NIFEDIPINE IN CORTICOSTEROID-DEPENDENT ASTHMA: PRELIMINARY STUDY

1. To test whether nifedipine reduces corticosteroid requirements of patients with asthma, a 16-week double-blind crossover trial comparing nifedipine with placebo was performed. 2. Eight females and seven males with corticosteroid-dependent asthma were studied, ranging in age between 20 and 65 years (mean = 45 years). 3. Results showed that in 12 of 15 patients, nifedipine caused significant reduction in corticosteroid requirements when compared with placebo (P less than 0.01). No side-effects were reported apart from mild headache and leg oedema observed in a few patients receiving nifedipine. 4. It could be concluded that nifedipine has a steroid-sparing effect in steroid-dependent asthma.     

Difficult mammographic needle localizations: use of alternate orthogonal projections

Lesions deep within the breast are occasionally visible on only one standard mammographic projection and are therefore difficult to localize preoperatively. Such abnormalities can often be visualized on two orthogonal 45 degrees oblique views. In these cases, needle localizations may be performed in a routine manner without computed tomography or stereotactic methods.     

Honey ameliorates influence of hemorrhage and food restriction on renal and hepatic functions, and hematological and biochemical variables

The objectives were to assess the effects of various diets, including total food restriction with 50% honey feeding, total food restriction with 50% dextrose feeding or adlibitum (control group) commercial regular diet, on the hematology and biochemical variables, and to assess the effects of the various diets on the influence of acute blood loss on the same parameters. Thirty Sprague-Dawley albino rats were divided into three groups, 10 rats each: group A, fed a commercial regular diet; group B, total food restriction with 50% dextrose feeding; and group C, total food restriction with 50% honey feeding. After 8 days of feeding, rats were subjected to acute blood loss (6 ml/kg) and blood investigations were performed. After acute blood loss, the same feedings were continued for a further 8 days and the blood tests were repeated at day 8 post-bleeding. Total food restriction with 50% dextrose feeding compared with commercial regular diet reduces hematological and biochemical variables. Total food restriction with 50% honey feeding compared with total food restriction with 50% dextrose feeding causes a greater reduction in fasting blood glucose, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and triacylglycerol. Acute blood loss causes elevation of white blood cells, lymphocyte percentage, fasting blood sugar, blood urea nitrogen, alkaline phosphatase and triacylglycerol, and a reduction in serum albumen, protein, cholesterol, AST, serum creatinine and hemoglobin; the results are significant (P<0.05) concerning fasting blood glucose, AST, alkaline phosphatase, serum albumin and protein. A significant reduction in fasting blood glucose, white blood cells, BUN, AST, ALT, alkaline phosphatase and triacylglycerol, and a significant elevation of hemoglobin and serum albumin are obtained after acute blood loss in rats on total food restriction with 50% honey feeding as compared with the other two groups. Total food restriction with 50% honey feeding increases serum albumin, serum protein, fasting blood glucose, and causes lower reduction in hemoglobin as compared with the other groups. Conclusively, honey feeding during total food restriction significantly modifies and ameliorates biochemical and hematological changes observed after acute blood loss. This will pave the way to use honey as part of bleeding management and during a food restriction regimen.     

Effects of topical honey on post-operative wound infections due to gram positive and gram negative bacteria following caesarean sections and hysterectomies

The possible therapeutic effect of topical crude undiluted honey in the treatment of severe acute postoperative wound infections was studied. Fifty patients having postoperative wound infections following caesarean sections or total abdominal hysterectomies with gram positive or gram negative bacterial infections were allocated in two groups. Twenty-six patients (group A) were treated with 12 hourly application of crude honey and 24 patients (group B) were treated with local antiseptics: spirit (70% Ethanol) and povidone-iodine. Both groups received systemic antibiotics according to culture and sensitivity. Results showed that eradication of bacterial infections was obtained after 6 +/- 1.9 days (mean +/- SD) in group A and after 14.8 +/- 4.2 days in group B (p <0.05). Period for antibiotics use was 6.88 +/- 1.7 days in-group A and 15.45 +/- 4. 37 in-group B (p <0.05). Complete wound healing was evident after 10. 73 +/- 2.5 days in group A and after 22.04 +/- 7.33 in group B (p <0. 05). Size of postoperative scar was 3.62 +/- 1.4 mm after using topical honey and was 8.62 +/- 3.8 mm after local antiseptics (p <0. 05). The mean hospital stay was 9.36 +/- 1.8 days in group A and 19. 91 +/- 7.35 days in group B (p <0.05). After using honey, 22/26 patients (84.4%) showed complete wound healing without wound disruption or need for re-suturing and only 4 patients showed mild dehiscence. In group B, 12/24 patients (50%) showed complete wound healing and 12 patients showed wound dehiscence, six of them needed re-suturing under general anesthesia. We concluded that topical application of crude undiluted honey could (1) faster eradication of bacterial infections, (2) reduce period of antibiotic use and hospital stay, (3) accelerate wound healing, (4) prevent wound dehiscence and need for re-suturing and (5) result in minimal scar formation.     

Sampling time and indications appropriateness for therapeutically monitored drugs at a teaching university hospital in Oman

Objective: To evaluate prospectively the appropriateness of indications, sampling time and outcome of TDM requests at a teaching university hospital in Oman. Methods: A prospective cross-sectional study was conducted over a four months period; October 2013–January 2014 at the Sultan Qaboos University Hospital (SQUH), an 855 bed university teaching hospital. Appropriateness criteria for indications and sampling time were defined a priori. The evaluated drug’s requests were for carbamazepine, phenytoin, phenobarbital, valproic acid, digoxin, gentamicin, amikacin, vancomycin, tobramycin, theophylline, lithium, and cyclosporine. Results: Of 733 evaluated TDM requisitions, the majority were for antibiotics (75.0%) followed by antiepileptics (10.5%) and cyclosporine (8.9%). Most of the requests had appropriate indication (78.2%), however, only 28.5% had appropriate sampling time. Results were applied by dosage adjustments in 65.8% of requests and some of the inappropriately sampled requests (15.3%) were used as a basis for modifying the dosage regimen. Of all the reported plasma concentrations 42.3%, 41.2%, and 16.5% were within, below and above the reference range, respectively. Conclusion: TDM service is much less than optimal in SQUH. A lot of effort needs to be carried out to improve TDM use in the developing countries as adjusting the doses on results that are based on wrong sampling time might expose patients to toxicity or therapeutic failure.     

Efalizumab for severe refractory atopic eczema: retrospective study on 11 cases

Background Efalizumab is a recombinant humanized murine monoclonal antibody against CD11a, approved for the treatment of plaque psoriasis. However, recent reports suggest that it also may be effective in the treatment of severe atopic dermatitis (AD). Objective To evaluate the clinical effect of efalizumab in AD. Methods A systematic retrospective study of the medical files of patients treated with efalizumab for AD in Danish dermatology departments. Positive outcome was defined as improvement of the disease registered in the patient's file over a period exceeding 6 months. Results Two of eleven patients had a positive outcome. Nine patients stopped treatment due to progression of AD or lack of effect. Limitations Retrospective study. Conclusions Only a minority of patients with severe AD responded to efalizumab treatment in a standard dose.     

Involvement of sinoaortic afferents in renal sympathoinhibition and vasodilation induced by acute hypernatremia

Despite the abundance of evidence that supports the important role of aortic and carotid afferents to short‐term regulation of blood pressure and detection of variation in the arterial PO₂, PCO₂ and pH, relatively little is known regarding the role of these afferents during changes in the volume and composition of extracellular compartments. The present study sought to determine the involvement of these afferents in the renal vasodilation and sympathoinhibition induced by hypertonic saline (HS) infusion. Sinoaortic‐denervated and sham male Wistar rats were anaesthetised with intravenous (i.v.) urethane (1.2 g/kg body weight (bw)) prior to the measurement of the mean arterial pressure (MAP), renal vascular conductance (RVC) and renal sympathetic nerve activity (RSNA). In the sham group, the HS infusion (3 mol/L NaCl, 1.8 mL/kg bw, i.v.) induced transient hypertension (12 ± 4 mmHg from baseline, peak at 10 min; P < 0.05), an increase in RVC (127 ± 9% and 150 ± 13% from baseline, at 20 and 60 min respectively; P < 0.05) and a decrease in RSNA (?34 ± 10% and ?29 ± 5% from baseline, at 10 and 60 min respectively; P < 0.05). In sinoaortic‐denervated rats, HS infusion promoted a sustained pressor response (30 ± 5 and 17 ± 6 mmHg of baseline values, at 10 and 30 min respectively; P < 0.05) and abolished the increase in RVC (85 ± 8% from baseline, at 10 min) and decrease in RSNA (?4 ± 3% from baseline, at 10 min). These results suggest that aortic and carotid afferents are involved in cardiovascular and renal sympathoinhibition responses induced by acute hypernatremia.