Analysis of Adverse Drug Reactions in Pediatric Patients with Epilepsy: An Intensive Pharmacovigilance Study

Epilepsy is a chronic neurological disease characterized by the presence of spontaneous seizures, with a higher incidence in the pediatric population. Anti-seizure medication (ASM) may produce adverse drug reactions (ADRs) with an elevated frequency and a high severity. Thus, the objective of the present study was to analyze, through intensive pharmacovigilance over 112 months, the ADRs produced by valproic acid (VPA), oxcarbazepine (OXC), phenytoin (PHT), and levetiracetam (LEV), among others, administered to monotherapy or polytherapy for Mexican hospitalized pediatric epilepsy patients. A total of 1034 patients were interviewed; 315 met the inclusion criteria, 211 patients presented ADRs, and 104 did not. A total of 548 ASM-ADRs were identified, and VPA, LEV, and PHT were the main culprit drugs. The most frequent ADRs were drowsiness, irritability, and thrombocytopenia, and the main systems affected were hematologic, nervous, and dermatologic. LEV and OXC caused more nonsevere ADRs, and PHT caused more severe ADRs. The risk analysis showed an association between belonging to the younger groups and polytherapy with ADR presence and between polytherapy and malnutrition with severe ADRs. In addition, most of the severe ADRs were preventable, and most of the nonsevere ADRs were nonpreventable.

Folic acid increases levels of GHS in brain of rats with oxidative stress induced with 3-nitropropionic acid

Aim: This study tested the hypothesis that folic acid (FA) modulates biogenic amines and protects the brain against oxidative stress induced by 3-nitropropionic acid (3NPA).Methods: Male Wistar rats received (groups of six) for 5 d: FA (50 mg/kg); 3NPA (10 mg/kg); or FA +3NPA. At last day, rats were sacrificed, and their brain was obtained to measure the levels of dopamine, 5-hydroxiindol acetic acid (5-HIAA). Reduced glutathione (GSH), total ATPase, H₂O₂ and lipid peroxidation were measured.Results: GSH increased significantly in cortex of rats treated with FA. ATPase increased significantly in cerebellum/medulla oblongata and decreased in cortex of animal treated with 3NPA. 5-HIAA increased in striatum of rats that received 3NPA alone or combined with FA.Conclusion: 3NPA generates free radicals such effect can be counteracted with FA administration since this folate increases antioxidant capacity and modulates biogenic amines.

Cytarabine and Ferric Carboxymaltose (Fe+3) Increase Oxidative Damage and Alter Serotonergic Metabolism in Brain

BACKGROUND & OBJECTIVE

The purpose of this study was to measure the effect on brain biomarkers after treatment with anticancer compounds - cytarabine (CT) and ferric carboxymaltose (FC) (Fe+3) in Wistar rats.

METHODS

The Wistar rats were treated as follows: group 1 (control), NaCl 0.9%; group 2, CT (25 mg/k), group 3, FC(Fe+3) (50 mg/k) and group 4, CT + FC(Fe+3). The animals were sacrificed and their brains were obtained and used to measure lipoperoxidation (TBARS), H2O2, Na+, K+ ATPase, glutathione (GSH), serotonin metabolite (5-HIAA) and dopamine. The results indicated an enhancement of lipid peroxidation in the cortex and striatum of groups treated with FC(Fe+3) and CT, while GSH decreased in the cortex of group treated with CT + FC(Fe+3). Dopamine decreased in the cortex of the rats that received CT, while in the striatum, 5HIAA increased in all groups.

RESULTS & CONCLUSION

These results suggest that the treatment with CT and FC(Fe+3) boosted oxidative stress and led to an alteration in momoamine concentrations in the brain.

Oseltamivir and indomethacin reduce the oxidative stress in brain and stomach of infected rats

The aim of this study was to determine the effect of oseltamivir and indomethacin on lipid peroxidation (LP), GABA levels, and ATPase activity in brain and stomach of normal and infected rats (IR), as novel inflammation model. Female Sprague Dawley rats grouped five each, either in the absence or presence of a live culture of Salmonella typhimurium (S. typh), were treated as follows: group 1 (control), PBS buffer; group 2, oseltamivir (100 mg/kg); group 3, indomethacin (67 μg/rat); group 4, oseltamivir (100 mg/kg) + indomethacin (67 μg/rat). All drugs were given intraperitoneally for 5 days. IR received the same treatments and the brain and stomach of the rats were removed in order to measure levels of GABA, LP, and total ATPase, using validated methods. Levels of GABA increased in stomach and cortex of IR with oseltamivir, but decreased in striatum and cerebellum/medulla oblongata of IR with indomethacin. LP decreased in the three brain regions of IR with oseltamivir. ATPase increased in stomach of IR and non-IR with oseltamivir and in striatum and cerebellum/medulla oblongata of IR with indomethacin. Results suggest that the effect of free radicals produced in an infection and inflammatory condition caused by S. typh could be less toxic by a combination of oseltamivir and indomethacin.

Effect of cerebrolysin on dopaminergic neurodegeneration of rat with oxidative stress induced by 3-nitropropionic acid

The study tested the hypothesis that cerebrolysin protects the brain from free radicals in rats treated with 3-nitropropionic acid (3-NPA). To address this hypothesis, the levels of dopamine (DA) and some oxidative stress biomarkers were measured after administration of 3-NPA. Young male Fischer rats were treated for three days with cerebrolysin, 3-NPA or both substances. Their brains were extracted, and DA, lipid peroxidation (LP), glutathione (GSH), calcium, and H2O2 were measured using validated methods. In the cortex, hemispheres and cerebellum/medulla oblongata of the group treated with cerebrolysin and 3-NPA, the levels of DA and LP decreased. In addition, calcium and H2O2 levels decreased in the hemispheres of the same group, while GSH increased in cortex. The increased dopamine metabolism due to the administration of cerebrolysin led to increased formation of radical species and oxidative stress, especially when free radicals were generated by 3-NPA.

Mechanisms involved in the development of diabetic retinopathy induced by oxidative stress

BACKGROUND

Diabetic retinopathy (DR) is one of the main complications in patients with diabetes and has been the leading cause of visual loss since 1990. Oxidative stress is a biological process resulting from excessive production of reactive oxygen species (ROS). This process contributes to the development of many diseases and disease complications. ROS interact with various cellular components to induce cell injury. Fortunately, there is an antioxidan t system that protects organisms against ROS. Indeed, when ROS exceed antioxidant capacity, the resulting cell injury can cause diverse physiological and pathological changes that could lead to a disease like DR.

OBJECTIVE

This paper reviews the possible mechanisms of common and novel biomarkers involved in the development of DR and explores how these biomarkers could be used to monitor the damage induced by oxidative stress in DR, which is a significant complication in people with diabetes.

CONCLUSION

The poor control of glucemy in pacients with DB has been shown contribute to the development of complications in eyes as DR.

Moieties in antidiabetic drugs as a target of insulin receptors in association with common neurological disorders

Insulin is a peptide that can be harmful with regards to neuroplasticity, neuroprotection and neuromodulation. Furthermore, the role of insulin highlights its relevance in the progress of diverse clinical disorders as well as in the mechanisms associated with certain pathogenesis and their evolution towards diabetes, obesity and neurodegenerative diseases. The precise molecular mechanisms by which these diseases are induced remain to be elucidated. The benefits in knowing/discovering these mechanisms in animal models and humans cannot be undermined. An in depth understanding of the principal risk factors leading to obesity and their management is vital in the implementation of early-life strategies of intervention and prevention, with a view to avoid adverse late-life outcomes. Therefore, the aim of the present study was to review their possible association with antidiabetic drugs.

Assessment of the effects of oseltamivir and indomethacin on dopamine, 5-HIAA, and some oxidative stress markers in stomach and brain of Salmonella typhimurium-infected rats

OBJECTIVES

The purpose of this study was to measure the effect of oseltamivir and indomethacin on dopamine and 5-HIAA levels and some oxidative biomarkers in brain and stomach of young rats in conditions of infection.

METHODS

Female Sprague Dawley rats in absence or presence of a live culture of Salmonella typhimurium (S.Typh), were treated as follows: PBS, group 1 (control); oseltamivir (100 mg/kg), group 2; indomethacin (67 µg/kg) group 3; oseltamivir (100 mg/kg) + indomethacin (67 µg/kg), group 4. The drugs were administered intraperitoneally every 24 hr for 5 days while S. Typh was give orally in the first and third day. C-reactive proteins was measured in blood on sacrifice, and from brain extract, dopamine and 5-HIAA levels as well as GSH, calcium, and H2O2 and total ATPase activity were measured by validated methods.

RESULTS

Dopamine increased significantly in cortex and cerebellum/medulla oblongata of groups that received indomethacin and oseltamivir. 5-HIAA increased significantly in all groups that received S.Typh. H2O2 decreased significantly in cortex regions of animals that received oseltamivir and indomethacin in presence of S.Typh. Total ATPase increased significantly in cortex and hemispheres of groups that received oseltamivir as well as in cerebellum/medulla oblongata and stomach of animals that received oseltamivir and indomethacin combined with S.Typh. GSH increased and calcium decreased significantly in stomach of animals that received oseltamivir or indomethacin alone or combined with S.Typh.

CONCLUSION

These results demonstrate the association between inflammatory response, oxidative stress, dopaminergic, and serotonergic metabolism in an experimental inflammatory animal model.

Effect of prostaglandin E1 (PGE1) and sildenafil on serotonin metabolism and some oxidative damage markers in rat prostate gland and brain

The aim of this study was to evaluate the effect of sildenafil and prostaglandin E1 (PGE1) (drugs used in erectile dysfunction) on production of free radicals in prostate and brain of rat. A single dose of sildenafil (10 mg kg(-1) ) and PGE1 (20 μg kg(-1) ) was given to Sprague-Dawley rats (300 g weight) intraperitoneally. The levels of testosterone were measured in blood. Their brains and prostate glands were separated to measure lipid peroxidation, Na(+) and K(+) ATPase activity, reduced glutathione (GSH) and serotonin levels, by means of validated methods. The levels of testosterone increased slightly in animals treated with sildenafil and PGE1. The activity of total ATPase was increased in the prostate of animals treated with sildenafil + PGE1 but decreased in those that received sildenafil alone. PGE1 caused significant diminution of GSH levels in both organs. Sildenafil increased the levels of serotonine in brain, whereas in prostate they decreased instead. Our results suggest that sildenafil induced changes in GSH levels as well as in the serotonergic metabolism, alone or with PGE1 in prostate and brain, respectively. Thus, the combination therapy may be ideal to sustain the biochemical balance due to biphasic stimulation on brain and prostate.

Effect of oseltamivir on catecholamines and select oxidative stress markers in the presence of oligoelements in the rat brain

The effect that osteltamivir has on the metabolism of catecholamines and oxidative damage in the brains of young patients remains unclear. The purpose of this study was to measure the effects of oseltamivir, in the presence of oligoelements, on biogenic amines and select oxidative biomarkers in the brains of uninfected, young rats under normal conditions. The study was conducted using male Wistar rats intraperitoneally treated for three days with either a control dose of 0.9 % NaCl, oseltamivir (50 mg/kg), oligoelements (50 μL/rat), or oseltamivir (50 mg/kg) and oligoelements (50 μL/rat). The brain tissue extracted from the treated rats was used to determine the concentrations of adrenaline, noradrenaline, and dopamine, as well as the levels of GSH, lipid peroxidation, and ATPase activity. An increase in the concentration of adrenaline and noradrenaline and in the level of GSH in the group treated with oligoelements (p < 0.001) was observed, while the group treated with oseltamivir and oligoelements, the levels of dopamine increased (p < 0.001), and in the groups treated with oligoelements alone or combination with oseltamivir a decrease in lipid peroxidation was observed (p < 0.001). The results of this study suggest that the consumption of oseltamivir and oligoelements induce biphasic changes in the metabolism of catecholamines; thereby, inducing a protective mechanism against oxidative damage in the brains of young rats.

Levels of 5-hydroxyindol acetic acid and lipid peroxidation in brain after administration of marijuana and nalbuphine in male and female rat

We analyzed the effect of marijuana and nalbuphine on levels of 5-hydroxyindol acetic acid and lipid peroxidation in rat brain. Single and repeated dosages of 250 mg/kg marijuana extract or 10 mg/kg nalbuphine were administered to male and female Wistar rats. Animals were sacrificed and brains were obtained to measure the content of 5-hydroxyindol acetic acid, reduced glutathione, thiobarbituric acid reactive substances, total ATPase and Na+/K+ ATPase activities. There was an increase in thiobarbituric acid reactive substances, total ATPase and Na+/K+ ATPase activity in the animals that received a single dose of marijuana and nalbuphine (p=0.001), with a notable decrease in glutathione and 5-hydroxyindol acetic acid levels (p=0.001). Both marijuana and nalbuphine increased levels of oxidative damage biomarkers in rat brain and decreased glutathione and 5-hydroxyindol acetic acid levels which could provoke changes in cellular and biochemical regulations and serotonergic activity in either male or female rats.

Effect of sibutramine on Na+, K+ ATPase activity and tryptophan levels on male and female rat brain

Some drugs that are clinically used in weight control, like sibutramine, act on the serotonergic metabolism, but its relation with free radical (FR) production in the CNS is still unknown. The aim of the work was to evaluate the effect of sibutramine on FR production. Female and male Wistar rats (250 g weight) were used; the animals received sibutramine (10 mg/kg each 36 hours) intraperitoneally during 15 days. At the end of the study, the rats were sacrificed and their brains used to measure lipid peroxidation (TBARS), Na+, K+ ATPase activity, reduced glutathione (GSH), and tryptophan (TRP) levels, by means of validated methods. The activity of Na+, K+ATPase and total ATPase was increased in males and decreased in females. GSH concentration was increased and the levels of TBARS decreased by an effect related to sibutramine in the female group. Sibutramine decreased TRP concentration in the female group, but increased it in the male one, with respect to the control group. Our results suggest that sibutramine produce an antioxidant effect stimulated by the endogenously produced tryptophan and it protects the fluidity of plasma membrane in rat brain.

Comparison between types of cancer chemotherapies used in a private and a government-based hospital in Mexico

We have compared the frequency and types of cancer chemotherapies used in a private hospital and in a government-based hospital in Mexico City. A retrospective study was conducted from January 2005 to December 2007, and therapeutic management determined in 415 cases reviewed by the attending physicians of the oncology service. In the government-based hospital, 60 different types of cancer were found among 273 patients diagnosed. Acute lymphoblastic leukemia (ALL) had the greatest incidence (30%), followed by Hodgkin's lymphoma (9%), retinoblastoma (7%), neuroblastoma (6%), and osteosarcoma (6%). The entire number of chemotherapy sessions was 7575. Drugs most frequently employed included etoposide (577), followed by methotrexate (575), vincristine (483), cyclophosphamide (312), and cytarabine (277). The economic status among these patients was mainly of limited resources and represented 80% of the total number of patients. The types of cancer found in the private hospital were similar, however the drugs used were predominantly cyclophosphamide (416), doxorubicin (382), 5-fluorouracil (368), paclitaxel (237) and cisplatin (128). The types of cancer were similar in both hospitals and reflected the incidence among the entire population in Mexico, since acute lymphoblastic leukemia, Hodgkin's lymphoma and retinoblastoma, were the types most represented. However, the treatment schemes differed; the chemotherapeutic agents used in the private hospital were rather more specific but significantly more expensive than those employed in the government hospital.

Levels of glutathione and some biogenic amines in the human brain putamen after traumatic death

Mexico City is among the world's largest metropolitan city centers and one of the most difficult and challenging cities in which to drive a motor vehicle. During peak transit hours and maximum congestion, numerous accidents occur, many of them fatal. The aim of the study presented here was to analyze the levels of select indicators against oxidative stress and levels of biogenic amines as a consequence of accident or altercation and fear deaths. Eighteen cases were studied (sixteen males, two females). Subjects ranged from twelve to eighty-one years of age. Nine of the deaths studied were the result of motor vehicle or subway accidents. Eight of the eighteen deaths were the result of a violent altercation, while one of the deaths resulted from a drug overdose and cardiac arrest. Biopsies of cadaver putamen were homogenized and analyzed for Tryptophan (Trp), 5-hydroxyindole acetic acid (5-HIAA), Dopamine (DA), and Glutathione (GSH) levels by fluorometric methods. Trp, 5-HIAA, DA, and GSH levels showed an increase in the subjects who's death was caused by violent altercation combined with fear, while DA levels showed significant differences in all accident groups. This data suggest that biogenic amines in cadaver putamen tissue, such as DA, can be telling biochemical markers, indicative of altercation and fear deaths.

Assessment of Antioxidant Effect of 2,5-Dihydroxybenzoic Acid and Vitamin A in Brains of Rats with Induced Hyperoxia

The aim of this study was to evaluate the effect of 2,5-dihydroxybenzoic acid, a salicylate derived from Acetyl salicylic acid (ASA) and vitamin A (vit A) on Na(+), K(+) ATPase enzyme and GSH levels in brain of rats exposed to hyperoxia (Hyp) as oxidant protocol. Rats were treated as follow: group I (control), group II (Hyp), group III (Hyp, ASA), group IV (vit A), group V (Hyp, vit A), group VI (Hyp, vit A, ASA). Vit A was given 5 days before and during Hyp, aspirin at the end of Hyp. Na(+),K(+) ATPase and total ATPase activity was significantly increased in group V. Levels of GSH showed a significant increase in group III, besides, levels of 2,5-dihydroxybenzoic acid as salicylate in plasma were significantly increased in group II. These results elucidate differences in the biochemical response of animal towards intake of various types of antioxidant substances, with increased GSH and salicylate in hyperoxia.

Effect of ivelip and sodium nitroprusside on 5-HT, glutathione and lipid peroxidation in normal and malnourished rat brain

We examined the effect of experimental malnutrition and diet supplementation of parameters of central nervous system damage. Wistar rats were fed during 30 days and classified as malnourished (MN, 7% protein content diet) or well-nourished (WN, 23% protein content diet), were grouped and treated as follows: I-control; II-SNP (20 microg/kg); IIl-Ivelip (280 mg/kg) and IV-Ivelip + sodium nitroprusside (SNP). Levels of lipid peroxidation (TBARS), glutathione (GSH), tryptophan (Trp) and serotonin (5-HT) were assessed in brain by liquid chromatography. TBARS and GSH levels increased significantly (p < 0.05) in MN vs. WN rats that did not receive Ivelip. No significant differences were observed in TBARS and GSH among rats that received Ivelip or SNP. The weight of rats decreased significantly (p < 0.05) in all MN groups in relation to the WN groups. Hemoglobin (Hb) levels increased significantly (p < 0.05) in MN and WN groups that received Ivelip. 5-HT levels increased significantly (p < 0.05) in all MN groups. Trp levels increased significantly (p < 0.05) in the WN + Ivelip group vs. control. Early malnutrition induces changes in the metabolism of biogenic amines and this condition may promote oxidative injury of the brain.

Effect of Nutritional Status and Ozone Exposure on Some Biomarkers of Oxidative Stress in Rat Brain Regions

The aim of this study was to analyze the effect of nutritional condition and simulated exposure to ozone on Glutathione (GSH), the activity of Na+/K+ ATPase and lipid peroxidation in rat brain. Male Wistar rats were fed with 7% and 23% protein diets. Two groups were formed for each nutritional condition: one group was exposed for 15 successive days to 0.75 ppm of ozone and the other to air. Subsequently, the brain was dissected in cortex, hemispheres, cerebellum, and brainstem to measure the activity of thiobarbituric acid reactive substances (TBARS), ATPase, and levels of GSH. The activity of Na+/K+ ATPase increased in cerebellum of well-nourished rats exposed to ozone, while total ATPase and TBARS decreased in all studied areas in the malnourished groups. The levels of GSH decreased significantly (P < 0.05) in the brain of rats fed with 7% of protein diet and exposed to ozone but increased in rats fed with normal diet and exposed to ozone. These results suggest that malnutrition causes alterations in the values of Na+/K+ ATPase, total ATPase, GSH, and lipid peroxidation, while ozone contributes to these modifications. As a consequence, both variables are involved in oxidative stress in the rat brain.

Assessment of Oxidative Damage Induced by Acute Doses of Morphine Sulfate in Postnatal and Adult Rat Brain

The aim of the present study is to evaluate the oxidative damage in rats of different ages. Weaned rats of 25 g and adults of 300 g were used in groups of 6, a single i.p. dose of morphine sulfate of 3, 6 or 12 mg/kg was administered. All animals were sacrificed to measure GSH and 5-HT levels in brain by liquid chromatography, as well as Na(+), K(+)-ATPase and total ATPase enzymatic activity. 5-HT levels decreased significantly (p < 0.05) in adult animals that received 3 and 6 mg morphine. Na(+), K(+)-ATPase activity increased significantly (p < 0.05) in all groups of weaned animals. In adult animals, Na(+), K(+)-ATPase and total ATPase partially diminished. GSH levels diminished significantly (p < 0.05) both in weaned and in adult groups. The results indicate age-induced changes in cellular regulation and biochemical responses to oxidative stress induced by morphine.

Effect of testosterone and steroids homologues on indolamines and lipid peroxidation in rat brain

The purpose of the present study was to evaluate the effect of 4-pregnen-17-hydroxy-3-one (A) and two steroids homologues: 3beta-acetoxy-5,16-pregnadien-20-one (B) and 3beta-acetoxy-16alpha-17alpha-epoxy-4-pregnen-20-one (C). Male Wistar rats were treated with o-cresol combined (A, B or C) steroids. Lipid peroxidation status as result of measurement reactive substances to thiobarbituric acid (TBARS) as well as serotonin (5-HT) and its precursor 5-hydroxytryptophan (5-HTP) were measured. The prostate glands were weighed, the 5alpha-reductase activity was determined. The animals treated with A, B, and C steroids showed a slight increase in both 5alpha-reductase activity and prostate size. 5-HT and 5-HTP levels did not change significantly, and TBARS showed an increase in the group treated with B steroid and a decrease in the A steroid group with significant differences in both groups (p<0.05) versus control group. Results suggest that A steroid reduces TBARS in rat brain, perhaps as a result of the interaction between the testosterone unsaturated carbons and OH(-) groups with free radicals.

Effect of nutritional status and ozone exposure on Na+/K+ ATPpase and lipid peroxidation in rat brain

The aim of this study was to analyze the effect of nutritional status and exposure to ozone on the activity of Na+/K+ ATPase and lipid peroxidation in rat brain. Male Wistar rats were fed 7% and 23% protein diets. Two groups were formed for each nutritional status: one group was exposed for 15 successive days to 0.75 ppm of ozone in air and the other was exposed to air. Subsequently, the brain was dissected and cortex, hemispheres, cerebellum and brainstem separately homogenized to measure the activity of thiobarbituric acid reactive substances (TBARS) and ATPase in the presence and absence of ouabain. The activity of Na+/K+ ATPase increased in cerebellum of well-nourished rats exposed to ozone, while total ATPase and TBARS decreased in all studied areas in the malnourished groups. These results suggest that nutritional status and exposure to ozone generate changes in lipid membrane composition, in turn changing the activity of sodium pump with similar consequences for brain metabolism.

Antioxidant effects of selenium in rat brain and the stimulating role of nitric oxide

OBJECTIVE

To evaluate the antioxidant effect of selenium on Na+, K(+)-ATPase in rat brain in the presence of nitric oxide.

METHODS

Male Wistar rats (70 g) were treated as follows: group 1 received 1 microg of i.p. sodium nitroprus-side per kg (SNP), group 2 received 5 microg sodium selenite during 20 days, group 3 received sodium selenite 5 microg + SNP 1 microg and the control group received vehicle 50 microl (0.9% NaCl), same period and route. At the end of treatment, animals were sacrificed and their brain dissected into cortex, hemispheres, cerebellum and brain stem in order to determine lipid peroxidation (TBARS), Na+, K+ ATPase and total ATPase in each section. Blood hemoglobin concentration (Hb) and prostate weight were also assessed.

RESULTS

A significant increase of Hb in blood and of proteins in cortex and hemisphere was detected, but TBARS values fell due to the effect of sodium selenite in all examined regions, except for cerebellum. ATPase activity declined in all groups and regions with and without NTP. We conclude that diet supplementary selenium to inhibit NO generation can be a useful treatment in chronic inflammatory diseases.