A stepwise increase in pharmacotherapy depending on the severity of COPD

The overall approach to managing stable COPD should be characterized by a stepwise increase in treatment, depending on the severity of the disease in accordance with JRS COPD guideline. None of the existing medications has been shown to modify the long term decline in lung function that is the hallmark of this disease. Therefore, pharmacothepary for COPD is used to decrease symptoms and/or complications. Smoking cessation and influenza vaccines are the base of pharmacotherapy. And the principal short and long acting bronchodilator treatments are anticholinergics, beta2-agonists, methylxanthines, and a combination of one or more of these drugs. And regular treatment with inhaled glucocorticosteroids should only be prescribed for symptomatic COPD patients with a documented spirometric response to glucocorticosteroids or for those with stage III and repeated exacerbations.     

Independent evolution of pyrimethamine resistance in Plasmodium falciparum isolates in Melanesia

Pyrimethamine resistance in Plasmodium falciparum has previously been shown to have emerged once in Southeast Asia, from where it spread to Africa. Pyrimethamine resistance in this parasite is known to be conferred by mutations in the gene encoding dihydrofolate reductase (dhfr). We have analyzed polymorphisms in dhfr as well as microsatellite haplotypes flanking this gene in a total of 285 isolates from different regions of Melanesia (Papua New Guinea, Vanuatu, and the Solomon Islands) and Southeast Asia (Thailand and Cambodia). Nearly all isolates (92%) in Melanesia were shown to carry a dhfr double mutation (CNRNI [underlining indicates the mutation]) at positions 50, 51, 59, 108, and 164, whereas 98% of Southeast Asian isolates were either triple (CIRNI) or quadruple (CIRNL) mutants. Microsatellite analysis revealed two distinct lineages of dhfr double mutants in Melanesia. One lineage had the same microsatellite haplotype as that previously reported for Southeast Asia and Africa, suggesting the spread of this allele to Melanesia from Southeast Asia. The other lineage had a unique, previously undescribed microsatellite haplotype, indicative of the de novo emergence of pyrimethamine resistance in Melanesia.     

Circadian rhythm of serum concentration of small dense low-density lipoprotein cholesterol

BACKGROUND: The atherogenicity of small dense low-density lipoprotein (sdLDL) has been reported and recently a new easy-handling method for measuring serum concentration of sdLDL cholesterol (sdLDLC) has been developed. Using this method, we observed the circadian rhythm of sdLDLC to determine the adequacy of fasting measurement of it and to seek the modulator of the atherogenic lipoprotein. METHODS: Study population was consisted of 20 healthy volunteers (10 women and 10 men, mean age 28 y). They had 3 meals per day and blood samples were taken before and 2 h after every meal and next morning. Serum concentrations of sdLDLC and other valuables including triglyceride (TG) and remnant-like particles cholesterol (RLPC) were determined. RESULTS: Serum concentration of sdLDLC had a unique circadian rhythm that was highest before breakfast (fasting status), decreased after each meal, hit the bottom after dinner and then increased during at night. Fasting sdLDLC was highly correlated with TG levels. The sum of the 6 TG values during a day (i.e., average TG level) had higher correlation coefficient with sdLDLC than fasting TG or fasting RLPC. CONCLUSIONS: From the observation of the unique circadian rhythm, measuring sdLDLC at fasting status is exactly reasonable because it never underestimate the risk of atherosclerotic diseases. Measuring sdLDLC can also be used as a marker for average TG levels regardless of the existence of postprandial hyperlipidemia.     

A case of listerial meningitis treated with a regimen containing panipenem-betamipron

Although panipenem-betamipron, which is commercially available only in Japan, is recommended for treatment of pediatric bacterial meningitis by some experts, only a limited number of clinical studies have been reported. In the present report, we describe a 2-year-old boy with meningitis caused by Listeria monocytogenes who was treated with a regimen containing panipenem-betamipron and recovered without any apparent neurological sequelae. On the basis of our experience and previous reports, panipenem-betamipron appears to be effective for the treatment of listerial meningitis.     

Disruption of blood flow in the outflow graft is a valuable marker for detecting suction events in patients with continuous-flow left ventricular assist devices

Journal of Echocardiography -