Not just anti covid vaccine in hub! Local Health Authority Rome 4, Lazio, Italy experience

Issue

At the end of December 2020 in Italy was started anti-covid vaccination campaign. For this purpose in the territory of Local Health Authority Rome 4, vaccination Hubs have been set up, one per each of four territory districts. The Hubs were large, never available previously, with routes suitable for welcoming and vaccinating a large number of people. Vaccination Service (SV) has organized anti-covid vaccinations with every day open Hubs, for 12 hours a day and more, without stopping, reaching very high vaccination coverage, but adherence to vaccinations into the calendar for 0-16 years further decreased during the pandemic period, particularly in adolescence.

Description of the problem

At the end of January covid vaccination requests decreased and SV realized a vaccination line dedicated to other vaccinations in each Hub so SV decided to invite the cohort of those born in 2010 that defaulted with the vaccination against human papilloma virus (HPV) and other mandatory/recommended vaccines.

Results

There were 2629 non-compliant adolescents (83% of resident population in 28 company territory municipalities). 2,353 phone calls were made and 232 smart-sms were sent (very recent method). They booked 598 children, who were vaccinated in just 3 days from 8.30 to 12.30 between February and March 2022. Total vaccines performed were 678: HPV9 389; meningococcal (ACWY and B) 278; 11 other. About 38 teenagers vaccinated every hour

Lessons

The way we used to contact resident population was innovative, easy and quick, necessary features to complete the intervention in a short time. This confirmed the importance in recruiting and adhering to vaccinations and leds to a driving effect also in the following days. Hubs as capacious and familiar places for the population, have allowed an excellent organization with a fast vaccination course, facilitated reception, resources optimization of health personnel.

Key messages

• To achieve vaccine prevention goals it is important to take advantage of available opportunities.

• It is very important to apply the experience gained with the Covid vaccination to non covid vaccinations as well.

Prevention of the spread of SARS COV-2 by Rapid Antigenic Tests on the passengers entering an Italian seaport

Abstract

Out of 38,282 passengers entering Italy at a major seaport, submitted to SARS-CoV-2 rapid antigenic test, 272 (0.6%) resulted positive and 212 (93.4%) were confirmed positive by qRT-PCR, leaving a 0.6% of false positive. Those resident in the area under control of the same Local Health Authority of the seaport were immediately submitted to isolation and investigated for contact tracing, the others notified to their Local Health Authority which did the same in the following day. This procedure was made possible by a full-time dedication of the local healthcare workers who managed all the passengers disembarking around the clock along the months of the emergency.

The vaccination registry of the local health company (ASL) Roma 4

Issue

The regional vaccination of Lazio (AVR) and the ASL vaccination registries(AVA) that feed it, have had to adapt to the directions of national vaccination registry. The ASL Roma 4 added other implementations.

Description of the Problem

L'AVA must, first of all, allow easy search of subjects, defaulters and vaccination coverage for various filters but it can also facilitate the recording and analysis activity.

Results

The provision of barcodes allows the prompt search of subjects, the check of tax code and AIC codes of vaccines. The digital signature of the privacy and consent forms and anamnesis, taken from the “Guide to contraindications to vaccinations” directly available, allows the elimination of the paper. The possibility to go directly to AVR allows the registration of vaccinations made in other ASL. In addition, the AVA allows the compilation of the adverse event reporting form and vaccine management. The link with the portal on the ASL website allows users to download the vaccination certificate. Important is the possibility to send SMS before vaccination deadlines or appointments. The SMART-SMS allows sending videos or photos and manage a short link (http://tiny.cc/XXX) to an information page on ASL website, as well as user response SMS, that can also directly change appointments.

Lessons

The dematerialization of the forms leds to a greater compliance with the procedures, a more accurate anamnesis and the streamling of the vaccination session, the SMS bring greater compliance of users and an increase in vaccination coverage. The use of mobile analytics tools allows monitoring of vaccination campaigns.

Key messages

The dematerialization of the forms in the vaccination registry leds to a greater compliance with the procedures, a more accurate anamnesis and the streamling of the vaccination session. The ability to send SMS through the vaccination registry brings greater compliance of users and an increase in vaccination coverage.

Vaccine prevention at the time of covid-19: the ASL Roma 4 experience

The end of January 2020 WHO sanctioned an international public health emergency and the Italian government issued directives with urgent measures to counter and manage the epidemiological emergency: bans, suspensions of activities have profoundly changed school, work and health social life which have an impact on vaccination prevention

Vaccinations Service (VS) of ASL Roma 4 vaccinates people of all ages and the healthcare professional (HP) noticed that the fear in the population is making the accesses less frequent and the vaccination coverage decrease and the infectious diseases will re-emerge. DPCM 4/3/2020 has established rules to contain the virus, the ASL task force and VS adopted and adapted them for a protected vaccination activity. Results Surgeries are cleaned more frequently and fomites have been removed. The rules were published on the ASL website, social networks, displayed on posters posted before entering the clinic and waiting rooms: vigilantes lets you enter without crowding the waiting room; only one parent enters; the adult enters alone; if you have a cough or sneeze cover your nose and mouth with a tissue or ask for the surgical mask, wash your hands with the disinfectant gel, sit only in the spaced chair. Inside the children find a nice poster with drawings to explain how to avoid the virus to be colored at home. Health care workers wear masks designed to calm children. As long as the epidemiological situation allows the vaccine prevention activity must be maintained. HP must give messages of trust for activities that are carried out safely. An emergency plan within the VS also provides the behavior to be used in the event that many health workers fall ill. At the time of Covid-2019 infection all forms of prevention are to be remodeled, not just vaccine prevention. Reducing the preventive actions could in a short time lead to the emergence of infectious diseases and not only with consequent important damages, including economic ones

ICH3, a selective alpha7 nicotinic acetylcholine receptor agonist, modulates adipocyte inflammation associated with obesity

PURPOSE

The alpha7 nicotinic acetylcholine receptor (α7nAChR), involved in the modulation of inflammation and insulin sensitivity, is downregulated in white adipose tissue (WAT) of obese patients. This study aims to test the ability of a selective synthetic α7nAChR agonist, the spirocyclic Δ²-isoxazoline derivative (R)-(-)-ICH3 (ICH3), to counteract acute inflammation and obesity-associated modifications in WAT.

METHODS

We employed the LPS-septic shock murine model, human primary adipocytes and diet-induced obese (DIO) mice. Inflammatory factor expression was assessed by ELISA and quantitative real-time PCR. Flow cytometry was employed to define WAT inflammatory infiltrate. Insulin signaling was monitored by quantification of AKT phosphorylation.

RESULTS

In the septic shock model, ICH3 revealed antipyretic action and reduced the surge of circulating cytokines. In vitro, ICH3 stimulation (10 µM) preserved viability of human adipocytes, decreased IL-6 mRNA (P < 0.05) and blunted LPS-induced peak of TNFα (P < 0.05) and IL-6 (P < 0.01). Chronic administration of ICH3 to DIO mice was associated with lower numbers of CD8+ T cells (P < 0.05) and to changed WAT expression of inflammatory factors (Hp, P < 0.05; CD301/MGL1, P < 0.01; Arg-1, P < 0.05). As compared to untreated, ICH3 DIO mice exhibited improved insulin signaling in the skeletal muscle (P < 0.01) mirrored by an improved response to glucose load (ipGTT: P < 0.05 at 120 min).

CONCLUSIONS

We proved that ICH3 is an anti-inflammatory drug, able to reduce inflammatory cytokines in human adipocytes and to blunt the effects of obesity on WAT inflammatory profile, on glucose tolerance and on tissue insulin sensitivity.

Health tourism: an opportunity for sustainable development

In February 2017, the "Programma Mattone Internazionale Salute" (ProMis), that is the Italian Program for Internationalization of Regional Health Systems of the Ministry of Health (MoH), presented the first version of its Position Paper on Health Tourism, which embeds a first shared approach to the recommendations expressed by the European Committee of Regions (CoR) on "Age-Friendly" tourism. The CoR stresses the importance of local and regional authorities in the coordination of multi-sectoral policies such as healthcare, social assistance, transport, urban planning and rural development in relation to the promotion of mobility, security, accessibility of services, including health care and social services. "Age-friendly" tourism is an example of an innovative tourist offer that strives to meet the health needs of the entire "traveling" population, with an integrated and cross-sector approach that involves various organizations operating in sectors such as healthcare, accessibility and transport. The aim of the workshop was to explore the interest of the stakeholders to participate in a systemic action in the field of "health" tourism, and to identify priority implementation areas that offer opportunities to take advantage of validated, innovative experiences that strengthen the accessibility to health and social services in regional, national and international contexts. This effort provides the opportunity to take advantage of aligning the European Structural and Investment Funds (ESIF) to the development of tourism, coherently with the needs and resources of local and regional health authorities.

Immune sensitization of equine bronchus: glutathione, IL-1beta expression and tissue responsiveness

BACKGROUND

Increasing clinical epidemiological and experimental evidence indicates that excess of production of reactive oxygen free radicals (ROS) induced by an oxidative stress is involved in the pathogenesis of a number of human airway disorders, as well as equine recurrent airway obstruction. Free-radicals modulate the activation of transcription factors, such as nuclear factor-(NF)-kappaB and activator protein (AP)-1, in several different cells. This activation leads to expression of many pro-inflammatory cytokines, including interleukin (IL)-1beta. We have hypothesized that equine airway sensitization might induce an oxidative stress and increase the ROS production, which in turn might enhance a production of IL-1beta and airway hyperresponsiveness.

METHODS

We have examined the effect of passive sensitization on IL-1beta mRNA expression and electrical field stimulation (EFS)-induced contraction in equine isolated bronchi, and the potential interference of reduced-glutathione (GSH), an antioxidant, with these responses. Bronchi passively sensitized with serum from animals suffering from heaves and having high total level of IgE, and control tissues, either pretreated or not with GSH (100 microM), were used to quantify IL-1beta mRNA. Other tissues were used to study the effect of EFS (3-10-25 Hz).

RESULTS

Mean IL-1beta mRNA expression was higher in passively sensitized than in control rings. GSH significantly (p < 0.05) reduced the IL-1beta mRNA expression only in passively sensitized bronchi. ELF induced a frequency-dependent contraction in both non-sensitized and passively sensitized tissues, with a significantly greater response always observed in sensitized tissues. GSH did not modify the EFS-induced contraction in non-sensitized bronchi, but significantly (p < 0.05) decreased it in passively sensitized tissues.

CONCLUSION

Our data indicate that the passive sensitization of equine bronchi induces inflammation and hyperresponsiveness. These effects might be due to an oxidative stress because a pretreatment with GSH decreased the increased IL-1beta mRNA expression and responsiveness to EFS of passively sensitized bronchi.

Effect of chronic prolactin infusion on pituitary prolactin and hypothalamic proopiomelanocortin

Although there is evidence that endogenous opioids, and in particular beta-endorphin (beta-EP), may mediate some of the suppressive effects of hyperprolactinemia on the hypothalamic-pituitary-gonadal (HPG) axis, there is controversy about the effects of prolactin (PRL) on beta-EP and its precursor, proopiomelanocortin (POMC), in the hypothalamus. In this study we have therefore examined the effects of chronic peripheral and intracerebroventricular (i.c.v.) infusion of ovine PRL on POMC gene expression and beta-EP levels in the medial basal hypothalamus (MBH) of castrated male and female rats. Endogenous pituitary and plasma PRL levels were determined by RIA with an antiserum to rat PRL which does not crossreact with oPRL. Suppression of endogenous rPRL levels was used as a confirmation of the biological effectiveness of the infused oPRL. POMC mRNA was measured in the MBH by solution hybridization assay. In the first experiment oPRL (5 microg/microl/h) or vehicle was infused for 2 weeks by osmotic minipump into the right lateral ventricle of ovariectomized rats. The mean plasma concentration of rPRL declined from 3.7+/-1.0 ng/ml in the controls to 1.4+/-0.13 ng/ml in the oPRL infused animals (P<0.05); pituitary rPRL content similarly decreased from 39.1+/-4.6 microg to 20.4+/-3.7 microg (P<0.02). There was no significant change in the concentration of POMC mRNA or beta-EP in the MBH of the oPRL treated animals. In the second experiment oPRL was infused for 1 week into the third ventricle of orchiectomized rats. Again despite a fall in endogenous PRL levels, there was no significant change in POMC or beta-EP in the MBH. In the third experiment oPRL was infused subcutaneously into orchiectomized rats for 2 weeks. Mean plasma oPRL levels were 150+/-7.3 ng/ml after 1 week and 58+/-7.5 ng/ml after 2 weeks. Pituitary rPRL content was again suppressed in the oPRL treated animals but no change in POMC or beta-EP was detected in the MBH. We conclude that oPRL can be infused both peripherally and centrally for up to 2 weeks with resulting suppression of endogenous pituitary PRL content and release. Under these conditions no effects on the concentrations of POMC mRNA or beta-EP could be demonstrated in the hypothalamus. These results suggest that either PRL has nongenomic effects on hypothalamic beta-EP or that endogenous opioids other than beta-EP mediate the suppressive effects of PRL on the HPG axis.

Interleukin-1 stimulates the central release of corticotropin-releasing hormone in the primate

The cytokine interleukin-1 (IL-1) is present in the brain and is known to cause a variety of neuroendocrine and immune effects in the rodent; the neuropeptide corticotropin-releasing hormone (CRH) plays a critical role in mediating many of these effects. Little is known about these neuropeptide interactions in the primate. We have therefore examined the effects of IL-1 alpha on the release of CRH in the ovariectomized rhesus monkey in vitro and in vivo. In 3 animals, the effect of IL-1 alpha on CRH release from the superfused hypothalamus was studied in vitro. The hypothalamus was divided in half and fragments from each half were superfused separately. Mean CRH release was 262 +/- (SE) 46 pg/20 min and increased to 1,340 +/- 470 pg/20 min after exposure to IL-1 alpha (p < 0.05). The effect of IL-1 alpha on CRH release into cerebrospinal fluid (CSF) in vivo was studied in 8 animals with chronic cannulas implanted in the lateral ventricle for IL-1 infusion; indwelling catheters were also placed via lumbar puncture and threaded into the cervical area for CSF collection. CSF was collected at a rate of 800 microliters/h during a 4-hour baseline period and for 4-8 h after intracerebroventricular infusion of 4.2 micrograms of IL-1 alpha. CRH increased significantly over time in CSF after IL-1 alpha infusion; the mean concentration of CRH increased from 83 +/- 17 pg/ml during the baseline period to 203 +/- 40 pg/ml after IL-1 alpha infusion (p < 0.01). We conclude that IL-1 stimulates central CRH release in the primate and that the effects of cytokines on the release of this important neuromodulator can be monitored in chronically cannulated animals in vivo.

Effect of chronic opioid antagonism on the hypothalamic-pituitary-ovarian axis in hyperprolactinemic women

Short term naloxone infusion studies have suggested that enhanced endogenous opioid activity may play a role in inhibiting GnRH and gonadotropin secretion in hyperprolactinemic patients. Because it was not known whether long term opioid antagonism would lead to persistent stimulation of LH with a subsequent ovarian response, we administered the long-acting oral opiate antagonist, naltrexone (NTX), to six hyperprolactinemic amenorrheic women. Blood was drawn from all subjects every 15 min for 10 h on a control day and again on the next day after the administration of 50 mg NTX. Five subjects continued NTX (50 mg daily) for 3-8 weeks. There was a significant increase in the mean concentration of LH (6.7 +/- 1.1 to 12.2 +/- 1.6 IU/L), area under the LH curve (200%), and LH pulse amplitude (3.2 +/- 0.6 to 7.2 +/- 1.0 IU/L) on the first NTX day compared to the control day (P < 0.02). Estradiol levels also increased on the first NTX day (P < 0.01). The mean peak estradiol level increased from 76 +/- 9.9 pmol/L on the control day to 138 +/- 21 pmol/L during NTX treatment (P < 0.02). NTX stimulated LH release in five of six patients, followed by a rise in estradiol in four of these five patients. This initial increase in estradiol was not sustained in most cases, and the mean estradiol level during the entire NTX treatment period was not significantly different from the control level. One patient achieved an estradiol level of 187 pmol/L after 3 weeks of NTX treatment and reported withdrawal bleeding after stopping NTX. No patient ovulated. PRL levels did not change on the first NTX day vs. the control day (166 +/- 79 vs. 167 +/- 67 micrograms/L); however, PRL did increase over time with continued NTX treatment (P < 0.05). The mean PRL level during chronic NTX treatment was 255 +/- 121 micrograms/L. We conclude that treatment of hyperprolactinemic amenorrheic women with NTX results in a prompt partial reactivation of the hypothalamic-pituitary-gonadal axis, as indicated by increased gonadotropin and subsequent estradiol release. The effect of opioid antagonism, however, did not lead to a sustained increase in estradiol secretion with chronic treatment. Thus, although endogenous opioids appear to play a key role in mediating PRL-induced gonadal suppression, chronic opioid antagonism with NTX does not appear to be an effective treatment for amenorrhea in these patients.

Aromatization is not required for androgen induced changes in proopiomelanocortin gene expression in the hypothalamus

Testosterone regulation of POMC mRNA and peptide levels has been previously demonstrated in the medial basal hypothalamus (MBH) of the rat. Although both dihydrotestosterone (DHT) and estradiol are known to affect POMC peptide levels in the MBH, it is unclear if the effects of testosterone on POMC gene expression are due to conversion by aromatization to estradiol or due to independent androgen actions. We have therefore compared the effects of the nonaromatizable androgen DHT and estradiol on POMC gene expression and beta-endorphin (beta-EP) levels in the MBH of castrated male rats. We have also examined the effect of the dopamine agonist, pergolide, on POMC in the DHT and estradiol treated animals in light of previous studies in female rats. In the first study POMC mRNA in the MBH, as measured by a solution hybridization assay, was 0.85 +/- 0.07 pg/microgram RNA 3 weeks after castration and decreased to 0.64 +/- 0.07 pg and 0.65 +/- 0.07 pg in the DHT treated rats with and without pergolide (P < 0.05). In the second study the mean POMC mRNA concentration in the MBH was 0.95 +/- 0.10 pg/microgram RNA and decreased to 0.68 +/- 0.06 pg and 0.70 +/- 0.08 pg in the estradiol treated rats with and without pergolide (P < 0.05). In both studies significant changes in beta-EP peptide levels paralleled the changes in POMC mRNA levels. We conclude that both androgens and estrogens can affect POMC mRNA levels in the male rat.(ABSTRACT TRUNCATED AT 250 WORDS)

Recombinant interferon alpha-2b as treatment of essential thrombocythaemia

We report the disease characteristics and therapeutic results for 25 patients suffering from essential thrombocythaemia (ET), treated with recombinant interferon-alpha-2b (IFN-alpha 2b). ET was diagnosed according to the criteria of the Polycythaemia Vera Study Group. All patients were programmed to receive a subcutaneous induction treatment consisting of 3 MU of IFN-alpha 2b daily for 6 months. In responding patients, treatment was continued for a further 6 months with 3 MU of IFN-alpha 2b three times a week. Complete response was achieved in 13 of 25 patients, partial response in 10 of 25. In 2 cases, therapy was unsuccessful. Side effects were usually mild, consisting of flu-like symptoms in most cases, and were easily controlled by paracetamol. After a median follow-up of 14 months after discontinuation of the treatment, most patients retained the therapeutic response in the absence of toxicity.

Dopamine and sex steroid regulation of POMC gene expression in the hypothalamus

Previous studies have shown that POMC mRNA and peptide levels are increased in the medial basal hypothalamus (MBH) of the chronically castrated rat and are suppressed with sex steroid replacement. In a parallel time course, hypothalamic dopamine turnover similarly changes after chronic castration and sex steroid replacement. In this study we have examined the effects of dopamine on POMC in the MBH and questioned whether the increase in dopamine activity which occurs in the MBH of chronically castrated rats is responsible for the stimulation of POMC seen under these conditions. We have therefore measured POMC gene expression and peptide content in the MBH of chronically castrated male and female rats in response to the dopamine antagonist haloperidol, and in intact or sex steroid replaced animals in response to the dopamine agonist pergolide. Adult male and female rats were studied 3-4 weeks after castration with and without testosterone (T) or estradiol (E2) replacement. POMC mRNA was measured by a solution hybridization S1 nuclease protection assay; beta-endorphin (beta-EP) and alpha-MSH were measured by RIA. In the first study 4 groups of ovariectomized (OVX) rats were treated with saline, haloperidol, E2 or E2 + pergolide. The mean POMC mRNA concentration in the MBH was 0.85 +/- 0.04 pg/microgram RNA in the saline group and decreased to 0.62 +/- 0.06 pg/microgram with haloperidol (p < 0.01). A similar decrease to 0.53 +/- 0.03 pg/microgram was seen with E2 (p < 0.01); pergolide however prevented the E2 induced decrease in POMC mRNA. In the second study ORCX rats received saline or haloperidol and sham-ORCX rats received saline or pergolide.(ABSTRACT TRUNCATED AT 250 WORDS)

Recombinant interferon alpha-2b in the treatment of polycythemia vera

We studied the effects of recombinant alpha 2-b interferon (alpha 2-b IFN) in a dose of 3 x 10(6)U intramuscularly three times a week for 1 year in 13 patients affected by polycythemia vera (PV) previously treated with phlebotomy only. Response to treatment was evaluated by reduction of the number of phlebotomies required to retain normal hematocrit value. Ten out of 13 patients (77%) responded to treatment; in 4 of them the exigency of phlebotomy was completely eliminated. In all responders a concomitant decrease of platelet count and splenomegaly was obtained. Treatment was well tolerated and side effects were easily controlled. We conclude that alpha-IFN may represent an attractive therapeutic option in the management of the proliferative stages of PV.

Effects of teicoplanin on human platelet aggregation in vitro and ex vivo

The effects of teicoplanin on adenosine-diphosphate (ADP)-induced human platelet aggregation in vitro and on both ADP- and ristocetin-induced human platelet aggregation ex vivo were investigated. In the in vitro study carried out on platelets from 7 healthy volunteers, teicoplanin had no effect on platelet function even at a concentration (1 mg/ml) 10 times higher than the peak level found in the in vivo state, but at the highest concentration (10 mg/ml), which is 100 times higher than that reached in vivo, it inhibited ADP-induced platelet aggregation. In the ex vivo studies carried out in 10 healthy volunteers, teicoplanin, following single intravenous doses of 400 mg and 800 mg, did not produce any effect on platelet function up to 6 hours after administration. After 12 hours, teicoplanin, when given at 800 mg i.v., reduced ADP-induced platelet aggregation.

Sonographic evolution of cornual pregnancies treated without surgery

Transvaginal sonography allows early and accurate diagnosis of cornual pregnancy, as well as providing a means for puncture injection treatment of certain ectopic pregnancies. We describe four cases of cornual pregnancy managed nonsurgically and followed with transvaginal sonography for 47-64 weeks. Sonographic evidence of cornual pregnancy persisted throughout the period of follow-up, despite resumption of normal menstrual cyclicity. We conclude that some early live cornual pregnancies can be managed by puncture injection, and cornual pregnancies in which the embryo has died can be followed conservatively.

Prevalence of use of cocaine and other substances in an obstetric population

Increasing use of cocaine among pregnant women has been reported. This study was conducted to determine the prevalence of positive urine toxicologic screens for cocaine and other substances of patients admitted to the Sloane Hospital for Women. Urine samples were obtained from 509 women admitted to the delivery suite. The overall prevalence of cocaine was 10% (n = 51). Cocaine use was 10 times more prevalent in the clinic population (14%) than in the private population, (1.4%). In addition, women whose urine samples were positive for cocaine were more likely to have no prenatal care, previous induced abortions, to be human immunodeficiency virus-positive, and admitted previous use of cigarettes, alcohol, cocaine, and other drugs. Amphetamines were detected in 13% (n = 65) of patients. However, the screens did not distinguish between metabolites of amphetamines and other drugs such as cold medications. The medical history alone predicted only 37% (n = 19) of the cocaine-positive screens and none of the amphetamine-positive screens.

3,5-Diphenyl-1H-pyrazole derivatives. V--1-Acetyl-4-hydroxy-3,5-diphenyl-2-pyrazoline esters, 4-hydroxy-3,5-diphenyl-1H-pyrazole esters and N-substituted 4-(3-amino-2-hydroxy-1-propoxy)-1-methyl-3,5-diphenyl-1H-pyrazoles with antiarrhythmic, sedative and platelet antiaggregating activities

The synthesis of 1-acetyl-4-hydroxy-3,5-diphenyl-2-pyrazoline esters 3, 4-hydroxy-3,5-diphenyl-1H-pyrazole esters 5 and N-substituted 4-(3-amino-2-hydroxy-1-propoxy)-1-methyl-3,5-diphenyl-1H-pyrazoles 7, starting from 4-hydroxy-3,5-diphenyl-2-pyrazoline is described. Some of compounds 3, 5 and 7 showed a considerable antiarrhythmic and sedative activity in rats and mice, respectively, as well as a remarkable in vitro platelet antiaggregating activity. Moreover, the above compounds usually exhibited moderate antihypertensive, local anesthetic, analgesic and antiinflammatory activities in rats and mice.

3,5-Diphenyl-1H-pyrazole derivatives. III--Esters from 1-(2-hydroxyethyl)-3,5-diphenyl-1H-pyrazole and its 4-bromo derivative with hypotensive, depressant, antiarrhythmic and analgesic activities

The synthesis of dialkylaminoalkyl ethers (III a-g) by reaction of 1-(2-hydroxyethyl)-3,5-diphenyl-1H-pyrazole (I) sodium salt with a series of omega-chloroalkyldialkylamines is described. Cyanoethylation of alcohol (I) and its 4-bromo derivative (II) gave 2-cyanoethyl ethers (III h, i), one of which (III h) was hydrolyzed to the corresponding carboxylic acid. Cyanoethylation of 3,5-diphenylpyrazole (IV) and its 4-bromo derivative (V) yielded nitriles (VI) and (VII), respectively, which were hydrolyzed to the corresponding carboxylic acids (VIII) and (IX). Some of the above compounds showed considerable hypotensive, depressant, antiarrhythmic and analgesic activities in mice and rats, as well as a remarkable platelet antiaggregating activity in vitro. Moreover, the above compounds usually exhibited a moderate antiinflammatory activity in rats and infiltration anesthesia in mice.

[Preparation and pharmacologic activity of N-oxides of 4'-(benzotriazol-2-yl-phenylalkanoic and -phenoxyalkanoic acids]

A number of N-oxides of 4'-(benzotriazol-2-yl)-phenylalkanoic and -phenoxyalkanoic acids bearing various substituents on position 6 of benzotriazole together with 4'-(benzotriazol-2-yl) phenylacetic acid were prepared and subjected to a wide pharmacological screening. Several compounds exhibited significant antiinflammatory and diuretic activities, while one was endowed with antihypertensive activity.

Interference of prenatal and postnatal exposure to Ca2+-antagonist agents on rat functional development of vascular system

Exposure to drugs during pregnancy can alter functional development of the vascular system. The present investigation was carried out in order to evaluate the effects of prenatal and postnatal exposure to Ca2+-antagonist (diltiazem, verapamil, and nimodipine) drugs on the development of rat vasomotor reactivity. Studies were carried out on pregnant female albino rats exposed from the first day of pregnancy until weaning to diltiazem and verapamil (6 and 24 mg/kg in their drinking water ad libitum) and nimodipine (3 and 12 mg/kg in their food ad libitum). After weaning, pups were exposed until the 60th day of age to the same treatment as their mothers were. Afterwards, pups from the 60th to 90th day of age were fed with a normal diet. In 30-, 60-, and 90-day-old conscious and anaesthetized pups, we evaluated the following: 1) systolic arterial blood pressure; 2) vasomotor responses elicited by various agents: L-noradrenaline (0.1, 1, and 5 micrograms/kg IV), L-isoprenaline (0.01, 0.1, and 1 micrograms/kg IV), and acetylcholine (0.01, 0.1, and 1 micrograms/kg IV) and by sinus-carotid baroreceptor stimulation; and 3) catecholamine, acetylcholinesterase, and adenosinase plasma levels. Prenatal and postnatal exposure to Ca2+-antagonist drugs significantly (P less than .05) decreased the pressor response to sinus-carotid baroreceptor stimulation and to L-noradrenaline and increased the hypotensive responses to L-isoprenaline and acetylcholine. Moreover, this type of treatment, although it induced a significant (P less than .05) decrease of catecholamine plasma levels, did not modify the acetylcholinesterase and adenosinase plasma levels in 30- and 60-day-old rats. On the 90th day of age, the evaluated parameters were not different from those of control rats. Our results showed that exposure to Ca2+ antagonists during pregnancy and the postnatal period may alter the functional development of rat vasomotor reactivity.

Aminoethers of (+)-1,3,3-trimethyl-2-oxabicyclo[2.2.2]octan-6-hydroxyimine with hypotensive activity

The synthesis of beta-dialkylaminoethyl ethers (II a-f) and gamma-dialkylaminopropyl ethers (II g-i), as well as of aryl carbamates (III 1, m), starting from (+)-1,3,3-trimethyl-2-oxabicyclo[2.2.2]octan-6-hydroxyimine (I), is described. beta-Dimethylaminoethyl ether (II a) showed a remarkable hypotensive and bradycardic activity in rats; moreover, nearly all compounds (II) and (III) exhibited a weak antiarrhythmic activity in rats. Infiltration anesthesia in mice, beta-blocking activity in dogs and antiacetylcholine activity in vitro are also reported.

Synthesis and pharmacological activity of derivatives of exo-trimethylenenorbornane. V

The synthesis of two series of amides and glycinamides starting from N-phenyl exo-5,6-trimethylenenorbornan-2-endo-amine, prepared from exo-5,6-trimethylenenorbornan-2-one via sodium borohydride reduction of its N-phenyl imine, is described. All amides showed a moderate hypotensive activity in rats, whereas some glycinamides and amides showed weak infiltration anesthesia and antiarrhythmic activity in mice. Effects on heart rate in rats are also reported.

Amides of N-phenyl benzonorbornen-2-endo-amine with hypotensive and other activities

The synthesis of two series of amides and glycinamides starting from N-phenyl benzonorbornen-2-endo-amine, prepared from benzonorbornen-2-one via sodium borohydride reduction of its N-phenyl imine, is described. Some amides showed a remarkable hypotensive activity in rats, whereas amides and glycinamides usually exhibited a moderate infiltration anesthesia in mice. Effects on heart rate in rats and antiarrhythmic activity in mice are also reported.

N-substituted 4,7,7-trimethyl-3-(1-piperidinyl)bicyclo-[2.2.1]hept-2-ene 2-carboxamides and 2-carbothioamides with hypotensive activity

The synthesis of two series of N-substituted 4,7,7-trimethyl-3-(1-piperidinyl)bicyclo[2.2.1]hept-2-ene 2-carboxamides (I d-h) and 2-carbothioamides (I i-o), as well as of some N-aryl 4,7,7-trimethyl-3-(1-pyrrolidinyl)bicyclo[2.2.1]hept-2-ene 2-carboxamides (I a-c), by reaction of camphor piperidinoenamine and pyrrolidinoenamine with aryl isocyanates and isothiocyanates is described. On the whole compounds (I d-h) showed a weak hypotensive activity in rats.

Cardiovascular effects of putrescine in dogs after systemic, intra-arterial vertebral and intraventricular injection

Putrescine produced in anesthetized dogs significant cardiovascular changes at higher doses than other transmitters. The hypotensive response observed after intravenous injection is due to histamine release. Tachycardic effects seem to be due both to release of histamine and to a reflex stimulation of carotid-sinus baroreceptors. The hypotensive and bradycardic effects observed after microinjection of putrescine into the III cerebral ventricle or into the vertebral artery are due to an increase in parasympathetic output.

[Analysis of a case of multiple myeloma with late dissemination of skin nodules]

A case of a 55 years old woman suffering from multiple myeloma with strong bone marrow proplasmocytic infiltration, several osteolytic and osteoporotic lesions and high seric M-component level and hypertensive heart failure is described. After 32 months of partial remission obtained with cyclic chemotherapy, large cutaneous tumors arose. Despite of a new therapeutic trial, in the last 8 months, an increase of bone marrow and seric signs was observed without involvement of the lungs or kidneys or expression of plasma-cell leukemia. Death occurred at 50th month because of sepsis and heart failure. A real cutaneous tropism, late occurred and without cytohistological changes, is stressed. The meaning of the rich vascularization of the skin over the tumors in absence of inflammation and necrosis remains unclear.