The effects of add-on zafirlukast treatment to budesonide on bronchial hyperresponsiveness and serum levels of eosinophilic cationic protein and total antioxidant capacity in asthmatic patients

Mild persistent asthma is most effectively controlled with inhaled corticosteroids. Leukotriene receptor antagonists have complementary effects to corticosteroids on inflammation control. The additional effect of a leukotriene receptor antagonist, zafirlukast, was investigated in stable asthma patients under control with inhaled budesonide. We conducted a randomised, double-blind, placebo-controlled, single center trial to investigate the effects of add-on zafirlukast treatment to budesonide, on symptom score, pulmonary function, bronchial responsiveness, and serum levels of eosinophilic cationic protein (ECP) and antioxidant capacity in stable asthmatic patients under control with inhaled budesonide. The present study included 21 mild or moderate asthmatic patients (8 males and 13 females), who were stable at least for 6 weeks with inhaled budesonide (400 microg/day). Serum total antioxidant capacity (TAC) and ECP levels were measured, and symptom scoring, spirometry, and bronchial provocation with methacholine were performed. Then, the patients were randomised to use either placebo or oral zafirlukast (40 mg/day) in addition to budesonide for 6 weeks. At the 6th week, symptom scoring, spirometry, and bronchial provocation tests were repeated and serum TAC and ECP levels were measured again. After add-on zafirlukast treatment to budesonide, forced expiratory volume in 1 second (FEV(1)), TAC and ECP values did not change significantly (p > 0.05) but bronchial hyperresponsiveness and symptom score decreased significantly (p = 0.022) compared to baseline. Thus, in stable asthmatic patients, add-on zafirlukast treatment to budesonide improves symptoms and decreases bronchial hyperresponsiveness.     

Bacteriological profile and antibiotic resistance: comparison of findings in a burn intensive care unit, other intensive care units, and the hospital services unit of a single center

The purpose of the study was to define the bacteriological profile and antibiotic resistance patterns of a burn intensive care unit (ICU) and to compare them with the patterns from three other hospital areas in the same center (ie, cardiovascular-coronary ICU, a general ICU, and the hospital service unit). Bacterial isolates were collected prospectively from the burned patients and the patients from the other hospital areas between May 2001 and November 2003. In the burn ICU, Pseudomonas aeruginosa was the isolated pathogen most frequently (40.4%), followed by Staphylococcus aureus (29.3%) and Acinetobacter spp. (9.8%). S. aureus was the most common isolated pathogen in other hospital areas. The agents that were most effective against P. aeruginosa in the burn ICU were piperacillin/tazobactam and sulbactam/cefoperazon. We observed higher antimicrobial resistance in burn ICU than in the other hospital areas studied. In conclusion, bacteriological profile and antibiotic resistance patterns of patients in the burn ICU are significantly different from those in other ICUs and hospital units at our center. This knowledge is crucial for early treatment of infections in burned patients.     

Validity and reliability of the Motion Sensitivity Test

The Motion Sensitivity Test (MST) is a clinical protocol designed to measure motion-provoked dizziness during a series of 16 quick changes to head or body positions. The MST has been used as a guide for developing an exercise program for patients with motion-provoked dizziness and as a treatment outcome measure to monitor the effectiveness of vestibular rehabilitation therapy. This study determined validity, test-retest reliability, and interrater reliability of the MST. Fifteen individuals with motion-provoked dizziness and ten control individuals were tested during sessions occurring 90 min and/or 24 hr after baseline testing. The MST was found to be reliable across raters (intraclass correlation coefficient [ICC] = 0.99) and test sessions (ICC = 0.98 and 0.96). Test validity was good. The results indicated that the MST can be used reliably in clinical practice to develop exercise programs for patients with motion-provoked dizziness and to provide evidence of intervention efficacy.     

Comparison of candesartan and felodipine alone and combined in the treatment of hypertension: a single-center, double-blind, randomized, crossover trial

Background: In the past decade, many studies have indicated that the combination of low doses of different classes of antihypertensive agents may be more efficacious than monotherapy while minimizing the likelihood of dose-dependent adverse effects (AEs).Objective: The aim of this study was to determine whether combination therapy with lower doses of candesartan and a calcium antagonist, felodipine, would be more effective and tolerable in controlling mild to moderate hypertension compared with either drug used alone.Methods: In this 18-week, single-center, double-blind, crossover study, patients with mild to moderate essential hypertension were randomized to 1 of 2 treatment groups after a 2-week placebo washout period. Patients in group 1 received candesartan 16 mg once daily and patients in group 2 received felodipine 5 mg once daily, for 6 weeks. All patients then received half-dose combination therapy (candesartan 8 mg plus felodipine 2.5 mg, once daily) for 6 weeks. Finally, patients received 6 weeks of monotherapy with the alternate medication (group 1 received felodipine 5 mg once daily and group 2 received candesartan 16 mg once daily).Results: Thirty patients (18 men, 12 women; mean [SD] age, 54.0 [4.9] years; range, 39-62 years) were included in the study. During both monotherapy periods, candesartan and felodipine significantly reduced blood pressure (BP) (both P<0.001). BP further decreased with combination therapy (P<0.001 in both groups). Overall, 90.0% (27/30) of the patients achieved the target BP at the end of combination therapy. The incidence of AEs was similar with combination therapy compared with either monotherapy.Conclusions: In this study population, candesartan and felodipine had additive effects when used in combination, even at low doses, in the treatment of hypertension. Therefore, the combination of candesartan and felodipine is an effective alternative to that of candesartan and hydrochlorothiazide.     

Clinical and histologic evaluations of experimental <Emphasis Type="Italic">Acanthamoeba</Emphasis> keratitis

Amoebic keratitis, a sight-threatening, progressive corneal disease, is commonly caused by ubiquitous, pathogenic, free-living Acanthamoeba spp., which are widely distributed in the environment. We investigated clinical findings and histology of Acanthamoeba keratitis in a rat cornea model. Experimental Acanthamoeba keratitis was induced in Wistar rats by intrastromal inoculation of Acanthamoeba castellanii trophozoites. The clinic features of Acanthamoeba keratitis by day 70 are observed. All rats inoculated with Acanthamoeba developed keratitis. Histologically, the eyes displayed blood vessels, edema, and amoebae in stroma. A mixed cellular response, including neutrophils, mononuclear cells, and spindle-shaped cells, was seen. In conclusion, progressive, suppurative Acanthamoeba keratitis can be induced in the rat cornea model. This rat cornea model assists researchers who study the pathogenesis of Acanthamoeba keratitis and devise treatment for this difficult condition.     

Interdisciplinary approach to treating a patient with amelogenesis imperfecta: a clinical report

Treatment of a patient with amelogenesis imperfecta (AI) presents a real problem from both functional and esthetic points of view. An esthetic result also will result in an improvement in the patient's quality of life. This clinical report illustrates the oral rehabilitation of a 24-year-old man diagnosed with hypomature type of AI. The aim of treatment was to both restore esthetics and improve masticatory function. Esthetic expectations of the patient were successfully attained by placing all-porcelain crowns from canine to canine in each arch, 12 crowns total. Moreover, metal-ceramic three-unit fixed partial dentures for the missing mandibular right first molars were fabricated for the patient's masticatory function. Resin composite restorations were applied to the maxillary premolars, the maxillary right first molar, the mandibular left premolars, and the right first premolar to modify the occlusion. No deterioration in the restorations and no pathology associated with the rehabilitation were found at the 1-year recall, and the patient's esthetic and functional expectations were satisfied. CLINICAL SIGNIFICANCE This article provides an overview of an interdisciplinary approach to treating the difficult condition of AI using a combination of treatments to achieve optimal esthetics and function.     

Restoration of an anterior edentulous space with a unique glass fiber-reinforced composite removable partial denture: a case report

The loss of anterior teeth can be hurtful to the patient both psychologically and socially. In adolescent patients, temporary replacement of the teeth can minimize these concerns. Many approaches have been described for this temporary replacement. This article presents an alternative approach for the oral rehabilitation of the preadolescent male who has edentulous space including sutura palatina media in the anterior maxilla. High expectations regarding esthetics by the patient were successfully met by utilizing a glass fiber-reinforced composite temporary removable partial denture. The restorations remained intact, with no discoloration or deterioration at the 16-month recall. CLINICAL SIGNIFICANCE: As growth and development of the jaws continue in the preadolescent patient, a glass fiber- reinforced composite temporary removable partial denture can be an esthetic and conservative option for replacement of missing anterior teeth.     

The effects of hyperbaric oxygen treatment on oxidant and antioxidants levels during liver regeneration in rats

The effects of hyperbaric oxygen (HBO) therapy on oxidant/antioxidant metabolism are controversial and its effects on hepatic regeneration are not known. In this study, we investigated a possible beneficial effect of HBO therapy on oxidant and antioxidants levels during liver regeneration. To conduct this study, seventy percent hepatectomy was performed on forty-eight Spraggue-Dawley rats and the rats were divided into two equal groups: HBO-treated group and untreated group (non-HBO group). We determined the levels of malondialdehyde (MDA), an oxidative stress marker, and the levels of antioxidant enzymes/reagents, including glutathione (GSH), superoxide dismutase (SOD) activity, copper (Cu) and zinc (Zn), in the remnant liver samples. We also measured mitotic index (MI) and proliferating cell nuclear antigen (PCNA) levels to assess the degree of liver regeneration. HBO treatment significantly decreased MDA levels, whereas it increased SOD activity, GSH and Zn levels. In contrast, Cu levels were lower in the HBO-treated livers than the levels in the untreated remnant livers. The effect of HBO treatment may be mediated by the suppression of certain enzymes that are responsible for lipid peroxidation. In addition, HBO treatment may induce the production of antioxidant enzymes/reagents by remnant liver tissues. The HBO-treated rats maintained their body weights but the untreated rats lost body weights. HBO treatment also increased MI and PCNA levels, indicating HBO treatment enhances liver regeneration. These results indicate that HBO treatment has beneficial effects on liver regeneration by decreasing MDA and by increasing antioxidant activities. We therefore suggest that HBO therapy may be useful after liver resection.     

Monitoring of peripheral blood CD34+ cell counts on the first day of apheresis is highly predictive for efficient CD34+ cell yield.

The purpose of this study was to evaluate the correlation of preleukapheresis circulating CD 34+ cells/micro L, white blood cells (WBC), and platelet counts on the first day of apheresis with the yield of collected CD 34+ cell counts in 40 patients with hematological malignancies (n = 29) and solid tumors (n = 11). The median numbers of apheresis cycles, numbers of CD 34+ cells, peripheral blood (PB) mononuclear cells, and total nucleated cells collected were 2 (range, 1-4), 5.5 x 106/kg (range, 0.05-33.78), 2.59 x 108/kg (range, 0.04-20.68), and 7.36 x 108/kg (range, 0.15-28.08), respectively. There was a strong correlation between the number of preleukapheresis circulating CD 34+ cells/micro L and the yield of collected CD 34+ cells per kilogram (r = 0.962, p < 0.001). The threshold levels of PB C 34+ cell/micro L to obtain > or =1 x 106/kg and > or =2.5 x 106/kg CD 34+ cell in one collection were 12/micro L and 34/ micro L, respectively. Fifteen of 17 (88%) patients who had > or =34 CD 34+ cells/ micro L in the PB before collection reached the level of > or =2.5 x 106/kg in a single apheresis. Despite a low r value, WBC and platelet counts on the first day of apheresis also correlated with the yield of collected daily CD 34+ cells per kilogram (r = 0.482, p < 0.01 and r = 0.496 p < 0.01, respectively). These data suggest that preleukapheresis circulating CD 34+ cells/ micro L correlated significantly better with the yield of collected CD 34+ cells than WBC and platelet counts on the first day of apheresis. Using a value of 34/micro L preleukapheresis circulating CD 34+ cells as a guide for the timing of peripheral blood stem cells collections can be time saving and cost-effective.