Absorption, Metabolism, and Excretion of N,N-Diethyl-m-toluamide Following Dermal Application to Human Volunteers

The absorption, metabolism, and excretion of N,N-diethyl-m-toluamide(DEET) in male human volunteers following dermal applicationof |¹⁴C|DEET was studied. DEET was applied to two groups ofsix volunteers either as the undiluted technical grade materialor as a 15% solution in ethanol. The material was applied overa 4 x 6-cm area on the volar surface of the forearm and wasleft in contact with the skin for 8 hr, then rinsed off theskin. Application sites also were tape stripped at 1, 23, and45 hr after rinsing. Serial blood samples and all urine andfeces were collected for 5 days after application. Aliquotsof these materials were analyzed for total radioactivity inorder to define absorption and excretion patterns. Urine samplesalso were analyzed by HPLC to characterize the metabolic profileand/or to identify metabolites. Absorption of DEET as evidencedby plasma radioactivity occurred within 2 hr after dose application.Elimination of radioactivity from plasma was rapid and quantifiablelevels of radioactivity were observed in plasma for only 4 hrafter the end of the 8-hr exposure period. Urine was the principalroute of excretion of radioactivity and accounted for an averageof 5.61 and 8.33/ of the applied dose in the undiluted DEETand 15/ DEET in ethanol groups, respectively. Excretion of radioactivityin the feces was less than 0.08/ of the applied dose in bothgroups. DEET did not accumulate in the superficial layers ofthe skin as evidenced by low amounts of radioactivity in thetape strippings. The major fraction of the applied radioactivitywas recovered in the skin rinses. Absorbed DEET was completelymetabolized and six major metabolites were observed in urine.Two major urinary metabolites tenta tively were identified.Based upon the percentage of applied dose recovered in the excreta,dermal absorption of DEET ranged from 3 to 8% with a mean of5.6/ in the volunteers applied undiluted technical grade DEET.The corresponding values for the volunteers applied 15/ DEETin ethanol were 4 to 14/ and 8.4/, respectively.     

Study of T cell subsets in patients with cutaneous leishmaniasis

Summary The proportion of T lymphocyte populations was assessed using monoclonal antibodies (OKT 3, OKT 4, OKT 8) and spontaneous E-rosette tests with SRBC (for total and active TE cells) in 36 patients with cutaneous leishmaniasis subdivided according to the clinical variety. The T cell profile was normal in patients with simple cutaneous leishmaniasis of early ulcerative type whereas active TE cells and OKT 4 positive cells were reduced in some cases of late ulcerative type. A significant reduction of active TE cells and of OKT 4 positive cells (helper/inducerphenotype) and increase of OKT 8 positive cells (suppressor/ cytotoxic phenotype) was observed in peripheral blood of all patients with persistent active lesions and leishmaniasis recidivans. In patients with highly ulcerated persistent lesions a low proportion of active TE cells was also demonstrated in cellular extracts from dermal tissue. The results support the data obtained in experimental leishmaniasis that lack of helper/inducer cells and generation of suppressor T cells may be responsible for the development of chronic leishmaniasis.     

COMBINATION TAPING TECHNIQUE VERSUS ANKLE FOOT ORTHOSIS ON IMPROVING GAIT PARAMETERS IN SPASTIC CEREBRAL PALSY: A CONTROLLED RANDOMIZED STUDY

BackgroundOne of the important goals in the treatment of spastic cerebral palsy is to maintain efficient and effective walking in order to be independent in activities and participate in society.ObjectiveTo compare the efficacy of foot combination taping of kinesio tape and athletic tape vs ankle foot orthosis in correcting spatiotemporal gait parameters in children with spastic diplegia.MethodsThirty-six children with spastic diplegia were randomly assigned into 3 groups; control, combination taping, and ankle foot orthosis groups. Children in the control group, in addition to those in both experimental groups, continued with conventional physical therapy, 1 h, 3 times per week for 4 weeks. Spatiotemporal gait parameters were assessed with the GAITRite system before and after the application of interventions.ResultsThere were significant increases in walking velocity, step length, stride length, right single support duration, and left single support duration of the ankle foot orthosis and combination taping groups compared with pre-intervention values. Moreover, the post-intervention values of the double support duration of the ankle foot orthosis and combination taping groups were significantly lower than pre-intervention values. There were no significant differences between the post-intervention values of the ankle foot orthosis and combination taping groups for all parameters.ConclusionThe results demonstrated that combination taping is an effective alternative technique to ankle foot orthosis to improve spatiotemporal parameters in children with spastic diplegic in combination with conventional physiotherapy.LAY ABSTRACTChildren with cerebral palsy have abnormal patterns of walking secondary to spasticity, which can negatively affect their functional abilities and quality of life. Several therapeutic interventions are used, with the aim of improving gait quality in those children so that they become independent in functional activities and can participate in society. This study compared the effectiveness of ankle bracing with the application of a combination taping on gait parameters. The results showed that both interventions are equally effective. Combination taping might be considered a promising alterative to ankle joint bracing, as it is a more functional and less aggressive technique.Key words: combination taping, ankle foot orthosis, gait parameters, cerebral palsy

Cerebral palsy (CP) is a lifelong motor impairment caused by an early brain injury. Depending on the dominant neurological signs of children with CP, the condition is classified as spastic, ataxic, athetoid, or flaccid (1). More than 70% of children with CP are spastic (2). Gait in children with spastic CP is frequently associated with abnormal gait kinematics, linked to increased walking energy cost, which may lead to activity limitations (3).Plantar flexion in the ankle at the beginning of standing and in all phases of walking is one1 of the most common dynamic musculoskeletal deformities in children with spastic CP, which could be accompanied by additional abnormal joint positions of the lower extremities (4). The ability to maintain proper joint alignment of the lower extremity, and monitor the position of the foot while standing and walking, are critical prerequisites for gait in children with CP (5).Lower extremity orthosis, such as ankle foot orthosis (AFO) is widely recommended in children with spastic CP to prevent the progression of the deformity and to improve the child’s gait efficiency (6). The solid AFO maximizes control by restricting both plantarflexion and dorsiflexion movements in the stance and swing phases. Its rigid structure prevents ankle rocker function and reduces excessive plantarflexion during the stance phase, thus facilitating clearance of the toes during the swing phase (7). The benefits of wearing an AFO on gait parameters in children with spastic CP have already been documented in the literature (8).Athletic and Kinesio tapes are the 2 most common types of tape used in clinical settings. Both can be used on patients with orthopaedic or neurological dysfunctions. Athletic tape is a rigid/inelastic tape that restricts movement, while Kinesio tape is a form of flexible/elastic tape. Researchers have used them for similar purposes, such as spasticity control, muscle function facilitation, and joint stabilization (9). Furthermore, studies suggest that rigid tape is more effective than elastic tape at controlling joint mobility (10).The use of Kinesio taping in paediatric rehabilitation has become increasingly popular in recent years. Recent systematic reviews reported moderate evidence that Kinesiology taping is a valuable complement to physiotherapy treatment in better-performing children with CP (11, 12). Combination taping is a technique first introduced by Kenzo et al. (13), in which Kinesio tape is combined with rigid athletic tape to maximize the treatment benefits. This approach remains briefly addressed in the literature with no prior studies has examined the effects of combination tapings of Kinesio tape and athletic tape in the CP paediatric population. Hence, this study was conducted to compare the effectiveness of foot combined taping vs AFO in correcting spatiotemporal gait parameters in spastic CP children with equinus deformity.     

Regulation of blood and vascular cell function by bioactive lysophospholipids

Summary.  Lysophosphatidic acid (LPA), its sphingolipid homolog sphingosine 1-phosphate (S1P) and several other related molecules constitute a family of bioactive lipid phosphoric acids that function as receptor-active mediators with roles in cell growth, differentiation, inflammation, immunomodulation, apoptosis and development. LPA and S1P are present in physiologically relevant concentrations in the circulation. In isolated cell culture systems or animal models, these lipids exert a range of effects that suggest that S1P and LPA could play important roles in maintaining normal vascular homeostasis and in vascular injury responses. LPA and S1P act on a series of G protein-coupled receptors, and LPA may also be an endogenous regulator of PPARγ activity. In this review, we discuss potential roles for lysolipid signaling in the vasculature and mechanisms by which these bioactive lipids could contribute to cardiovascular disease.     

Richner-Hanhart syndrome (tyrosinaemia-II) (report of four cases without ocular involvement)

Four cases of tyrosinaemia with cutaneous manifestations, but without ocular involvement, are reported in a family with consanguineous parents. The tyrosine levels in the serum and in the urine were normal in both parents, while in the offsprings the tyrosine levels were elevated 7½–13 times in the serum and3–13 times in the urine. Although the serum tyrosine levels in our cases were higher than in most of the cases reported in the literature the eyes of all our patients were normal. The skin manifestations were very impressive, and varying degrees of mental retardation were present in all patients. The patients put on a low-protein diet improved considerably and have been kept symptom-free for 1½ years. The possible implication of the discrepancy between the high serum levels and lack of ocular changes is discussed. Our results suggest that the Richner-Hanhart syndrome may include more than one distinct biochemical entity.     

UVB phototherapy for psoriasis of skin type V

UVB phototherapy was used to treat 60 psoriatic patients of skin type V. The treatment was effective and doses of UVB necessary to clear patients were compared with those used in similar trials performed elsewhere on patients of skin types II, III and IV. The results indicate that the doses were similar to those obtained by other authors.     

Cold extremities and difficulties initiating sleep: evidence of co‐morbidity from a random sample of a Swiss urban population

Difficulties initiating sleep (DIS) can frequently occur in psychiatric disorders but also in the general population. The primary vasospastic syndrome is a functional disorder of vascular regulation in otherwise healthy subjects complaining of thermal discomfort from cold extremities (TDCE). Laboratory studies have shown a close relationship between long sleep onset latency and increased distal vasoconstriction in healthy young subjects. Considering these findings, the aims of the Basel Survey were to assess the prevalence rates for DIS and TDCE and to determine whether both symptoms can be associated in the general population. In a random population sample of Basel‐Stadt, 2800 subjects (age: 20–40 years) were requested to complete a questionnaire on sleep behavior and TDCE (response rate: 72.3% in women, n = 1001; 60.0% in men, n = 809). Values of DIS and TDCE were based on questionnaire‐derived scores. In addition, TDCE was externally validated in a separate group of subjects (n = 256) by finger skin temperature measurements—high TDCE values were significantly associated with low finger skin temperature. A total of 31.1% of women and 6.9% of men complain of TDCE. In contrast, prevalence rates of DIS were only slightly higher in women in comparison to men (9.3% versus 6.7%, P < 0.1). Irrespective of gender, each seventh subject complaining of TDCE had concomitant DIS and the relative risk in these subjects was approximately doubled. Therefore, a thermophysiological approach to DIS may be relevant for its differential diagnosis and its treatment.     

Association of Helicobacter pylori infection with gastroduodenal disease, epidemiologic factors and iron-deficiency anemia in Turkish children undergoing endoscopy, and impact on growth

BACKGROUND: The purpose of the present paper was to investigate the relationship between Helicobacter pylori infection and clinical symptomatology, breast-feeding and socioeconomic level. The relationship between H. pylori and iron-deficiency anemia (IDA) and the effect of H. pylori infection on growth were also investigated. METHODS: The subjects consisted of 70 patients aged 4-16 years who underwent upper gastrointestinal endoscopy for recurrent abdominal pain, nausea, vomiting, and dyspeptic complaints during a 2 year period. Patients were divided into two groups according to presence of histological evidence of H. pylori infection (group 1, H. pylori positive; group 2, H. pylori negative) and groups were compared with respect to epidemiologic characteristics, gastrointestinal complaints, height and weight SD scores and IDA. RESULTS: Thirty-five (50%) of the 70 patients participating in the study were H. pylori positive. The mean age of group 1 was significantly higher than that of group 2. There were similar characteristics and symptomatology between groups. The majority of the patients in group 1 belonged to low socioeconomic class (class I and II; P < 0.05). The number of the patients exclusively breast-fed for > or =4 months was significantly higher in group 2 than in group 1. Gastritis was significantly more frequent in group 1. Mean hemoglobin, serum Fe and ferritin levels were 11.6 +/- 1.7 g/dL, 45.0 +/- 23.2 microg/dL and 11.9 +/- 8.4 microg/dL, respectively, for group 1 and 12.2 +/- 0.7 g/dL, 79.3 +/- 26.4 microg/dL and 42.1 +/- 31.8 microg/dL, respectively, for group 2. The mean serum Fe and ferritin levels of group 2 were significantly higher than those of group 1. IDA was observed in 20 (57.1%) and six (17.1%) patients in groups 1 and 2, respectively. IDA was significantly more frequent in group 1. Helicobacter pylori infection was found to be the only variable that had significant effect on IDA. Mean SD height and weight for group 1 were lower than those of the group 2. When the patients were evaluated in four groups according to H. pylori and IDA status, mean height SD score of patients with both H. pylori infection and IDA was significantly lower than that of the patients negative for H. pylori and IDA concomitantly. CONCLUSION: Low socioeconomic status seems to be an important risk factor for H. pylori infection. Exclusive breast-feeding at least for 4 months can have a protective role against H. pylori infection. Increased frequency of growth retardation and IDA in H. pylori-infected patients in the present study supports similar findings in the literature, although there is still need for detailed studies to clarify the causative mechanisms.