Studies on dapsone induced haemolytic anaemia

The present study was undertaken on the hypothesis that methaemoglobin production and haemolytic anaemia following dapsone administration could be ascribed to an impairment of glucose-6-phosphate dehydrogenase-enzymatic activity. Analysis of the kinetic parameters of the G-6-PD (Vmax and KM) was performed in ten patients, normal with respect to G-6-PD, suffering from various dermatoses. It was concluded that haemolytic anaemia after dapsone therapy is not due to a functional impairment of the enzyme. The close relationship between dapsone dosage, methaemoglobin production and anaemia make reasonable the hypothesis that a toxic dapsone derivative (DDS-NHOH) could be responsible for the methaemoglobin formation and the haemolytic anaemia.     

Longitudinal Evaluations of Psychological Distress in Parents of Children with Malignancies

ABSTRACT. The authors evaluated the psychological distress in 41 parents of children with acute lymphocytic leukaemia or with Hodgkin's disease using the Symptom Distress Checklist (SCL-90). The subjects were tested three times: within the first few days after the child's admission to hospital and 8 months and 20 months later. The experimental population was compared with a control group of 25 subjects matched for age, sex, marital status and social class. At the first evaluation the experimental group had higher mean scores than the controls for obsession, depression, anxiety and sleep disturbances. Seventy-eight % of the subjects (65.8 % excluding the sleep disturbances (SIDi) subscale) scored moderate distress on at least one of the SCL-90 subscales. The 8 month and 20 month follow-ups confirmed the presence of high scores of psychological distress particularly in the sleep disturbances and depression subscales, with 78 % (58.4 % excluding SIDi) and 82.3 % (70 % excluding SIDi) of the subjects gaining scores of moderate distress in at least one of the subscales of the SCL-90.     

Postprandial hyperglycemia is a determinant of platelet activation in early type 2 diabetes mellitus

Summary. Background: Chronic hyperglycemia is a major contributor to in vivo platelet activation in diabetes mellitus. Objectives: To evaluate the effects of acarbose, an α‐glucosidase inhibitor, on platelet activation and its determinants in newly diagnosed type 2 diabetic patients. Methods: Forty‐eight subjects (26 males, aged 61 ± 8 years) with early type 2 diabetes (baseline hemoglobin A_1c ≤ 7% and no previous hypoglycemic treatment) were randomly assigned to acarbose up to 100 mg three times a day or placebo, and evaluated every 4 weeks for 20 weeks. The main outcome measures were urinary 11‐dehydro‐thromboxane (TX)B₂ (marker of in vivo platelet activation) and 8‐iso‐prostaglandin (PG)F_2α (marker of in vivo lipid peroxidation) excretion rate, 2‐h postprandial plasma glucose (PPG) after a test meal, and assessment of glucose fluctuations by mean amplitude of glycemic excursions (MAGE). Results: Baseline measurements revealed biochemical evidence of enhanced lipid peroxidation and platelet activation. As compared with the placebo group, patients treated with acarbose had statistically significant reductions in urinary 11‐dehydro‐TXB₂ and 8‐iso‐PGF_2α excretion rate as early as after 8 weeks and at each subsequent time point (between‐group P < 0.0001 at 12, 16 and 20 weeks), following earlier decreases in PPG and MAGE. Multiple regression analyses in the acarbose group revealed that PPG was the only significant predictor of 11‐dehydro‐TXB₂ urinary excretion rate (β = 0.39, P = 0.002) and MAGE the only predictor of 8‐iso‐PGF_2α urinary excretion rate (β = 0.42, P = 0.001). Conclusions: Postprandial hyperglycemia is associated with enhanced lipid peroxidation and platelet activation in early type 2 diabetes. A moderate decrease in PPG achieved with acarbose causes time‐dependent downregulation of these phenomena, suggesting a causal link between early metabolic abnormalities and platelet activation in this setting.     

Inhibition of in vitro growth of Plasmodium falciparum field isolates mediated by human antibodies to Pf155/RESA and Pf332

The capacity of antibodies to interfere with Plasmodium falciparum growth in in vitro cultures is considered to reflect some of their potential protective effects in vivo. Almost all previous analyses of antibody mediated inhibition of parasite growth in vitro were performed with different laboratory strains of P. falciparum. This study was performed to investigate if the long-term culturing of parasites has any effect on their susceptibility to such growth inhibition. The growth inhibitory effects of human antibodies to the vaccine candidate antigens Pf155/RESA and Pf332 on fresh field isolates from children in Burkina Faso were analysed and compared with their effect on an established laboratory strain of the parasite. Although there was variation in the inhibition titres between different isolates tested against one antibody preparation, the differences in inhibition capacity for the three different antibodies were highly significant. No correlation was found between serum levels of anti-Pf155/RESA or -Pf332 antibodies and sensitivity of the corresponding parasite isolates to antibody mediated growth inhibition.     

Incessant Ectopic Atrial Tachycardia and Sudden Death

A patient with refractory and incessant ectopic atrial tachycardia (IEAT) is reported in whom it was possible to document, during EGG (Holter) the occurrence of aborted sudden death by spontaneous ventricular fibrillation (VF). Following the second of two attempts at surgical ablation of the origin of the IEAT, the patient has been asymptomatic without antiarrhythmic drugs and in sustained sinus rhythm for 24 months. Although we cannot exclude the residual action of amiodarone and flecainide (proarrhythmia) or the residual peripartum cardiomyopathy it is probable that the observed VF was a true complication of a cardiomyopathy induced by a chronically increased heart rate (HR). Although unclear, this VF might be considered as a form of adrenergic-dependent long QT syndrome due to early afterdepolarization in the presence of predisposing myocardial conditions.     

A RANDOMIZED COMPARISON OF MIDAZOLAM AND DIAZEPAM FOR SEDATION IN UPPER GASTROINTESTINAL ENDOSCOPY

One hundred and eighty-five patients were allocated at randomto receive pethidine with diazepam (in an emulsion), or pethidinewith midazolam i.v. as sedation for upper gastrointestinal endpscopy.Sedation and conditions for examination were comparablèand satisfactory in both groups. Midazolam produced more amnmia(P= <0.001), and scored higher in patients' opinion (P= <0.001);it was associated with a slightly greater frequency of venoussequelae, but the difference in thrombophlebitis was not statisticallysignificant. Recovery of sensory - motor performance, as assessedby Trieger test, was still incomplete 2 h after endoscopy with,both drug regimens.