Adverse reactions of anti-tuberculosis drugs in hospitalized patients: incidence, severity and risk factors

BACKGROUND: Tuberculosis (TB) has been a common chronic infectious disease in human communities. Besides disease-related complications, there could be serious adverse reactions due to anti-tuberculosis (anti-TB) drug therapy. OBJECTIVES: To assess the incidence and severity of adverse drug reactions (ADRs) induced by anti-TB drugs. To determine possible covariates associated with detected ADRs. METHODS: All patients with respiratory TB admitted to a teaching hospital who received anti-TB drugs during the research period entered the study and were monitored for ADRs. Socio-demographic and medical history of patients were used as independent covariates. The relationship between independent covariates with frequency and severity of ADRs was analysed using multivariate logistic regression. Preliminary analyses of the Mann-Whitney, Chi-square, Kruskal-Wallis and the Fisher's exact tests were applied to determine factors unlikely associated with the independent variables. RESULTS: Among 204 patients admitted, there were 92 patients (45.1%) with ADRs induced by anti-TB drugs. Patients with a previous history of anti-TB drugs usage (OR = 5.81, 95% confidence interval [95%CI]: 1.31-25.2), patients with a history of drug allergy (OR = 6.68, CI: 1.28-36.2), those from Afghani ethnic (OR = 4.91, 95%CI: 1.28-18.30) as well as smoker patients with concurrent diseases (OR = 19.67, CI: 1.24-341.51) had a higher rate of ADR incidence. Being female (OR = 1.63, 95%CI: 1.96-36.40) and having previous history of ADR (OR = 17.46, 95%CI: 1.96-20.42) were identified as risk factors. CONCLUSION: Anti-TB drugs could cause severe and frequent adverse effects. Females, those with a previous history of ADRs to anti-TB drugs and Afghani patients, should be considered as high-risk groups.     

Propranolol hydrochloride osmotic capsule with controlled onset of release

Hard gelatin capsule was coated by a cellulose acetate as a semipermeable membrane with or without castor oil and filled with propranolol hydrochloride and sorbitol as an osmotic agent. After sealing the capsule with white bees wax plug, the onset of release and dissolution rate of the drug were studied. Water penetration into the capsule from the dissolution medium increases simultaneously the osmotic and hydrostatic pressures of its content. When the hydrostatic pressure is high enough to overweigh the gravity and frictional forces of the plug, the expulsion of the plug occurs and drug release starts. The effects of thicknesses of the membrane and plug as well as the concentrations of cellulose acetate and castor oil on the onset of drug release were presented by a polynomial model. We found that the effect of plug thickness on the onset of release is more important when the membrane is thicker. The results showed that the presence of caster oil in coating formulation (cellulose acetate 10% or 15%) increased the onset of release (t_o values). The onset of release varied from 0.6 to 10.5 hr among which the onset times of 4.2, 4.8, 5.9, 5.5, 7.5, 5.0, 7.8 and 10.5 hr could be of use for either chronotherapeutic purposes in protection of patients against heart attacks and strokes during early morning hours or reducing daily frequency of dosage.     

Accumbens neurochemical adaptations produced by binge-like alcohol consumption

Rationale The Scheduled High Alcohol Consumption (SHAC) binge drinking model is a simple, partial murine model with which to investigate some of the neurobiological underpinnings of alcoholism. Objectives The SHAC model was used to characterize monoamine and amino acid adaptations produced in the nucleus accumbens (NAC) by repeated bouts of high alcohol consumption. Methods In vivo microdialysis was conducted in the NAC of C57BL/6J (B6) mice during consumption of water, a 5% alcohol (v/v) solution for the first time (SHAC1) or a 5% alcohol solution for the sixth time (SHAC6). A second set of microdialysis experiments assessed the neurotransmitter response to an alcohol challenge injection (1.5 or 2 g/kg, IP). Results In both drinking experiments, SHAC1 and SHAC6 mice consumed comparable amounts of alcohol during the 40-min period of alcohol availability (~1.5 g/kg) and total fluid intake was similar between water and SHAC1/6 mice. Despite the similarity in alcohol consumption, alcohol-mediated increases in the extracellular concentration of GABA and serotonin were reduced, but glutamate was increased in the NAC of SHAC6 mice, relative to SHAC1 animals. No differences were observed in extracellular dopamine between SHAC1 and SHAC6 mice during alcohol consumption. After alcohol injection, SHAC6 mice also exhibited sensitized glutamate release, but did not differ from water or SHAC1 animals for any of the other neurotransmitters examined. Brain alcohol concentrations did not differ between groups after injection. Conclusions Repeated bouts of high alcohol consumption induce an imbalance between inhibitory and excitatory neurotransmission within the NAC that may drive excessive drinking behavior.     

Relationship between serum magnesium level and arrythmias following post-coronary artery bypass grafting

INTRODUCTION: Atrial and ventricular arrhythmias are among the most common complications after coronary artery bypass graft (CABG) surgery. It is known that cardiopulmonary bypass reduces serum magnesium level. In this study, we evaluated the relationship between total blood magnesium level (TMG) and the incidence of perioperative arrhythmias. METHODS: TMG was measured in patients who were scheduled for CABG on three occasions: just before anesthesia, on intensive care unit (ICU) arrival and on the first morning after operation. Patients were evaluated for primary cardiac rhythm, serum creatinine, urine output in operating room and diuretic therapy. Supplemental magnesium (SMG) was also recorded in operating room and ICU. Patients were then evaluated for the rate and kind of arrhythmia occurring during the next 3 days. RESULTS: Mean TMG level in 170 cases was 2.2 (0.5), 2.6 (0.6) and 2.4 (0.6) mg/dl on three occasions respectively. 53 patients developed post-operative arrhythmia (31%) [Atrial Fibrillation (AF) (7.1%), Non-AF Supraventricular arrhythmia (14.7%) and Ventricular arrhythmia (16.5%)]. Although there was a significant difference between TMG on three occasions (P <0.001), all values were within normal range. Although TMG was higher in arrhythmic patients compared to non- arrhythmics (2.26 vs. 2.14), both values were in normal range and there was no significant difference between two groups. DISCUSSION: This study shows that routine magnesium administration has no significant effect on serum magnesium level. We conclude that though routine regimen of magnesium administration has no effect on incidence of perioperative arrhythmia, it is probably necessary for maintaining normal magnesium level.     

Zidovudine and interferon-alpha treatment induces a high response rate and reduces HTLV-1 proviral load and VEGF plasma levels in patients with adult T-cell leukemia from North East Iran

Human T-cell lymphotropic virus type I (HTLV-I) associated adult T-cell leukemia/lymphoma (ATLL) is endemic in southern Japan, the Caribbean, intertropical Africa, and Brazil. Recently north east Iran, particularly the region of Mashhad, has been recognized as a new endemic region. ATLL is an aggressive T-cell lymphoproliferative disorder. Patients with ATLL have high plasma levels of VEGF that induce angiogenesis. Prognosis of ATLL remains poor because of immunosuppression and intrinsic resistance to chemotherapy. Important advances in the treatment of ATLL were reported with the combination of zidovudine (AZT) and interferon-alpha. We investigated the effect of AZT/IFN treatment on vascular endothelium growth factor (VEGF) plasma levels and HTLV-I proviral load in ATLL patients from the region of Mashhad. We confirmed that AZT/IFN treatment induces a high response rate and prolonged survival with minimal side effects. We also confirmed that VEGF plasma levels and HTLV-I proviral load are higher in ATLL patients than in asymptomatic carriers. We finally showed that AZT/IFN treatment reduced both HTLV-I proviral load and importantly VEGF plasma levels, suggesting a potential antiangiogenic effect of this therapy. These results provide further evidence for the efficacy and the mechanism of action of AZT/IFN therapy for ATLL in a developing country.     

Iran cancer incidence should be corrected for under-ascertainment in cancer cases in the elderly (aged 65+).

OBJECTIVE: This article is to calculate corrected Iran cancer incidence by a novel method to compensate under-ascertainment of cancer cases in the very elderly (aged 65+). STUDY DESIGN AND SETTING: Corrected age-specific rate for a certain cancer in age group 65+ was calculated from the age-specific rate of that cancer in age group 55-64 multiplied by the corresponding coefficient from reference cancer registry (sex- and age-specific coefficients from Finnish Cancer Registry, a nation-wide registry with high validity of data). All cancer data were obtained from GLOBOCAN 2002. RESULTS: The crude rate (and number of new cases) for "All sites excluding skin" was 13.6% (men 18.7%; women 8.1%) under-estimated. The under-enumeration was 18.9% for the age-standardized rate (men 25.4%; women 11.8%). This means there were 58,000 new cancer cases (about 7,000 more than original) in 2002. Corrected incidence for the year 2050 was 26.1% higher (men 32.8%; women 17.3%) than the original estimate (49,000 more). Depending on cancer site and sex, percentage under-estimation varied remarkably. CONCLUSION: After correction, the estimates of number of new cases and incidence rates of Iran increase substantially. Without correction, cancer occurrence measures can be remarkably under-estimated which may lead to inadequate resource allocation for control measures.     

Follow-up examination in a cat with hypereosinophilic syndrome: case report

A 1.5-year-old female, domestic shorthair cat with a 2-week history of proximal humerus fracture and open lesion infection was presented to Tehran University Veterinary Teaching Hospital. On physical examination the cat was quiet but alert. No other physical abnormalities were detected. The complete blood count, cytochemical staining, serum biochemistry tests as well as fecal flotation test, bone marrow cytology, radiography, and sonography were performed. Bone marrow aspiration showed a mildly increased myeloid-to-erythroid ratio (3.49:1). This cat had a healthy appetite without vomiting, diarrhea, or weight loss throughout the following-up course. All previous cases have been reported as having anorexia as a clinical finding.     

White Core of Cerebellum in Nicotine Treated Rats - A Histological Study

Although numerous studies explored the consequences of nicotine exposure on cerebellum and on its various layers, little research is focused on nicotine exposure on White core of cerebellum. In the present study, we assessed the effects of long-term nicotine exposure on White matter of cerebellum. Nicotine was administered for 60 days orally via cannula, using dose rate (5mg / day, 10 mg / day) to Male Drukrey rats. The results were compared to control adult rats, given vehicle in identical manner. After 60 days exposure, the cerebellum was removed and processed for histopathologic study. The results showed that long term nicotine treatment regime did result in significant loss of White core of cerebellum. These findings indicated that mature adult cerebellum is susceptible to the damaging effects of nicotine in depleting White core of cerebellum.     

Hemoprotozoa in free-ranging birds from rural areas of Mazandaran Province, northern Iran

A range of protozoa infect the blood of birds including Plasmodium, Aegyptianella, Haemoproteus, and Leukocytozoon and are transmitted by known vectors. The parasites occur worldwide and can cause reduced production, anemia, and even death. The aim of present study was to undertake the first survey of hemoprotozoa in the native birds of the Central zone of Mazandaran province. A total of 213 blood samples were collected from five different species of birds, 70 (32.9%) were infected by at least one parasite. The prevalence of infection by Aegyptianella pullorum, Plasmodium spp., and Haemoproteus spp. was 23.9%, 2.3%, and 6.6%, respectively. Our results showed a high prevalence of A. pullorum (38.3%) among ducks, as well as a high prevalence of Haemoproteus spp. (87.5%) in pigeons. Moreover, only ducks and turkeys were found to be infected with Plasmodium spp. Infections with multiple genera were found in 30.04% (64/213) of birds examined which included 91.4% of the 70 infected birds. It also seems that birds which migrate to the area annually might play an important role in infecting domestic birds in the province.