Intravitreal vancomycin. Retinal toxicity, clearance, and interaction with gentamicin

Some of the gram-positive isolates from exogenous bacterial endophthalmitis cases treated at our institution have been found to be resistant to either cefazolin sodium, gentamicin sulfate, or both. However, all of these isolates have been sensitive to vancomycin. These findings prompted us to reevaluate the retinal toxicity and clearance of intravitreal vancomycin in pigmented rabbits. Doses up to 2 mg were found to be nontoxic in phakic and aphakic-vitrectomized eyes. Clearance was determined in phakic and aphakic-vitrectomized rabbit eyes with or without intact lens capsules. The antibiotic was cleared most slowly in phakic eyes. Aphakic-vitrectomized eyes without an intact lens capsule cleared antibiotic most rapidly, while aphakic-vitrectomized eyes with intact capsules exhibited an intermediate clearance rate. In addition, the interaction between vancomycin and gentamicin on gram-positive endophthalmitis isolates was found to be additive or synergistic depending on the bacterial species. Based on these data, we recommend the combination of vancomycin and an aminoglycoside as the initial antibiotic therapy for exogenous bacterial endophthalmitis.

Untoward effects of pharmacological doses of insulin in early chick embryos: through which receptor are they mediated?

The teratogenic effect of insulin in early vertebrate embryos is controversial and the mechanisms involved are unknown. We studied the effects of pharmacological doses of insulin in chick embryos during the period of differentiation. We compared the effects of insulin with two proinsulins, desoctapeptide-insulin and multiplication-stimulating activity, peptides that have little insulin-like metabolic activity while they have significant growth effects. Chick embryos at 46 h of development were injected with the different peptides. At 96 h the mortality and abnormal growth elicited by the peptides were dose-dependent. Considering the indices of lethality (LD50) and affected embryos (ED50) as 100% for insulin, proinsulin was 59-66% as potent as insulin, desoctapeptide-insulin 2-6% and multiplication-stimulating activity 176-204%. In the surviving embryos, insulin (5 micrograms, decreased DNA, RNA and protein content by 49%, 40% and 48% respectively compared with controls. The effects of insulin were not corrected by simultaneous glucose injections. These data suggest that insulin, at pharmacological doses, interferes with embryo development through a non-metabolic pathway, probably via a growth-type receptor.

Protein digestibility of methionine supplemented common beans (Phaseolus vulgaris) in adult human subjects

The study reports on the protein digestibility of five cultivars of common beans (Phaseolus vulgaris) of different color, tested in young adult human subjects, as the sole dietary protein source. Cheese protein was used as reference protein. The cooked beans provided 0.65 g protein/kg/day, and energy intake was adjusted to 45 kcal/kg/day. Results indicated apparent protein digestibility to vary from 49.6 to 62.1%. White colored beans showed the highest value, while black beans gave the lowest. Cheese protein showed an apparent protein digestibility of 76.2%. The true protein digestibility was calculated using the endogenous nitrogen excretion values obtained in the study, as well as literature values. Digestibility increased as expected, but it is still low as compared to other protein sources. A high correlation was found between dry matter digestibility and protein digestibility. Fecal nitrogen was fractionated between soluble and insoluble nitrogen in a 0.02 N NaOH solution. This assay was also carried out in the cooked beans, and findings revealed that the soluble nitrogen fraction was highly correlated with protein digestibility, with a correlation coefficient of -0.94. This fraction, still to be identified, could very well be responsible for the low digestibility values found for common beans in human subjects.

Systemic and cardiac haemodynamic interactions between guanfacine and hydrallazine in hypertensive patients

The effect of guanfacine and hydrallazine on cardiovascular haemodynamics and on sympathetic nervous activity has been studied in 16 patients with essential hypertension. Two groups of patients were investigated: in Group A guanfacine brought the blood pressure back to normal (diastolic blood pressure less than or equal to 90 mmHg), and in Group B diastolic blood pressure was greater than 90 mmHg and required the addition of hydrallazine. Guanfacine significantly decreased heart rate, plasma renin activity and urinary excretion of noradrenaline, without altering cardiac contractility. In Group B, guanfacine 2 to 6 mg/day produced a significant decrease in blood pressure from 178.7/112.4 to 164.4/102.9 mmHg and in heart rate from 77.1 to 62.7 beats/min after 4 weeks of treatment. Guanfacine did not significantly alter preejection period, cardiac output or total peripheral resistance. Hydrallazine 50 to 300 mg/day caused a further reduction in blood pressure from 164.4/102.9 to 150.7/90.2 mmHg and an increase in heart rate from 62.7 to 72.1 beats/min. Limb blood flow was increased from 4.55 to 5.93 ml/100 g/min and limb vascular resistance was decreased from 39.55 to 23.6 mmHg 100 g X min/ml. Hydrallazine also caused a slight increase in plasma renin activity and urinary excretion of noradrenaline. It is concluded that guanfacine is a useful agent to block a hydrallazine-induced increase in sympathetic nervous activity.

Effect of indoramin and propranolol on cardiovascular response to cold in hypertensive patients

Immersion of the hand into ice water (cold-pressor test) in nine hypertensive subjects induced elevation of mean blood pressure, increase of vascular resistance in the extremities, decrease of blood flow in the extremities, and increase in heart rate. The preejection phase of systole was not altered. Indoramin and propranolol, each alone and together, attenuated the pressor and other cardiovascular responses. Submaximal exercise increased heart rate during placebo treatment, a response only partially attenuated by indoramin, propranolol, and their combination, but it did not induce changes in mean blood pressure during any of the treatments.

[Supplementary effect of 3 sources of soy protein on various corn products]

The purpose of the study was to demonstrate that the supplementary effect of soybean protein to corn depends on the protein quality of the soybean product and of the corn products used. Four types of corn flour of different protein quality were used, which included two whole corn flours produced from common corn, one from Opaque-2 corn, and one from degerminated corn. Likewise, three soybean products were tested, including a solvent-extracted soybean flour, a texturized soybean product and a soybean protein isolate. The study was carried out with weanling rats and the effects were measured by PER assays. The results corroborated the hypothesis that the protein quality of the ingredients controls the response observed. The supplementary effects were more evident for low-quality corn flours. Furthermore, large increments in quality were observed with additions of 5% soy protein, which became smaller as this level increased, independent of the corn flour used.

Effect of minoxidil on sympathetic nervous activity in clonidine-treated hypertensive patients

The effects of clonidine and minoxidil on sympathetic nervous activity has been studied in 10 patients with accelerated or resistant hypertension. Clonidine 150 to 900 micrograms/day caused a significant decrease in blood pressure of 18.6 mm Hg, of heart rate 16.4 beats/min, of plasma renin activity 1.13ng/ml h, and of urinary noradrenaline excretion 11.55 micrograms/day, and a significant lengthening of the pre-injection period of 12.4 ms. Minoxidil 5 to 22.5 micrograms/day caused a further significant decrease in blood pressure of 24.2 mm Hg, and significant increases in heart rate 8.2 beats/min, plasma renin activity 1.68 ng/ml h and of urinary noradrenaline excretion 5.0 micrograms/day, and a significant shortening of the pre-ejection period of 20.6 ms. Neither clonidine nor minoxidil altered plasma dopamine beta-hydroxylase activity or the cardiovascular responses to treadmill exercise. It is concluded that clonidine is a useful alternative agent to block a minoxidil-induced increase in sympathetic nervous activity.

Hemodynamic response to isometric handgrip in acute myocardial infarction

Thirteen patients underwent right cardiac catheterization during the first 24 hours after the onset of symptoms of acute myocardial infarction. All had normal (less than 12 mm Hg) pulmonary arterial diastolic pressure or normal mean pulmonary wedge pressure (7.6 +/- 0.6 mm Hg). The patients did isometric forearm contraction to a measured level of 100 mm Hg. All patients had elevation of systemic systolic blood pressure, with a mean rise of 14.2 +/- 2.9 mm Hg; heart rate rose by 12 +/- 2 beats per minute. When compared to a control group, patients with acute myocardial infarction had a significant (P less than 0.005) elevation of 5.4 +/- 1.3 mm Hg in the pulmonary arterial diastolic or pulmonary wedge pressure. This may be a result of either increased left ventricular stiffness or decreased myocardial functional reserve. In the setting of acute myocardial infarction, patients with normal left ventricular filling pressures have abnormal ventricular performance. Isometric effort is poorly tolerated and should be avoided.

Bancroftian filariasis in Puerto Limón, Costa Rica

In four neighborhoods of Puerto Limón, a Caribbean coastal city in a tropical rainforest area of Costa Rica, examination of 1-ml samples of night blood from 1,142 randomly selected, and 1,196 associated, persons by the Knott and filter-chamber techniques revealed microfilariae of Wuchereria bancrofti in about 3% of the 2,338 samples. The frequency of infection was higher in males (3.9%) than in females (1.9%), higher in persons of black (4.1%) than of white (1.0%) race, and highest in persons aged 10-19 (4.0%) and over 50 years (4.8%), lowest in those under 10 years (1.1%). The median microfilaria density was 3.5, the highest 45, per 20 lambdas of blood. Microfilaremia was distinctly periodic. Dissection of 663 female Culex pipiens fatigans from 42 houses of infected persons revealed filarial larvae in 25; only 1 larva was third (infective) stage. Of 64 infected persons, 11 had clinical findings suggestive of filariasis. Elephantiasis was seen in 21 others. Other forms of symptomatic filariasis without microfilaremia, though presumed to be present, were not assessed specifically.