Beta blockers in coronary artery disease with and without hypertension

Beta-adrenergic blockers (BB) were developed to treat angina. Trials of BB with myocardial infarction (MI) setting were highly successful in the pre-thrombolytic era. Subsequently BB proved to be beneficial in post-thrombolytic MI in long-term use. In stable angina BB gives good symptomatic relief primarily by reducing myocardial oxygen demand. In the set-up of unstable angina/non-ST elevation MI they prevent arrhythmia and progression to ST elevation MI. BB have also been shown to retard the progression of atherosclerosis. In congestive cardiac failure (CCF) they are now the first-line drugs with ACE inhibitors to impart prognostic benefit. Their role in improving outcome of cardiac and non-cardiac surgeries has found good evidence and recommendation. But in the field where BB have scored maximally, ie, in hypertension, their role is recently debated. But the unchallenged fact remains that in presence of any form of coronary artery disease, BB are the most preferred class of drugs to treat hypertension.     

Gaps in the knowledge about advancements in rabies vaccines among the undergraduate medical students

Enormous developments have taken place during the past few years in the field of Rabies prevention and control particularly rabies vaccines. Intra-dermal Rabies Vaccination (IDRV) has already emerged as a safe, ethical and cost-effective replacement. However appropriate dissemination of knowledge and implementation by medical fraternity is imperative for effective prevention and control of this fatal disease. Gaps were found in the knowledge of medical students regarding the newer rabies vaccines. This can be resolved to great extent by updating the undergraduate curriculum with the current control strategies used in this field.     

Refining the depression-nicotine dependence link: Patterns of depressive symptoms in psychiatric outpatients with current,past, and no history of nicotine dependence

The aim of this study was to elucidate the depression-nicotine dependence link by evaluating which specific depressive symptoms are uniquely associated with nicotine dependence in psychiatric outpatients. Participants were assessed using structured clinical interviews which yielded psychiatric diagnoses and clinical ratings on a wide variety of depressive symptoms. Depressive symptoms were compared across three groups: (1) patients with no history of nicotine dependence (NND; n = 1015); (2) patients with past nicotine dependence in full remission for at least 2 months (PND; n = 211); and (3) patients with current nicotine dependence (CND; n = 342). Participants with CND evidenced elevations on certain typical-vegetative, melancholic, and dysphoric depressive symptoms as compared to patients with NND and (to a lesser extent) patients with PND. Group differences were most consistent for depressed mood, anhedonia, appetite/weight loss, psychomotor disturbance, fatigue, and insomnia. Differences were least apparent for atypical symptoms. The symptomatic profiles of PND and NND patients were virtually indistinguishable. Certain vegetative, melancholic and dysphoric depressive symptoms are closely associated with nicotine dependence and could play an important etiological role in depression-nicotine dependence comorbidity.     

Formulation, characterization and evaluation of rotavirus encapsulated PLA and PLGA particles for oral vaccination

Polylactide (PLA) and polylactide-co-glycolide (PLGA) particles entrapping rotavirus (strain SA11) were formulated using a solvent evaporation technique. To minimize denaturation of viral antigen during the emulsification process, serum albumin was used as a stabilizer. Use of NaHCO(3) and sucrose during the primary emulsification step resulted in uniform stabilized particles entrapping rotavirus. Sonication during the primary emulsion and homogenization during the secondary emulsion process resulted in particles of sizes 2-8 microm, whereas nanoparticles were formed when sonication was used during both primary and secondary emulsion processes. Scanning electron and atomic force microscopy showed uniform pores and roughness throughout the polymer particle surface. Single dose oral immunization with 20 microg of antigen entrapped in PLA particles elicited improved and long-lasting IgA and IgG antibody titer in comparison to the soluble antigen. The study shows results illustrating the usefulness of polymeric microparticles as a potential oral delivery system for rotavirus vaccine.     

Oxygen supplies during a mass casualty situation

Mass casualty and pandemic events pose a substantial challenge to the resources available in our current health care system. The ability to provide adequate oxygen therapy is one of the systems that could be out-stripped in certain conditions. Natural disasters can disrupt manufacturing or delivery, and pandemic events can increase consumption beyond the available supply. Patients may require manual resuscitation, basic oxygen therapy, or positive-pressure ventilation during these scenarios. Available sources of oxygen include bulk liquid oxygen systems, compressed gas cylinders, portable liquid oxygen (LOX) systems, and oxygen concentrators. The last two are available in a variety of configurations, which include personal and home systems that are suitable for individual patients, and larger systems that can provide oxygen to multiple patients or entire institutions. Bulk oxygen systems are robust and are probably sustainable during periods of high consumption, but are at risk if manufacturing or delivery is disrupted. Compressed gas cylinders offer support during temporary periods of need but are not a solution for extended periods of therapy. Personal oxygen concentrators and LOX systems are limited in their application during mass casualty scenarios. Large-capacity oxygen concentrators and LOX systems may effectively provide support to alternative care sites or larger institutions. They may also be appropriate selections for governmental emergency-response scenarios. Careful consideration of the strengths and limitations of each of these options can reduce the impact of a mass casualty event.     

Pharmacological properties of N-(3,5-diamino-6-chloropyrazine-2-carbonyl)-N'-4-[4-(2,3-dihydroxypropoxy)phenyl]butyl-guanidine methanesulfonate (552-02), a novel epithelial sodium channel blocker with potential clinical efficacy for cystic fibrosis lung disease

Amiloride improves mucociliary clearance (MC) by blocking airway epithelial sodium channels (ENaC) and expanding airway surface liquid (ASL). However, the low potency and rapid absorption of amiloride by airway epithelia translated into a short duration of efficacy as an aerosolized therapy for cystic fibrosis (CF) patients. To improve ENaC blocker CF pharmacotherapy, a more potent and durable ENaC blocker tailored for aerosol delivery was synthesized. Parion compound N-(3,5-diamino-6-chloropyrazine-2-carbonyl)-N'-4-[4-(2,3-dihydroxypropoxy)phenyl]butyl-guanidine methanesulfonate (552-02) was tested for potency and reversibility of ENaC block, epithelial absorption and biotransformation, selectivity, durability of ASL expansion under isotonic and hypertonic conditions in canine and human CF bronchial epithelial cells, and drug dissociation on ENaC in Xenopus oocytes. Short-circuit current assessed compound potency and reversibility, patch-clamp recordings of ENaC current assessed drug off-rate (k(off)), a gravimetric method and confocal microscopy measured mucosal water retention and ASL height, and drug absorption and biotransformation were assessed using liquid chromatography-mass spectrometry. Amiloride and 552-02 were tested in vivo for MC activity in sheep immediately and 4 to 6 h after aerosol dosing. Compared with amiloride, compound 552-02 was 60 to 100-fold more potent, it was 2 to 5-fold less reversible, it was slower at crossing the epithelium, and it exhibited a 170-fold slower k(off) value. 552-02 exhibited greater ASL expansion over 8 h in vitro, and it was more effective than amiloride at increasing MC immediately and 4 to 6 h after dosing. When combining hypertonic saline and 552-02, a synergistic effect on ASL expansion was measured in canine or CF bronchial epithelia. In summary, the preclinical data support the clinical use of 552-02 +/- hypertonic saline for CF lung disease.     

The Oxford Ankle Foot Questionnaire for children: responsiveness and longitudinal validity

Purpose  

To evaluate how scores from the Oxford Ankle Foot Questionnaire change over time and with treatment using both distribution-based and anchor-based approaches.     

Degradation of total carotenoids and texture in frozen pumpkins when kept for storage under varying conditions of time and temperature

The total carotenoid content and textural properties of pumpkin pieces thermally treated at 55 degrees C, 65 degrees C, 75 degrees C, 85 degrees C and 95 degrees C for different blanch times (3 min, 5 min, and 10 min) and subsequently kept for storage at 0 degrees C, -18 degrees C and -40 degrees C for a period of 80 days were measured. The total carotenoids content increased in the thermally treated pumpkin pieces, the increase being greater at 55 degrees C than at 95 degrees C. Storing the pumpkin pieces caused the total carotenoids content to decrease by 35-40% at 0 degrees C, by 15-20% at -18 degrees C and by 25-30% at -40 degrees C. A low-temperature blanch gave a firmer texture to pumpkin in comparison with high-temperature blanching. The texture of thermally treated pumpkins degraded when kept for storage, the losses being greater at 0 degrees C than at -18 degrees C and -40 degrees C. A split plot analysis was performed to study the effect of the factors on the retention of carotenoids.