N,N'-dialkylimidazolium chloroplatinate(II), chloroplatinate(IV), and chloroiridate(IV) salts and an N-heterocyclic carbene complex of platinum(II): synthesis in ionic liquids and crystal structures

The first imidazole-type carbene complex of platinum(II), cis-(C2H4)(1-ethyl-3-methylimidazol-2-ylidene)PtCl2, has been obtained by reacting PtCl2 and PtCl4 with ethylene in the basic [EMIM]Cl/AlCl3 (1.3:1) ionic liquid (where [EMIM]+ = 1-ethyl-3-methylimidazolium) at 200 degrees C and structurally characterized (monoclinic P21/c space group, a = 10.416(2) A, b = 7.3421(9) A, c = 15.613(2) A, beta = 101.53(2) degrees, Z = 4). This complex can be regarded as a stable analogue of the pi-alkene-Pd(II)-carbene intermediate in the Heck reaction. In addition, a series of new N,N'-dialkylimidazolium salts of platinum group metals of the type [RMIM]2[MCln], where [RMIM+] = 1-alkyl-3-methylimidazolium and M = Pt(II), Pt(IV), or Ir(IV), have been prepared and characterized. The salts [EMIM]2[PtCl6] (1) and [EMIM]2[PtCl4] (2) were prepared in the ionic liquid [EMIM]Cl/AlCl3 and the salts [BMIM]2[PtCl4] (3) and [BMIM]2[PtCl6] (4) (where [BMIM]+ = 1-n-butyl-3-methylimidazolium) and [EMIM]2-[IrCl6] (5) in aqueous or acetonitrile media. From TGA measurements, salts 1-5 decompose in air in several steps eventually to form the corresponding metal, the onset of decomposition being observed at (degree C) 260 (1), 220 (2), 200 (3), 215 (4), and 210 (5). The structures of 1, 2, and 5 were determined by single-crystal X-ray analysis. The three salts crystallize in the monoclinic P21/n space group (1, a = 7.6433(9) A, b = 16.353(2) A, c = 9.213(1) A, beta = 113.56(1) degrees, Z = 2; 2, a = 8.601(1) A, b = 8.095(2) A, c = 13.977(2) A, beta = 91.75(2) degrees, Z = 2; 5, a = 10.353(2) A, b = 9.759(2) A, c = 10.371(2) A, beta = 92.98(3) degrees, Z = 2).

Influenza vaccination coverage in old people's home in Carmarthenshire, UK, during the winter of 1998/99

A mailed questionnaire survey was undertaken in old people's (nursing and residential) homes in Carmarthenshire, UK to determine the influenza vaccine uptake during the 1998/99 season. Out of the total 60 questionnaires circulated, response was received from 47 homes giving an overall response rate of 78%. Amongst the 1399 residents, 1132 (81%) received influenza vaccine in the winter of 1998/99. Uptake was higher in nursing homes (89%) than in residential homes (79%) or dual registered homes (81%). The most common reason for not receiving influenza vaccination was refusal by the residents themselves, although the vaccine was offered to 99% of residents. This study suggests that strategies to improve communication and provision of educational materials outlining the benefits of influenza vaccine to elderly residents and health professionals may help increase the likelihood of vaccine uptake.

Influenza immunization coverage in older hospitalized patients during winter 1998-99 in Carmarthenshire, UK

OBJECTIVE

to determine the coverage of influenza vaccination in hospitalized elderly patients in view of the 1998 recommendations of the UK Department of Health, and the reasons for refusal in those unvaccinated.

DESIGN

questionnaire-based interview.

SETTING

acute elderly-care wards in a district general hospital in South Wales, UK.

SUBJECTS

443 consecutive patients aged over 65 hospitalized during December 1998 and January 1999.

RESULTS

of 383 patients in whom influenza vaccination was recommended according to Department of Health guidelines, only 48% received it during the winter of 1998-99. The commonest reason given by those unvaccinated was lack of information from the general practitioner (in 26% of cases). Other reasons were concern about vaccine side effects (21%), perceived good health (16%) and concern about vaccine efficacy (11%).

CONCLUSIONS

influenza vaccine uptake in high-risk older hospitalized patients is still unsatisfactory. Improved education of the health-care staff and the general public about the benefits of vaccine is necessary to improve uptake.

Speed of onset of regional analgesia in labour: a comparison of the epidural and spinal routes

This study compares the speed of onset of effective analgesia in two randomly assigned groups of patients requesting analgesia in labour. Patients in the combined spinal-epidural group (n = 69) were given a subarachnoid injection of 1.5 ml containing bupivacaine 2.5 mg and fentanyl 25 microg for initiation of analgesia. Patients in the epidural group (n = 73) were given an epidural injection of 10 ml containing bupivacaine 12.5 mg and fentanyl 50 microg. Mean (SD) onset times to the first pain-free contraction were 10.0 (5.7) min in the combined spinal-epidural group and 12.1 (6.5) min in the epidural group (p = 0.054). Patients in the combined spinal-epidural group suffered a higher incidence of motor weakness and proprioceptive deficit than those in the epidural group (p = 0.01). The incidence of technique failure and side-effects was similar in the two groups. It is our contention that the statistically nonsignificant difference in onset times does not justify the additional potential for side-effects and the extra cost of the equipment involved in the combined spinal-epidural technique.

IL-12 is a heparin-binding cytokine

Using an ELISA approach, we demonstrate that recombinant human IL-12 (rhIL-12) binds strongly to an immobilized heparin-BSA complex. This binding is completely displaceable with soluble heparin, IC50 approximately 0.1 microg/ml, corresponding to approximately 10 nM. By interpolation with our previous findings, this indicates an affinity for heparin greater than that of antithrombin III and comparable with that of FGF-2, two high-affinity heparin-binding proteins. Recombinant murine IL-12 also binds strongly to heparin. The binding of rhIL-12 to heparin shows specificity because chondroitin sulfates A and C fail to compete, whereas chondroitin B inhibits weakly. A highly sulfated heparan sulfate is a strong competitor, whereas other heparan sulfates show weak or no activity. Small heparin fragments inhibit binding, although activity decreases with size. An octasaccharide pool derived by cleavage of heparin with nitrous acid is a significantly stronger inhibitor than its heparinase I-derived counterpart, further indicating structural specificity in the interaction between rhIL-12 and heparin. The binding of recombinant p40 to heparin appears indistinguishable from that of the IL-12 heterodimer, implying that the heparin binding site is largely if not solely located in this subunit. These results show for the first time that IL-12 is a heparin-binding cytokine, a property common to the other Th1-response-inducing cytokines, IFN-gamma and IL-2. Our findings strongly suggest that IL-12 will tend to be retained close to its sites of secretion in the tissues by binding to heparin-like glycosaminoglycans, thus favoring a paracrine role for IL-12.

Prevalence of Helicobacter pylori in asymptomatic population--a pilot serological study in Bangladesh

Epidemiological reports reveal that H. pylori is distributed among all population in the world. The present cross-sectional study was undertaken to see the H. pylori seroprevalence rates among the asymptomatic adults, as yet reportedly no such data available in Bangladesh. Serum samples were collected from 181 consecutive subjects who attended at the health check-up centre of Bangladesh Institute of Diabeties, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, during the period of August to November 1995 for medical check up. The mean age of these subjects was 30.33 years (range 20-44 yrs). Incidentally all were male and belonged to average socioeconomic class. H. pylori specific IgG antibody level was assayed by an enzyme immunoassay kit ElAgen (Clone system). Among the 181 subjects, 166 (92%) had H. pylori specific antibodies and 15 (8%) were seronegative. No significant difference (p < 0.90) in seroprevalence rates was observed among different age groups. However, the results of higher seroprevalence rates of H. pylori infection in these asymptomatic adult population of Bangladesh are consistent with that of Africa and India.

Continuing medical education in Wales: a survey of geriatricians

OBJECTIVE

to determine what practising geriatricians in Wales do to continue their education; what they would prefer to do; and what their views are on study leave, resources and funding.

DESIGN

questionnaire survey.

SETTING

the principality of Wales.

PARTICIPANTS

hospital-based, career-grade geriatricians.

RESULTS

the overall response rate from a total of 56 questionnaires was 87%. More than half [26 (53%)] of the respondents stated they were able to take only half of their study leave entitlement of 10 days a year. Twenty-five (51%) considered this to be due to service commitment. Geriatricians regarded attendance at routine hospital meetings [47 (96%)] and specialist society meetings [45 (92%)], reading books and journals [49 (100%)] and discussion with colleagues [44 (90%)] as their preferred methods of keeping up to date. Most respondents [44 (90%)] said that the resources and funding required to underpin the system of continuing medical education (CME) should be provided by the employing authority.

CONCLUSIONS

the many barriers to the continuing education of geriatricians in Wales include service commitments and funding constraints. Geriatricians placed great emphasis on the traditional CME methods such as reading books and journals, attending meetings and conferences and discussion with colleagues and were reluctant to use technology-based educational methods. The results of this study have implications for the way in which geriatricians fulfil CME obligations in the future and provide directions for the planners of CME.

Antitubercular treatment does not prevent constriction in chronic pericardial effusion of undetermined etiology: a randomized trial

Patients of chronic exudative pericardial effusion are frequently treated with antitubercular treatment on presumptive grounds in developing countries, in a hope to prevent constrictive pericarditis. To assess the impact of antitubercular treatment on development of constrictive pericarditis in chronic large exudative pericarditis effusion of undetermined etiology, 25 patients above 12 years of age, with large pericarditis effusion beyond 12 weeks duration, were randomized in a prospective 2:1 fashion, to receive either 3-drug antitubercular treatment (group A) or placebo (group B) for six months. End points studied were, development of pericardial thickness as diagnosed by CT scan and constrictive pericarditis as diagnosed by cardiac catheterization. Twenty-one patients (14 in group A and 7 in group B) completed the study protocol. In all, five (23.8%) patients developed constrictive pericarditis/pericardial thickening. Histopathological examination of pericardiectomy specimens in over five patients were negative for tubercular pathology. Pericardial effusion resolved completely in another 10 (47.8%) patients. There was no significant difference in both the groups in development of constrictive pericarditis/pericardial thickening (group A: n = 3, 21.4% and group B: n = 2, 29.6%, p = NS). On multivariate analysis, development of constrictive pericarditis/pericardial thickening was associated with recurrent tamponade (p = 0.01), presence of tamponade at admission (p = 0.07) and haemorrhagic pericardial effusion (p = 0.08). Thus, antitubercular treatment does not prevent the development of constrictive pericarditis in patients of large chronic pericardial effusion of undetermined etiology.

Development of gastroenterology in Bangladesh

Diseases of the gastrointestinal tract and liver are very common in Bangladesh. Gastroenterology as a dedicated specialty was initiated in 1977 at the Institute of Postgraduate Medicine and Research in Dhaka. One more centre was set up later and these centres are providing specialized diagnostic and therapeutic services. These centres are also imparting training in endoscopy and 49 endoscopists trained so far are providing services in 22 centres around the country. Clinical gastroenterologists are also being trained in a 3 year Master's degree course and three specialists have already completed this. A Gastroenterology Society was formed in 1988 and has held three national scientific conferences and 20 regional meetings. Research in special problems of the country has also been initiated and work on aspects of peptic ulcer disease, chronic calcific pancreatitis and chronic viral hepatitis has been conducted. The demand for gastrointestinal services is high and the specialty has attracted a good number of young doctors. Gastroenterology is likely to grow in size and quality in Bangladesh.

Improvement in contractility of infarct zone after dobutamine infusion predicts good (TIMI II or III) flow in infarct related artery

Eighteen patients of 'Q' wave acute myocardial infarction (AMI) (age 50 +/- 6.2 years), underwent dobutamine stress echocardiography (DSE) before hospital discharge (7.2 +/- 1.3 days after AMI) to find out the correlation between response of infarct zone to dobutamine infusion and TIMI grade flow in infarct related artery (IRA). The aim of study was to test the hypothesis that infarct zone which shows improvement in contractility after dobutamine infusion has viable myocardial tissue and would have good flow (TIMI II or III) in IRA. Echocardiographically, improvement in contractility in the centre of infarct zone by at least 1 grade (on a scale of 4) was termed as positive response on DSE. The mean dose of dobutamine was 19.4 micrograms/kg/min. Ten patients had positive response on DSE; 8 of them had good antegrade flow in IRA. Eight patients had no improvement in contractility of infarct zone on DSE; 6 of them had poor flow in IRA. Clinical markers of reperfusion (relief of chest pain, early ST settlement, peak CPK-MB levels), age of patient, site of AMI, time to thrombolysis, resting left ventricular ejection fraction, wall motion score of the infarct zone and presence of collaterals were not significantly different in patients with good or poor flow in IRA. Thus, improvement in contractility of infarct zone after dobutamine infusion can predict good flow (TIMI II or III) in IRA with 80 percent sensitivity, 75 percent specificity, 80 percent diagnostic accuracy, 80 percent positive predictive value and 75 percent negative predictive value.

Bioavailability and pharmacokinetic properties of 2 sustained-release formulations of diclofenac sodium, Voltaren vs inflaban: effect of food on inflaban bioavailability

In this study, in vitro characterization, bioavailability and pharmacokinetics of 2 different sustained-release diclofenac sodium dosage forms were compared, Voltaren (100 mg tablets), manufactured by Ciba-Geigy and Inflaban (100 mg enteric-coated tablets), manufactured by the Arab Pharmaceutical Manufacturing Company. The in vitro results demonstrated a faster rate of dissolution for Inflaban as compared to Voltaren, but both products exhibited a sustained-release pattern. The bioavailability study was conducted on 20 healthy male subjects who received a single oral dose (100 mg) of each product according to a randomized 2-way crossover design. Blood samples were obtained over a 26-hour period, and drug concentrations were determined by an HPLC method. Concentration time profiles revealed a sustained-release pattern for both products. The Tlag for Voltaren was 0.8 +/- 0.2 h, significantly shorter than for Inflaban (1.7 +/- 0.2 h) indicating a faster rate of absorption from the upper gastrointestinal tract. The Cmax obtained with Voltaren was significantly higher than that obtained with Inflaban (1,161 +/- 102 and 799 +/- 83, respectively). With respect to Tmax and AUC0-26h parameters, both products were not found to be statistically different. Tmax for Voltaren and Inflaban was 4.2 +/- 0.5 and 4.5 +/- 0.4 h, respectively, whereas AUC0-26h values for both products were 5,423 +/- 562 and 5,237 +/- 520 ng x h/ml, respectively. It is believed that the observed differences between Voltaren and Inflaban are mainly due to the fact that Inflaban is designed as an enteric-coated tablet form, with a core tablet having different sustained-release behavior. In addition, the effect of food on the bioavailability of Inflaban was evaluated in randomly selected 6 male volunteers. Our results revealed that, following light and heavy meals, the AUC0-30 and Cmax were minimally affected by food whereas a significant increase in Tmax and Tlag as compared to fasting conditions was observed.

Predictors of duodenal ulcer healing in sucralfate treated patients

The objective of the study was to assess the efficacy of sucralfate in promoting duodenal ulcer healing and to assess the value of some variables in predicting outcome of such therapy. Following variables were tested for predicting the outcome: age at onset, age at presentation, duration of symptoms, sex, periodicity, smoking, nocturnal pain, relief by food, relief by antacid, gastric stasis like symptoms, associated irritable bowel syndrome, site, size and number of ulcers and degree of deformity of bulb. Sixty patients with uncomplicated DU confirmed at endoscopy were treated with sucralfate one gram before three major meals and 1 g at bedtime for two months. Endoscopy was repeated at the end of the trial. There were four drop-outs. Complete, partial and no healing occurred in 45 (80.36)%, 3 (5.36%) and 8 (14.28%) subjects. Ulcer healing rate was higher in those without gross bulbar deformity (41/46) than in those with gross deformity (4/10), (Odd's ratio 12.3, 95% ci 1.98 to 78.44). Other variables were not found to be associated with ulcer healing.

Effects of oral lithium on the action of various C.N.S. active drugs

Effects of prolonged lithium administration was seen on the action of various psychoactive drugs in animals. Apomorphine induced pecking in pigeons increased significantly by lithium treatment for 14 days, from 1445.3 +/- 202.5 in control to 2785.8 +/- 205.8 in Gp. B. Haloperidol-induced catalepsy score in albino rats increased significantly following chronic lithium treatment compared to control. Chlorpromazine-induced hypothermia in rabbits was immediate but transient, while in lithium treated rabbits induction of hypothermia was delayed, sustained and of greater magnitude. This action of lithium may be mediated by increasing the permeability of blood-brain barrier, or enhancing the sensitivity of alpha-adrenoceptors in brain.

The corporate practice of health care ... a panel discussion

The pros and cons of treating health care as a profit-making business got a lively airing in Boston May 16, when the Harvard School of Public Health's "Second Conference on Strategic Alliances in the Evolving Health Care Market" presented what was billed as a "Socratic panel." The moderator was Charles R. Nesson, J.D., a Harvard Law School professor of 30 years' standing whose knack for guiding lively discussions is well known to viewers of such Public Broadcasting Service series as "The Constitution: That Delicate Balance. "As one panelist mentioned, Boston was an interesting place for this conversation. With a large and eminent medical establishment consisting mostly of traditionally not-for-profit institutions, the metropolis of the only state carried in 1972 by liberal Presidential candidate George McGovern is in one sense a skeptical holdout against the wave of aggressive investment capitalism that has been sweeping the health care industry since the 1994 failure of the Clinton health plan. In another sense, though, managed care-heavy Boston is an innovative crucible of change, just like its dominant HMO, the not-for-profit but merger-minded Harvard Pilgrim Health Care. Both of these facets of Beantown's health care psychology could be discerned in the comments heard during the panel discussion. With the permission of the Harvard School of Public Health--and asking due indulgence for the limitations of tape-recording technology in a room often buzzing with amateur comment--MANAGED CARE is pleased to present selections from the discussion in the hope that they will shed light on the business of health care.

Solitary thyroid nodule: a study of 100 cases

One hundred cases of solitary thyroid nodules attending the thyroid clinic, Institute of Postgraduate Medicine & Research, Dhaka (IPGMR) and the Institute of Nuclear Medicine (INM) were included in a prospective study. Thyroid ultrasonography (USG), scintiscanning, radioactive iodine (I131) uptake (RAIU), estimation of serum total T3, T4 & TSH and Fine Needle Aspiration Cytology (FNAC) were performed in all cases. Surgical resection with histopathologic study was performed in selected cases. Extra-nodular part of the thyroid gland was normal in 68 and diffusely enlarged in 32, RAIU was normal in 62, high in 36 and very low in two subjects. Nodules were solid at USG in 67 subjects, cystic in 16 subjects and of mixed consistency in 17 subjects. Goitrous subjects had significantly lower T4 (p < 0.001) and higher T3 (p < 0.01) and TSH (p < 0.001) than non-goitrous ones. Colloid nodule was the commonest pathology occurring in 41 cases, followed by thyroid cysts (26), follicular adenoma (23), adenoma with cystic change (7), subacute thyroiditis (2) and papillary carcinoma (1). Colloid nodules were more common in goitrous subjects which could hint at iodine deficiency as the major cause of such nodules. Hyperfunctioning follicular adenomas occurred exclusively in non-goitrous subjects. Carcinoma appeared to be uncommon in patients with solitary nodules. It gives an opportunity to our physicians to be more conservative in selecting patients with solitary thyroid nodules for surgical treatment.

Multidrug-resistant Salmonella typhi in Pakistani children: clinical features and treatment

Multidrug-resistant Salmonella typhi has become a major public health problem. In this study, typhoid fever was diagnosed by isolation of Salmonella typhi from blood or by a positive Widal's reaction in 170 Pakistani children. There were 111 boys (65%) and 59 girls (35%). The average age was 6.2 years; 4 (2%) were less than 1 year old, 78 (46%) were 1 to 5 years old, and 88 (52%) were more than 5 years old. All patients were pretreated with antibiotics. Salmonella typhi was detected by culture in 109 cases (64%), by Widal's test in 84 (49%), and by both in 23 (14%). All 79 isolates that were multidrug resistant were sensitive to ofloxacin, cefotaxime, and ceftriaxone. Clinical features of infections due to resistant S typhi did not differentiate these from other cases of typhoid. Fifty-five infections (70%) due to resistant S typhi were treated with ofloxacin and 24 (30%) with ceftriaxone. Sixteen patients had complications, and all recovered.