Hypertrophic pyloroduodenal tuberculosis

Hypertrophic pyloroduodenal tuberculosis is a rare cause of Gastric Outlet Obstruction (GOO) often forgotten in the differential diagnosis of gastric outlet obstruction. Since laboratory and radiological investigations often prove inconclusive in reaching the diagnosis of hypertrophic pyloroduodenal tuberculosis, surgery has a key role in the management of hypertrophic pyloroduodenal tuberculosis. Postoperative anti-tuberculosis chemotherapy (ATT) becomes imperative for complete resolution of hypertrophic pyloroduodenal tuberculosis. This case report describes the condition and management in a young girl.     

Hyoscine skin patches for drooling dilate pupils and impair accommodation: spectacle correction for photophobia and blurred vision may be warranted

Hyoscine skin patches diminish salivation by their anticholinergic action. The aim of reporting this case series is to present the ophthalmic side effects in children, and to highlight the precautions to take. Five children (two males, three females; age range 8-18y) with quadraplegic cerebral palsy (Gross Motor Function Classification System Level V) and profound intellectual impairment, wearing hyoscine skin patches to control excessive salivation, were examined. Binocular visual acuity, pupil reaction, pupil diameter, and dynamic retinoscopy were recorded before and after instilling guttae cyclopentolate 1%. The accommodative responses were compared with the expected norms. Spectacle correction was provided for refractive error and to compensate for lack of accommodation. Tinted lenses were provided for photophobia. Visual assessment was repeated 6 months later. All children had dilated pupils with a mean diameter of 7.8mm (range 7-9mm) before instilling guttae cyclopentolate. Mean pupil constriction to bright light was only 1.8mm (range 1-2mm). Mean resting accommodation was 0.45 dioptres (D; range 0-1D) and no accommodative responses were detected on dynamic retinoscopy. Three children were photophobic. Visual behaviour was seen to improve after the use of appropriate spectacles. Photophobia was relieved by tinted lenses. The anticholinergic effects of hyoscine skin patches can cause photophobia and impair vision due to pupil dilatation and paralysis of accommodation. Appropriate spectacles are recommended.     

Swyer-James-MacLeod Syndrome

This case report describes a patient with Swyer-James-MacLeod Syndrome (SJMS) in an adult male diagnosed on the basis of findings on X-ray chest, high resolution CT (HRCT) of chest and radionuclide perfusion lung scan. This rare syndrome is considered to be an acquired disease due to repeated pneumonias in early childhood.     

Aged garlic extract and S-allyl cysteine prevent formation of advanced glycation endproducts

Hyperglycaemia causes increased protein glycation and the formation of advanced glycation endproducts which underlie the complications of diabetes and ageing. Glycation is accompanied by metal-catalysed oxidation of glucose and Amadori products to form free radicals capable of protein fragmentation. Aged garlic extract is a potent antioxidant with established lipid-lowering effects attributed largely to a key ingredient called S-allyl cysteine. This study investigated the ability of aged garlic extract and S-allyl cysteine to inhibit advanced glycation in vitro. Bovine serum albumin (BSA) was glycated in the presence of Cu(2+) ions and different concentrations of aged garlic extract and protein fragmentation was examined by sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE). Lysozyme was glycated by glucose or methylglyoxal in the presence of different concentrations of aged garlic extract or S-allyl cysteine with subsequent analysis of glycation-derived crosslinking using SDS-PAGE. Amadori-rich protein was prepared by dialysing lysozyme that had been glycated by ribose for 24 h. This ribated lysozyme was reincubated and the effects of aged garlic extract, S-allyl cysteine and pyridoxamine on glycation-induced crosslinking was monitored. Aged garlic extract inhibited metal-catalysed protein fragmentation. Both aged garlic extract and S-allyl cysteine inhibited formation of glucose and methylglyoxal derived advanced glycation endproducts and showed potent Amadorin activity when compared to pyridoxamine. S-allyl cysteine inhibited formation of carboxymethyllysine (CML), a non-crosslinked advanced glycation endproduct derived from oxidative processes. Further studies are required to assess whether aged garlic extract and S-allyl cysteine can protect against the harmful effects of glycation and free radicals in diabetes and ageing.     

Synthesis and antibacterial activity of N-[5-chlorobenzylthio-1,3,4-thiadiazol-2-yl] piperazinyl quinolone derivatives

A series ofN-[5-(chlorobenzylthio)-1,3,4-thiadiazol-2-yl] piperazinyl quinolone derivatives (4a-1) have been synthesized by reaction of piperazinyl quinolones with 5-chloro-2-(chloroben-zylthio)-1,3,4-thiadiazoles. Their structures were confirmed by elemental analysis, IR and NMR spectra. The antibacterial activities of4a-1 against a variety of Gram-positive and Gram-negative bacteria were determined. Several compounds showed a good antibacterial activity against Gram-positive bacteria among which, compound 4e with a 2-chlorobenzylthio moiety in ciprofloxacin derivative, exhibited high activities againstStaphylococcus aureus andStaphylococcus epidermidis (MIC=0.06 μg/mL). The structure-activity relationship (SAR) study revealed that the position of chlorine atom on benzyl moiety would dramatically affect the antibacterial activities of the synthesized compounds.     

Incorporating in vitro information on drug metabolism into clinical trial simulations to assess the effect of CYP2D6 polymorphism on pharmacokinetics and pharmacodynamics: dextromethorphan as a model application

In vitro-in vivo extrapolation of clearance, embedded in a clinical trial simulation, was used to investigate differences in the pharmacokinetics and pharmacodynamics of dextromethorphan between CYP2D6 poor and extensive metabolizer phenotypes. Information on the genetic variation of CYP2D6, as well as the in vitro metabolism and pharmacodynamics of dextromethorphan and its active metabolite dextrorphan, was integrated to assess the power of studies to detect differences between phenotypes. Whereas 6 subjects of each phenotype were adequate to achieve 80% power in showing pharmacokinetic differences, the power required to detect a difference in antitussive response was less than 80% with 500 subjects in each study arm. Combining in vitro-in vivo extrapolation with a clinical trial simulation is useful in assessing different elements of study design and could be used a priori to avoid inconclusive pharmacogenetic studies.     

Involvement of hypothalamic pituitary adrenal axis on the analgesic cross-tolerance between morphine and nifedipine

Bidirectional cross-tolerance develops between opioids and Ca(2+) channel blockers relating to their antinociceptive effects; however, the role of hypothalamic pituitary adrenal (HPA) axis on this action has not been elucidated yet. We examined the analgesic cross-tolerance between morphine and nifedipine, a dihydropyridine calcium channel blocker, in intact and adrenalectomized (ADX) rats and also evaluated modification of HPA activity during this phenomenon. The tail-flick test was used to assess the nociceptive threshold. The plasma level of corticosterone, as a marker of HPA function, was measured by radioimmunoassay. Our results showed that, in sham operated rats which were chronically treated with morphine, nifedipine failed to affect nociceptive threshold but it could induce significant antinociceptive effect in ADX morphine treated animals. This effect was reversed by corticosterone replacement. Furthermore, morphine could not induce analgesic effect either in sham operated or in ADX animals that received chronic nifedipine. Chronic morphine inhibited the effect of nifedipine on corticosterone secretion but nifedipine treatment had no effect on morphine-induced corticosterone secretion. Based on these results, we can conclude that HPA axis is involved in the induction of cross-tolerance between morphine and nifedipine due to chronic morphine and not nifedipine treatment.     

Substance abuse in Iranian high school students

Adolescent substance abuse potentially holds a number of negative implications for the health and well-being of the individual, including increased risk for injury and death from interpersonal violence, motor vehicle accidents, and drowning, increased probability of engaging in high risk sexual behaviors; and increased risk for suicidal ideation and behaviors. The aim of this paper is to estimate prevalence of substance abuse among the sample of 10th grade male students in Tabriz City, and to evaluate the associated factors. Of all 10th grade male students in Tabriz, Iran, 1785(13.7%) were randomly sampled. Mean age of the subjects was 16.3+/-0.87 years. A self-administered questionnaire was used to collect demographic data, substance abuse, smoking status and friends smoking. The influence of different factors on substance abuse was evaluated with a logistic regression model. Among 1785 students 226 (12.7%, 95% CI: 11.2-14.3) had ever used alcohol and 36 (2.0%, 95% CI: 1.5-2.8) had used drugs. The results indicate that older age (OR=1.55), having general risk taking behavior (OR=1.70), higher smoking stage (OR=3.70), having self-injury (OR=1.22), higher socioeconomic class (OR=1.62), and ever use of illicit drugs (OR=5.72) were factors associated with student's ever use of alcohol. This study has shown low prevalence of substance abuse and determined some of its risk factors among students. More studies about adolescent population are necessary to approve the observed results of this study and thus allow for a certain generalization of the observations.