Azithromycin prophylaxis against a chloroquine-resistant strain of Plasmodium falciparum

Azithromycin has antimalarial activity and favourable pharmacokinetic properties for a prophylactic antimalarial agent. We investigated the ability of azithromycin to prevent malaria in volunteers infected with a chloroquine-resistant strain of Plasmodium falciparum. 4 volunteers received oral azithromycin 500 mg followed by 250 mg daily for 7 further days. Subjects were infected on the third day of azithromycin. 3 subjects were protected compared with none of 15 controls. The volunteer not protected by azithromycin had unquantifiable plasma levels of azithromycin, probably because of poor absorption. Azithromycin could be a promising prophylactic agent for P falciparum malaria.

Calcium dependency and tetrodotoxin sensitivity of neostriatal dopamine release in 5-day-old and adult rats as measured by in vivo microdialysis

The calcium dependency and tetrodotoxin sensitivity of extracellular dopamine levels were assessed by microdialysis in the neostriatum of 5-day-old rat pups and were compared with those obtained in adult rats. The removal of calcium from the dialysate reduced spontaneous levels of extracellular dopamine to 20% of normal in the 5-day-old pups and to 10% of normal in the adults. Calcium-free dialysate also decreased potassium-evoked dopamine release to approximately 20% of baseline in both ages. Furthermore, the addition of tetrodotoxin to the dialysate decreased spontaneous levels of extracellular dopamine to 10% of baseline in both ages. The effects of calcium removal and the addition of tetrodotoxin on extracellular levels of the dopamine metabolite 3,4-dihydroxyphenylacetic acid were less pronounced. The results of this study demonstrate that extracellular levels of dopamine sampled by microdialysis in rats as young as 5 days of age are both calcium dependent and tetrodotoxin sensitive; thus, they are derived from neuronal activity and not from injury caused by acute implantation of the probe. Other age-related differences support the hypothesis that dopamine release and turnover is greater in immature rats and may represent a form of compensation for incomplete dopamine nerve terminal ingrowth.

The development of D2 autoreceptor-mediated modulation of K(+)-evoked dopamine release in the neostriatum

A within-subject dose-response analysis was conducted by locally perfusing increasing concentrations (0.1, 1, 10 and 100 microM) of the selective D2 agonist quinpirole via a microdialysis probe into the neostriatum of urethane-anesthetized rat pups 5, 10-11, 15-16 and 21-22 days of age and adult rats. In Expt. 1, K(+)-evoked dopamine release was significantly decreased by quinpirole relative to the vehicle control group for each age in a dose-dependent manner. The maximum effect of quinpirole was not influenced by acute tolerance or the length of the experiment (Expt. 2). Finally, the effect of quinpirole (10 microM) was blocked by the addition of the selective D2 antagonist (-)-sulpiride (100 microM) to the perfusion solution (Expt. 3). These results support and extend previous research that suggests that presynaptic D2 autoreceptors in the neostriatum are able to modulate K(+)-evoked dopamine release in vivo by postnatal day 5 in the rat.

The ontogeny of apomorphine-induced alterations of neostriatal dopamine release: effects on potassium-evoked release

The effects of apomorphine (0.05, 0.1, and 1.0 mg/kg, s.c.) on K(+)-evoked dopamine release were studied through the use of in vivo microdialysis in the neostriatum of developing and adult rats. Fifteen-minute samples were collected from urethane-anesthetized rats 5, 10-11, 21-22, 35-36 days of age, and adults, and quantified by high performance liquid chromatography with electrochemical detection. Apomorphine attenuated K(+)-evoked dopamine release in all age groups, suggesting that the dopamine autoreceptor modulating release in the neostriatum is functional by 5 days of age. A dose-response effect of apomorphine was observed in all age groups except at 5 and 10 days of age. Absolute levels of extracellular dopamine were significantly lower at 5 and 10 days of age compared with the other ages, and the effectiveness of a high-K+ artificial cerebrospinal fluid to evoke dopamine release increased with age.

In vitro activity of bisquinoline WR268,668 against African clones and isolates of Plasmodium falciparum

The in vitro activity of a new bisquinoline, WR268,668, was determined against chloroquine-susceptible and chloroquine-resistant African clones and isolates of Plasmodium falciparum using an isotopic semimicro drug susceptibility assay. The chloroquine-resistant clone (mean 50% inhibitory concentration [IC50] = 61.2 nM) was 11 times less susceptible to WR268,668 than the chloroquine-susceptible clone (IC50 = 5.75 nM). A similar result was obtained with fresh clinical isolates, with the chloroquine-susceptible isolates (IC50 = 5.36 nM, n = 11) being significantly (P < 0.05) more susceptible to WR268,668 than the chloroquine-resistant isolates (IC50 = 16.1 nM, n = 18). The compound WR268,668 exhibited a high activity against some moderately chloroquine-resistant isolates. There was a significant positive correlation between the in vitro responses to chloroquine and WR268,668 (r = 0.904, P < 0.05). Combinations of WR268,668 and desipramine, a chloroquine efflux inhibitor, showed that resistance to WR268,668 can be reversed against the chloroquine-resistant clone and that desipramine has no effect on the activity of WR268,668 against the chloroquine-susceptible clone. The results of the study indicate the presence of cross-resistance between chloroquine and WR268,668, and suggest that the basis of resistance to WR268,668 may be similar to that of other 4-aminoquinolines.

The ontogeny of apomorphine-induced alterations of neostriatal dopamine release: effects on spontaneous release

The effects of apomorphine (0.05, 0.1, and 1.0 mg/kg, s.c.) on the extracellular levels of dopamine and the dopamine metabolite 3,4-dihydroxyphenylacetic acid were studied through the use of in vivo microdialysis in the neostriatum of developing and adult rats. Fifteen-minute samples were collected from urethane-anesthetized rats 5, 10-11, 21-22, and 35-36 days old and adults and quantified by HPLC with electrochemical detection. Apomorphine attenuated extracellular levels of dopamine in all age groups, suggesting that the dopamine autoreceptor modulating release in the neostriatum is functional by 5 days of age. A dose-response effect of apomorphine on extracellular dopamine was observed in all age groups except at 10-11 days of age. Extracellular levels of 3,4-dihydroxyphenylacetic acid were also significantly decreased in all age groups, consistent with the hypothesis that synthesis-modulating dopamine autoreceptors in the neostriatum are functional by 5 days of age. Apomorphine had a significantly greater effect on extracellular 3,4-dihydroxyphenylacetic acid levels at the 0.05 and 0.1 mg/kg doses in the 5- and 10-11-day-old age groups compared with the other ages. Absolute levels of extracellular dopamine were significantly attenuated at 5 days of age compared with the other ages, and absolute levels of extracellular 3,4-dihydroxyphenylacetic acid monotonically increased with age.

Na(+)-K+ pump stimulation elicits recovery of contractility in K(+)-paralysed rat muscle

1. This study explores the role of active electrogenic Na(+)-K+ transport in restoring contractility in isolated rat soleus muscles exposed to high extracellular potassium concentration ([K+]o). This was done using agents (catecholamines and insulin) known to stimulate the Na(+)-K+ pump via different mechanisms. 2. When exposed to Krebs-Ringer bicarbonate buffer containing 10 mM K+, the isometric twitch and tetanic force of intact muscles decreased by 40-69%. The major part of this decline could be prevented by the addition of salbutamol (10(-5) M). In the presence of 10 mM K+, force could be restored almost completely within 5-10 min by the addition of salbutamol or adrenaline and partly by insulin. 3. In muscles exposed to 12.5 mM K+, force declined by 96%. Salbutamol (10(-5) M), adrenaline (10(-6) M) and insulin (100 mU ml-1) produced 57-71, 61-71 and 38-47% recovery of force within 10-20 min, respectively. The effects of these supramaximal concentrations of salbutamol and insulin on force recovery were additive. Salbutamol and adrenaline produced significant recovery of contractility at concentrations down to 10(-8) M (P < 0.005). 4. In soleus, the same agents stimulated 86Rb+ uptake and decreased intracellular Na+. These actions reflect stimulation of active Na(+)-K+ transport and both showed a highly significant correlation to the recovery of twitch as well as tetanic force (r = 0.80-0.88; P < 0.001). 5. The force recovery induced by salbutamol, adrenaline and insulin was suppressed by pre-exposure to ouabain (10(-5) M for 10 min or 10(-3) M for 1 min) as well as by tetrodotoxin (10(-6) M). 6. The observations support the conclusion that the inhibitory effect of high [K+]o on contractility in skeletal muscle can be counterbalanced by stimulation of active electrogenic Na(+)-K+ transport, the ensuing increase in the clearance of extracellular K+ and in the transmembrane electrochemical gradient for Na+.

Modulation of dopamine binding in the fetal rat: effects of milk and exogenous opioid manipulation

Presentation of milk to the newborn rat promotes changes in sensory and motor behavior and concomitant changes in both endogenous opioid and dopamine systems. The present study employed an in vivo binding technique with a tritiated ligand for the D2 receptor ([3H]raclopride) to examine the effects of intraoral milk infusion and opioid manipulations on dopamine activity in the term rat fetus (E21). In Experiment 1, fetuses received a series of milk infusion, which resulted in decreased occupancy at D2 receptors by the endogenous ligand, dopamine, in striatal, septal, and hypothalamic brain regions. In Experiment 2, fetuses were pretreated with morphine, the mu-agonist [D-Ala2,NMe-Phe4,Gly5-ol]-enkephalin (DAMGO), the kappa-agonist U50,488, or saline. Opioid manipulations had no effect on binding at D2 receptors. These results confirm that intraoral milk infusion can modulate activity in the dopamine system of the near-term fetal rat.

Ontogeny of the stretch response in the rat fetus: kappa opioid involvement

Previous studies have demonstrated that the kappa opioid system is functional and plays a role in mediating the stretch response of the rat fetus on Day 21 of gestation. In this study, a kappa opioid agonist (U50,488) was administered on Days 19, 20, or 21, and fetal behavior was recorded after infusion of either milk or saline. Activation of the kappa opioid system promoted stretching in response to saline on Days 20 and 21. Although fetuses on Day 19 did not stretch, videotape analysis indicated that kappa opioid manipulation promoted modest increases in rearlimb activity and changes in fetal body posture that typically occur antecedent to the stretch. These findings suggest that functional maturity, of the kappa opioid system may be a limiting factor in the expression of the fetal stretch response.

Mu and kappa opioid systems modulate responses to cutaneous perioral stimulation in the fetal rat

The prenatal ontogeny of functional mu and kappa opioid systems was investigated in a series of four experiments conducted with rat fetuses on the last day of gestation (E21). Fetal motor activity and responsiveness to cutaneous stimulation were measured following administration of various opioid agonists, including morphine, DAMGO, U69,593, and U50,488. The effectiveness of selective mu (CTOP) and kappa (nor-binaltorphimine) antagonists to block the effects of opioid agonists, and the effects of combined administration of DAMGO and U69,593, also were assessed. These experiments provide evidence that both mu and kappa opioid systems are functional and are capable of modulating fetal behavior during the late prenatal period. The data also suggest that different subclasses of kappa receptors may mediate different aspects of fetal behavior. These findings suggest a role for endogenous opioids in regulating important aspects of perinatal behavior, including the development of suckling, maternal-infant interaction and early learning at the nipple.

Ontogeny of the stretch response in the rat fetus: kappa opioid involvement

Previous studies have demonstrated that the kappa opioid system is functional and plays a role in mediating the stretch response of the rat fetus on Day 21 of gestation. In this study, a kappa opioid agonist (U50,488) was administered on Days 19, 20, or 21, and fetal behavior was recorded after infusion of either milk or saline. Activation of the kappa opioid system promoted stretching in response to saline on Days 20 and 21. Although fetuses on Day 19 did not stretch, videotape analysis indicated that kappa opioid manipulation promoted modest increases in rearlimb activity and changes in fetal body posture that typically occur antecedent to the stretch. These findings suggest that functional maturity, of the kappa opioid system may be a limiting factor in the expression of the fetal stretch response.

Calcitonin gene-related peptide stimulates active Na(+)-K+ transport in rat soleus muscle

Calcitonin gene-related peptide (CGRP) is found in a wide variety of tissues, including sensory and motor nerve endings in skeletal muscle. After intense electrical stimulation or K(+)-induced depolarization, CGRP can be released from nerve terminals and bound to receptors on sarcolemma. We show here that CGRP (rat and human) and salmon calcitonin stimulate 22Na extrusion and the influx of 86Rb and 42K in isolated rat soleus muscle. This leads to a pronounced (up to 56%) decrease in intracellular Na+, a minor increase in intracellular K+, and hyperpolarization. All these effects were blocked by ouabain or cooling, indicating that they reflect an acute stimulation of active electrogenic Na(+)-K+ transport. Capsaicin, which induces release of CGRP from sensory nerve endings, was found to exert similar effects on Na(+)-K+ transport. Various Na(+)-K+ pump-stimulating agents have been shown to counteract the inhibitory effect of a high extracellular concentration of K+ ([K+]o) on muscle contractility (4, 20). CGRP and capsaicin were likewise found to improve contractile performance of muscles inhibited by high [K+]o, and these effects were blocked by ouabain. CGRP might play a role in the maintenance of Na(+)-K+ gradients and excitability during intensive muscle work, known to be associated with an acute rise in the interstitial K+ concentration.

Effect of milk on dopamine release in the newborn rat: an in vivo microdialysis study

Newborn rats exhibit a rich behavioral repertoire to access the nipple and obtain milk. In older pups, catecholamines including dopamine (DA) mediate the behavioral effects of milk. In the present study, pups were delivered at term by caesarean section and instrumented with the microdialysis probe. Microdialysis samples were collected at 15 min intervals and K(+)-evoked levels of DA were measured with HPLC-ED. Pups received either no infusion, single or multiple intraoral infusions of saline or milk during subsequent samples. A decrease in K(+)-evoked DA release was evident after the first infusion in all subjects. Repeated milk infusions continued to reduce levels of extracellular DA, which remained evident 30 min after the last milk infusion. The rat neonate's first exposure to milk exerts lasting effects on neostriatal DA activity in the absence of prior suckling experience.

Dispiro-1,2,4,5-tetraoxanes: a new class of antimalarial peroxides

Dispiro-1,2,4,5-tetraoxanes 2-4 were synthesized as potential peroxide antimalarial drugs. They had curative activity against Plasmodium berghei in vivo at single doses of 320 and 640 mg/kg which confirms earlier unpublished data. Moreover, artemisinin (1) and 4 had equivalent ED50's against P. berghei in vivo in the multiple-dose Thompson test; neither showed any evidence of acute toxicity at total doses of more than 12 g/kg. Dispiro-1,2,4,5-tetraoxane 4 had IC50's comparable to those of 1 against Plasmodium falciparum clones in vitro. These results confirm the potential of dispiro-1,2,4,5-tetraoxanes as a new class of inexpensive peroxide antimalarial drugs.

Bisquinolines. 1. N,N-bis(7-chloroquinolin-4-yl)alkanediamines with potential against chloroquine-resistant malaria

On the basis of observations that several bisquinolines such as piperaquine possess notable activity against chloroquine-resistant malaria, 13 N,N-bis-(7-chloroquinolin-4-yl)alkanediamines were synthesized and screened against Plasmodium falciparum in vitro and Plasmodium berghei in vivo. Twelve of the thirteen bisquinolines had a significantly lower resistance index than did chloroquine; the resistance index was apparently unrelated to either in vitro or in vivo activity. Except for two compounds, there was a reasonable correlation between in vitro and in vivo activities. Seven of the thirteen bisquinolines had IC50's of less than 6 nM against both chloroquine-sensitive (D-6) and -resistant (W-2) clones of P. falciparum and were curative against P. berghei at doses of 640 mg/kg. In contrast to chloroquine, these bisquinolines did not show any toxic deaths at curative dose levels. Four bisquinolines, however, caused skin lesions at the site of injection. Maximum activity was seen in bisquinolines with a connecting bridge of two carbon atoms where decreased conformational mobility seemed to increase activity. Bisquinoline 3 (+/-)-trans-N1,N2-bis(7-chloroquinolin-4-yl)cyclohexane-1,2-diamin e was not only the most potent bisquinoline in vitro, but was clearly unique in its in vivo activity--80% and 100% cure rates were achieved at doses of 160 and 320 mg/kg, respectively. In summary, these preliminary results support the premise that bisquinolines may be useful agents against chloroquine-resistant malaria.

Antimalarial activity of new dihydroartemisinin derivatives. 5. Sugar analogues

A series of dihydroartemisinin derivatives containing a sugar moiety was prepared in the search for analogues with good water solubility and high antimalarial activity. The preparation of the new compounds was achieved by treatment of dihydroartemisinin (2) with chlorotrimethylsilane in pyridine solution at -10 degrees C to give a nearly quantitative yield of 10-O-(trimethylsilyl)dihydroartemisinin (3), which was then condensed with 1-hydroxypolyacetylated sugars 5 to give dihydroartemisinin derivatives 7a-d. Deacetylation of intermediates 7 gave the desired sugar derivatives 8. The resulting derivatives, tested in vitro against Plasmodium falciparum, were found to be more effective against W-2 than D-6 clones and were not cross-resistant with existing antimalarials. Trimethylsilylated compound 3 is more effective than derivatives 7a-d, which possess activity comparable to or better than that of artemisinin itself. Deacetylated compounds 8a-d were substantially less active than 7 in both cell lines. In P. berghei-infected mice, 7a-c showed 5/5, 2/5, and 3/5 cures, respectively, at 320 mg/kg per day x 3, whereas 7d showed no activity at the same dosage. However, 7d did prolong the life span in 3/5 of the infected mice at 640 mg/kg per day x 3 dose level. Trimethylsilylated compound 3 was also the most effective among the compounds studied, with 5/5 cures at 80 mg/kg per day x 3. The deacetylated sugar derivatives 8a-d showed only slight in vivo antimalarial activity.

Preceptor teaching strategies: behaviors that facilitate role transition in senior nursing students

This article describes the learning outcomes of students who participated in a senior preceptorship course. Data from student logs and course evaluations forms were analyzed descriptively to identify the specific instructional strategies of preceptors that were instrumental in teaching students the roles and functions of the staff nurse. Role modeling was one of the most effective strategies and also the one regarded by preceptors as least significant.

Do student preceptorships affect moral reasoning?

The author examines the effects of a senior preceptorship course on the moral reasoning of senior nursing students. The findings suggest a broadening gap between education and practice resulting from changes in the health care industry, more specifically, in the acute care facility and a compromise of professional role enactment in the hospital. The author suggests we reconsider the following questions: Is the patient still the first priority in nursing? Is the hospital setting an appropriate placement for nursing students?

Project BEGIN: recruiting students from ancillary personnel

Project BEGIN (Be Envied: Get Into Nursing!) was a joint education-service endeavor to recruit students and boost employee morale. A hospital and its school of nursing worked together in preparing licensed practical nurses, unit receptionists, and nursing assistants with the requisites for entry to nursing school. In a span of 2 weeks, 22 employees were in various stages of completing the requirements. The authors discuss the project's implementation and outcomes.

The nurse advocate project: a strategy to retain new graduates

Would you like to have 96% of the newly graduated nurses you hired last year still working for you a year later? Does your staff know how to help new graduates, who have been in the student role for over 20 years, adjust to the world of work? The author discusses the nurse advocate project which increased retention, decreased costs, and fostered a more positive work environment for all staff.