Effects of packaging and storage conditions on the quality of amoxicillin-clavulanic acid - an analysis of Cambodian samples

BACKGROUND

The use of substandard and degraded medicines is a major public health problem in developing countries such as Cambodia. A collaborative study was conducted to evaluate the quality of amoxicillin-clavulanic acid preparations under tropical conditions in a developing country.

METHODS

Amoxicillin-clavulanic acid tablets were obtained from outlets in Cambodia. Packaging condition, printed information, and other sources of information were examined. The samples were tested for quantity, content uniformity, and dissolution. Authenticity was verified with manufacturers and regulatory authorities.

RESULTS

A total of 59 samples were collected from 48 medicine outlets. Most (93.2%) of the samples were of foreign origin. Using predetermined acceptance criteria, 12 samples (20.3%) were non-compliant. Eight (13.6%), 10 (16.9%), and 20 (33.9%) samples failed quantity, content uniformity, and dissolution tests, respectively. Samples that violated our observational acceptance criteria were significantly more likely to fail the quality tests (Fisher's exact test, p < 0.05).

CONCLUSIONS

Improper packaging and storage conditions may reduce the quality of amoxicillin-clavulanic acid preparations at community pharmacies. Strict quality control measures are urgently needed to maintain the quality of amoxicillin-clavulanic acid in tropical countries.

Anti-citrullinated glucose-6-phosphate isomerase peptide antibodies in patients with rheumatoid arthritis are associated with HLA-DRB1 shared epitope alleles and disease activity

To identify and characterize anti-citrullinated glucose-6-phosphate isomerase (GPI) peptide antibodies in patients with rheumatoid arthritis (RA). Nine GPI arginine-bearing peptides in human GPI protein were selected and cyclic citrullinated GPI peptides (CCG-1-9) were constructed. Samples were obtained from RA (n = 208), systemic lupus erythematosus (SLE) (n = 101), Sjögren's syndrome (SS; n = 101) and healthy controls (n = 174). Antibodies against CCG-1-9 were measured, and anti-citrullinated α-enolase-1 (CEP-1), -cyclic citrullinated peptides (CCP) and -GPI proteins antibodies were also examined. Patients with RA were genotyped for HLA-DRB1. The numbers of shared epitope (SE) alleles were counted and compared with those of the autoantibodies. Rabbit GPI was citrullinated with rabbit peptidylarginine deiminase and immunoblot analysis of RA sera performed. The levels of autoantibodies were compared before and after treatment with TNF antagonists in 58 RA patients. Anti-CCG-2, -4 and -7 antibodies were detected in 25·5, 33·2 and 37·0% patients with RA, respectively, and these antibodies were very specific for RA (specificity, 98·1-99·7%). Altogether, 44·2, 86·1 and 13·9% of RA sera were positive for anti-CEP-1, -CCP and -GPI protein antibodies, respectively. Anti-CCG-2, -4 and -7 antibodies were correlated with anti-CCP and anti-CEP-1 antibodies and with the presence of HLA-DRB1 SE alleles. Citrullinated GPI protein was detected using RA sera. Treatment with tumour necrosis factor antagonists reduced significantly the levels of anti-CCG-2 and -7 but not of anti-CEP-1 antibodies. This is the first report documenting the presence of anti-CCG antibodies in RA. Anti-CCG-2 and -7 antibodies could be considered as markers for the diagnosis of RA and its disease activity.

Public health concerns for anti-obesity medicines imported for personal use through the internet: a cross-sectional study

OBJECTIVE

To explore the circulation of anti-obesity medicines via the internet and their quality.

DESIGN

Cross-sectional study.

SETTING

Internet pharmacies and pharmaceutical suppliers accessible from Japan.

PARTICIPANTS

Anti-obesity medicines were purchased using relevant keywords on Japanese Google search engine. Blogs and advertisement-only sites were excluded.

PRIMARY AND SECONDARY OUTCOME MEASURES

The authenticity of the samples was investigated in collaboration with the manufacturers of the samples and medicine regulatory authorities. Quality of the samples was assessed by pharmacopoeial analyses using high-performance liquid chromatography.

RESULTS

82 samples were purchased from 36 internet sites. Approximately half of the sites did not mention a physical address, and 45% of the samples did not contain a package insert. A variety of custom declarations were made for the shipments of the samples: personal health items, supplement, medicines, general merchandise, tea and others. Among 82 samples, 52 samples were analysed to check their pharmacopoeial quality. Authenticity responses were received from only five of 20 manufacturing companies. According to the pharmacopoeial analyses and authenticity investigation, three of the samples were identified as counterfeits and did not contain any active ingredients. Two of these samples were confirmed as counterfeits by the manufacturer of the authentic products. The manufacturer of the other sample did not respond to our request for an authenticity check even after several communication attempts. These counterfeit cases have been reported at the rapid alert system of Western Pacific Region of the WHO.

CONCLUSIONS

Many counterfeit and unapproved anti-obesity medicines may be easily bypassing regulatory checks during shipping and are widely circulated through the internet. Regulatory authorities should take measures to prevent these medicines from entering countries to safeguard their citizens.

Preparation of Al Doped PZT Thin Films Using a Sol-Gel Method

Al substitution for Zr/Ti site of PZT was attempted using a sol-gel method, and the ferroelectric properties of 200nm-thick Al doped PZT thin films were compared with those of non- doped PZT film. The leakage current of the thin films decreased with increasing Al content. Ps and Pr also decreased with increasing Al content, whereas Ec did not show a significant change. Furthermore, a simple capacitor cell structure like FeRAM was prepared using a seed layer process. The capacitor structure was Pb(Ti0.975Al0.025)O3/ Pb1.1((Zr0.52Ti0.48)0. 975Al0.025)O3/ Pb(Ti0.975Al0.025)O3, and 2Pr was 26μC/cm2. The fatigue properties of the A1 doped PZT capacitor cell showed a little improvement, because the reduction rate of the fatigue was smaller than that of non-doped PZT thin film.

Association between perceived happiness levels and peripheral circulating pro-inflammatory cytokine levels in middle-aged adults in Japan

OBJECTIVES

The idea that perceived happiness may be associated with health and well-being is a recent topic of focus. However, the neurobiological mechanisms underlying the positive effects of happiness on psychological and physiological wellness remain obscure. In this study, we attempted to clarify the association between systemic inflammation and happiness.

METHODS

We recruited 160 healthy volunteers for experiment 1 and compared peripheral inflammatory markers, namely the concentrations of pro-inflammatory cytokines in the serum, between perceived high-happiness and low-happiness groups. Subsequently, we recruited 7 romantic couples for experiment 2 and investigated changes in peripheral pro-inflammatory cytokine levels after the evocation of happiness, which was induced by warm physical contact with the partner.

RESULTS

We found that circulating levels of interferon-γ (IFN-γ), which can affect brain functions and induce depressive symptoms, were lower in the high-happiness group than in the low-happiness group. A negative correlation between the levels of perceived happiness and IFN-γ concentrations was also observed. Furthermore, we also found that experimentally induced happiness could reduce peripheral IFN-γ levels.

CONCLUSIONS

These results revealed an association between the perception of happiness and systemic inflammation. Increased happiness may suppress the peripheral circulation of pro-inflammatory cytokines.

Psychological and physiological responses to odor-evoked autobiographic memory

OBJECTIVE

The "Proust phenomenon" occurs when a certain smell evokes a specific memory. Recent studies have demonstrated that odor-evoked autobiographic memories are more emotional than those elicited by other sensory stimuli because of the direct neural communication between the olfactory system and the amygdala. The amygdala is known to regulate various physiological activities including the endocrine and immune systems; therefore, odor-evoked autobiographic memory may trigger various psychological and physiological responses; however, the responses elicited by this memory remains obscure. In this study, we aimed to investigate the psychological and physiological responses accompanying odor-evoked autobiographic memory.

METHODS

We recruited healthy male and female volunteers and investigated changes in their mood states and autonomic nervous, endocrine, and immune activities when autobiographic memory was evoked in the participants by asking them to smell an odor(s) that was nostalgic to them.

RESULTS

The autobiographic memories associated with positive emotion resulted in increased positive mood states, such as comfort and happiness, and decreased negative mood states, such as anxiety. Furthermore, heart rate was decreased, skin-conductance level was increased, and peripheral interleukin-2 level was decreased after smelling the nostalgic odor. These psychological and physiological responses were significantly correlated.

CONCLUSIONS

The present study suggests that odor-evoked autobiographic memory along with a positive feeling induce various physiological responses, including the autonomic nervous and immune activities. To the best of our knowledge, the present study is the first to observe an interaction between odor-evoked autobiographic memories and immune function.

New epitopes and function of anti-M3 muscarinic acetylcholine receptor antibodies in patients with Sjögren's syndrome

M3 muscarinic acetylcholine receptor (M3R) plays a crucial role in the secretion of saliva from salivary glands. It is reported that some patients with Sjögren's syndrome (SS) carried inhibitory autoantibodies against M3R. The purpose of this study is to clarify the epitopes and function of anti-M3R antibodies in SS. We synthesized peptides encoding the extracellular domains of human-M3R including the N-terminal region and the first, second and third extracellular loops. Antibodies against these regions were examined by enzyme-linked immunosorbent assay in sera from 42 SS and 42 healthy controls. For functional analysis, human salivary gland (HSG) cells were preincubated with immunoglobulin G (IgG) separated from sera of anti-M3R antibody-positive SS, -negative SS and controls for 12 h. After loading with Fluo-3, HSG cells were stimulated with cevimeline hydrochloride, and intracellular Ca(2+) concentrations [(Ca(2+) )i] were measured. Antibodies to the N-terminal, first, second and third loops were detected in 42·9% (18 of 42), 47·6% (20 of 42), 54·8% (23 of 42) and 45·2% (19 of 42) of SS, while in 4·8% (two of 42), 7·1% (three of 42), 2·4% (one of 42) and 2·4% (one of 42) of controls, respectively. Antibodies to the second loop positive SS-IgG inhibited the increase of (Ca(2+) )i induced by cevimeline hydrochloride. Antibodies to the N-terminal positive SS-IgG and antibodies to the first loop positive SS-IgG enhanced it, while antibodies to the third loop positive SS-IgG showed no effect on (Ca(2+) )i as well as anti-M3R antibody-negative SS-IgG. Our results indicated the presence of several B cell epitopes on M3R in SS. The influence of anti-M3R antibodies on salivary secretion might differ based on these epitopes.

Profiling of serum proteins influenced by warm partner contact in healthy couples

OBJECTIVES

Warm physical contact may positively influence our health and well-being; however, it has not been investigated yet whether serum proteins are influenced by warm physical contact in healthy couples. In this study, we focused on psychological and physiological effects of warm partner contact in healthy couples.

METHODS

When participants freely kissed and hugged their romantic partners, they were asked to subjectively evaluate their present emotions. Furthermore, changes of serum proteins were determined by using ProteinChip surface enhanced laser desorption/ionization-time-of-flight-mass spectrometry (SELDI-TOF-MS). We characterized these proteins by using biochemical techniques combined with gel filtration high performance liquid chromatography (HPLC), reverse-phase HPLC, and sequencing analyses.

RESULTS

Romantic couples became happier and less irritated after kissing and hugging. Accompanying these psychological changes, SELDI-TOF-MS indicated that the intensities of 66-k Da, 11.7-k Da, and 5.9-k Da serum proteins were increased. These proteins were identified as serum albumin and beta2-microglobulin, and probably fibrinogen fragment. The feeling of happiness positively correlated and the feeling of irritation negatively correlated with intensities of serum albumin and beta2-microglobulin.

CONCLUSION

These results suggest that psychological stress may be reduced and we may feel happiness when we kiss and hug a romantic partner. Furthermore, these results also suggest that warm partner contact influences peripheral circulating proteins, more importantly, may promote health and well-being.

Laboratory and febrile features after joint surgery in patients with rheumatoid arthritis treated with tocilizumab

OBJECTIVES

To understand the acute phase responses to surgical intervention in patients with rheumatoid arthritis (RA) treated with the anti-interleukin (IL)6 receptor antibody, tocilizumab.

METHODS

In a retrospective 1:1 pair-matched case-control study, 22 tocilizumab-treated RA cases and 22 cases treated with conventional disease-modifying antirheumatic drugs (DMARDs) and matched for type of surgery, age and sex were evaluated for body temperature every day, and blood C-reactive protein (CRP) levels and white blood cell (WBC), neutrophil and lymphocyte counts on days -1, 1, 3 and weeks 1 and 2 after joint surgery. Safety issues were also monitored.

RESULTS

No complications of infection or delay of wound healing occurred in either patient group. Tocilizumab partially, but significantly, suppressed the increase in body temperature on postoperative days 1 and 2, compared with DMARDs (average (SD) maximum increase in temperature was 0.45 (0.1) degrees C in the tocilizumab group and 0.78 (0.1) degrees C in the DMARD group; p<0.01). Tocilizumab completely suppressed the increase in CRP after surgery, whereas all cases treated with DMARDs showed a significant increase of CRP at postoperative day 1 (5.5 (0.6) mg/dl; p<0.001). WBC, neutrophil and lymphocyte counts showed no remarkable change after surgery, and there was no significant difference in any cell counts between the patient groups.

CONCLUSIONS

Within this small number of cases, safe operations on patients were performed during tocilizumab treatment. Tocilizumab suppressed fever and increase of CRP after surgery, whereas there was no influence on the transition in number of leukocytes. This characteristic postoperative response should be considered during tocilizumab treatment.

Responses of ultra-weak chemiluminescence and secretory IgA in saliva to the induction of angry and depressive moods

Oxidative damage to tissues and cells contributes to disease processes. We used ultra-weak chemiluminescence (uwCL) as an indicator of oxidative activity to examine the effects of psychological challenges on oxidative responses. We also examined the association of underlying psychological characteristics with oxidative and immune responses. Eighteen healthy men and women with a mean age of 24.1 were recruited. Anger and depressive symptoms were evaluated using the State-Trait Anger Expression Inventory and the Center for Epidemiological Studies Depression Scale, respectively. Following a baseline period, participants were required to complete two separate speech tasks where they were asked to recall life events that made them feel angry (AT) or depressed (DT). The tasks were separated by a 30-min recovery period and the order was randomized between participants using a counterbalanced design. Saliva was sampled and assayed for uwCL and secretory immunoglobulin A (sIgA). The level of uwCL was significantly increased in response to both tasks (p<.05), whereas sIgA concentrations decreased significantly in response to DT (p<.05). At 30 min after each task, uwCL values were positively related to anger-in (p<.005), anger expression (p<.05) and trait anger (p<.05) post-AT, and sIgA concentrations were positively related to anger-out (p<.05) post-AT and -DT, after controlling for covariates. The present study suggests that induction of angry and depressive moods can increase oxidative activity and transiently weaken immunity indicated by salivary sIgA concentrations. In addition, anger personality traits may modify these responses.

[The Waffle procedure for constrictive epicarditis after direct closure of atrial septal defect; report of a case]

A 20-year-old man was admitted with a diagnosis of constrictive pericarditis 6 months after direct closure of atrial septal defect (ASD). He complained of fatigue and dyspnea. Cardiac echo cardiography, computed tomography (CT), magnetic resonance imaging (MRI) and cardiac catheterization suggested pericardial and epicardial constriction. During the operation, the thickened pericardium was peeled off. Multiple longitudinal and transverse incisions were made in the thickened epicardium as reported by waffle. Postoperative hemodynamic state was improved. The cardiac index increased from 1.91 to 3.17 l/min/m2. The pulmonary capillary wedge pressure (PCWP) decreased from 26 to 14 mmHg, although dip and plateau pattern was maintained. The postoperative course was uneventful.

Five-hour sleep restriction for 7 days increases subjective sleepiness

We investigated the effects of a 5-h sleep restriction for 7 d on subjective sleepiness in an ambulatory condition by comparing them with baseline conditions consisting of an 8-h sleep for 7 consecutive days. Subjects were 13 healthy male students (mean age 21.1 yr). Each subject was required to get 8 h of sleep (baseline, from 2300 to 0700) for 7 d, and 5 h of sleep (sleep restriction, from 0100 to 0600) for 7 d in an ambulatory condition. The order of the two sleep schedules was randomly assigned. Subjective sleepiness was assessed by a Visual Analog Scale (VAS) every 3 h at 0900, 1200, 1500, 1800, and 2100 for 7 successive days during each sleep schedule. The VAS score during sleep restriction gradually increased up to the 5th day and then reached a plateau. The patterns of time-course changes in the VAS score were similar to those at baseline. The VAS scores showed a peak at 0900, taking a dip at 1200, and then gradually increasing toward 2100. The mean VAS score of the last three days of the 5-h sleep restriction was significantly higher than that at baseline (p<0.001). A 5-h sleep restriction for 7 d in an ambulatory condition increased subjective sleepiness up to the 5th day and then reached a plateau. The patterns of the time-course changes in sleepiness of 5-h sleep restriction per day did not differ from that at baseline.

Possible connections among job stress, depressive symptoms, lipid modulation and antioxidants

BACKGROUND

Oxidative/antioxidative status may be related to psychological stress or pathogenesis of depression.

SUBJECTS AND METHODS

Participants were selected from 381 female nurses working in a university hospital, and the Brief Job Stress Questionnaire was utilized to assess them. Nurses with high job stress (JS) (n = 18) and with low JS (n = 15) consented to participate in this study. Depressive symptoms were assessed by the Centre for Epidemiologic Studies Depression scale (CES-D). Cholesterols, lipid peroxidation (malondialdehyde, MDA) and antioxidants in the plasma were measured.

RESULTS

High JS participants exhibited significantly higher CES-D scores (t = 3.34, p < 0.005), and significantly lower concentrations of total cholesterol (TC), low density+very low density lipoprotein cholesterols (LDL+VLDL), alpha-tocopherol, and beta-carotene compared with low JS participants (t = 2.69, p < 0.05; t = 3.46, p < 0.005; t = 2.96, p < 0.05; t = 2.98, p < 0.05, respectively). However, the reductions in plasma indicators were substantially weakened after controlling for lifestyle factors with the exception of LDL+VLDL and alpha-tocopherol. In addition, the significance of alpha-tocopherol concentrations appeared to depend on cholesterol levels. CES-D scores correlated positively with plasma MDA levels, the MDA/TC ratio and the MDA/LDL+VLDL ratio among the low JS group (r = 0.69, p < 0.001; r = 0.79, p < 0.001; r = 0.75, p < 0.005, respectively), whereas there were no correlations among the high JS group. After controlling for lifestyle covariates, the relationship between CES-D scores and the MDA/LDL+VLDL ratio remained significant (beta = 0.95, p < 0.05) using a multiple linear regression model (F = 3.61, p < 0.05).

LIMITATIONS

Sample numbers in each JS group were relatively small.

CONCLUSIONS

Psychological stress may reduce the plasma levels of LDL+VLDL accompanying an alpha-tocopherol decrease. There appeared to be a correlation between elevated MDA and depressive symptoms in low JS participants.

Limited VH gene usage in B-cell clones established with nurse-like cells from patients with rheumatoid arthritis

OBJECTIVES

Nurse-like stromal cells (NLC) in synovia and bone marrow of patients with rheumatoid arthritis (RA) can support pseudoemperipolesis, protect from apoptosis and enhance immunoglobulin production of peripheral blood B cells isolated from healthy individuals, suggesting the profound contribution of hyperactivation of B cells in RA. In the course of establishing RA-NLC from RA patients, we observed the growth of B cells in the presence of RA-NLC.

METHODS

We cloned B cells from the synovium or bone marrow of RA patients using the limiting dilution technique. For established clones, nucleotide sequences of immunoglobulin and surface antigens were investigated. To investigate the dependence of these clones on NLC, differences in the proliferation and the amount of immunoglobulin produced in the presence or absence of NLC were compared. Immunocytochemical staining of various cells was performed using the antibody these clones produced.

RESULTS

Nine B-cell clones established from RA patients showed RA-NLC-dependent growth. These B-cell clones expressed CD19, CD20, CD38, CD39 and CD40, suggesting that the cloned cells were mature and activated. All clones secreted immunoglobulins in culture media, which were specific for intracellular components of various cell lines, including RA-NLC. Interestingly, we found limited usage of immunoglobulin heavy-chain variable regions (VH) among B-cell clones from RA patients. These repertoires were reported to be detected preferentially in fetal livers.

CONCLUSION

The present study provides a novel insight into the involvement of RA-NLC in the immunopathogenesis of RA via an autoreactive B cell development and/or activation mechanism.

Depressive symptoms and life satisfaction in elderly women are associated with natural killer cell number and cytotoxicity

Well-preserved natural killer (NK) cell cytotoxicity (NKCC) is associated with healthy aging. The objective of the survey was to investigate psychological factors related to NKCC and NK cell populations in elderly women. A cross-sectional study involving 181 participants was conducted using the Japanese version of the 28-item General Health Questionnaire (GHQ) and additional questions assessing psychological status and lifestyle. Spearman's rank test revealed a significant negative correlation between NKCC and the GHQ depression subscale (GHQ-D) scores. Significantly reduced NKCC was found in participants presenting high GHQ-D scores (12 < or = GHQ-D, n = 58) compared with those showing middle (8 < or = GHQ-D < or = 11, n = 55) or low (GHQ-D = 7, n = 68) scores. Adjusting for covariates regarding lifestyle, multiple logistic regression analysis was applied; consequently, significant associations were found between reduced NKCC and high depressive symptoms and between increased NK cell numbers and life satisfaction. These results indicated a clue to longitudinal studies in the future.