimen (N° 27839/SRF-CAM) has been deposited. The seed was first cleaned by washing several times under running tap water and then cut into small slices, followed by successive surface sterilization in 70% ethanol and NaOCl (6-14% active chlorine) for 2 min and finally with sterile distilled water for 2–3 times. The plant material was then dried in between the folds of sterile filter papers and deposited on a Petri dish containing potato dextrose agar medium (PDA) (200 g potato, 20 g dextrose, and 15 g agar in 1 L of H2O, supplemented with 100 mg/L of chloramphenicol to suppress bacterial growth). All the plates were incubated at 28 °C to promote the growth of endophytes and were regularly monitored for any microbial growth. On observing the microbial growth, subculturing was done. Each endophytic culture was checked for purity and transferred to freshly prepared PDA plate
Identification of the fungus CAM240
Cultures were grown on PDA at 25 °C under 12 h light / 12 h darkness cycles. The strain CAM240 formed abundant mycelium that filled out the Petri dishes (9 cm diameter) in 8 days. The isolate was identified by Dr Clovis Douanla-Meli after macroscopic and microscopic examinations of its morphological features. Isolate was deposited as AGMy0319 in the Culture Collection of Federal Research Centre for Cultivated Plants (JKI), Braunschweig, Germany.
Fungal culture and extraction
Phomopsis sp. was cultured in 12 flat culture bottles containing 100 g rice and 100 mL water enriched with 0.3% peptone each, autoclaved at 121 °C for 45 min. Each flask received about 5 small pieces of mycelium from PDA plate under sterile conditions. After 40 days of growth at 25 °C, ethyl acetate (12 x 500 mL) was added to each bottle, homogenized and filtered after 24 h and taken to dryness to afford 11.6 g of crude extract.
Microbial growth conditions
A total of six bacterial strains were tested for their susceptibility to compounds and these strains were taken from our laboratory collection (kindly provided by Dr. T. Ramamurthy, NICED, Kolkata). Among the clinical strains of Vibrio cholerae used in this study, strains NB2 and SG24 and CO6 belonged to O1 and O139 serotypes, respectively. All these strains were able to produce cholera toxin and hemolysin and multi-drug-resistants (MDR). The other strains used in this study were V. cholerae non-O1, non-O139 (strain PC2); and Shigella flexneri SDINT. The MDR V. cholerae non-O1 and non-O139 strain PC2 isolated from aquatic environment was positive for hemolysin production but negative for cholera toxin production . The American Type Culture Collection (ATCC) strain, Staphylococcus aureus ATCC 25923, was used for quality control. The bacterial strains were maintained on agar slant at 4 °C and subcultured on a fresh appropriate agar plates 24 h prior to any antibacterial test. The Mueller Hinton Agar (MHA) was used for the activation of bacteria. The Mueller Hinton Broth (MHB) and nutrient agar (Hi-Media) were used for the MIC and MBC determinations respectively.
Suspensions of bacteria were prepared in MHB from cells arrested during their logarithmic phase growth (4 h) on MHB at 37 °C. The turbidity of the microbial suspension was read spectrophotometrically at 600 nm and adjusted to an OD of 0.1 with MHB, which is equivalent to 1 × 108 CFU/mL. From this prepared solution, other dilutions were made with MHB to yield 1x106 CFU/mL.
Determination of minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC)
MIC and MBC of compounds 1–3 were assessed using the broth microdilution method recommended by the National Committee for Clinical Laboratory Standards [26, 27] with slight modifications. Each test sample was dissolved in dimethylsulfoxide (DMSO) to give a stock solution. The 96-well round bottom sterile plates were prepared by dispensing 180 μL of the inoculated broth (1x106 CFU/mL) into each well. A 20 μL aliquot of the stock solution of compound was added. The concentrations of sample tested were 0.125, 0.25, 0.50, 1, 2, 4, 8, 16, 32, 64, 128, 256 and 512 μg/mL. The final concentration of DMSO in each well was < 1% [preliminary analyses with 1% (v/v) DMSO did not inhibit the growth of the test organisms]. Dilutions of tetracycline and ampicillin served as positive controls, while broth with 20 μL of DMSO was used as negative control. The ATCC strain Staphylococcus aureus ATCC 25923 was included for quality assurance purposes. Plates were covered and incubated for 24 h at 37 °C. After incubation, minimum inhibitory concentrations (MIC) were read visually; all wells were plated to nutrient agar (Hi-Media) and incubated. The minimal bactericidal concentration (MBC) was defined as a 99.9% reduction in CFU from the starting inoculums after 24 h incubation interval.
HeLa (Human cervical cancer cell line, ATCC No. CCL-2) and Vero cells (African green monkey kidney cells, normal non-cancer cells, ATCC No. CCL-81), obtained from the American Type Culture Collection (ATCC) were used in this study. Cytotoxic activity was determined using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT, Sigma, USA) assay reported by Mosmann  for the HeLa and Vero cells. This cell viability assay is based on living cell‘s property to transform the MTT dye tetrazolium ring into a purple-colored formazan structure due to the action of mitochondrial and other dehydrogenases inside the cell. The color intensity yielded by the cell population is directly proportional to the number of viable cells, and one can quantify the absorbance measurements using mathematical parameters. Each test sample was dissolved in dimethylsulfoxide (DMSO) to give a stock solution. Compounds 1–3 were prepared from the stock solutions by serial dilution in RPMI 1640 to give a volume of 100 μL in each well of a microtiter plate (96-well). Each well was filled with 100 μL of cells at 2 × 105 cells/mL. The assay for each concentration of compound was performed in triplicates and the culture plates were kept at 37 °C with 5% (v/v) CO2 for 24 h. After removing the supernatant of each well and washing twice by PBS, 20 μL of MTT solution (5 mg/mL in PBS) and 100 μL of medium were then introduced. After 4 h of incubation, 100 μL of DMSO were added to each well to dissolve the formazan crystals and the absorbance values at 490 nm were measured with a microplate reader (Bio-RAD 680, USA). The relative cell viability (%) was expressed as a relative percentage of treated cells to the untreated control cells (TC/UC × 100). The rate of cell inhibition was calculated using the following formula: inhibition rate = [1- (ODtest/ODnegative control)] × 100%. The LC50 values were calculated as the concentration of test sample resulting in a 50% reduction of absorbance compared to untreated cells. Cells treated with 5-fluorouridine + RPMI 1640 served as positive control while cells left untreated + 1% (v/v) DMSO + RPMI 1640 were used as negative control.
Whole blood (10 mL) from a healthy man was collected into a conical tube containing heparin as an anticoagulant. Erythrocytes were harvested by centrifugation at room temperature for 10 min at 1,000 × g and were washed three times in PBS solution. The top layer (plasma) and the next, milky layer (buffy coat with a layer of platelets on top of it) were then carefully aspirated and discarded. The cell pellet was resuspended in 10 mL of PBS solution and mixed by gentle aspiration with a Pasteur pipette. This cell suspension was used immediately.
For the normal human red blood cells, which were in suspension, the cytotoxicity was evaluated as previously described . Compounds 1–3, at concentrations ranging from 32 to 512 μg/mL, were incubated with an equal volume of 1% human red blood cells in phosphate buffered saline (10 mM PBS, pH 7.4) at 37 °C for 1 h. Tetracycline was tested simultaneously. Non-hemolytic and 100% hemolytic controls were the buffer alone and the buffer containing 1% Triton X-100, respectively. Cell lysis was monitored by measuring the release of hemoglobin at 595 nm with a spectrophotometer (Thermo Scientific, USA). Percent hemolysis was calculated as follows: [(A595 of sample treated with compound - A595 of sample treated with buffer)/(A595 of sample treated with Triton X-100 – A595 of sample treated with buffer)] x 100.
Statistical analysis was carried out using Statistical Package for Social Science (SPSS, version 12.0). The experimental results were expressed as the mean ± Standard Deviation (SD). Group comparisons were performed using One Way ANOVA followed by Waller-Duncan Post Hoc test. A p value of 0.05 was considered statistically significant.
Results and discussion
Identification of the fungus
Macroscopic examination of the isolate revealed that colonies were cottony, developing compact aerial mycelium, at first uniformly white (Fig. 1a) then becoming whitish with pale brown patches. The reverse side of cultures was whitish, then turned light brown with scattered darker spots which later appeared regularly concentrical. Conidiation began in 12-day old colonies with the formation of spherical, subglobose to ampuliform black stromata, measuring 210–250 × 220–380 μm and arranged in a circle in the Petri disch (Fig. 1a) and containing pycnidia. Watery exudate drops from pycnidia contained only beta conidia. These were 17–28.5 × 0.9-1.9 μm, unicellular, hyaline, filiform and mostly slightly curved at one end (Fig. 1b).
Cultural and morphological features of the strain CAM240 enabled its reliable placement in the genus Phomopsis. There was noticeable morphological similarity with Phomopsis longicolla , a species generally known as a Soybean pathogen, but that can be isolated as endophyte from other different host plants. With reference to recent revision of species concept in Phomopsis, specific determination requires a muli-locus analysis of ITS, tef and ß-tubulin loci . Therefore, taxonomy of strain CAM240 as based only on the morphology in this study was restricted to generic level.
The mycelium from Petri dish after ten days fermentation was extracted with 10 mL ethyl acetate. The obtained extract was submitted to HR-LC-MS and the major compounds were directly identified (Fig. 2). The crude extract (11.60 g) from the large scale fermentation was firstly submitted to HR-LC-MS and then chromatographed on a silica gel column (0.04–0.063 mm, 6 cm x 60 cm, 100 g) eluting with cyclohexane, mixture cyclohexane/ethyl acetate by increasing the polarity and finally with methanol. 56 fractions of 200 mL each were collected and combined according to TLC profile into 17 fractions. Each fraction was monitored by LC-MS and fractions 7, 10 and 16 were further purified by means of high performance reverse phase liquid chromatography to yield 3 cytochalasins: 18-metoxycytochalasin J (1) (4.1 mg, tR = 9.48 min) isolated as brown amorphous powder, its molecular formula was determined to be C29H39O4N by its HRESIMS m/z 466.29587 [M + H]+ (calculated 466.29573 for [M + H]+) ; cytochalasin H (2) (136.2 mg, tR = 8.94 min), isolated as white powder, HRESIMS m/z 494.28949 [M + H]+ (calculated for C30H40O5N, 494.29065) ; cytochalasin J (3) (16.7 mg, tR = 7.41 min) was obtained as white crystals, HRESIMS m/z 452.28052 [M + H]+ (calculated for C28H38O4N, 452.28008) , was the major metabolite and alternariol (4) (5.3 mg, tR = 7.55 min) as a white powder, HRESIMS m/z 259.06009 [M + H]+ (calculated for C14H11O5, 259.06065) . The chemical structures of the isolated compounds are shown in Fig. 3.
The chemical investigation of the crude extract from the rice medium of Phomopsis sp. harboring nut of Garcinia kola, by means of different chromatography techniques yielded four main compounds. Cytochalasins were the major secondary metabolites as detected and shown in Fig. 2, and this class of compounds is commonly found in Phomopsis genus.
The cytochalasins showed different degrees of antibacterial activities against the tested bacterial pathogens (Table 1). Shigella flexneri SDINT was the most sensitive microorganism while Vibrio cholerae SG24 and V. cholerae PC2 were the most resistant. Ampicillin did not show any antibacterial activity against V. cholerae NB2, V. cholerae PC2, and Shigella flexneri SDINT at concentrations up to 512 μg/mL while these multi-drug resistant bacterial strains were found sensitive to the cytochalasin metabolites. This finding suggests the antibacterial potencies of these compounds in particular for the treatment of multi-drug-resistant (MDR) bacterial strains. Compounds 1, 2 and 3 showed selective activities; their inhibitory effects being noted respectively on 4/6 (66.66%), 5/6 (83.33%) and 4/6 (66.66%) of the studied microorganisms. A keen look at the MBC values indicates that most of them are equal to their corresponding MICs. This proves that the killing effects of many tested samples could be expected on the sensitive strains .
The present study showed significant antibacterial activity of cytochalasin compounds against MDR entero-pathogenic bacteria including the clinical isolates of toxigenic Vibrio cholerae, the causative agents of dreadful disease cholera and Shigella sp., the causative agent of shigellosis. These compounds were having significant antibacterial activities against Gram-positive bacterium, Staphylococcus aureus. Although cytochalasin compounds have been reported to possess interesting activity against a wide range of microorganisms , no study has been reported on the activity of the metoxycytochalasin J (1), cytochalasins H (2) and J (3) against these types of pathogenic strains.
Compounds 1–3 were evaluated for their anticancer against human cervical cancer cells (HeLa cells) (Table 2). The lowest LC50 value (corresponding to the most cytotoxic compound) was found with compound 3 (LC50 = 3.66 μg/mL) followed in decreasing order by compound 1 (LC50 = 8.18 μg/mL) and compound 2 (LC50 = 35.69 μg/mL) (Table 2). Interestingly, the cytotoxicity of compound 3 can be considered more important when taking into consideration the criterion of the American National Cancer Institute (NCI) regarding the cytotoxicity of pure compounds (LC50 < 4 μg/mL) . The data also showed that the tested compounds were most cytotoxic to HeLa cells (LC50 = 3.66–35.69 μg/mL) when compared with Vero cells (LC50 = 73.88–129.10 μg/mL) indicating that they are less toxic to normal cells. Our results are in agreement with those of Xu et al.  who showed the cytotoxicity activity of some cytochalasin compounds isolated from the solid substrate culture of Endothia gyrosa IFB-E023 against the human leukaemia K562 cell line with the IC50 values varying between 1.5 to 28.3 μM.
In the present study, Selectivity Index (SI) of active compounds was determined in order to investigate whether the cytotoxic activity was specific to cancer cells/bacterial strains. The SI of the samples are defined as the ratio of cytotoxicity (LC50 values) on normal non-cancer cells (Vero cells) to cancer cells (HeLa cells) or bacterial cells: SI = LC50 on Vero cells / LC50 on HeLa cells or MIC. Test agents with SI equal or higher than ten were considered to have high selectivity towards cancer cells . Apart from compounds 1 and 3 on HeLa cells, the SI values of the tested samples against the HeLa cells and bacterial strains ranged from 0.14 to 3.61 and could be considered as poor.
Human red blood cells provide a handy tool for toxicity studies of compounds, because they are readily available, their membrane properties are well known, and their lysis is easy to monitor by measuring the release of hemoglobin . The hemolytic activities of compounds 1–3, and tetracycline on human red blood cells (as a function of sample concentration) are shown in Fig. 4. At the highest concentration tested in this study (512 μg/mL), compounds 1, 3 and tetracycline caused less than 10% hemolysis, while compound 2 caused 20.14% hemolysis.
The chemical study of the ethyl acetate extract of Phomopsis sp. mycelium afforded three known cytochalasins including 18-metoxycytochalasin J (1), cytochalasins H (2) and J (3) together with alternariol (4). Compounds 1, 2 and 3 showed different degrees of antibacterial activities against MDR clinical strains of enteropathogenic bacteria with low toxicity to human red blood cells and normal Vero cells. These compounds also showed significant cytotoxic properties against human cervical cancer cells. The overall results of this study indicate that cytochalasin compounds 1–3 isolated from the Phomopsis sp. mycelium could be a clinically useful alternative for the treatment of cervical cancer and severe infections in particular those caused by Shigella flexneri and Vibrio cholerae strains resistant to ampicillin.
American Type Culture Collection
Heteronuclear Multiple Bond Connectivities
High Performance Liquid Chromatography
High-resolution electrospray ionization mass spectrometry
High-resolution-liquid chromatography–mass spectrometry
- LC50 :
Concentration of test sample resulting in a 50% reduction of absorbance compared to untreated cells
Liquid chromatography–mass spectrometry
Minimum bactericidal concentration
Mueller Hinton agar
Mueller Hinton broth
Minimum inhibitory concentration
Nuclear Magnetic Resonance
Phosphate buffered saline
Potato dextrose agar
Roswell Park Memorial Institute
Thin layer chromatography
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JDT acknowledges funding from the Indian Ministry of Education and Research through their CV Raman fellowship grant. We also thank CAS (UGC) for providing partial contingency support at the Department of Biochemistry, University of Calcutta. This work was also supported by grants of the German Academic Exchange Service (DAAD), grant A/12/90548 to Jouda Jean-Bosco for his Ph.D. studies, DAAD initiative “Welcome to Africa” and the German Research Foundation (DFG) for funding a high-resolution mass spectrometer.
The study was funded by the Indian Ministry of Education and Research and the German Academic Exchange Service (DAAD).
Availability of data and materials
The datasets supporting the conclusions of this article are presented in this paper. Also, mass spectra for structure elucidation in this study are provided in the supporting information file.
JBJ, CDM and JDT carried out the study and wrote the manuscript; CDM, PS, PKB, and JW supervised the work. All authors read and approved the final manuscript.
The authors declare that they have no competing interests.
Consent for publication
No individual clinical data is presented in the article, the information is not relevant.
Ethics approval and consent to participate
Authorization for the collection of blood was obtained from the Medical and Ethical Committee (2013–10, in Kolkata, India). The written informed consent for participation in the study was obtained from a healthy parent.
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Cite this article
Jouda, JB., Tamokou, JdD., Mbazoa, C.D. et al. Antibacterial and cytotoxic cytochalasins from the endophytic fungus Phomopsis sp. harbored in Garcinia kola (Heckel) nut. BMC Complement Altern Med 16, 462 (2016). https://doi.org/10.1186/s12906-016-1454-9
- Garcinia kola
- Endophytic fungi
- Phomopsis sp


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In a move called a major win for all kids and families affected by a rare form of juvenile arthritis, an 11-year old girl has become the first in B.C. to be granted access to an effective but expensive drug through Pharmacare.
Jaylene Prime of Aldergrove has a rare, painful and potentially life-threatening auto-inflammatory disease called Systemic Juvenile Idiopathic Arthritis (SJIA).
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Cassie and Friends is a Vancouver-based charity advocating for the BC Government to drastically improve the outlook of children with SJIA by allowing reimbursement coverage for Canakinumab on a case-by-case basis for the small number of children who need it.
One of those other children is 6-year old Landen Alexa of Sooke who also suffers from SJIA
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Photo/Landen Alexa – Change.Org