Chloramphenicol in the 21st century

Chloramphenicol use has declined in the UK, despite it remaining highly active against a wide range of bacteria. This article will review the activity, pharmacology, toxicology, uses and potential uses of chloramphenicol in an era of increasing antimicrobial resistance.     

Species extrapolation for the 21st century

Safety factors are used in ecological risk assessments to extrapolate from the toxic responses of laboratory test species to all species representing that group in the environment. More accurate extrapolation of species responses is important. Advances in understanding the mechanistic basis for toxicological responses and identifying molecular response pathways can provide a basis for extrapolation across species and, in part, an explanation for the variability in whole organism responses to toxicants. We highlight potential short- and medium-term development goals to meet our long-term aspiration of truly predictive in silico extrapolation across wildlife species' response to toxicants. A conceptual approach for considering cross-species extrapolation is presented. Critical information is required to establish evidence-based species extrapolation, including identification of critical molecular pathways and regulatory networks that are linked to the biological mode of action and species' homologies. A case study is presented that examines steroidogenesis inhibition in fish after exposure to fadrozole or prochloraz. Similar effects for each compound among fathead minnow, medaka, and zebrafish were attributed to similar inhibitor pharmacokinetic/pharmacodynamic distributions and sequences of cytochrome P45019A1/2 (CYP19A1/2). Rapid advances in homology modeling allow the prediction of interactions of chemicals with enzymes, for example, CYP19 aromatase, which would eventually allow a prediction of potential aromatase toxicity of new compounds across a range of species. Eventually, predictive models will be developed to extrapolate across species, although substantial research is still required. Knowledge gaps requiring research include defining differences in life histories (e.g., reproductive strategies), understanding tissue-specific gene expression, and defining the role of metabolism on toxic responses and how these collectively affect the power of interspecies extrapolation methods.     

Physician leadership for the 21st century

This article examines how rapidly evolving health care delivery structures are radically altering the traditional clinical and organizational autonomy enjoyed by physicians. These changes may render maintenance of prior levels of physician autonomy virtually impossible. The author calls for the emergence of a new breed of physician leaders who will preserve the best of traditional medical practice culture but also effectively implement a nascent form of integrated health care practice.     

Fertility regulation in the 21st century

The Society for Drug Research, based in the UK organized a 1 day symposium in London during December 1982 entitled "Fertility Control in the 21st Century." The meeting's objective was to stimulate further research into fertility regulation. Professor Carl Djerassi of Stanford University, California eloquently supported the case for postcoital contraception. He focused on teenagers who failed to use reliable contraceptive methods as an example of a subgroup of society who would particularly benefit from postcoital contraception. Djerassi presented a profile of the ideal contraceptive, which emphasized the potential for postcoital contraception. Characteristics of his "ideal" contraceptive included a need to focus on women, independence from coitus, and in the case of systemic contraception, short term exposure to the drug. Djerassi also reviewed the rigorous drug trial procedures that any new contraceptive had to undergo. Professor Martin Vessey of Oxford University focused his comments on the benefits and risks of oral contraceptives (OCs). In addition to the high efficacy of OCs, other benefits included the suppression of pelvic inflammatory disease, endometrial cancer, functional ovarian cysts, and benign breast disease. Regarding the association between OCs and benign breast tumors, Vessey stated that it appeared that it was only the most benign form that was suppressed. The protective effect against ovarian cancer appeared to persist in former users, seemed to be apparent across the spectrum of age groups, and appeared to be most pronounced in nulliparous women. 1 risk associated with OCs, according to Vessey, was the association between hepatocellular adenoma and OC. Dr. Malcolm Potts directed his comments to discussion of contraception in the 3rd world, demonstrating with a series of slides the variety of social and economic circumstances in which family planning services were needed. Other contributors to the symposium discussed new uses for old steroids, prostanoids in fertility control, immunization against fertility, and contraception in the male.     

Leprosy--a stigma in the 21st century

For the initiation of the French journalist Raoul Follereau in 1954 the UNO inaugurated the Leprosy Day (Martyr's Day) that is celebrated on the last Sunday of January every year. Although the bacterium that causes leprosy was isolated by the Norwegian scientist Gerhard Henrik Armauer Hansen in 1873 and from 1982 this disease can be cured with a special pharmaceutical complex, still 219.826 new leprous are detected on Earth every year, according to the data published in August, 2010 by WHO-experts. Ancient Chinese and Hindu source-strings from 600 B. C. are referring to leprosy, however, the disease was imported by the army of Alexander the Great from India around 327-326 B. C. Even the Old and the New Testament from the Holy Bible are mentioning leprosy in several details. During the Middle Ages the Military and Hospitaller Order of St. Lazarus of Jerusalem, established in the Holy Land in 72 A. D., did pioneer work in nursing leprous. In the process of time the medical attendance concerning leprous was organized in special hospitals called "leprosoriums" built on river-banks. Special office and even services were organized for the treatment and isolation of the people infected. Although medical science has prevailed against leprosy, and almost simultaneously even jurisprudence defended the patients' rights via legislation, still mankind can regrettably not get rid of this disease that stigmatizes seriously.     

Tuberculosis control in the 21st century

In response to tuberculosis (TB) outbreaks in the United States in the late 1980s and early 1990s, U.S. hospitals spent tremendous resources to ensure a safer workplace. A remarkable decrease in nosocomial transmission resulted, along with a decrease in TB cases nationally. Federal standards have been promulgated to ensure a safer work environment for all U.S. workers potentially exposed to TB. However, these measures may prove costly and burdensome and thus may compromise the ability to deliver care.