Acute renal failure caused by pheniramine maleate induced rhabdomyolysis: an unusual case

Antihistamines are easily available over-the-counter medications, which are frequently involved in overdoses. The usual course is accompanied by the anticholinergic effects of these agents. We report a case of a suicide attempt in a young male, where ingestion of antihistamine pheniramine maleate was complicated by nontraumatic rhabdomyolysis and oliguric acute renal failure. Rhabdomyolysis and acute renal failure is a rarely reported but potentially serious complication among patients who present to the emergency after intentional overdoses making recognition and prompt intervention essential. We also describe the potential mechanism of muscle injury in antihistamine overdose.

Skunk and psychosis in South East London

Background:

Epidemiological studies have reported that the increased risk of developing psychosis in cannabis users is dose related. In addition, experimental research has shown that the active constituent of cannabis responsible for its psychotogenic effect is Delta-9-Tetrahydrocannabinol (THC) (Murray et al, 2007). Recent evidence has suggested an increased in potency (% TCH) in the cannabis seized in the UK (Potter et al, 2007).

Hypothesis:

We predicted that first episode psychosis patients are more likely to use higher potency cannabis and more frequently than controls.

Methods:

We collected information concerning socio-demographic, clinical characteristics and cannabis use (age at first use, frequency, length of use, type of cannabis used) from a sample of 191 first-episode psychosis patients and 120 matched healthy volunteers. All were recruited as part of the Genetic and Psychosis (GAP) study which studied all patients who presented to the South London and Maudsley Trust.

Results:

There was no significant difference in the life-time prevalence of cannabis use or age at first use between cases and controls. However, cases were more likely to be regular users (p=0.05), to be current users (p=0.04) and to have smoked cannabis for longer (p=0.01). Among cannabis users, 86.8% of 1st Episode Psychosis Patients preferentially used Skunk/Sinsemilla compared to 27.7% of Controls. Only 13.2 % of 1st Episode psychosis Patients chose to use Resin/Hash compared to 76.3% of controls. The concentration of TCH in these in South East London, ranges between 8.5 and 14 % (Potter et al, 2007). Controls (47%) were more likely to use Hash (Resin) whose average TCH concentration is 3.4% (Potter et al, 2007).

Conclusions:

Patients with first episode psychosis have smoked higher potency cannabis, for longer and with greater frequency, than healthy controls.

Pharmaceutical development, quality control, stability and compatibility of a parenteral lyophilized formulation of the investigational polymer-conjugated platinum antineoplastic agent AP5346

AP5346 is a low molecular weight polymer-conjugated platinum antineoplastic agent. The lyophilized drug product has completed a phase I clinical trial. In order to guarantee a constant quality of AP5346 pharmaceutical products, quality control and analysis of the drug substance and final product were performed. The identity of AP5346 was confirmed using 1H NMR, 195Pt NMR and IR spectroscopy. Furthermore, the free platinum content, platinum release characteristics, molecular size and size distribution were established. With the selected analytical techniques, AP5346 could be distinguished very well from its polymeric analogues, such as AP5280 and AP5279. Stability experiments revealed that AP5346 final product is stable for 12 months at 5 degrees C, in the dark. For administration to patients, AP5346 final product is reconstituted with 5% w/v dextrose and diluted in infusion containers. To investigate the influence of container materials, the stability of AP5346 after reconstitution and dilution in infusion containers was determined. The infusion containers investigated were composed of glass, polyvinyl chloride (PVC, intraflex) and low density polyethylene (LD-PE, Ecoflac). AP5346 was shown to be stable after reconstitution and dilution with 5% w/v dextrose in these infusion containers for at least 96 h at 2-8 degrees C in the dark and at room temperature with ambient light conditions.

Cell-type-specific signatures of microRNAs on target mRNA expression

Although it is known that the human genome contains hundreds of microRNA (miRNA) genes and that each miRNA can regulate a large number of mRNA targets, the overall effect of miRNAs on mRNA tissue profiles has not been systematically elucidated. Here, we show that predicted human mRNA targets of several highly tissue-specific miRNAs are typically expressed in the same tissue as the miRNA but at significantly lower levels than in tissues where the miRNA is not present. Conversely, highly expressed genes are often enriched in mRNAs that do not have the recognition motifs for the miRNAs expressed in these tissues. Together, our data support the hypothesis that miRNA expression broadly contributes to tissue specificity of mRNA expression in many human tissues. Based on these insights, we apply a computational tool to directly correlate 3' UTR motifs with changes in mRNA levels upon miRNA overexpression or knockdown. We show that this tool can identify functionally important 3' UTR motifs without cross-species comparison.

A genome-wide map of conserved microRNA targets in C. elegans

BACKGROUND

Metazoan miRNAs regulate protein-coding genes by binding the 3' UTR of cognate mRNAs. Identifying targets for the 115 known C. elegans miRNAs is essential for understanding their function.

RESULTS

By using a new version of PicTar and sequence alignments of three nematodes, we predict that miRNAs regulate at least 10% of C. elegans genes through conserved interactions. We have developed a new experimental pipeline to assay 3' UTR-mediated posttranscriptional gene regulation via an endogenous reporter expression system amenable to high-throughput cloning, demonstrating the utility of this system using one of the most intensely studied miRNAs, let-7. Our expression analyses uncover several new potential let-7 targets and suggest a new let-7 activity in head muscle and neurons. To explore genome-wide trends in miRNA function, we analyzed functional categories of predicted target genes, finding that one-third of C. elegans miRNAs target gene sets are enriched for specific functional annotations. We have also integrated miRNA target predictions with other functional genomic data from C. elegans.

CONCLUSIONS

At least 10% of C. elegans genes are predicted miRNA targets, and a number of nematode miRNAs seem to regulate biological processes by targeting functionally related genes. We have also developed and successfully utilized an in vivo system for testing miRNA target predictions in likely endogenous expression domains. The thousands of genome-wide miRNA target predictions for nematodes, humans, and flies are available from the PicTar website and are linked to an accessible graphical network-browsing tool allowing exploration of miRNA target predictions in the context of various functional genomic data resources.

Sclerotinia Root Rot: A New Threat to Buckwheat Seedlings in India

In the temperate regions of India, buckwheat (Fagopyrum esculentum Moench and F. tataricum Gaertn.) is produced extensively. During the first week of June in 2001 and 2002, a severe incidence of root rot (35% seedling mortality) was observed in the Sangla Valley of Himachal Pradesh when the crop was at the seedling stage. The disease was more severe on F. tataricum, resulting in a poor crop stand. The disease appeared as water-soaked areas on the upper portion of the root, which turned brown. The brown patches gradually proceeded downward covering the whole root system. The above ground foliage wilted and died. The disease spread rapidly with cloudy, humid weather and day temperatures ranging from 15 to 20°C. Mycelium of the causal fungus was inter- and intracellular type with hyaline, branched, and septate hyphae. Sclerotia were pink but later turned black, measuring 3.0 to 3.5 mm in diameter. The pathogenicity of the causal fungus was proved following Koch's postulates. The pathogen was identified as Sclerotinia sclerotiorum (Lib.) de Bary (2). In Japan, the association of S. libertiana on buckwheat has been reported (1). To our knowledge, this is the first report of Sclerotinia root rot on buckwheat from India. References: (1) H. Singh and T. A. Thomas. Indian Counc. Agric. Res. New Delhi, India, 1978. (2) H. J. Willets and J. A. L. Wong, Bot. Rev. 46:101,1980.

Brain abscess due to Xylohypha bantiana

A case of brain abscess due to Xylohypha bantiana without any obvious predisposing factors and with the uncommon clinical feature of seizures is presented.

Mitral valve endocarditis following balloon mitral valvotomy

The case of a patient who developed fungal valve endocarditis due to Candida albicans following balloon mitral valvotomy is presented. The patient did not have any obvious predisposing factors which led to the development of fungal endocarditis.

Candidemia in neonatal intensive care unit

The present study was conducted over a period of 6 months to determine the Candida species causing candidemia in a neonatal intensive care unit and to analyse the risk factors associated with acquisition of significant fungemia. Speciation of the 19 isolated Candida spp was done by the standard techniques. Antimicrobial susceptibility of these isolates was determined by disc diffusion method against Amphotericin B, Fluconazole, Ketoconozole and 5-Flucytosine. Candida glabrata was the most common species involved (42.1%). Other species isolated were C. tropicalis (31.6%). Calbicans (21.1%) and C.parapsilosis (5.2%). All the isolates were sensitive to Amphotericin B. Resistance to other antigungal agents was seen only in C. globrata. Significant candidemia was seen in 14/19 (72.6%) of neonates. Risk factors found to be associated with significant candidemis in these neonates included intake of multiple broad-spectrum antibiotics (p<0.0001), use of total parenteral nutrition (p<0.045) and ventilators (p<0.0001).

Potential infection hazards of stethoscopes

This study was conducted to assess the bacterial flora carried on stethoscopes used by medical personnel and to study the effect of disinfection of stethoscopes on the flora. In the 106 stethoscopes sampled, Gram-positive organisms were the most (60%) frequently isolated. Among them, Staphylococcus aureus accounted for 15.8% of the flora of which 21% were resistant to methicillin. The rate of isolation of S aureus and methicillin resistant S aureus (MRSA) was higher in critical care units. Disinfection was found to significantly reduce the bacterial count.

Malingering and symptom magnification: a case report illustrating the limitations of clinical judgement

Malingering and symptom embellishment are of concern to specialists in pain medicine. Valid criteria to identify malingering individuals suffering chronic pain do not exist. We present a case of a patient on worker's compensation identified as a malingerer by six different physicians who had evaluated the patient for her chronic complaints. Ultimately, she was found to have a lesion that explained all of her subjective complaints. Physicians should exercise caution in labeling patients suffering intractable pain as malingerers.

Postantibiotic effect of a combination of antimicrobial agents on pseudomonas aeruginosa

Treatment of severe Pseudomonas infections often calls for multidrug therapy. Combinations of aminoglycosides, beta-lactams and/or quinolones are generally administered, the effect of which may be additive, synergistic or indifferent. The present in vitro study was designed to find out the exact outcome of the postantibiotic effect (PAE). The minimal inhibitory concentrations and the PAE of three antibiotics (amikacin, ceftazidime and ciprofloxacin) were determined both singly and in combination. Ceftazidime alone exhibited a negative PAE but a synergistic effect was observed for the combination of ceftazidime with amikacin. The combination of ceftazidime with ciprofloxacin and ciprofloxacin with amikacin however gave an indifferent PAE. This synergistic PAE of amikacin with ceftazidime has a significant effect on designing optimal dosage regimens.

Comparison of Vitek Yeast Biochemical Card with conventional methods for speciation of Candida

The ability of the Vitek Yeast Biochemical Card to identify yeast isolates was compared with conventional methods. Of the fifty yeast isolates tested same species identification was obtained in thirty-four isolates. The Vitek yeast biochemical card identified 13 isolates which could not be identified by the conventional tests. Though the Vitek Yeast biochemical card gave a good rapid identification the high cost of each test severely limits its routine use in most of the laboratories.

Central nervous system abnormalities in complex regional pain syndrome (CRPS): clinical and quantitative evidence of medullary dysfunction

OBJECTIVE

Sensory and motor abnormalities are common among patients with complex regional pain syndrome (CRPS). The purpose of the present study was to define and characterize these abnormalities and to develop a hypothesis regarding the area of the central nervous system from which they derive.

DESIGN

Data were acquired from study subjects using clinical examination and quantitative assessment of neurological function. Subjects were divided into four groups. CRPS patients were differentiated into two groups based on the presence or absence of sensory deficit on the face to clinical examination. The other two groups were composed of patients with other chronic pain syndromes and normal individuals without chronic pain or disability. Clinical and quantitative data were compared between groups.

PATIENTS

One hundred forty-five CRPS patients, 69 patients with other pain conditions, and 26 normal individuals were studied.

RESULTS

A high incidence of trigeminal hypoesthesia was observed in CRPS patients. CRPS patients with trigeminal hypoesthesia manifested bilateral deficits of sensory function, with a predominant hemilateral pattern. These patients also manifested bilateral motor weakness with a more prominent hemiparetic pattern. Both sensory and motor deficits were greatest ipsilateral to the painful side of the body. These features differed significantly from those of CRPS patients lacking clinical trigeminal deficit, other pain patients, and normals. A lower cranial nerve abnormality (sternocleidomastoid weakness) and a myelopathic feature (Hoffman's reflex) were more common in CRPS patients with trigeminal hypoesthesia.

CONCLUSIONS

Nearly half of CRPS patients had abnormalities of spinothalamic, trigeminothalamic, and corticospinal function that may represent dysfunction of the medulla. One-third of the remaining CRPS patients had neuroimaging evidence of spinal cord or brain pathology. The majority of CRPS patients in this study have measurable abnormalities of the sensory and motor systems or neuroimaging evidence of spinal cord or brain dysfunction.

Passive smoking, domestic fuels and lung function in north Indian children

A study was carried out in 200 school children from north India to find out the effects of passive smoking and exposure to domestic cooking fuels on their lung functions. Forced vital capacity and FEV1 were the lowest in boys whose households used biomass fuel (p < 0.05) and PEFR and FEF 25% and 50% were lowest in boys with their homes using kerosene as fuels. All these were the best for LPG fuel. However, in girls there was no significant difference in different parameters, although the values were lower in those using kerosene and biomass fuel. All parameters were lower in passive smokers irrespective of the type of fuel used although they were not statistically significant. However, FEF 50% was significantly less in passive smokers whose households used mixed fuels. The same was true for PEFR, PEFR %, and FEF 25% in cases of LPG fuel use.

Respiratory symptoms in Indian children exposed to different cooking fuels

Smoke emission from fuels is an important source of indoor air pollution. Children spend considerable time indoors. It is therefore important to determine whether air contaminants from indoor air sources affect incidence of respiratory illness, cause symptoms and changes in pulmonary function status in them. Two hundred children in the age group of 7-15 were selected randomly. They were stratified according to the fuel used in their homes and respiratory symptoms were inquired from them according to a questionnaire recommended by the American Thoracic Society. The most symptomatic children were those whose households used kerosene (52%) and mixed fuels (46%) although different symptoms were present in varying extent in all 4 groups of children. Cough, cold, congestion or phlegm for one week or more occurred more frequently with mixed fuel use followed by kerosene. The present study thus showed that mixed fuel and kerosene fuel had worst effects on respiratory system in children whose households used these fuels.

Characterization of the autophosphorylation of Era, an essential Escherichia coli GTPase

Era is an essential protein in Escherichia coli which binds both GTP and GDP and has an intrinsic GTPase activity. Studies on the role of GTP/GDP binding and GTPase activity in an attempt to understand its function lead to the observation that Era is autophosphorylated. The autophosphorylation reaction is specific for GTP and cannot use ATP as a phosphoryl group donor. The reaction velocity is of first order with respect to protein concentration, suggesting an intramolecular mechanism. Autophosphorylation occurs at serine and threonine residues. The major phosphorylated tryptic peptide isolated after autophosphorylation has been identified as ISITSR, from residue 33 to 38. The peptide contains the site of phosphorylation and two potential sites for serine and threonine phosphorylation. Subsequently, both the threonine residue at position 36 and the serine residue at position 37 were altered to alanine. The double mutant Era, but not individual single mutants, was unable to functionally complement the growth of an E. coli strain which cannot produce wild-type Era protein at high temperature. This suggests that either threonine 36 or serine 37 has to exist for the function of Era in vivo. In vivo phosphorylation of Era was also examined by two-dimensional gel electrophoresis. Era has been previously assigned two distinct positions having two different X-Y co-ordinates: one of the spots (H032.0) was identified as phosphorylated Era, indicating that a substantial portion of Era in the cell is indeed phosphorylated. Therefore, Era autophosphorylation is likely to play an important physiological role in the cell.(ABSTRACT TRUNCATED AT 250 WORDS)

Cold-sensitive growth and decreased GTP-hydrolytic activity from substitution of Pro17 for Val in Era, an essential Escherichia coli GTPase

A substitution mutation of Pro17 by Val (P17V) was constructed in the guanine nucleotide binding domain of Era, an essential protein in Escherichia coli. The mutation is analogous to the oncogenic activating allele at position 12 in the GTP-binding domain of p21ras. The phenotype of this mutant was analysed in a strain which exclusively expressed the mutant protein (Era-V17) in null allele chromosomal background (era1: :kan). The strain was found to be cold-sensitive for growth. Mutant Era-V17 purified from the strain was cold-sensitive for GTP-hydrolytic activity, suggesting that the GTPase activity of Era is required for cell growth since the P17V mutation resulted in both cold-sensitive growth of cells and cold-labile GTPase activity of the purified protein.

Epilepsy, myasthenia gravis, and effect of plasmapheresis on antiepileptic drug concentrations

A 28-year-old woman developed complex partial seizures at the age of 17 years and was treated with phenytoin sodium. Five years later she developed myasthenia gravis, and phenytoin was replaced by valproic acid and phenobarbital. She required plasmapheresis (PP). During one course of PP, total and unbound concentrations of valproic acid and phenobarbital were measured in serum sampled before, during, and after PP and in plasma removed by PP. It was determined that the magnitude of loss of valproic acid or phenobarbital by PP was small, and the changes of unbound/total ratio did not reach clinical importance.