Posaconazole for the treatment of mucormycosis

Posaconazole (PCZ) is an orally administered, extended-spectrum triazole antifungal agent with activity against the Mucorales. This article describes the clinical and laboratory data supporting its use against this rare group of pathogens. To date, PCZ has been mostly used for salvage therapy and at present there is no strong published clinical evidence to support its role as a single agent in the treatment of mucormycosis. Further studies are required to explore its role as a single agent and in combination therapy for the management of these infections.     

A proposed taxonomy for characterization and assessment of avian influenza outbreaks

PURPOSE: The speed and high potential impact of avian influenza's (AI) on local bird populations, poultry economies and human health make timely and coordinated characterization, assessment and response to possible threats essential. To collaborate effectively, stakeholders (public health, medical, veterinary, and agricultural professionals) must be able to communicate and record findings, assessments, and actions in a standard fashion. We seek to discern a taxonomy of concepts and relationships that are important to the stakeholder community when sharing information about the characterization and assessment of an AI outbreak, according to a consistent and common perspective, interpretation, and level of detail. METHODS: To derive concepts relevant to AI characterization and assessment, we reviewed selected journal articles, reporting and laboratory forms, and public health websites associated with AI case reporting. We mapped concepts to existing medical terminologies within the Unified Medical Language System when possible, using the National Library of Medicine's MetaMap program. RESULTS: From 54 distinct information sources, we extracted 1113 concepts, of which 533 mapped to 15 medical terminologies; 580 did not map to specific terminologies. Using a combination of semantic type-relationship matching and expert consensus, we constructed the proposed taxonomy, with linkages to existing terminologies where pragmatic. CONCLUSION: The proposed taxonomy describes core knowledge, data and communication needs for the characterization and assessment of AI outbreaks in the context of existing medical terminologies across different domains. We also describe areas for further work.     

Exogenous Ghrelin Enhances Endocrine and Exocrine Regeneration in Pancreatectomized Rats

Aim  Ghrelin, the most important modulator of endocrine and exocrine pancreatic functions, has a role in the development of islets of Langerhans during embryogenesis. The aim of this study was to evaluate the effects of ghrelin on pancreatic regeneration in rats with 90% pancreatectomy. Materials and Methods  Two- to 3-week-old Wistar rats were used in the study. After anesthesia, 90% pancreatectomy was performed. In the ghrelin group, 90% pancreatectomy was performed. Ten nanomoles per kilogram per day of ghrelin was administered intraperitoneally from the first postoperative day. In the antagonist group, 90% pancreatectomy was performed. From the first postoperative day, rats received the ghrelin receptor antagonists and substance P intraperitoneally at 1 μmol/kg. In the control group, 90% pancreatectomy was performed, and intraperitoneal saline was administered. The sham group did not receive pancreatectomy. Eight rats from each group were randomly selected and sacrificed on the second, third, and 30th days. Results  Blood glucose levels in pacreatectomized rats were significantly higher than in rats in the sham group. The number of beta islet cells, serum insulin levels, and PDX-1 and cytokeratin staining scores decreased in rats with pancreatectomy when compared to the sham-group rats. In the ghrelin-receiving rats, blood glucose levels tended to decrease from the 15th postoperative day. Ghrelin treatment increased insulin levels, insulin-positive islet cell number, and 5-bromo-2-deoxyuridine and PDX-1 staining, whereas ghrelin antagonist administration resulted in significant decreases in these parameters. Ghrelin treatment significantly improved glucose tolerance test results. Conclusion  Exogenous ghrelin administration decreased blood glucose levels after 90% pancreatectomy by increasing islet cell numbers and enhancing endocrine and exocrine regeneration. Kerem M and Salman B contributed equally to this work; Kerem M, Salman B, and Bedirli A designed experiments; Kerem M, Salman B, Pasaoglu H, Ozsoy S, Haziroglu R, and Yilmaz Tu performed experiments; Kerem M, Salman B, and Bedirli A analyzed data; Kerem M, Salman B, and Bedirli A wrote the paper.     

Ventricular septal rupture and mitral regurgitation caused by trauma

We present a young patient with traumatic septal rupture following traffic accident in whom transthoracic echocardiography allowed comprehensive noninvasive assessment of location and size of the septal defect and structure atrioventricular valve apparatus.     

Mutagenicity studies with N-acetyl-l-aspartic acid

Analytical studies have reported that N-acetyl-l-aspartic acid (NAA) is present at low concentrations in many foods. The current studies were conducted to assess the mutagenicity of NAA using standard OECD guideline in vitro bacterial and in vivo mammalian mutagenicity studies. For comparison and control data, mutagenicity studies were also conducted with its constituent amino acid l-aspartate (ASP) because NAA is metabolized to ASP. The combination of an in vitro method for assessing point mutations in bacteria and an in vivo method to assess clastogenicity in an animal model provided adequate evidence for mutagenicity hazard assessment of NAA. No evidence of mutagenicity was observed in either test system with either NAA or ASP. The results from the current studies demonstrate that the presence of NAA in foods is not likely to represent a risk for mutagenicity.     

Does adenosine A1 receptor stimulation causes QRS prolongation by blocking beta adrenergic receptors in amitriptyline poisoning?

Aims

To investigate the role of beta receptor blockade via adenosine A₁ receptor stimulation on amitriptyline-induced QRS prolongation.

Methods

Isolated rat hearts were randomized into three groups (n = 8 for each group). After pretreatment with 5% dextrose (control) or DPCPX (8-cyclopentyl-1,3-dipropylxanthine), or propranolol + DPCPX, amitriptyline infusion was given to all groups. Intact beta adrenergic receptor response was verified with a bolus dose of isoproteranol (3 × 10⁻⁵ M).

Results

Amitriptyline (5.5 × 10⁻⁵ M) infusion following pretreatment with 5% dextrose or 10⁻⁴ M DPCPX prolonged QRS by 40–110% and 30–75%, respectively. After the beta receptor blockade with 10⁻² M propranolol bolus, amitriptyline infusion following pretreatment with DPCPX prolonged QRS by 40–130%. Amitriptyline infusion following pretreatment with DPCPX (10⁻⁴ M) shortened the QRS at 40, 50 and 60  min significantly when compared to propranolol + DPCPX group (168.8 ± 4.9%, p < 0.05; 170.8 ± 6.9%, p < 0.01; 174.0 ± 6.9%, p < 0.01, respectively). Amitriptyline infusion following pretreatment with 5% dextrose prolonged QRS duration significantly at 50th minutes (209.5 ± 6.1%, p < 0.05) compared to DPCPX pretreatment group.

Conclusion

DPCPX pretreatment shortened amitriptyline-induced QRS prolongation. Beta adrenergic receptor blockade enhanced QRS prolongation shortened by DPCPX pretreatment. Adenosine A₁ receptor stimulation related to beta adrenergic receptor blockade may play a role in amitriptyline-induced QRS prolongation in isolated rat hearts.