Ibogaine related sudden death: A case report

Ibogaine is a naturally occurring alkaloid derived from the roots of the rain forest shrub Tabernanthe iboga. Deaths have occurred temporarily related to the use of ibogaine. However, although not licensed as therapeutic drug, and despite evidence that ibogaine may disturb the rhythm of the heart, this alkaloid is currently used as an anti-addiction drug in alternative medicine for detoxification purposes. We report the case of a man who died suddenly 12–24 h after ibogaine use for alcohol detoxification treatment. In the autopsy liver cirrhosis and heavy fatty infiltration was found. The concentration of ibogaine was 2 mg/l. The potential risks of ibogaine use, especially for persons with pathological medical background, are discussed.     

Legionella pneumophila pathogenesis in the Galleria mellonella infection model

Legionella pneumophila is a facultative intracellular human pathogen and the etiological agent of severe pneumonia known as Legionnaires' disease. Its virulence depends on protein secretion systems, in particular, the Dot/Icm type IV secretion system (T4SS), which is essential to establish a replication-permissive vacuole in macrophages. The analysis of the role of these systems and their substrates for pathogenesis requires easy-to-use models which approximate human infection. We examined the effectiveness of the larvae of the wax moth Galleria mellonella as a new model for L. pneumophila infection. We found that the L. pneumophila strains 130b, Paris, and JR32 caused mortality of the G. mellonella larvae that was strain, infectious dose, growth phase, and T4SS dependent. Wild-type L. pneumophila persisted and replicated within the larvae, whereas T4SS mutants were rapidly cleared. L. pneumophila strain Lp02, which is attenuated in the absence of thymidine but has a functional T4SS, resisted clearance in G. mellonella up to 18 h postinfection without inducing mortality. Immunofluorescence and transmission electron microscopy revealed that L. pneumophila resided within insect hemocytes in a vacuole that ultrastructurally resembled the Legionella-containing vacuole (LCV) observed in macrophages. The vacuole was decorated with the T4SS effector and LCV marker SidC. Infection caused severe damage to the insect organs and triggered immune responses, including activation of the phenoloxidase cascade leading to melanization, nodule formation, and upregulation of antimicrobial peptides. Taken together, these results suggest that G. mellonella provides an effective model to investigate the interaction between L. pneumophila and the host.     

Prevalence of different HPV types and estimation of prognostic risk factors based on the linear array HPV genotyping test

The aim of the study was to evaluate the prevalence and risk factors of HPV in a gynecologic population attending outpatient clinics using two new molecular tests. The Amplicor HPV test and the Linear Array (LA) HPV Genotyping test were used for the detection of HPV DNA in 320 women. Multiple logistic regression was used to identify independent prognostic factors of HPV positivity. The agreement between the two methods in terms of their qualitative results was 89.3% (kappa: 0.63). Based on the LA results, the overall prevalence of HPV DNA was 49.1%, 95% confidence interval (95% CI: 43.5%, 54.7%). The prevalence of high‐risk HPV types was 30.3%. The predominant types were HPV‐6 (24.8%) and HPV‐16 (20.4%). Among women with normal cytology, the prevalence of HPV was much higher in those presenting other findings, such as inflammation, than those without other abnormal findings (49.5% vs. 31.5%). On the basis of multivariate analysis, the risk of HPV infection was higher among women with multiple sexual partners [>3 vs. 1: OR = 3.1, 95% CI: (1.5, 7.2)], Pap smear findings [low/high‐grade lesions vs. negative: OR = 2.8, 95% CI: (1.2, 6.5)], the presence of warts [yes vs. no: OR = 3.0, 95% CI: (1.5, 6.3)] and no history of child birth [no vs. yes: OR = 2.6, 95% CI: (1.0, 6.7)]. Younger age was an additional risk factor for HPV infection with carcinogenic genotypes [OR for 1 year increase = 0.93, 95% CI: (0.89, 0.98)]. J. Med. Virol. 81:2059–2065, 2009. © 2009 Wiley‐Liss, Inc.     

Survey of Pharmacy Preceptors’ Expectations and Experiences with Students on Rotations in an Inaugural Combined BScPhm/PharmD Class

Background:

In September 2011, the Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, began offering a combined BScPhm/PharmD program to third-year students and postbaccalaureate graduates. Learning consisted of in-class teaching and Advanced Pharmacy Practice Experience (APPE) rotations.

Objective:

To explore preceptors’ expectations and perceptions of student performance in the APPE rotations of the new combined degree program.

Methods:

A survey was distributed via email to 132 pharmacists from the Toronto Academic Health Science Network who had acted as preceptors for the combined degree program in academic year 2011/2012. The 17 questions were designed to gather information on preceptors’ demographic characteristics and their expectations and evaluations of the combined-program students. Responses were analyzed qualitatively for common themes and quantitatively using sums and means. Survey responses were compared to identify alignment and discrepancies between preceptors’ expectations and evaluations of students.

Results:

The survey response rate was 48% (63/132). Most respondents (46 [73%]) were from a teaching hospital, and the same proportion (46 [73%]) reported being preceptors for a direct patient care rotation. Forty-four (70%) of the respondents expected students to be at the level of traditional PharmD students, hospital residents, or advanced-level Structured Practical Experience Program students, and 35 (80%) of these 44 respondents reported that their students met or exceeded expectations. According to survey responses, 31% of respondents (18/58) ranked students at the corresponding level of performance on the faculty’s assessment form, while 62% (36/58) ranked students at a higher level (5 respondents did not complete the question). Only one-third of respondents felt that they personally had received adequate training before taking on preceptor duties for combined-program students.

Conclusions:

Preceptors’ perceptions of the rotation and their expectations of students varied widely and were influenced by prior teaching and learning experiences. There was a disconnect between preceptor-specific expectations and preceptors’ final evaluations of students. Training to standardize the expected level of performance and additional training for preceptors would further enhance the APPE rotations of the combined degree program.     

Determination of okadaic acid, dinophysistoxin-1 and related esters in Greek mussels using HPLC with fluorometric detection, LC-MS/MS and mouse bioassay

An approach involving both chemical and biological methods was undertaken for the detection and quantification of the marine toxins okadaic acid (OA), dinophysistoxin-1 (DTX-1) and their respective esters in mussels from different sampling sites in Greece during the period 2006-2007. Samples were analyzed by means of a) high performance liquid chromatography with fluorometric detection (HPLC-FLD), using 9-athryldiazomethane (ADAM), as a pre-column derivatization reagent, b) liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) and c) the mouse bioassay. Free OA and DTX-1 were determined by both HPLC-FLD and LC-MS/MS, while their respective esters were determined only by LC-MS/MS after alkaline hydrolysis of the samples. The detection limit (L.O.D.) and quantification limit (L.O.Q.) of the HPLC-FLD method were 0.015 μg/g HP and 0.050 μg/g HP, respectively, for OA. The detection limit (L.O.D.) and quantification limit (L.O.Q.) of the LC-MS/MS method were 0.045 μg/g HP and 0.135 μg/g HP, respectively, for OA. Comparison of results between the two analytical methods showed excellent agreement (100%), while both HPLC-FLD and LC-MS/MS methods showed an agreement of 97.1% compared to the mouse bioassay.