REINVESTING HOSPITAL WASTE – A MASTER PLAN FOR DEVELOPMENT OF PATIENTS

It is a general observation that hospital stay is dull and boring. It is mainly because the patients remain unoccupied. Their time is wasted. It is more so in service hospitals where apparently trivial cases are admitted for prolonged periods. A development programme for the patients by reinvesting their own wasted seconds may generate revolutionary progress in patient care.KEY WORDS: Managing patients'' time, Patients development programme     

Pharmacodynamic and Pharmacokinetic Studies in Rats of S-8-(2-Furyl)- and R-8-Phenyl-2-(di-n-Propylamino)Tetralin,Two Novel 5-HT1A Receptor Agonists In-vitro with Different Properties In-vivo

R- and S-8-(2-Furyl)- and R- and S-8-phenyl-2-(di-n-propylamino)tetralins (R- and S-LY-55 and R- and S-LY-49, respectively), novel enantiopure dipropylaminotetralins, have been screened as 5-HT_1A receptor ligands. All had nanomolar affinities for 5-HT_1A receptors and fully inhibited forskolin-stimulated adenylyl cyclase in-vitro (i.e. the four compounds appeared to be 5-HT_1A agonists). It was also found that the enantiomers of LY-55 behaved as typical 5-HT_1A receptor agonists in rats in-vivo by inducing a typical behavioural 5-HT syndrome, hypothermia and a decrease in 5-HT synthesis and turnover, indicating effects both on postsynaptic 5-HT_1A receptors and somatodendritic 5-HT_1A autoreceptors. In contrast, R- and S-LY-49 did not cause any 5-HT_1A receptor-related effects in-vivo except for a partial inhibition of 5-HT synthesis after high doses. The 5-HT_1A receptor antagonist WAY-100635 was shown to attenuate the R-LY-49-induced inhibition of 5-HT synthesis, indicating the compound to be a weak agonist at somatodendritic 5-HT_1A autoreceptors. R-LY-49 at a high dose and with a long pre-treatment time interval inhibited the hypothermic and behavioural effects, but not the inhibition of 5-HT synthesis induced by the 5-HT_1A receptor agonist R-8-hydroxy-(dipropylamino)tetralin (R-8-OH-DPAT). Taken together, these findings seem to indicate, that R-LY-49 is a weak partial agonist at 5-HT_1A receptors. A comparative pharmacokinetic study showed that the enantiomers of LY-55 entered the brain rapidly after subcutaneous administration and reached peak brain tissue/plasma concentration ratios within 15–30 min of injection, whereas the brain concentrations of R-LY-49 increased slowly, reaching a relatively low peak brain tissue/plasma concentration ratio 90 min after injection despite their similar lipophilicity. The differences between the pharmacological activity of the two compounds in-vivo seem to be explained by their different abilities to cross the blood-brain barrier, and a weak agonistic activity of R-LY-49 on 5-HT_1A receptors, both pre- and postsynaptically, compared with S-LY-55. Further studies are, however, needed for a deeper understanding of these differences.     

COURSE OF RENAL FUNCTION IN IgA GLOMERULONEPHRITIS IN CHILDREN AND ADOLESCENTS

ABSTRACT. The pathophysiology of IgA GN was investigated in different stages of the disease. Seventeen patients who were between 3.5 and 16.5 years of age at the onset were included in the study. Clearance studies were performed repeatedly in 6 patients (in 5 of them over a period extending from the onset to 5-9.5 years) and only once in 9 patients (10-23 years after the onset). Two patients (one with uremia) were only evaluated clinically. C_In, C_PAH and U_NaV were studied during hydropenia (HP) and 3% isotonic saline volume expansion (VE). Shortly after the onset C_In, C_PAH and U_NaV were depressed. Renal function was essentially normal 1 and 2 years after the onset in spite of signs of active disease. A supernormal GFR was found in 7 patients after they had had the condition between 5 and 17 years. After a duration of IgA GN for >9 years 3 of 12 patients had developed hypertension and uremia and 2 had hypertension or labile BP. Three of 10 patients had a normal GFR and BP, but had increased natriuresis during VE. Only 2 of 10 patients were normotensive and had normal renal function. Disturbancies in the renal function are thus frequent in all stages of IgA GN and the changes seem to be related to the duration of the disease. Exaggerated natriuresis may indicate progressive disease.     

Dental health of homeless adults

As part of a community-based study, we were able to assess the number of grossly decayed and missing teeth, as well as recent use of dental services, among 529 homeless adults. We found that 27% reported having had a toothache during the previous month (only one-tenth of these individuals had sought help from a dentist for their toothache). Homeless adults, as compared with a general population, were half as likely to have made a dental visit within the preceding year (26.7% versus 55.0%) and had more grossly decayed teeth (x?= 2.3 versus = 1.4). Individuals with more tooth decay and missing teeth were more likely to be older, have physical health problems, smoke more cigarettes, use more alcohol, and have worse personal hygiene. Age, not length of homelessness, was the most important predictor variable of missing teeth. Thus, homeless adults have a higher degree of dental pathosis as well as a lower use of dental services than the general population. On the basis of these findings, more accessible dental services need to be designed for the homeless population.     

Lingual Infarction and Sudden Blindness Due to Giant Cell Arteritis

ABSTRACT. A 72-year-old woman suffered from giant cell arteritis (GCA) which developed into lingual infarction and monocular blindness. Temporary obscuration of vision and lingual symptoms such as increasing malaise, pain and intermittent claudication may precede the catastrophic results of arteritis. Emphasis is laid on early recognition and treatment of GCA.