Recent upsurge of tuberculosis in paediatric admissions at the University Hospital of the West Indies

These case reports describe the clinical course of eight children who were admitted to the University Hospital of the West Indies, Kingston, Jamaica, between July 2000 and November 2001 because of a diagnosis of tuberculosis. This represented an increase in the incidence of the disease in children at this institution. The purpose of this report is to make healthcare workers aware of the resurgence of tuberculosis. The diagnosis of paediatric tuberculosis is challenging and requires a high index of suspicion in the presence of suggestive clinical and laboratory findings. The diagnosis should not be limited to the immunocompromised patient, as in this report the majority of the patients were HIV negative.     

The association between personal care products and lung function

PurposeChemical exposures are important determinants of respiratory health. The objective of the present study was to determine the association between the use of personal care products, which may contain respirable components, and lung function.MethodsUsing questionnaire and spirometry data collected during the Canadian Health Measures population survey, the association was tested between 1-second forced expiratory volume (FEV_l) and forced vital capacity (FVC) expressed as a percentage of predicted, and the frequency of use of personal care products categorized as eye makeup, fragrances, hairstyle products, lipstick, and scented body products.ResultsFive thousand sixteen of the 5604 participants in the survey reported using at least one personal care product in the past 3 months. Among men and women, an interquartile increase in hairstyle products was associated with an approximate 2% decrease in both FEV₁ and FVC (P < .05). Among women, each product category was associated with a significant decrease in lung function with the largest observed effect being a 4.08% (95% confidence interval, 7.71–0.45) decrease in FVC associated with an interquartile range increase in the frequency of use of scented body products.ConclusionsThis study provides data suggesting that using personal care products may have a small adverse effect on lung function. Further research is warranted to investigate this possibility.     

Sporotrichoid lymphangitis due to group A Streptococcus.

We describe what is, to our knowledge, the first case of sporotrichoid lymphangitis caused solely by group A Streptococcus in an otherwise healthy patient. Infection with pyogenic pathogens, such as streptococci and staphylococci, as well as with the most common causes of sporotrichoid lymphangitis (i.e., Sporothrix schenkii, Nocardia brasiliensis, Mycobacterium marinum, and Leishmania species) should be considered in differential diagnosis for some patients.     

Galactogogues: medications that induce lactation.

Galactogogues are medications that aid in initiating and maintaining adequate milk production. Most exert their pharmacologic effects through interactions with dopamine receptors, resulting in increased prolactin levels and thereby augmenting milk supply. Metoclopramide remains the galactogogue of choice due to its documented record of efficacy and safety in women and infants. Domperidone crosses the blood brain barrier and into the breast milk to a lesser extent than metoclopramide, decreasing the risk of toxicity to both mother and infant possibly making it an attractive alternative. Traditional antipsychotics, sulpiride and chlorpromazine, have been evaluated, but adverse events limit their use. Human growth hormone, thyrotrophin-releasing hormone, and oxytocin have also been studied. Finally, a natural product, fenugreek, has been purported to be effective in anecdotal reports. Use of this agent may be warranted after considering risks versus benefits.     

Role of antibiotics for the prevention of cardiovascular disease

OBJECTIVE: To evaluate the data regarding the use of antibiotic therapy for the prevention of cardiovascular events. DATA SOURCES: Pertinent literature was identified through a MEDLINE search (1966-September 2001) and through other secondary literature databases and/or bibliographies of pertinent articles. DATA SYNTHESIS: Cardiovascular disease is a common cause of morbidity and mortality among the general population, with well-defined risk factors (e.g., diabetes, hypertension, hyperlipidemia, cigarette smoking, genetic predisposition). Clinical data evaluating the association between the aforementioned risk factors and the development of atherosclerosis and subsequent cardiovascular disease are substantial; however, these risk factors may only partially explain the high prevalence of cardiovascular disease. The presence of Chlamydia pneumoniae within atherosclerotic lesions has been documented and may be an additional risk factor for the development and progression of cardiovascular disease. CONCLUSIONS: The results of primary and secondary prevention trials have shown conflicting evidence with regard to the beneficial effects of antibiotic therapy to reduce cardiovascular events. Currently, the lack of certainty in published data does not support the use of antibiotics for the prevention of cardiovascular disease. Clinicians should continue to emphasize interventions proven to reduce adverse cardiovascular events such as smoking cessation, reduction of hyperlipidemia, and control of hypertension.     

Cognitive and emotional empathy in typical and impaired readers and its relationship to reading competence

Studies indicate a strong relationship between empathy and language skills, but the relationship between reading and empathy remains elusive, although a shared neural substrate (the temporoparietal junction; TPJ) has been implicated in both reading and empathy. Motivated by these observations, the purpose of the current study was to examine empathic skills in a large spectrum of reading abilities, including typical readers and individuals with dyslexia, and their relationship to reading competence. We administered the Intrapersonal Reactivity Index (IRI) test, which differentiates between two subscales of empathy (cognitive and emotional empathy), to a group of participants with dyslexia and typical readers. Results indicate that the general reading score (average z scores of all reading tests) was significantly positively correlated with empathic scores. In addition, tests of specific reading abilities—decoding, reading fluency, and reading-related measures of phonological awareness—were significantly positively correlated with empathic scores. Finally, participants with dyslexia who showed low reading abilities had significantly lower scores in total empathy and cognitive empathy, as measured by the IRI test, than did typical participants with high reading abilities. Taken together, these results indicate a strong association between reading-related skills and empathic abilities and may point to involvement of the TPJ in both empathy and reading.     

Cytokine inhibitors in the treatment of rheumatoid arthritis

Rheumatoid arthritis (RA) is an immune-mediated disease characterised by articular inflammation and subsequent tissue damage leading to severe disability and increased mortality. A variety of cytokines are produced locally in the rheumatoid joints. Numerous studies have demonstrated that IL-1 and TNF-alpha, two prototypic pro-inflammatory cytokines, play an important role in the mechanisms involved in synovial inflammation and in progressive joint destruction. Indeed, the administration of TNF-alpha and IL-1 inhibitors in patients with RA led to a dramatic improvement of clinical and biological signs of inflammation and a reduction of radiological signs of bone erosion and cartilage destruction. However, despite these encouraging results, a significant percentage of patients do not respond to these agents, suggesting that other mediators are also involved in the pathophysiology of arthritis. This review describes the results of clinical trials with TNF-alpha inhibitors and a specific IL-1 inhibitor (IL-1 receptor antagonist [IL-1Ra]). In addition, other therapeutic strategies are also discussed.     

The H2 Receptor Antagonist Nizatidine is a P-Glycoprotein Substrate: Characterization of its Intestinal Epithelial Cell Efflux Transport

The aim of this study was to elucidate the intestinal epithelial cell efflux transport processes that are involved in the intestinal transport of the H₂ receptor antagonist nizatidine. The intestinal epithelial efflux transport mechanisms of nizatidine were investigated and characterized across Caco-2 cell monolayers, in the concentration range 0.05–10 mM in both apical–basolateral (AP–BL) and BL–AP directions, and the transport constants of P-glycoprotein (P-gp) efflux activity were calculated. The concentration-dependent effects of various P-gp (verapamil, quinidine, erythromycin, ketoconazole, and cyclosporine A), multidrug resistant-associated protein 2 (MRP2; MK-571, probenecid, indomethacin, and p-aminohipuric acid), and breast cancer resistance protein (BCRP; Fumitremorgin C) inhibitors on nizatidine bidirectional transport were examined. Nizatidine exhibited 7.7-fold higher BL–AP than AP–BL Caco-2 permeability, indicative of net mucosal secretion. All P-gp inhibitors investigated displayed concentration-dependent inhibition on nizatidine secretion in both directions. The IC₅₀ of verapamil on nizatidine P-gp secretion was 1.2 × 10⁻² mM. In the absence of inhibitors, nizatidine displayed concentration-dependent secretion, with one saturable (J_max = 5.7 × 10⁻³ nmol∙cm⁻²∙s⁻¹ and K_m = 2.2 mM) and one nonsaturable component (K_d = 7 × 10⁻⁴ μL∙cm⁻²∙s⁻¹). Under complete P-gp inhibition, nizatidine exhibited linear secretory flux, with a slope similar to the nonsaturable component. V_max and K_m estimated for nizatidine P-gp-mediated secretion were 4 × 10⁻³ nmol∙cm⁻²∙s⁻¹ and 1.2 mM, respectively. No effect was obtained with the MRP2 or the BCRP inhibitors. Being a drug commonly used in pediatrics, adults, and elderly, nizatidine susceptibility to efflux transport by P-gp revealed in this paper may be of significance in its absorption, distribution, and clearance, as well as possible drug–drug interactions.Key words: BCS class III drugs, caco-2 permeability, efflux transporters, intestinal absorption, nizatidine, P-glycoprotein