A possible drug interaction between rifampicin and enalapril

Summary When a 35-year-old man with essential hypertension was treated with antibiotics for brucellosis his blood pressure rose significantly. While all other treatment was kept constant rifampicin was discontinued. On rechallenge rifampicin did not alter serum concentrations of enalapril or the area under the curve (AUC) between 0 and 7 h, but it did reduce the AUC of the active metabolite enalaprilat by 31%. These observations suggest that there may be an interaction between rifampicin and enalapril, causing reduced hypotensive efficacy of enalapril. The mechanism of such an interaction merits further study, but it could be due to enhanced renal clearance of enalaprilat.     

Prevalence of Obesity and Factors Associated with it in a Worksite Setting in Malaysia

Socio-economic status, lifestyle behaviors, and psychosocial factors have been implicated in the development of overweight and obesity. This study aims to observe the prevalence of overweight and obesity in an academic worksite and to examine the possible association between variables such as socio-economic characteristics, work factors, psychosocial factors, and weight control behaviors and obesity. In this study, the target population were full-time academic and non-academic staff. Body mass index (BMI) and waist circumference (WC) were computed to determine obesity. A pretested self-administered questionnaire was used to obtain information on socio-demographic factors, work related factors, psychosocial factors, and weight control behaviors. Data were obtained on 367 adults of whom 39.2% were males and 60.8% females. Overweight was seen in 31.9% of males and 26.5% of females while 16.1% of them were obese, irrespective of gender. Central obesity was noted in about 37% of males and 39% of females. The results showed that socio-demographic factors (age, gender, and education) and psychosocial factors (perceived health status, body weight perception, and weight-control goals) were significantly associated with BMI. Working hours were also significantly associated with BMI. However, weight control practices (diet-control practices and physical activity practices) were not significantly associated with BMI. In conclusion, this study found a higher prevalence of overweight and obesity among employees of a selected public university in comparison to the general population. Socio-demographic, psychosocial factors, and working hours were found to contribute to obesity in this sample of adults.     

Intraoperative radiotherapy in colorectal cancer: Systematic review and meta-analysis of techniques,long-term outcomes,and complications

BackgroundThe precise contribution of IORT to the management of locally advanced and recurrent colorectal cancer (CRC) remains uncertain. We performed a systematic review and meta-analysis to assess the value of IORT in this setting.MethodsStudies published between 1965 and 2011 that reported outcomes after IORT for advanced or recurrent CRC were identified by an electronic literature search. Studies were assessed for methodological quality and design, and evaluated for technique of IORT delivery, oncological outcomes, and complications following IORT. Outcomes were analysed with fixed-effect and random-effect model meta-analyses and heterogeneity and publication bias examined.Results29 studies comprising 14 prospective and 15 retrospective studies met the inclusion criteria and were assessed, yielding a total of 3003 patients. The indication for IORT was locally advanced disease in 1792 patients and locally recurrent disease in 1211 patients. Despite heterogeneity in methodology and reporting practice, IORT is principally applied for the treatment of close or positive margins. When comparative studies were evaluated, a significant effect favouring improved local control (OR 0.22; 95% CI = 0.05–0.86; p = 0.03), disease free survival (HR 0.51; 95% CI = 0.31–0.85; p = 0.009), and overall survival (HR 0.33; 95% CI = 0.2–0.54; p = 0.001) was noted with no increase in total (OR 1.13; 95% CI = 0.77–1.65; p = 0.57), urologic (OR 1.35; 95% CI = 0.84–2.82; p = 0.47), or anastomotic complications (OR 0.94; 95% CI = 0.42–2.1; p = 0.98). Increased wound complications were noted after IORT (OR 1.86; 95% CI = 1.03–3.38; p = 0.049).ConclusionsDespite methodological weaknesses in the studies evaluated, our results suggest that IORT may improve oncological outcomes in advanced and recurrent CRC.     

Antioxidants: Promising neuroprotection against cardiotoxin-4b-induced cell death which triggers oxidative stress with early calpain activation

Cardiotoxin-4b (CTX-4b), isolated from Naja naja sputatrix venom, shows lethality in several cell types. Employing murine primary cortical neurons, this study was undertaken to investigate the molecular mechanisms of CTX-4b in the induction of neuronal death. CTX-4b induced a dose- and time-dependent neuronal death. Strong induction of calpains as early as 4 h post-CTX-4b 75 nM treatment was detected in neurons with negligible caspase 3 activation. For the first time in cultured murine primary cortical neurons, it was noted that CTX-4b-mediated cell death triggered oxidative stress with an increase in reactive oxygen species (ROS) levels, and that application of antioxidants showed effective attenuation of cell death. Taken together, these results indicate that CTX-4b-mediated neuronal death is associated with (i) early calpain activation and (ii) oxidative stress. Most importantly, antioxidants have proved to be a promising therapeutic avenue against CTX-4b-induced neuronal death.     

A critical evaluation of high density lipoprotein cholesterol as an index of coronary artery disease risk in Malaysians

Fasting serum specimens from (a) 217 male and 46 female patients with coronary artery disease (CAD), aged 35-75 years, who had undergone angioplasty (PTCA) / coronary artery bypass graft (CABG), and (b) 160 apparently healthy controls (106 males, 54 females, aged 30-75 years), were assessed for serum lipid profile. Both sex and ethnicity significantly influenced the levels of serum high density lipoprotein cholesterol (HDLC); in the controls, females had higher HDLC levels than males (46.7 mg/dl vs 38.5 mg/dl, p<0.00l), while the Indian males possessed significantly lower HDLC values than the male Malay or Chinese. HDLC, triglycerides (TG) and the atherogenic index- LDLC/HDLC ratio were significantly different between the CAD patients and the healthy controls, while total cholesterol (TC) and LDLC did not seem to be of diagnostic value. Serum HDLC was lower in the CAD patients compared to the healthy controls in both sexes (p<0.001), either expressed as HDLC per se or as % HDLC. This observation combined with the odds ratio (OR) values of 0.24 and 0.28 for HDLC and % HDLC respectively in males, firmly establishes HDL as a protective factor of CAD in Malaysians. Significance testing for the X2 values associated with the OR values for the various lipid indices, together with the findings on the receiver-operating characteristices (ROC) curves, i.e. plots of sensitivity vs 1-specificity, indicated that HDLC, % HDLC and TQ were equally efficient as a means of risk assessment to CAD in Malaysians.     

The modified Glasgow prognosis score predicts for overall and disease-free survival following cytoreductive surgery and HIPEC in patients with pseudomyxoma peritonei of appendiceal origin

Background

The modified Glasgow prognostic score (incorporating C-reactive protein and albumin) predicts survival in patients with gastro-intestinal tract cancer but has not been evaluated in patients with peritoneal malignancy. The aim was to evaluate the modified Glasgow score preoperatively in patients undergoing complete cytoreductive surgery (CCRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) for pseudomyxoma peritonei (PMP) of appendiceal origin.