Clinical and laboratory characteristics of infectious mononucleosis by Epstein-Barr virus in Mexican children

Background

Infectious mononucleosis (IM) or Mononucleosis syndrome is caused by an acute infection of Epstein-Barr virus. In Latin American countries, there are little information pertaining to the clinical manifestations and complications of this disease. For this reason, the purpose of this work was to describe the clinical and laboratory characteristics of infection by Epstein-Barr virus in Mexican children with infectious mononucleosis.

Methods

A descriptive study was carried out by reviewing the clinical files of patients less than 18 years old with clinical and serological diagnosis of IM by Epstein-Barr virus from November, 1970 to July, 2011 in a third level pediatric hospital in Mexico City.

Results

One hundred and sixty three cases of IM were found. The most frequent clinical signs were lymphadenopathy (89.5%), fever (79.7%), general body pain (69.3%), pharyngitis (55.2%), hepatomegaly (47.2%). The laboratory findings were lymphocytosis (41.7%), atypic lymphocytes (24.5%), and increased transaminases (30.9%), there were no rupture of the spleen and no deaths among the 163 cases.

Conclusions

Our results revealed that IM appeared in earlier ages compared with that reported in industrialized countries, where adolescents are the most affected group. Also, the order and frequency of the clinical manifestations were different in our country than in industrialized ones.

Experimental models of developmental hypothyroidism

Hypothyroidism is a systemic disease resulting from either thyroid gland's anatomical and functional absence or lack of hypophyseal stimulation, both of which can lead to deficiency in thyroid hormone (TH) production. TH is essential for human and animal development, growth, and function of multiple organs. Children with deficient TH can develop alterations in central nervous system (CNS), striated muscle, bone tissue, liver, bone marrow, and cardiorespiratory system. Among the clinical outlook are signs like breathing difficulty, cardiac insufficiency, dysphagia, and repeated bronchial aspiration, constipation, muscle weakness, cognitive alterations, cochlear dysfunction, reduced height, defects in temperature regulation, anaemia, jaundice, susceptibility to infection, and others. Experimental and clinical studies have shown that TH is very essential for normal brain development. Other research work based on mice pointed out that a reduced level of TH in pregnant mother leads to congenital hypothyroidism in animal models and it is associated with mental retardation, deep neurologic deficiency that impacts on cognitive, learning, and memory functions. The principal experimental model studies that have focused on hypothyroidism are reviewed in this study. This is important on considering the fact that almost all animal species require thyroid hormones for their metabolism.

The administration of food supplemented with cocoa powder during nutritional recovery reduces damage caused by oxidative stress in rat brain

Malnutrition contributes to the development of oxidative damage in the central nervous system. The selective administration of nutrients tends to show positive results in individuals who have suffered from malnutrition. To determine the effect of the administration of cocoa powder on the peroxidation of lipids and glutathione level during the nutritional recovery in brain, rats of 21 days old were subjected to a protocol that resembles malnutrition (MN) by feeding them with 60% of the daily food consumption of the control group (WN) and later to nutritional recovery with regular rodent feed (RFR) or added with cocoa (10 g of cocoa powder/kg of regular rodent feed) (CCR). Animals fed with regular rodent food showed significant reduction in brain glutathione: RFR (84.18 ± 6.38 ng/mg protein) vs. CCR (210.61 ± 50.10 ng/mg protein) and WN (186.55 ± 33.18 ng/mg protein), but with similar level to that of MN (92.12 ± 15.60 ng/mg protein). On the contrary, lipid peroxidation in RFR-fed animals increased RFR (1.32 ± 0.2 μM malondialdehyde/g of tissue), CCR (0.86 ± 0.07 μM malondialdehyde/g of tissue), WN (0.89 ± 0.09 μM malondialdehyde/g of tissue), but their thiobarbituric acid reactive substances concentration is similar to that of MN group (1.50 ± 0.2 μM malondialdehyde/g of tissue). Consumption of cocoa powder as a source of antioxidants favors the restoration of the concentration of glutathione and reduces the damage caused by oxidative stress during nutritional recovery in rat brain.

Effect of prostaglandin E1 (PGE1) and sildenafil on serotonin metabolism and some oxidative damage markers in rat prostate gland and brain

The aim of this study was to evaluate the effect of sildenafil and prostaglandin E1 (PGE1) (drugs used in erectile dysfunction) on production of free radicals in prostate and brain of rat. A single dose of sildenafil (10 mg kg(-1) ) and PGE1 (20 μg kg(-1) ) was given to Sprague-Dawley rats (300 g weight) intraperitoneally. The levels of testosterone were measured in blood. Their brains and prostate glands were separated to measure lipid peroxidation, Na(+) and K(+) ATPase activity, reduced glutathione (GSH) and serotonin levels, by means of validated methods. The levels of testosterone increased slightly in animals treated with sildenafil and PGE1. The activity of total ATPase was increased in the prostate of animals treated with sildenafil + PGE1 but decreased in those that received sildenafil alone. PGE1 caused significant diminution of GSH levels in both organs. Sildenafil increased the levels of serotonine in brain, whereas in prostate they decreased instead. Our results suggest that sildenafil induced changes in GSH levels as well as in the serotonergic metabolism, alone or with PGE1 in prostate and brain, respectively. Thus, the combination therapy may be ideal to sustain the biochemical balance due to biphasic stimulation on brain and prostate.

Effect of oseltamivir on catecholamines and select oxidative stress markers in the presence of oligoelements in the rat brain

The effect that osteltamivir has on the metabolism of catecholamines and oxidative damage in the brains of young patients remains unclear. The purpose of this study was to measure the effects of oseltamivir, in the presence of oligoelements, on biogenic amines and select oxidative biomarkers in the brains of uninfected, young rats under normal conditions. The study was conducted using male Wistar rats intraperitoneally treated for three days with either a control dose of 0.9 % NaCl, oseltamivir (50 mg/kg), oligoelements (50 μL/rat), or oseltamivir (50 mg/kg) and oligoelements (50 μL/rat). The brain tissue extracted from the treated rats was used to determine the concentrations of adrenaline, noradrenaline, and dopamine, as well as the levels of GSH, lipid peroxidation, and ATPase activity. An increase in the concentration of adrenaline and noradrenaline and in the level of GSH in the group treated with oligoelements (p < 0.001) was observed, while the group treated with oseltamivir and oligoelements, the levels of dopamine increased (p < 0.001), and in the groups treated with oligoelements alone or combination with oseltamivir a decrease in lipid peroxidation was observed (p < 0.001). The results of this study suggest that the consumption of oseltamivir and oligoelements induce biphasic changes in the metabolism of catecholamines; thereby, inducing a protective mechanism against oxidative damage in the brains of young rats.

Levels of 5-hydroxyindol acetic acid and lipid peroxidation in brain after administration of marijuana and nalbuphine in male and female rat

We analyzed the effect of marijuana and nalbuphine on levels of 5-hydroxyindol acetic acid and lipid peroxidation in rat brain. Single and repeated dosages of 250 mg/kg marijuana extract or 10 mg/kg nalbuphine were administered to male and female Wistar rats. Animals were sacrificed and brains were obtained to measure the content of 5-hydroxyindol acetic acid, reduced glutathione, thiobarbituric acid reactive substances, total ATPase and Na+/K+ ATPase activities. There was an increase in thiobarbituric acid reactive substances, total ATPase and Na+/K+ ATPase activity in the animals that received a single dose of marijuana and nalbuphine (p=0.001), with a notable decrease in glutathione and 5-hydroxyindol acetic acid levels (p=0.001). Both marijuana and nalbuphine increased levels of oxidative damage biomarkers in rat brain and decreased glutathione and 5-hydroxyindol acetic acid levels which could provoke changes in cellular and biochemical regulations and serotonergic activity in either male or female rats.

Comparative bioavailability of propafenone after administration of a magistral suspension vs. commercial tablets in healthy volunteers

Propafenone (CAS 34183-22-7) is an effective antiarrhythmic drug used in children, although in some countries no specific pediatric formulation is available. The aim of this study is to compare the relative bioavailability of a magistral (MAG) preparation of propafenone versus its commercial (COM) presentation in a group of 16 Mexican healthy volunteers. Bioavailability was determined after crossover administration of the drugs, through a randomized two-phase trial. All volunteers had normal hepatic and renal functions, determined clinically at the beginning of the study, and received 150 mg of either COM (tablets) or MAG (suspension). Blood samples were drawn for a 24-h post-dose analysis by HPLC to measure plasma levels of propafenone. Subjects (mean 25.9 +/- 5.3 years and 66.1 +/- 12.4 kg) had the following pharmacokinetic parameters: Cmax 189.9 +/- 20.92 ng/mL, Tmax 1.5 h, AUC 322.4 +/- 36.28 ng x ml(-1) x h for COM. Values for MAG were Cmax 225.8 +/- 24.38 ng/mL, Tmax 1.7 h and AUC 359.3 +/- 27.90 ng x ml(-1) x h. These values yielded a relative bioavailability of 111.42% for MAG compared with COM. No electrocardiographic changes were recorded in any subject with respect to the baseline value, in both treatment schemes. Therefore, propafenone suspension prepared as a magistral formulation may be used as an alternative drug in pediatric patients.

Effect of sibutramine on Na+, K+ ATPase activity and tryptophan levels on male and female rat brain

Some drugs that are clinically used in weight control, like sibutramine, act on the serotonergic metabolism, but its relation with free radical (FR) production in the CNS is still unknown. The aim of the work was to evaluate the effect of sibutramine on FR production. Female and male Wistar rats (250 g weight) were used; the animals received sibutramine (10 mg/kg each 36 hours) intraperitoneally during 15 days. At the end of the study, the rats were sacrificed and their brains used to measure lipid peroxidation (TBARS), Na+, K+ ATPase activity, reduced glutathione (GSH), and tryptophan (TRP) levels, by means of validated methods. The activity of Na+, K+ATPase and total ATPase was increased in males and decreased in females. GSH concentration was increased and the levels of TBARS decreased by an effect related to sibutramine in the female group. Sibutramine decreased TRP concentration in the female group, but increased it in the male one, with respect to the control group. Our results suggest that sibutramine produce an antioxidant effect stimulated by the endogenously produced tryptophan and it protects the fluidity of plasma membrane in rat brain.

Double blind study of placebo and ribavirin as prophylaxis in cases of contact with varicella in children

The aim of this study was to determine whether or not ribavirin provides protection against varicella in those who come in contact with the virus. In a double blind placebo study, ribavirin (20 mg/kg/day, p.o.) or placebo was administered to children who had contact with varicella. Treatment was administered to 61 children (Group 1) within the first 3 days of contact, 45 of them were immunocompetent and 16 were immunodepressed. Treatment was given to 54 children on the 7th day after contact (Group 2); 48 of them were immunocompetent and 6 immunodepressed. In group 1, 11 (50%) of the immunocompetent treated with ribavirin developed chicken pox while 11 (50%) were asymptomatic. For seroconversion, there was no significant difference (p=0.586). In group 2, we did not find varicella in immunocompetent patients receiving ribavirin (0/24), for placebo there were 2 (2/24) cases of varicella. Varicella was not observed in immunodepressed patients in Group 2. A difference was not observed with the administration of ribavirin at day 3 or 7 versus placebo to prevent development of varicella. This study may have implications for the public health efforts in the prophylaxis of chicken pox.

Extemporaneous suspension of propafenone: attending lack of pediatric formulations in Mexico

BACKGROUND

Physicians have frequently encountered difficulties when prescribing drugs not available in doses suitable for pediatric age groups. Furthermore, children have difficulty swallowing tablets. This study aimed to determine the stability of an oral propafenone suspension made from commercial tablets with a syrup vehicle and to establish its reliable use with children.

METHODS

An extemporaneous suspension of propafenone 1.5 mg/ml was prepared with commercial tablets. Its physicochemical and microbiologic stability was established by constant monitoring during 90 days at room temperature (15 +/- 5 degrees C) and at refrigeration (3-5 degrees C). Plasma levels of propafenona were measured in two children with supraventricular tachycardia at steady state.

RESULTS

The suspension was stable, maintaining its original physicochemical and microbiologic properties. Moreover, no apparent changes in color or odor were observed. Plasma levels of propafenone in patients demonstrated therapeutic concentrations after they had taken the suspension, with no unwanted outcome.

CONCLUSIONS

The conservation of both physicochemical and microbiologic stability of the suspension represents an option for the administration of propafenone to children.

Levels of glutathione and some biogenic amines in the human brain putamen after traumatic death

Mexico City is among the world's largest metropolitan city centers and one of the most difficult and challenging cities in which to drive a motor vehicle. During peak transit hours and maximum congestion, numerous accidents occur, many of them fatal. The aim of the study presented here was to analyze the levels of select indicators against oxidative stress and levels of biogenic amines as a consequence of accident or altercation and fear deaths. Eighteen cases were studied (sixteen males, two females). Subjects ranged from twelve to eighty-one years of age. Nine of the deaths studied were the result of motor vehicle or subway accidents. Eight of the eighteen deaths were the result of a violent altercation, while one of the deaths resulted from a drug overdose and cardiac arrest. Biopsies of cadaver putamen were homogenized and analyzed for Tryptophan (Trp), 5-hydroxyindole acetic acid (5-HIAA), Dopamine (DA), and Glutathione (GSH) levels by fluorometric methods. Trp, 5-HIAA, DA, and GSH levels showed an increase in the subjects who's death was caused by violent altercation combined with fear, while DA levels showed significant differences in all accident groups. This data suggest that biogenic amines in cadaver putamen tissue, such as DA, can be telling biochemical markers, indicative of altercation and fear deaths.

Assessment of Antioxidant Effect of 2,5-Dihydroxybenzoic Acid and Vitamin A in Brains of Rats with Induced Hyperoxia

The aim of this study was to evaluate the effect of 2,5-dihydroxybenzoic acid, a salicylate derived from Acetyl salicylic acid (ASA) and vitamin A (vit A) on Na(+), K(+) ATPase enzyme and GSH levels in brain of rats exposed to hyperoxia (Hyp) as oxidant protocol. Rats were treated as follow: group I (control), group II (Hyp), group III (Hyp, ASA), group IV (vit A), group V (Hyp, vit A), group VI (Hyp, vit A, ASA). Vit A was given 5 days before and during Hyp, aspirin at the end of Hyp. Na(+),K(+) ATPase and total ATPase activity was significantly increased in group V. Levels of GSH showed a significant increase in group III, besides, levels of 2,5-dihydroxybenzoic acid as salicylate in plasma were significantly increased in group II. These results elucidate differences in the biochemical response of animal towards intake of various types of antioxidant substances, with increased GSH and salicylate in hyperoxia.

Effect of Nutritional Status and Ozone Exposure on Some Biomarkers of Oxidative Stress in Rat Brain Regions

The aim of this study was to analyze the effect of nutritional condition and simulated exposure to ozone on Glutathione (GSH), the activity of Na+/K+ ATPase and lipid peroxidation in rat brain. Male Wistar rats were fed with 7% and 23% protein diets. Two groups were formed for each nutritional condition: one group was exposed for 15 successive days to 0.75 ppm of ozone and the other to air. Subsequently, the brain was dissected in cortex, hemispheres, cerebellum, and brainstem to measure the activity of thiobarbituric acid reactive substances (TBARS), ATPase, and levels of GSH. The activity of Na+/K+ ATPase increased in cerebellum of well-nourished rats exposed to ozone, while total ATPase and TBARS decreased in all studied areas in the malnourished groups. The levels of GSH decreased significantly (P < 0.05) in the brain of rats fed with 7% of protein diet and exposed to ozone but increased in rats fed with normal diet and exposed to ozone. These results suggest that malnutrition causes alterations in the values of Na+/K+ ATPase, total ATPase, GSH, and lipid peroxidation, while ozone contributes to these modifications. As a consequence, both variables are involved in oxidative stress in the rat brain.

Assessment of Oxidative Damage Induced by Acute Doses of Morphine Sulfate in Postnatal and Adult Rat Brain

The aim of the present study is to evaluate the oxidative damage in rats of different ages. Weaned rats of 25 g and adults of 300 g were used in groups of 6, a single i.p. dose of morphine sulfate of 3, 6 or 12 mg/kg was administered. All animals were sacrificed to measure GSH and 5-HT levels in brain by liquid chromatography, as well as Na(+), K(+)-ATPase and total ATPase enzymatic activity. 5-HT levels decreased significantly (p < 0.05) in adult animals that received 3 and 6 mg morphine. Na(+), K(+)-ATPase activity increased significantly (p < 0.05) in all groups of weaned animals. In adult animals, Na(+), K(+)-ATPase and total ATPase partially diminished. GSH levels diminished significantly (p < 0.05) both in weaned and in adult groups. The results indicate age-induced changes in cellular regulation and biochemical responses to oxidative stress induced by morphine.

Bioavailability of an extemporaneous suspension of propafenone made from tablets

Propafenone is an effective antiarrhythmic agent used in children, while in Mexico no specific formulation for children is available, which causes errors in adequate dosage. The aim of this study was to determine the bioavailability of a suspension prepared extemporaneously using commercial tablets of propafenone. The bioavailability was determined in two groups of rabbits (n = 8): the first group received a single intravenous dose of 2 mg/kg of propafenone; the second was orally administered an extemporaneous suspension of propafenone prepared from commercial tablets. Blood samples were drawn at several times during the next 24 h and analysed by HPLC to determine drug levels. The extemporaneous suspension was tested previously with satisfactory results regarding physicochemical and microbiologic stability. The area under the curve (AUC) for the i.v. route was 5600.6 ng/ml.h and for oral administration the AUC was 3327.6 ng/ml.h. The bioavailability was calculated at 59.41%. These results are consistent with previous reports for solid dosage forms. The propafenone suspension prepared extemporaneously using commercial tablets is bioavailable using an animal model; nevertheless, it is necessary to carry out human studies either in volunteers or in patients to confirm these results.

Effect of testosterone and steroids homologues on indolamines and lipid peroxidation in rat brain

The purpose of the present study was to evaluate the effect of 4-pregnen-17-hydroxy-3-one (A) and two steroids homologues: 3beta-acetoxy-5,16-pregnadien-20-one (B) and 3beta-acetoxy-16alpha-17alpha-epoxy-4-pregnen-20-one (C). Male Wistar rats were treated with o-cresol combined (A, B or C) steroids. Lipid peroxidation status as result of measurement reactive substances to thiobarbituric acid (TBARS) as well as serotonin (5-HT) and its precursor 5-hydroxytryptophan (5-HTP) were measured. The prostate glands were weighed, the 5alpha-reductase activity was determined. The animals treated with A, B, and C steroids showed a slight increase in both 5alpha-reductase activity and prostate size. 5-HT and 5-HTP levels did not change significantly, and TBARS showed an increase in the group treated with B steroid and a decrease in the A steroid group with significant differences in both groups (p<0.05) versus control group. Results suggest that A steroid reduces TBARS in rat brain, perhaps as a result of the interaction between the testosterone unsaturated carbons and OH(-) groups with free radicals.

Effect of nutritional status and ozone exposure on Na+/K+ ATPpase and lipid peroxidation in rat brain

The aim of this study was to analyze the effect of nutritional status and exposure to ozone on the activity of Na+/K+ ATPase and lipid peroxidation in rat brain. Male Wistar rats were fed 7% and 23% protein diets. Two groups were formed for each nutritional status: one group was exposed for 15 successive days to 0.75 ppm of ozone in air and the other was exposed to air. Subsequently, the brain was dissected and cortex, hemispheres, cerebellum and brainstem separately homogenized to measure the activity of thiobarbituric acid reactive substances (TBARS) and ATPase in the presence and absence of ouabain. The activity of Na+/K+ ATPase increased in cerebellum of well-nourished rats exposed to ozone, while total ATPase and TBARS decreased in all studied areas in the malnourished groups. These results suggest that nutritional status and exposure to ozone generate changes in lipid membrane composition, in turn changing the activity of sodium pump with similar consequences for brain metabolism.

Comparative pharmacokinetics of acetyl salicylic acid and its metabolites in children suffering from autoimmune diseases

The aim of the present study was to compare the effect produced by juvenile rheumatoid arthritis (JRA) or rheumatic fever (RF) on the pharmacokinetics of acetyl salicylic acid (ASA) and its metabolites in children with autoimmune diseases (AD).

METHODS

A prospective, open labelled study was performed in 17 children with JRA and 17 with RF who received a single dose of 25 mg ASA/kg orally. The pharmacokinetics of ASA and its metabolites were determined. The blood and urine levels of each salicylate collected during 24 h were measured by HPLC. A group of 15 healthy teenage volunteers was included as a control group.

RESULTS

The maximum plasma concentration, half-life time, area under the curve and the amount of salicylates excreted were statistically different between the JRA and the RF groups, as well as between the RF group and the controls, however, there were no significant differences between the JRA group and the controls.

CONCLUSIONS

Dosage schemes must be adjusted for JRA patients, since the half life in these patients is longer than in RF patients. However, due to ample variability of pharmacokinetic parameters it is recommended that dose schemes are individualized on the type of autoimmune disease considered.

Comparative effect of cyanamide and sodium nitroprusside on indolamine and lipid peroxidation levels in rat brain

The aim of this study was to compare the effect of cyanamide (CNM) and sodium nitroprusside (SNP) on nitrite (NO2-) and nitrate (NO3-), stable metabolites of nitric oxide (NO), serotonin (5-HT), tryptophan (Trp), and lipid peroxidation (TBARS) levels in rat brain. Twenty-four male Wistar rats (350 g) were used, divided in 3 groups of 8 animals each. Control group I received 0.9 % NaCl, CNM (40 mg/kg) was administered to group II, and SNP (20 microg/kg) to group III; all animals received a single intraperitoneal dose. The animals were sacrificed by decapitation and the brain was homogenized to measure the NO2-, NO3-, 5-HT, and Trp levels by liquid chromatography, and TBARS levels by spectrophotometry. NO2- levels significantly increased (p< 0.01) in the CNM group, while 5-HT and TBARS significantly increased (p = 0.001) both in SNP and CNM groups in relation to the control group. Trp levels presented a slight increase in the CNM group with respect to the control group. The results suggest that free radicals (Nitroxyl and NO) generated by CNM and SNP, respectively, are responsible for oxidative stress induced in brain.