Benzamide action at α2-adrenoceptors modifies catecholamine-induced contraction and relaxation of circular smooth muscle from guinea-pig stomach

Summary Dopamine was shown to act on the circular smooth muscle of the stomach body to cause contraction at a yohimbine-sensitive site (₂) and a relaxation at a prazosin-sensitive site (₁). Metoclopramide and tiapride failed to modify either response, failed to antagonise a relaxation to phenylephrine at 1(₁ sites in the same tissue, and failed to modify the contractions caused by dopamine and phenylephrine at an ₂-adrenoceptor site in the pyloric sphincter. However, (+)- and (–)-sultopride and (+)-sulpiride antagonised the dopamine-induced contractions of the stomach body indicating an ₂-antagonist action. An ability to attenuate the relaxation of this tissue may reflect a displacement of the contraction curve to the right rather than an ₂-antagonist action since the response to phenylephrine was not antagonised either in this tissue or in the pyloric sphincter. Within the central nervous system the (–)-enantiomers of sultopride and sulpiride have a highly selective dopamine receptor blocking action. This cotrasts with the present findings in the stomach musculature of a non-stereospecific antagonism at ₂-type adrenoceptors.     

Gastrointestinal issues in children with rheumatologic disease

Distinctive arthritic patterns, some of which may parallel or even precede intestinal disease activity, are seen in inflammatory bowel disease. Some spondyloarthropathies are associated with transient ileocolic inflammation. Vasculitis frequently affects the gastrointestinal tract, predominantly manifesting with abdominal pain. In severe cases, intestinal ischemia and perforation may occur. Various arthritides are thought to be associated with other gastrointestinal diseases, such as celiac disease and hepatitis. The association between intestinal disease and arthritis is still being investigated. Interactions between the inflammatory intestinal cells and inflamed synovial cells have been demonstrated. Certain intestinal bacteria such as Klebsiella pneumoniae are suspected to play a role as triggers for the development of arthropathies. Genetic factors, especially human leukocyte antigen associations, are also being increasingly investigated for better characterization of the types of arthritis and possible prognostic implications. Various therapies, including nonsteroidal anti-inflammatory drugs, used to treat rheumatologic diseases have the potential to cause gastrointestinal complications.     

Complications from Administration of Vasopressors Through Peripheral Venous Catheters: An Observational Study

Background

The placement of a central venous catheter for the administration of vasopressors is still recommended and required by many institutions because of concern about complications associated with peripheral administration of vasopressors.

Endocarditis due to Coxiella burnetti despite the absence of obvious exposure

Q?fever is an ubiquitous zoonotic disease caused by Coxiella burnetti, an intracellular Gram negative bacteria. It may present as an acute or a chronic disease course. Endocarditis due to Coxiella burnetti represents 1 to 5% of all infectious endocarditis. We report a 41-year-old man without obvious exposure history, who presented with a Q fever endocarditis.     

Urinary low-molecular-weight protein excretion in pediatric idiopathic nephrotic syndrome

Background

Minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) are the most common causes of idiopathic nephrotic syndrome (INS). We have evaluated the reliability of urinary neutrophil-gelatinase-associated lipocalin (uNGAL), urinary alpha1-microglobulin (uα1M) and urinary N-acetyl-beta-D-glucosaminidase (uβNAG) as markers for differentiating MCD from FSGS. We have also evaluated whether these proteins are associated to INS relapses or to glomerular filtration rate (GFR).

Methods

The patient cohort comprised 35 children with MCD and nine with FSGS; 19 healthy age-matched children were included in the study as controls. Of the 35 patients, 28 were in remission (21 MCD, 7 FSGS) and 16 were in relapse (14 MCD, 2 FSGS). The prognostic accuracies of these proteins were assessed by receiver operating characteristic (ROC) curve analyses.

Results

The level of uNGAL, indexed or not to urinary creatinine (uCreat), was significantly different between children with INS and healthy children (p?=?0.02), between healthy children and those with FSGS (p?=?0.007) and between children with MCD and those with FSGS (p?=?0.01). It was not significantly correlated to proteinuria or GFR levels. The ROC curve analysis showed that a cut-off value of 17 ng/mg for the uNGAL/uCreat ratio could be used to distinguish MCD from FSGS with a sensitivity of 0.77 and specificity of 0.78. uβNAG was not significantly different in patients with MCD and those with FSGS (p?=?0.86). Only uα1M, indexed or not to uCreat, was significantly (p?<?0.001) higher for patients in relapse compared to those in remission.

Conclusions

Our results indicate that in our patient cohort uNGAL was a reliable biomarker for differentiating MCD from FSGS independently of proteinuria or GFR levels.     

Serum leptin response to endogenous hyperinsulinemia in aging rats

To determine if aging is associated with altered serum leptin response to diet-induced changes in endogenous hyperinsulinemia, male Fisher 344 (F344) rats at different age groups were studied while on regular rat chow and following 10 days of experimental diets consisting of 60% of the weight as fructose or glucose. The serum leptin concentration (ng/ml) gradually increased from basal levels of 2.5+/-0.1 at age of 4 months to 3.7+/-0.1, 6.9+/-0.9, 9. 4+/-0.3 and 8.9+/-1.1 at 6, 12, 18 and 24 months of age, respectively (P<0.001). Hyperinsulinemia associated with 60% fructose diet was associated with increased serum leptin levels in 4, 12, and 24 month old rats to 5.1+/-0.8, 6.7+/-1.2, and 8.6+/-1.1, respectively (P<0.001). Feeding 60% glucose diet also was associated with increased serum leptin levels in 4, 12 and 24 month old rats to 7.6+/-0.6, 7.2+/-0.7, and 9.1+/-1.1, respectively (P<0.001). Restricting dietary intake to 60% of the calories consumed by control rats for 10 days resulted in a decrease in serum leptin to 1.0+/-0.02 in 4 month old rats and 2.5+/-0.4 in 24 month old rats (P<0.01). It is concluded that aging in F344 rats is associated with increased serum leptin concentrations. However, diet-related hyperinsulinemic effect on leptin is blunted in aging rats although leptin response to caloric restriction is maintained. The inability of aging rats to mount hyperleptinemic response to dietary changes may contribute to the age-related increase in adiposity.     

Feeding problems with the first feed in neonates with meconium-stained amniotic fluid

OBJECTIVE:

To compare the incidence of feeding problems at the first feed between neonates born with meconium-stained amniotic fluid (MSAF) and those born without MSAF.

DESIGN:

A prospective observational study conducted over a one-year period.

SETTING:

A level 2 neonatal unit.

POPULATION STUDIED:

A total of 2828 neonates were studied, including 275 neonates with MSAF. All neonates were born after more than 34 weeks of gestation, and had no birth asphyxia, hemodynamic, respiratory distress or major congenital anomalies. The neonates were offered a feed within 1 h of birth, and the incidence of early feeding problems (ie, retching, vomiting, slow feeding or poor suck) was studied.

RESULTS:

Feeding problems at the first feed developed in 55 infants (13 of 275 with MSAF and 42 of 2533 without MSAF). Feeding problems were more common in infants with MSAF (P=0.001, relative risk=2.8, 95% CI 1.45 to 5.63), regardless of the type of MSAF (thin or thick). Although fetal distress was more frequent in the MSAF group, there were no differences in the 1 and 5 min Apgar scores whether meconium was present. Maternal sedation was not found to be a contributing factor. The mechanical and chemical actions of meconium inside the stomach requires further study.

CONCLUSION:

Feeding problems at the first feed are 2.8 times more frequent in neonates born with MSAF, regardless of the consistency of the amniotic fluid. Mothers of such infants need to be informed and supported during feeding to minimize discouragement. The demands on the nursing staff must be anticipated accordingly.