Biomonitoring of polycyclic aromatic hydrocarbons exposure and short-time health effects in wildland firefighters during real-life fire events

Human biomonitoring data retrieved from real-life wildland firefighting in Europe and, also, worldwide are scarce. Thus, in this study, 176 Portuguese firefighters were biomonitored pre- and post- unsimulated wildfire combating (average:12-13 h; maximum: 55 h) to evaluate the impact on the levels of urinary polycyclic aromatic hydrocarbons hydroxylated metabolites (OHPAH; quantified by high-performance liquid chromatography with fluorescence detection) and the associated short-term health effects (symptoms, and total and differentiated white blood cells). Correlations between these variables and data retrieved from the self-reported questionnaires were also investigated. Firefighters were organized into four groups according to their exposure to wildfire emissions and their smoking habits: non-smoking non-exposed (NSNExp), non-smoking exposed (NSExp), smoking non-exposed (SNExp), and smoking and exposed (SExp). The most abundant metabolites were 1-hydroxynaphthalene and 1-hydroxyacenaphthene (1OHNaph + 1OHAce) (98-99 %), followed by 2-hydroxyfluorene (2OHFlu) (0.2-1.1 %), 1-hydroxyphenanthrene (1OHPhen) (0.2-0.4 %), and 1-hydroxypyrene (1OHPy) (0.1-0.2 %); urinary 3-hydroxybenzo(a)pyrene was not detected. The exposure to wildfire emissions significantly elevated the median concentrations of each individual and total OHPAH compounds in all groups, but this effect was more pronounced in non-smoking (1.7-4.2 times; p ≤ 0.006) than in smoking firefighters (1.3-1.6 times; p ≤ 0.03). The greatest discriminant of exposure to wildfire emissions was 1OHNaph + 1OHAce (increase of 4.2 times), while for tobacco smoke it was 2OHFlu (increase of 10 times). Post-exposure, white blood cells count significantly increased ranging from 1.4 (smokers, p = 0.025) to 3.7-fold (non-smokers, p < 0.001), which was accompanied by stronger significant correlations (0.480 < r < 0.882; p < 0.04) between individual and total OHPAH and total white blood cells (and lymphocytes > monocytes > neutrophils in non-smokers), evidencing the impact of PAH released from wildfire on immune cells. This study identifies Portuguese firefighters with high levels of biomarkers of exposure to PAH and points out the importance of adopting biomonitoring schemes, that include multiple biomarkers of exposure and biomarkers of effect, and implementing mitigations strategies.

Baseline data and associations between urinary biomarkers of polycyclic aromatic hydrocarbons, blood pressure, hemogram, and lifestyle among wildland firefighters

Introduction

Available literature has found an association between firefighting and pathologic pathways leading to cardiorespiratory diseases, which have been linked with exposure to polycyclic aromatic hydrocarbons (PAHs). PAHs are highlighted as priority pollutants by the European Human Biomonitoring Initiative in occupational and non-occupational contexts.

Methods

This cross-sectional study is the first to simultaneously characterize six creatinine-adjusted PAHs metabolites (OHPAHs) in urine, blood pressure, cardiac frequency, and hemogram parameters among wildland firefighters without occupational exposure to fire emissions (> 7 days), while exploring several variables retrieved via questionnaires.

Results

Overall, baseline levels for total OHPAHs levels were 2 to 23-times superior to the general population, whereas individual metabolites remained below the general population median range (except for 1-hydroxynaphthalene+1-hydroxyacenaphtene). Exposure to gaseous pollutants and/or particulate matter during work-shift was associated with a 3.5-fold increase in total OHPAHs levels. Firefighters who smoke presented 3-times higher total concentration of OHPAHs than non-smokers (p < 0.001); non-smoker females presented 2-fold lower total OHPAHs (p = 0.049) than males. 1-hydroxypyrene was below the recommended occupational biological exposure value (2.5 μg/L), and the metabolite of carcinogenic PAH (benzo(a)pyrene) was not detected. Blood pressure was above 120/80 mmHg in 71% of subjects. Firefighters from the permanent intervention team presented significantly increased systolic pressure than those who performed other functions (p = 0.034). Tobacco consumption was significantly associated with higher basophils (p = 0.01-0.02) and hematocrit (p = 0.03). No association between OHPAHs and blood pressure was found. OHPAHs concentrations were positively correlated with monocyte, basophils, large immune cells, atypical lymphocytes, and mean corpuscular volume, which were stronger among smokers. Nevertheless, inverse associations were observed between fluorene and pyrene metabolites with neutrophils and eosinophils, respectively, in non-smokers. Hemogram was negatively affected by overworking and lower physical activity.

Conclusion

This study suggests possible associations between urinary PAHs metabolites and health parameters in firefighters, that should be further assessed in larger groups.

Cellular Antioxidant, Anti-Inflammatory, and Antiproliferative Activities from the Flowers, Leaves and Fruits of Gallesia integrifolia Spreng Harms

Gallesia integrifolia, a notable species in the Atlantic Forest, has been traditionally employed in folk medicine for treating rheumatism, asthma, and worms. This study investigated the cellular antioxidant, antiproliferative, and anti-inflammatory activities of the essential oils (EOs) and crude extracts (CEs) from G. integrifolia flowers, fruits, and leaves. The chemical identification of EOs was performed by GC-MS and CEs by UHPLC-MS. Cellular antioxidant and anti-inflammatory activities were assessed through mouse macrophage cell culture. In addition, the antiproliferative potential was evaluated in gastric, colorectal, breast, and lung tumor cell lines and non-tumor VERO cells. EOs predominantly contained organosulfur compounds in flowers (96.29%), fruits (94.94%), and leaves (90.72%). We found the main compound is 2,2'-Disulfanediyldiethanethiol in the EOs of flowers (47.00%), leaves (41.82%), and fruits (44.39%). Phenolic compounds were identified in CEs. The EOs and CEs demonstrated potential against the tumor cell lines tested (GI₅₀ between 51 and 230 µg/mL). The selectivity index values were greater than 1.0 (1.01 to 3.37), suggesting a relative safety profile. Moreover, the anti-inflammatory activity IC₅₀ ranged from 36.00 to 268 µg/mL, and the cellular oxidation inhibition ranged from 69% to 82%. The results suggest that oils and extracts derived from G. integrifolia have potential for use in various industrial sectors.

Brazilian berry waste as a source of bioactive compounds: grumixama (Eugenia brasiliensis Lam.) as a case study

Grumixama, Eugenia brasiliensis Lam., is a Brazilian berry little explored commercially and scientifically. However, local small producers market this fruit in the form of frozen pulp, which generates bioresidues, composed of seeds and peels. With the view to propose strategies for valuing grumixama, this study aimed to determine the chemical composition and assess the bioactivities of the hydroethanolic extracts of the whole residue (GR), seed (GS) and peel (GP) fractions of E. brasiliensis. From the results, GP had the highest concentration of organic acids (oxalic, malic, ascorbic and citric acids), total tocopherols, condensed tannins, anthocyanins, and other flavonoids. On the other hand, GS showed the highest content of monounsaturated fatty acids and hydrolysable tannins, whereas GR displayed a mixture of compounds detected in each of its parts. Regarding the bioactivities, low extract concentrations were required in two in vitro antioxidant assays, namely TBARS (EC₅₀ = 0.90-1.34 μg mL^-1) and OxHLIA (IC₅₀ = 21-65 μg mL^-1). Furthermore, GP had the highest inhibition activity of cellular oxidation in the CAA assay (80 ± 0.6%), while GS showed the highest anti-inflammatory activity via nitric oxide production inhibition (EC₅₀ = 98.0 ± 0.5 μg mL^-1). All samples induced cell growth inhibition of the tested tumor cells (GI₅₀ = 14.7-186 μg mL^-1) besides antibacterial and antifungal effects at low concentrations, but all samples were harmful to normal cells at moderate concentrations (GI₅₀ = 145-268 μg mL^-1). Therefore, E. brasiliensis residue could be a good source of bioactive compounds to be used in several areas. However, additional studies are needed to confirm its safety as well as to unravel the mechanisms behind its biological activities.

Exploring Clinical Trials to Manage Firefighters' Sleep Quality: A PRISMA Compliant Systematic Review

Sleep research has grown over the past decades and investigators are deeply involved in studying sleep and its impact on human health and body regulation. Despite the understanding that insufficient sleep is strongly linked to the development of several disorders, unsatisfactory sleep exposes health and safety to innumerous risks. The present study aims to review and analyze the main results of clinical trials, registered at ClinicalTrials.gov and ICTRT databases, and developed construct strategies to improve sleep quality on firefighters and enhance professionals' sleep and health conditions. The protocol was registered in PROSPERO under number CRD42022334719. Trials registered between first registry and 2022 were included. We retrieved 11 registered clinical trials; seven met eligibility criteria and were included in the review. A relation between sleep disorders, shift work, and occupational health problems was found, and retrieved trials showed that sleep education programs can improve sleep quality and sleep hygiene. Science has already recognized sleep's importance for metabolic functioning and survivorship. Nevertheless, it continues to play a major role in discovering methods to diminish the problems faced. Strategies contemplating sleep education, or intervention, should be presented to fire services to tackle this problem and promote healthier and safer environments.

Linking the roles of personality and stress physiology for managing the welfare of captive big cats

Animal welfare is important for the humane treatment of animals under our care. Zoos and rescue centres manage various charismatic animals, such as big cats, with limited resources. It is therefore essential for caretakers to understand the needs of an individual big cat to ensure its welfare. However, these needs may differ due to a big cat's personality, which may be identified by its coping style in a stressful situation. In addition, stress is one of the major factors affecting animal welfare. There is limited evidence showing strong associations between personality and stress physiology in big cats. This review focuses on the integration of personality and stress physiology of captive big cats, to highlight possible improvements in their husbandry. Our review identifies key factors that may influence big cat responses to stressors. These influencing factors include: i) social interactions; ii) environment; iii) life history and evolutionary traits; iv) genetics; and v) health. The first two factors are relatively well covered in the literature; however, the final three are potentially very promising avenues for future research to better understand how we can improve big cat welfare.

Chemical and Bioactive Characterization of the Essential Oils Obtained from Three Mediterranean Plants

Cupressus sempervirens L., Juniperus communis L. and Cistus ladanifer L. are Mediterranean arboreal and shrub species that possess essential oils (EO) in their leaves and branches. This study aimed at characterizing the EOs obtained by steam distillation from the three species collected in different locations from Spain (Almazán, Andévalo, Barriomartín, Cerezal, Ermitas and Huéscar). For this purpose, volatiles composition was determined by GC-MS, and different bioactivities were evaluated. The highest content in terpenes was observed in C. sempervirens (Huéscar origin) followed by J. communis (Almazán origin), corresponding to 92% and 91.9% of total compounds, respectively. With exception of C. ladanifer from Cerezal that presented viridiflorol as the most abundant compound, all the three species presented in common the α-pinene as the major compound. The EOs from C. ladanifer showed high antibacterial potential, presenting MIC values from 0.3 to 1.25 mg/mL. Concerning other bioactivities, C. ladanifer EO revealed an oxidation inhibition of 83%, while J. communis showed cytotoxicity in the MCF-7 cell line, and C. sempervirens and C. ladanifer EOs exhibited the highest potential on NCI-H460 cell lines. Nevertheless, some EOs revealed toxicity against non-tumoral cells but generally presented a GI₅₀ value higher than that of the tumor cell lines.

Factors associated with high-risk pregnancy: role of environmental contaminants, Brazil

Introduction

The Região Metropolitana da Baixada Santista (RMBS) is considered as a region with the worst maternal and child mortality rates in the state of São Paulo, Brazil. Besides this, RMBS has the worst rates of environmental contamination. High-Risk Pregnancy is one of the factors that lead to a higher chance of morbidity and mortality of the mother and fetus binomial.

Objective

Evaluate the relationship between exposure to environmental contaminants and high-risk pregnancy.

Methodology

Case-control study, using a probabilistic sample composed of 402 pregnant women divided into with and without high-risk pregnancy. The instrument used was a self-administered questionnaire and secondary data on contaminated areas obtained from the Environmental Company of the State of São Paulo. Descriptive analysis, Chi-square test, univariate and multiple logistic regression analysis were performed. The participants were also georeferenced by place of residence.

Results

It was observed an association, by chi-square test between high-risk pregnancy and age over 35 years (p &lt; 0.05), use of insecticide (p &lt; 0.001), consumption of foods packed in plastics (p = 0.050) and manipulation with oil paint (p = 0.002). The final multiple logistic regression model demonstrated that those who live in contaminated areas are 2 times more likely to have a risk pregnancy (OR = 1.993; 95%CI: 1.02; 3.90), as well as identified as jointly important risk factors for pregnancy: working in health services (OR = 3.97 (95%CI: 1.00; 16.09)), use of insecticide (OR = 3.45 (95%CI: 1.66; 7.16)) and use of oil paint (OR = 6.96 (95%CI: 1.38; 35.09)).

Conclusions

Environmental contaminants play an important role in pregnancy, and mitigating measures are needed to improve the environment and reduce high-risk pregnancy in RMBS.

Key messages

Exposure to the environmental contaminants is an important rik factor in the pregnancy. The Região Metropolitana da Baixada Santista (RMBS) is considered as a region with the worst maternal and child mortality rates in the state of São Paulo, Brazil.

Firefighters exposure to fire emissions: Impact on levels of biomarkers of exposure to polycyclic aromatic hydrocarbons and genotoxic/oxidative-effects

Firefighters represent one of the riskiest occupations, yet due to the logistic reasons, the respective exposure assessment is one of the most challenging. Thus, this work assessed the impact of firefighting activities on levels of urinary monohydroxyl-polycyclic aromatic hydrocarbons (OHPAHs; 1-hydroxynaphthalene, 1-hydroxyacenaphthene, 2-hydroxyfluorene, 1-hydroxyphenanthrene, 1-hydroxypyrene, 3-hydroxybenzo(a)pyrene) and genotoxic/oxidative-effect biomarkers (basal DNA and oxidative DNA damage) of firefighters from eight firehouses. Cardiac frequency, blood pressure and arterial oxygen saturation were also monitored. OHPAHs were determined by liquid-chromatography with fluorescence detection, while genotoxic/oxidative-effect biomarkers were assessed by the comet assay. Concentrations of total OHPAHs were up to 340% higher (p ≤ 0.05) in (non-smoking and smoking) exposed workers than in control subjects (non-smoking and non-exposed to combat activities); the highest increments were observed for 1-hydroxynaphthalene and 1-hydroxyacenaphthene (82-88% of ∑OHPAHs), and for 2-hydroxyfluorene (5-15%). Levels of biomarker for oxidative stress were increased in non-smoking exposed workers than in control group (316%; p ≤ 0.001); inconclusive results were found for DNA damage. Positive correlations were found between the cardiac frequency, ∑OHPAHs and the oxidative DNA damage of non-smoking (non-exposed and exposed) firefighters. Evidences were raised regarding the simultaneous use of these biomarkers for the surveillance of firefighters' health and to better estimate the potential short-term health risks.

Chemical composition and bioactive properties of Sanguisorba minor Scop. under Mediterranean growing conditions

Sanguisorba minor Scop. is a perennial plant native to the Mediterranean region which exhibits several medicinal activities. In the present study, plant growth, chemical composition, and antitumor and antimicrobial properties of S. minor plants were evaluated under different growing conditions. In particular, plants were grown on different substrates, namely (A) peat, (B) peat : perlite (1 : 1) and (C) peat : perlite (2 : 1). The dry weight of the aerial parts and roots was higher for the peat treatment (A), whereas plant growth was severely affected in the peat : perlite (1 : 1) treatment (B). The major detected sugars were fructose and glucose, while the peat : perlite (2 : 1) treatment resulted in a significant increase of α-tocopherol, glucose and total sugars content, especially in the aerial parts. Oxalic acid and citric acid were the major organic acids detected, with a varied effect of growth substrate on organic acid profile. Growth substrate and plant part also had a significant effect on fatty acid composition, especially on linoleic acid and α-linolenic acid content which was higher in the peat : perlite (1 : 1) treatment in both aerial parts and roots. An impact on the composition of phenolic compounds was also observed, where the plants grown on peat : perlite (2 : 1) and peat : perlite (1 : 1) substrates had the highest content of individual and total phenolic compounds in their aerial parts and roots, respectively. Moreover, roots contained significantly higher amounts of phenolic compounds than the aerial parts. Moreover, plant extracts exhibited antiproliferative activity against four tumor cell lines (HeLa, HepG2, MCF-7 and NCI-H460) and a primary culture of porcine liver cells (PLP2), as well as significant antimicrobial properties. In conclusion, S. minor presented significant bioactive properties, while growth substrates affected the nutritional value, chemical composition, antitumor and antimicrobial properties of the species which could be probably attributed to the higher phenolic compound content and different compositions of phenolic compounds. Therefore, although the species is commonly found in the Mediterranean region, it is underexploited yet and its plant tissues could be a potential source of natural bioactive compounds with further use in pharmaceutical and medicinal applications.

Control of a community outbreak of hepatitis A in an area of low endemicity, Wales, 2016

Incidence of hepatitis A in Wales is low (average of 0.48/100,000 inhabitants from 2004-2015). We describe a community outbreak of hepatitis A involving 3 schools (primary and secondary) in South Wales between March and June 2016 and reflect on the adequacy of the control measures used. Anyone in South Wales epidemiologically linked to a serological and/or RNA positive confirmed case of hepatitis A during the 15-50 d before onset of symptoms (diarrhea, vomiting, fever, nausea, AND jaundice, or jaundice-associated symptom) was defined as a case. Case identification was based on laboratory or GP suspicion notification, changing to active surveillance toward the end. As per national guidance, household contacts were identified and offered immunisation while in schools vaccination followed evidence of transmission. We went beyond guidance by vaccinating street play mates and in secondary schools. Mass vaccination uptake was calculated. There were 17 cases, mostly in children under 16 y of age. All cases had an epidemiological link to either a school or a household case (except primary) and no travel history. Street playing was the only epidemiological link between 2 cases in different schools. A total of 139 household contacts were identified. All schools, including secondary one, had a transmission event preceding mass vaccination (overall uptake 85%, reaching 1,574 individuals) and no tertiary cases emerged after the campaigns. We recommend extending guidance to include actions taken that helped curb this outbreak: 1) vaccinating in secondary school and 2) broadening the household contact definition. Based on our learning we further suggest 3) vaccinating upon identification of a single case who attended school while infectious regardless of source and 4) active case finding by serologically testing contacts.

Contribution of the phenolic composition to the antioxidant, anti-inflammatory and antitumor potential of Equisetum giganteum L. and Tilia platyphyllos Scop

Naturally-occurring phytochemicals have received pivotal attention in the last few years, due to the increasing evidence of biological activities. Thus, in the present study, the antioxidant, anti-inflammatory and antitumor potentials of hydroethanolic extracts rich in phenolic compounds obtained from Equisetum giganteum L. and Tilia platyphyllos Scop. were assessed and directly correlated with their content of phenolic compounds, by using HPLC-DAD-ESI/MS analysis. T. platyphyllos showed the higher bioactive potential, evaluated in terms of antioxidant (radical scavenging effects - 105 μg mL^-1, reducing power - 123 μg mL^-1, β-carotene bleaching inhibition - 167 μg mL^-1, and lipid peroxidation inhibition - 56 μg mL^-1), anti-inflammatory (225 μg mL^-1 inhibited 50% of nitric oxide production) and antitumor (breast - 224 μg mL^-1; lung - 247 μg mL^-1; cervical - 195 μg mL^-1 and hepatocellular - 173 μg mL^-1 carcinoma cells) activity, without having cytotoxic effects (>400 μg mL^-1). These biological properties were positively correlated with its content and composition of phenolic compounds. Flavonoid contents were markedly higher than the content of phenolic acids, in both samples, being respectively 50.4 mg g^-1 and 11.65 mg g^-1 for T. platyphyllos, and 21.7 mg g^-1 and 4.98 mg g^-1 for E. giganteum. Moreover, while in E. giganteum extract, kaempferol-O-glucoside-O-rutinoside was the most abundant flavonoid, in T. platyphyllos extract protocatechuic acid and (-)-epicatechin were the most abundant phenolic acid and flavonoid, respectively. In relation to their content of phenolic acids, protocatechuic and caffeic acids existed in higher abundance in T. platyphyllos and E. giganteum hydroethanolic extracts, respectively. However, it would be interesting to evaluate the in vivo efficacy of both plant extracts to unveil the involved modes of action and to establish effective therapeutic doses.

Clinical effectiveness and safety of vildagliptin in >19 000 patients with type 2 diabetes: the GUARD study

The present GUARD study was a prospective, non-interventional study evaluating the clinical effectiveness, safety and tolerability of vildagliptin with or without metformin in adult patients with type 2 diabetes mellitus (T2DM) studied in routine clinical practice. Patients were enrolled from countries across four geographical regions. The primary endpoint was change in glycated haemoglobin (HbA1c) concentration from baseline after 24 weeks of treatment with vildagliptin with or without metformin. Of 19 331 patients analysed, 3511 received vildagliptin and 15 820 received vildagliptin plus metformin. At week 24, the mean HbA1c was reduced significantly from baseline by -1.27% (vildagliptin: -1.17%; vildagliptin plus metformin: -1.29%; p < 0.0001). Significant reductions in HbA1c from baseline were consistently reported regardless of patient age, body mass index (BMI) or baseline HbA1c. Weight and BMI were also significantly reduced from baseline. Vildagliptin treatment with or without metformin was generally well tolerated. It provided clinically relevant glycaemic and weight control, and was well tolerated in a large multi-ethnic population of patients with T2DM studied in routine clinical practice.

Laboratory capability for molecular detection and confirmation of novel coronavirus in Europe, November 2012

A rapid survey by the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) Regional Office for Europe ascertained the availability of national reference laboratory testing for a recently detected novel coronavirus as of 28 November 2012. Screening by internal quality controlled upE-RT-PCR assay was available in 23/46 of responding countries in the WHO European Region, of which 19/30 in European Union (EU) and European Economic Area (EEA) countries. Confirmation of positive screened samples by either ORF1b - RT-PCR, or other target RT-PCR assays with sequence analysis or whole-genome sequence analysis was available in 22/46 responding countries of which 18/30 in EU/EEA countries.

The early days of pandemic (H1N1) 2009 virus infection in the central region of Portugal

BACKGROUND

The first case of pandemic (H1N1) 2009 virus infection was diagnosed in the central region of Portugal on June 16, 2009, in a woman infected in Canada.

METHODS

The aim of our study was, first to characterize the clinical and epidemiologic aspects of all the patients with clinical manifestations included in the definition of case for investigation with samples submitted to diagnosis of the pandemic (H1N1) 2009 virus infection, in the central region of Portugal; second to assess the precision of the case definition of case for investigation considered in the study according to the presence or the absence of fever at the moment of clinical observation. We reviewed the medical records of all the patients presenting with Influenza like-illness classified as case for investigation and the first cases of patients infected with the new pandemic (H1N1) 2009 virus, diagnosed in the central region of Portugal during the pandemic period between June and August, 2009, were analyzed. Real-time reverse-transcriptase polymerase-chain-reaction (RT-PCR) testing was used to confirm the pandemic (H1N1) 2009 virus infection. Data collection was performed on a standardized paper format in agreement with the General Health Directorate.

RESULTS AND DISCUSSION

Pandemic (H1N1) 2009 virus infection was confirmed in 255 patients. Overall, median age was 23 years and 42.7 % were included in the category of 20 to 29 years. Confirmed infection in patients with less than 2 years or greater than 50 years was a rare event. The first cases were imported from Europe, namely France, Spain and England. On a second phase, pandemic (H1N1) 2009 virus infection was acquired in the south of Portugal (Algarve), before de diagnosis of the first domestic case. The incidence rate for pandemic (H1N1) 2009 virus infection was 10.7 per 100,000 persons and was different according to the district. It was higher in the district of Coimbra and Guarda were the main roads connecting to Europe are. The median calculated incubation period for the for pandemic (H1N1) 2009 virus infection was 2 days. The length of the clinical manifestations until the patients look for medical observation had a median time of 2 days. All the cases were of mild to moderate severity. No deaths were observed.

CONCLUSIONS

The early days of pandemic (H1N1) 2009 virus infection was mild in our region. Most affected patients were young adults, with the extreme categories ages of life being spared. Early detection and diagnosis, combined with stringent isolation and treatment procedures could have slowed the spread of the infection in our region.

Spontaneous intracerebral haemorrhage following evacuation of chronic subdural hematomas

Spontaneous intracerebral haematoma (ICH) is an extremely unusual complication following the evacuation of a chronic subdural haematoma (CSDH). Good outcome is expected after the drainage of the CSDH and neurological deterioration is a cause for serious concern. Authors report three cases of spontaneous ICH away from the site of surgery following evacuation of a CSDH with a review of literature. Changes in cortical blood flow following decompression of a long standing CSDH may be responsible for the ICH.

Sigmoid sinus thrombosis in a child after closed head injury

Sigmoid sinus thrombosis in children following a closed head injury is rare. The authors report such a case with the clinical presentation, radiological findings and current literature.

Precise mass measurement of 68Se, a waiting-point nuclide along the rp process

Mass measurements of 68Ge, 68As, and 68Se have been obtained with the Canadian Penning Trap mass spectrometer. The results determine the mass excess of 68Se as -54 232(19) keV, the first measurement with a precision and reliability sufficient to address the light-curve and energy output of x-ray bursts as well as the abundances of the elements synthesized. Under typical conditions used for modeling x-ray bursts, 68Se is found to cause a significant delay in the rp process nucleosynthesis.

Influence of caffeine on pharmacokinetic profile of sodium valproate and carbamazepine in normal human volunteers

The present study evaluates effect of pharmacokinetic interaction between caffeine (300 mg) in three divided doses with sodium valproate (400 mg) and carbamazepine (200 mg) given as single doses, in normal human volunteers, using a open cross over design. Both the serum concentration of sodium valproate and pharmacokinetic parameters remained unaltered, as against significant reduction in plasma concentration and area under the concentration curve of carbamazepine following the coadministration of caffeine. Also, the plasma t 1/2 (of carbamazepine was prolonged by two folds and bioavailability reduced by about 32% in presence of caffeine. The results are of clinical significance as xanthine consumption may have to be restricted in patients on carbamazepine therapy and this aspect may need further investigation.

Aminophylline alters pharmacokinetics of carbamazepine but not that of sodium valproate--a single dose pharmacokinetic study in human volunteers

Pharmacokinetic interaction of aminophylline with single dose sodium valproate (400 mg) and carbamazepine (200 mg) was evaluated in normal healthy volunteers using a cross over design. Neither the serum concentrations nor the pharmacokinetic parameters of sodium valproate (SV) were altered by the coadministration of aminophylline (AMP). In contrast AMP significantly decreased the plasma concentrations of carbamazepine (CBZ). The Cmax of CBZ was significantly lowered from 1.73 +/- 0.18 to 0.94 +/- 0.08 microgram/ml and the AUC o-t was significantly decreased from 76.19 +/- 6.20 to 52.66 +/- 1.84 micrograms/h/ml (P < 0.05). The pharmacokinetic parameters of CBZ that were altered in the presence of AMP were: the Tmax and t1/2 which was prolonged about threefold from 5.60 +/- 1.60 to 16.80 +/- 7.94 h and 44.88 +/- 4.50 to 125.07 +/- 29.09 h, respectively. The Vd was marginally increased from 2.19 +/- 0.13 to 3.85 +/- 0.57 L/kg and the Cl was decreased from 34.07 +/- 3.78 to 25.26 +/- 5.15 mL/min. None of these alterations are statistically significant. Bioavailability of CBZ was reduced by 29% in the presence of AMP, while that of SV was increased by about 8%. Results are of clinical significance because simultaneous administration of CBZ and AMP may reduce the efficacy of CBZ in epileptic patients.