Antileukotriene drugs in childhood asthma: what is their place in therapy?

Leukotriene antagonists are a new class of anti-inflammatory drugs which have shown clinical efficacy in the management of asthma. However, their role in paediatric asthma is still unclear. In essence, while there are theoretical reasons as to why leukotriene antagonists would be of use in the management of childhood asthma, there is little clinical data on their use in this patient group. Studies with leukotriene antagonists to date have been performed in children with chronic 'undertreated' asthma which, under current recommendations, should be treated with inhaled corticosteroids. Furthermore, the magnitude of effect of leukotriene antagonists on lung function (forced expiratory volume in one second of less than 5% better than placebo) and daily symptoms (0.23 puffs per day of B2 agonist less than placebo), while reaching statistical significance, is unlikely to be of clinical significance in children with chronic undertreated asthma. There is, however, good evidence for leukotriene antagonist use in exercise induced asthma in children. We conclude that although leukotriene antagonists may play an important role in the management of childhood asthma in the future, particularly as corticosteroid sparing agents and in exercise induced asthma, clinical data in paediatric asthma is poor.     

Aldrin poisoning of Sarus cranes (Grus antigone) and a few granivorous birds in Keoladeo National Park,Bharatpur, India

Between 1987–88 and 1989–90, 18 Sarus cranes (Grus antigone), more than 50 collared doves (Streptopelia decaocto) and a few blue rock pigeons (Columba livia) were found dead during winter in Keoladeo National Park, Bharatpur, which coincided with the application of aldrin in the crop fields around the Park. Brain tissue of Sarus cranes, collared doves and blue rock pigeons contained an average of 19.33 (3.56–43.46), 15.19 (7.40–20.70), and 20.42 (14.61–26.23) ppm, wet weight, of dieldrin, respectively. Dieldrin in other tissues ranged from 0.78 ppm to 92.26 ppm in Sarus cranes, 3.44 ppm to 66.17 ppm in collared doves and 16.92 ppm to 20.99 ppm in blue rock pigeons. Residues of aldrin were as high as 89.75 ppm in the gastrointestinal tract of a Sarus crane and 104.00 ppm in a collared dove. Very high residues of aldrin in the gastrointestinal tract, and dieldrin at much higher quantities in the brain than the lethal level (4–5 ppm) clearly indicate that dieldrin, after being metabolized from aldrin, was responsible for the deaths. A decline in the breeding population of Sarus cranes in Keoladeo National Park has been noticed, and is suspected to be an indication of its general population trend. The Registration Committee under the Indian Insecticide Act of 1968 has decided to include aldrin in the banned list with the ban taking effect from January 1994.     

A novel 5-HT2A receptor antagonist exhibits antidepressant-like effects in a battery of rodent behavioural assays: Approaching early-onset antidepressants

Collective evidence suggests that inhibition of neuronal 5-hydroxytryptamine type 2A (5-HT_2A) receptors contributes to the assuagement of depression-like behaviour in rodents. The present study evaluated the antidepressant-like effect of the 5-((4-benzo [α] isothiazol-3-yl) piperazin-1-yl) methyl)-6-chloroindolin-2-one (BIP-1), a compound having affinity to 5-HT_2A receptors, using a rodent behavioural test battery. Acute BIP-1 (0.25-4 mg/kg) pretreatment reduced the quipazine-induced head twitches in mice and produced antidepressant-like effects in mouse forced swim and tail suspension tests. BIP-1 reversed the depressogenic-like effects of meta-chlorophenyl piperazine and augmented the antidepressant-like effects of amitryptiline and harmane. Chronic (14 days) treatment with BIP-1 (1 and 2 mg/kg) or amitriptyline (10 mg/kg) alleviated the behavioural anomalies of olfactory bulbectomised rats in modified open field exploration, social interaction, hyperemotionality and sucrose preference paradigms. When BIP-1 treatment was combined with amitryptyline, a short duration regimen (7 days) was sufficient to reverse the bulbectomy induced anomalies. This investigation revealed that 5-HT_2A receptor antagonism is the principal mechanism behind the antidepressant-like effects of BIP-1. Finally, we propound the combination of 5-HT_2A receptor antagonists and tricyclic antidepressants as a likely strategy to achieve an early-onset of antidepressant action.     

Managing the cervical spine in multiple myeloma patients

Discuss the relevant literature on surgical and nonsurgical treatments for multiple myeloma (MM) and their complementary effects on overall treatment. Existing surgical algorithms designed for neoplasia of the spine may not suit the management of spinal myeloma. Less than a fifth of metastatic, including myelomatous lesions, occur in the cervical spine but have a poorer prognosis and surgery in this area carries a higher morbidity. With the advances of chemotherapy, early access to radiotherapy, early orthosis management, and high definition imaging, including CT and MRI, surgical indications in MM have changed. Medical decompression (or oncolysis), including in the presence of neurological deficit and orthotic stabilization, are proving viable nonsurgical options to manage MM. A key to decision making is the assessment and monitoring of biomechanical spinal stability as part of a multidisciplinary approach.