Correction to: Pharmacometabolomics applied to zonisamide pharmacokinetic parameter prediction

The original version of this article contains a mistake.

Pharmacometabolomics applied to zonisamide pharmacokinetic parameter prediction

INTRODUCTION

Zonisamide is a new-generation anticonvulsant antiepileptic drug metabolized primarily in the liver, with subsequent elimination via the renal route.

OBJECTIVES

Our objective was to evaluate the utility of pharmacometabolomics in the detection of zonisamide metabolites that could be related to its disposition and therefore, to its efficacy and toxicity.

METHODS

This study was nested to a bioequivalence clinical trial with 28 healthy volunteers. Each participant received a single dose of zonisamide on two separate occasions (period 1 and period 2), with a washout period between them. Blood samples of zonisamide were obtained from all patients at baseline for each period, before volunteers were administered any medication, for metabolomics analysis.

RESULTS

After a Lasso regression was applied, age, height, branched-chain amino acids, steroids, triacylglycerols, diacyl glycerophosphoethanolamine, glycerophospholipids susceptible to methylation, phosphatidylcholines with 20:4 FA (arachidonic acid) and cholesterol ester and lysophosphatidylcholine were obtained in both periods.

CONCLUSION

To our knowledge, this is the only research study to date that has attempted to link basal metabolomic status with pharmacokinetic parameters of zonisamide.

Proton pump inhibitors are associated with hypersensitivity reactions to drugs in hospitalized patients: a nested case-control in a retrospective cohort study

BACKGROUND

Previous research has shown that gastric acid suppression by antacid drugs can promote allergic reactions to acid-labile food proteins. No data are available about whether antacid drugs can promote drug hypersensitivity reactions. The most potent and longer lasting inhibition of gastric secretion is provided by proton pump inhibitors (PPIs). We hypothesized that gastric acid suppression by proton pump inhibitors could be causative of drug hypersensitivity reactions during hospitalization.

OBJECTIVE

To estimate the risk of developing drug hypersensitivity reactions during the hospitalization of patients treated with proton pump inhibitors, and other associated factors.

METHODS

A nested case-control in a retrospective cohort study of hospitalized patients from September 2008 to December 2010 (70 771 admissions) was conducted using the registry of cases of interconsultations to the Allergy Department (161 confirmed cases of drug hypersensitivity reactions). A total of 318 controls were matched by first drug suspected in the hypersensitivity reaction, time of admission, age, gender and hospitalization wards.

RESULTS

The relative risk of drug hypersensitivity reaction occurrence during hospitalization of patients treated with PPIs compared with those not treated in the period of study was significant (RR: 3.97; 95% CI: 1.97-8.29). After controlling for confounders in the nested case-control cohort, the use of PPIs persists as a predisposing factor (OR: 4.35; 95% CI: 2-9.45). Personal history of drug allergy and a long hospitalization time were other predisposing factors of drug hypersensitivity reactions (DHRs). The hazard that a DHR has occurred during PPI treatment was 3.7% per day. The hazard for immediate or accelerated reactions was 1.706 (P = 0.003) times that of delayed reactions.

CONCLUSION AND CLINICAL RELEVANCE

In hospitalized patients, the use of proton pump inhibitors was associated with a significant increase risk of drug hypersensitivity reactions along with a personal history of drug allergies and long hospitalization time.

A preliminary model to avoid the overestimation of sample size in bioequivalence studies

Often the only available data in literature for sample size estimations in bioequivalence studies is intersubject variability, which tends to result in overestimation of sample size. In this paper, we proposed a preliminary model of intrasubject variability based on intersubject variability for Cmax and AUC data from randomized, crossovers, bioequivalence (BE) studies. From 93 Cmax and 121 AUC data from test-reference comparisons that fulfilled BE criteria, we calculated intersubject variability for the reference formulation and intrasubject variability from ANOVA. Lineal and exponential models (y=a(1-e-bx)) were fitted weighted by the inverse of the variance, to predict the intrasubject variability based on intersubject variability. To validate the model we calculated the coefficient of cross-validation of data from 30 new BE studies. The models fit very well (R2=0.997 and 0.990 for Cmax and AUC respectively) and the cross-validation correlation were 0.847 for Cmax and 0.572 for AUC. A preliminary model analyses allow us to estimate the intrasubject variability based on intersubject variability for sample size calculation purposes in BE studies. This approximation provides an opportunity for sample size reduction avoiding unnecessary exposure of healthy volunteers. Further modelling studies are desirable to confirm these results especially suggestions of the higher intersubject variability range.

Towards the Improvement of Fruit-Quality Parameters in Citrus under Deficit Irrigation Strategies

Water shortage is becoming a severe problem in arid and semiarid regions worldwide, reducing the availability of agricultural land and water resources. In Spain, citrus is one of the most economically important crops, with 74,000 ha devoted to its cultivation. Since water resources are increasingly more insufficient, the efficient use of water is becoming more essential. Deficit irrigation in many agricultural crops has frequently proved to be an efficient tool for improving water-use efficiency. This paper examines the effects a deficit irrigation during the ripening period on yield and the most representative fruit quality properties. The study was conducted during two consecutive years (2009-2010) in a commercial 12-year-old orange orchard (Citrus sinensis L. Osb. cv. Navelina) grafted onto Carrizo citrange (Citrus sinensis L. Osb. × Poncirus Trifoliata L. Osb.). A regulated deficit irrigation (DI) was applied, which was fully irrigated during the flowering and fruit-growth stage, and during the ripening period it was subjected to a water-stress ratio of 0.75. A control treatment was established, this being irrigated at 100% of crop evapotranspiration. Along the water stress period, it was tested the temporal evolution of the main organoleptic and nutraceutical fruit properties (color index, the total soluble solids, titrable acidity, maturity index, rind weight, juice weight, the ratio of juice weight versus fruit weight, and the total C vitamin and flavonoids). It was not observed a descend in juice content, or fruit weight, or in the final yield. In terms of fruit organoleptic and nutraceutical properties, there were not detected negative effects in the studied properties. Furthermore, DI treatment showed higher values of maturity index than control treatment, which can be considered as a positive aspect in the fruit quality. Considering these results, we can affirm that a moderate water stress applied during the maturity period is a sustainable strategy for saving water, increasing the irrigation productivity and obtaining fruits with similar properties to those without deficit irrigation.

Ethical problems arising from the use of placebo in clinical trials with drugs for migraine. Their analysis by the moral deliberation method

INTRODUCTION

Migraine is characterised as episodes of headache plus a variety of accompanying symptoms. Its pharmacological control remains unsatisfactory for some patients. The use of placebo in drug clinical trials on migraine commonly leads to numerous ethical uncertainties.

METHODS

The purpose of this paper is to illustrate how the deliberation method helps in analysing the issues and finding solutions to selected ethical problems. Ethical decisions that try to solve conflicts arising from placebo use in clinical trials may be adopted using the moral deliberation method. Thus, the conflict is systematically assessed by identifying the following: Relevant facts; Values in conflict; Duties, or in other words, possible courses of action. Moral duty is following the optimal course of action. To identify this, it is recommended to state extreme courses of action, then intermediate courses of action, and then to proceed to the optimal course(s) of action.

RESULTS AND CONCLUSIONS

In this paper, the application of this method is shown in several conflicting situations arising in two placebo-controlled clinical trials with drugs under development for the prophylaxis and acute treatment of migraine.

[Ethical controversies on the use of placebo as control treatment in clinical trials in neurology]

Under certain circumstances, the best design to answer a therapeutic question is to conduct a randomized, blinded, placebo-controlled clinical trial. This paper suggests and comments the most controversial aspects of placebo use in clinical research in neurology. It also aims to provide criteria and alternatives, with a multidisciplinary approach (bioethics, research methodology and clinical neurology).

ETHICAL ASPECTS OF PLACEBO USE IN CLINICAL PHARMACOTHERAPEUTIC RESEARCH

Use of placebo as control treatment mainly affects four of the seven usually recognized requirements to consider a clinical trial as ethical: social or scientific value of the research, scientific validity, benefit/risk balance and informed consent. These four aspects are considered separately within the context of clinical trials with drugs in Neurology. The main questions at stake, ethical conflicts and possible options are stressed.

DISCUSSION AND RECOMMENDATIONS

The use of placebo-controlled clinical trials in Neurology is subject to many ethical controversies. Nevertheless, there are ethical reasons that justify study designs that use placebo, provided that the rights and safety of participants are adequately safeguarded. We need to increase our understanding of the concept of equipoise and recognize the benefit society obtains with research, thus requiring joint assessment of the benefit/risk ratio of a given clinical trial. Likewise, accurate information on the real risks and benefits of patients taking part in placebo-controlled clinical trials should be collected.

Influence of diminished susceptibility of Streptococcus pneumoniae to ciprofloxacin on the serum bactericidal activity of gemifloxacin and trovafloxacin after a single dose in healthy volunteers

The serum bactericidal activity against 2 Streptococcus pneumoniae strains (ciprofloxacin MIC 1 and 4 mg/l) was measured in 12 volunteers who received oral single doses of gemifloxacin 320 mg and trovafloxacin 200 mg in a crossover fashion. The 4-fold increase in ciprofloxacin MIC from the susceptible to the resistant strain resulted in a 2-fold increase in MIC (from 0.015 to 0.03 mg/l), a 2-fold decrease in C(max)/MIC (104 vs 52) and in AUC(0-24 h)/MIC (532 vs 266), but a 5.6-fold decrease in area under the bactericidal curve (AUBC: 168 vs 30) for gemifloxacin. Trovafloxacin showed a 4-fold higher MIC (0.25 vs 0.06 mg/l), a 4-fold lower C(max)/MIC (8.6 vs 36), a 4-fold lower AUC(0-24 h)/MIC (85 vs 356) and a 11-fold lower AUBCs (2 vs 22) against the resistant isolate compared with the susceptible one. Trovafloxacin serum bactericidal titres against the ciprofloxacin-resistant strain were measurable generally only at 1 h after dosing (median titre=2). Gemifloxacin showed similar ex vivo bactericidal activity against the ciprofloxacin-resistant strain to that of trovafloxacin against the ciprofloxacin-susceptible strain.

Modulation of the biosynthesis of some phenolic compounds in Olea europaea L. fruits: their influence on olive oil quality

The phenolic composition of olive fruits (Olea europaea L.) (cv. Picual, Villalonga, Alfafarenca, and Cornicabra) grown in different areas of Spain was studied by high performance liquid chromatography-mass spectrometry. Different levels of tyrosol, catechin, p-coumaric acid, rutin, luteolin, and oleuropein were observed in the different varieties analyzed. Treating the fruit with 0.3% Brotomax 50 days after anthesis had a beneficial effect on fruit size, oil content, levels of polyphenolic compounds, and Trolox-equivalent antioxidant activity (TEAC) in all the varieties analyzed.

Effect of zaleplon on digoxin pharmacokinetics and pharmacodynamics

The pharmacokinetics and pharmacodynamics of digoxin alone and digoxin plus zaleplon were studied. Healthy, nonsmoking men between 18 and 45 years of age were given a single oral dose of digoxin 0.375 mg daily on days 1 through 9. On days 10 through 14, the subjects received digoxin 0.375 mg plus oral zaleplon 10 mg daily. Blood samples were obtained on days 3, 5, 8, 9, and 14, and serum digoxin concentration data were analyzed by model-independent pharmacokinetic methods. Blood pressure, heart rate, PR interval, and QTc interval were recorded to determine the effect of zaleplon on digoxin pharmacodynamics. A total of 20 men completed the study. Maximum serum digoxin concentration and area under the serum digoxin concentration-versus-time curve from 0 to 24 hours met bioequivalence test criteria. There were no significant differences in QTc or PR interval between days 9 (digoxin alone) and 14 (digoxin plus zaleplon), and there were no clinically important changes from baseline to the study's end in vital signs, physical examination findings, or ECG results for individual subjects. Eighteen percent of the subjects who received digoxin alone and 35% of those who received digoxin plus zaleplon reported one or more adverse effects; all were mild and resolved quickly. Zaleplon had no significant effects on selected pharmacokinetic and pharmacodynamic properties of digoxin.

Cefminox versus metronidazole plus gentamicin intra-abdominal infections: a prospective randomized controlled clinical trial

BACKGROUND

The aim of this prospective study was to compare the safety and efficacy of a new cephamycin, cefminox 2 g/12 h, to those of the usual regimen combining metronidazole 500 mg/8 h and gentamicin 80 mg/8 h (M+G).

PATIENTS AND METHODS

160 patients with clinically proven intra-abdominal infection were prospectively included in an open parallel randomized comparative multicenter trial. Antibiotics were started preoperatively and discontinued after clinical and laboratory evidence of resolution of the infection. Serum and peritoneal fluid levels and serum bactericidal activities were also studied.

RESULTS

150 patients were clinically evaluable. There was one failure in the cefminox group and three in the M+G group (not significant, RR: 1.07, 95% CI: 1-1.15). No differences were found in the number of wound infections, length of stay or duration of antibiotic therapy. Adverse effects were reported in 11 cases, all of them mild to moderate. Escherichia coli and Bacteroides fragilis were the most frequently found microorganisms.

CONCLUSION

Cefminox is as effective and as safe as M+G in the treatment of intra-abdominal infections.

Digoxin level and clinical manifestations as determinants in the diagnosis of digoxin toxicity

The aim of this study was to determine the relative importance of different risk factors in the diagnosis of digitalis toxicity. The authors recruited inpatients for whom serum digoxin level was requested and prospectively followed them for a week to ascertain if they showed digitalis toxicity. The predictive value of different factors for the assessment of digoxin toxicity was analyzed by multiple logistic regression. Forty-one toxic and 58 nontoxic patients were included. In the univariant analysis, intoxicated patients were older, most were women, and they had worse renal function and higher digoxin level; but there were no differences in serum electrolytes or other risk factors. In the multivariant analysis, digoxin level was the only independent factor related to digitalis toxicity. A different risk of toxicity for each clinical manifestation was found for a certain digoxin level. Patients with signs of automaticity in the electrocardiogram had a higher likelihood of being intoxicated than patients with gastrointestinal symptoms, atrioventricular block, or bradycardia. Therefore, in the population evaluated in this study, digoxin level is the key independent factor in digoxin intoxication, although the probability of being intoxicated is also a function of the type of clinical manifestations. A graphic approximation of this probability based on these two factors is presented.

[Patient preference and stereotype about the gender of the family physician]

OBJECTIVE

To study the preferences of patients on the gender of the physician when consulting for particular health problems; and to know the gender stereotypes that patients assign to physicians.

DESIGN

Cross-sectional study.

SETTING

Five teaching health centres in Granada (Spain).

PATIENTS

Randomised sample of patients that consulted 10 female and 20 female physicians during three months (17 patients per physician), for alfa = 5%, beta = 80%, to detect a difference of 12% between male and female physicians.

MEASUREMENTS AND MAIN RESULTS

We used a questionnaire adapted from Fennema (Family Medicine Dept., Wisconsin University, 1990) that was administered by interviewers after the consultancy, following a previous pilot study. Preference and stereotype scales comprised 10 items, with five reponses (neutral mid-point). Differences were analysed with chi 2 with correction for continuity. Non-reponders (33%) were replaced, and their age and sex did not bias the study results. Responders were 210 males (40.9%) and 304 women (59.1%). For "flux in penis/vagina" and "haemorrhoids" 50-60% of the patients preferred a physician of the same sex, with the remainder expressing no preference. The women preferred female physicians for family problems (23%) and depression (23%). The male physicians were more often perceived to be unorganised than were the females (24% vs. 5%, p < 0.0005), while the female physicians were more often described as humane (15% vs. 10%, p < 0.0005). Characteristics expressing technical competence were more often attributed to the male physicians than to the females, while those expressing empathy were more often attributed to the female physicians.

CONCLUSIONS

Patients prefer physicians of the same gender for some health problems and not for others. Patients assign gender stereotypes to physicians. These findings will permit a better interpretation of doctor-patient relationships.

Effect of polymorphonuclear neutrophils on serum bactericidal activity against Streptococcus pneumoniae after amoxicillin administration

The effect of phagocytic killing on serum bactericidal activity against Streptococcus pneumoniae was investigated 0, 1.5, 8 and 12 h after a single 875 mg oral dose of amoxicillin in healthy adults. Killing curves were determined with polymorphonuclear neutrophils (PMN), serum or PMN plus serum. Global killing (i. e. intracellular and extracellular killing) over 3 h of incubation was expressed as the area under the killing curve (AUKC; log cfu x h/ml). Amoxicillin did not affect the activity of PMN alone. For serum alone, the AUKC of post-administration samples (with supra-inhibitory amoxicillin concentrations) was significantly lower than in baseline samples. For serum plus PMN, significant bactericidal activity of serum was still found in samples after antibiotic concentrations had reached sub-inhibitory levels.

Comparison between the evaluation of bacterial regrowth capability in a turbidimeter and biodegradable dissolved organic carbon bioreactor measurements in water

In recent years, two different approaches to the study of biodegradable organic matter in distribution systems have been followed. The assimilable organic carbon (AOC) indicates the portion of the dissolved organic matter used by bacteria and converted to biomass, which is directly measured as total bacteria, active bacteria or colony-forming units and indirectly as ATP or increase in turbidity. In contrast, the biodegradable dissolved organic carbon (BDOC) is the portion of the dissolved organic carbon that can be mineralized by heterotrophic microorganisms, and it is measured as the difference between the inflow and the outflow of a bioreactor. In this study, at different steps in a water treatment plant, the bacterial regrowth capability was determined by the AOC method that measures the maximum growth rate by using a computerized Monitek turbidimeter. The BDOC was determined using a plug flow bioreactor. Measurements of colony-forming units and total organic carbon (TOC) evolution in a turbidimeter and of colony-forming units at the inflow/outflow of the bioreactor were also performed, calculating at all sampling points the coefficient yield (Y = cfu/delta TOC) in both systems. The correlations between the results from the bioreactor and turbidimeter have been calculated; a high correlation level was observed between BDOC values and all the other parameters, except for Y calculated from bacterial suspension measured in the turbidimeter.

Pharmacodynamic effects of amoxicillin versus cefotaxime against penicillin-susceptible and penicillin-resistant pneumococcal strains: a phase I study

Serum bactericidal activity against a penicillin-susceptible strain and a penicillin-resistant strain of Streptococcus pneumoniae (amoxicillin and cefotaxime MICs, 0.001 and 1 microg/ml, respectively, and MBCs, 0.01 and 2 microg/ml, respectively) was measured in 12 healthy volunteers who each received an oral 875-mg dose of amoxicillin and an intramuscular 1-g dose of cefotaxime in a crossover fashion. The areas under the bactericidal activity-time curves for the two strains were found to be similar for both antibiotics despite the significantly higher (P < 0.002) AUC/MIC and peak level/MIC values for cefotaxime.

Cefminox versus Cefoxitin in Hysterectomy Prophylaxis : Clinical Efficacy and Serum and Tissue Concentrations

This phase III, prospective, randomised, open, controlled clinical trial compared the efficacy of single-dose cefminox (2g) versus triple-dose cefoxitin (2g every 4 hours) as antibiotic prophylaxis in 112 women undergoing gynaecological surgery (vaginal or abdominal hysterectomy). Peak, intraoperative and trough serum concentrations were determined for both antibiotics, as well as their concentrations in myometrial tissue in a subset of patients from the study (22 patients from the cefminox group and 18 from the cefoxitin group). Clinical response was satisfactory in all women treated with cefminox (59 of 59) and in 52 of 53 patients treated with cefoxitin. Fever-related morbidity, hospital stay and adverse reactions were similar in both groups. Peak serum concentrations were 132.3 mg/L for cefminox and 82.2 mg/L for cefoxitin. 12-hour concentrations were 2.82 mg/L for cefminox and 2.17 mg/L for cefoxitin, and were higher than the respective minimum inhibitory concentrations (MICs) for pathogens commonly associated with this pathology. Uterine tissue concentrations were 24.5 and 41.6 mg/L for cefminox and cefoxitin, respectively, and also clearly exceeded MIC. It was shown that the use of a single preoperative dose of cefminox was similar in efficacy to 3 doses of cefoxitin administered every 4 hours, and that the serum and tissue concentrations attained provide adequate antibiotic coverage. In view of the general trend towards the use of a single dose for prophylaxis, cefminox offers a new alternative for antibiotic prophylaxis in gynaecological surgery.

Dual transduction signaling by a Xenopus muscarinic receptor: adenylyl cyclase inhibition and MAP kinase activation

Using transient transfection of COS-7 and human embryonic kidney 293 cells, we studied the functional properties of a previously cloned muscarinic Xenopus receptor [Herrera et al. (1994): FEBS Lett 352:175-179] and its coupling to adenylyl cyclase (AC) and mitogen-activated protein kinase (MAPK) pathways. Expression of the Xenopus muscarinic receptor results in the inhibition of AC activity and activation of the MAPK pathway through a mechanism that involves a Pertussis-toxin-sensitive G-protein and the G beta gamma subunits. The signal transduction properties of this receptor are similar to the mammalian m2 and m4 muscarinic receptors. These results strongly support the idea that inhibition of AC and MAPK activation, signaled out from the muscarinic oocyte receptor, are involved in the oocyte maturation process.

Pharmacokinetic study of ebrotidine administered in multiple doses to healthy volunteers for 4 days

The safety of ebrotidine (N-[(E)-[[2-[[[2-[(diaminomethylene)amino]-4- thiazolyl]methyl]thio]ethyl]amino] methylene]-4-bromo-benzenesulfonamide, CAS 100981-43-9, FI-3542), a new H2-receptor antagonist with gastroprotective activity, was assessed and its main pharmacokinetic parameters were determined in order to establish the dose linearity after the repeated administration of three different dose levels. The study was carried out in a group of 8 healthy volunteers of either sex, aged between 20 to 29 years. Oral doses of ebrotidine were administered in a randomized, single-blind design. Volunteers remained in the Unit for two days at each of the three study phases with washout intervals of 2 weeks and received seven doses of ebrotidine (150, 300 and 500 mg b.i.d). Pharmacological evaluation included vital signs, laboratory tests, adverse events and blood and urine samplings for pharmacokinetic analysis. Ebrotidine was determined by high performance liquid chromatography (HPLC) with UV detection. The results showed a good tolerability of ebrotidine after the administration of seven doses for 4 days, with no changes in the vital signs or laboratory parameters. No clinically significant dose-related adverse events were reported during the study. The absorption of ebrotidine was relatively rapid (tmax approximately 2 h) and linear within the dose range from 150 to 500 mg. Drug biotransformation was linear with doses tested, and no metabolic saturation occurred. The terminal elimination half-life of ebrotidine was between 7 and 11 h or even longer. There was no accumulation of ebrotidine and the steady state was reached, regardless of the dose administered, within the first 24-48 h.

Assessment of biological activity and fate of organic compounds in a reactor for the measurement of biodegradable organic carbon in water

A new, rapid method for the determination of biodegradable dissolved organic carbon (BDOC), especially suited to water industry needs, was recently proposed by the authors. This dynamic method measured the BDOC of circulating water continuously pumped over a biofilm attached to a special support (sinterized porous glass) that fills a system of two glass columns. The BDOC value corresponds to the difference in dissolved organic carbon (DOC) between inflow and outflow water samples. The analytical results are not significantly different from those of other bioassays that use indigenous bacteria, and the total duration of the analysis is less than 3 h. However, a problem common to all the BDOC methods based on attached bacteria is the extent to which the decrease in DOC during the BDOC analysis is due to true biodegradation or to adsorption of organic matter to the reactor. In the present study, a reasonable support is provided for the hypothesis that this decrease, at least in the dynamic method, is predominantly due to microbiological activity. After comparing the support (sinterized porous glass) with a good physical adsorbent (granular activated carbon), the influence of temperature, residual chlorine and sodium azide on the reactor performance was tested, and a sensitivity only attributable to biological activity was observed. Another set of experiments were performed to assess the fate and specific elimination of different organic substances, explicable assuming that biodegradation processes were involved.

X-ray studies on phospholipid bilayers. XIII. Interactions with gentamicin

This study deals with the structural perturbations that the aminoglycoside antibiotic gentamicin (GENT) can produce to phospholipid bilayers. Two multi-bilayer systems, one built-up of dimyristoylphosphatidylcholine (DMPC) and the other of dimyristoylphosphatidylethanolamine (DMPE) were allowed to interact with GENT. The experiments were performed in both a hydrophobic and a hydrophilic medium below the phospholipid main transition temperatures. X-ray diffraction techniques were used to determine the extent of the perturbation induced by GENT. The maximum effect was attained when GENT interacted with DMPC in the hydrophobic medium. On the other hand, GENT in aqueous solutions was unable to perturb in any significant extent the structure of the phospholipids under study.

Changes in the carbohydrate composition of legumes after soaking and cooking

Using a high-performance liquid chromatography (HPLC) method, researchers analyzed the sugar composition of chick-peas, kidney beans, and lentils at various points in the preparation and cooking process: after soaking, after "normal" cooking (ie, boiling), after pressure-cooking, and after cooked legumes had been held at 35 degrees C for 5 hours. There was a considerable decrease in the amount of monosaccharides, disaccharides, and raffinose oligosaccharides in chick-peas and kidney beans after soaking and cooking. This change in carbohydrate composition was less pronounced when the cooking water was not drained before analysis, which was the method used when analyzing the lentils. Method of cooking (either boiling or pressure-cooking) did not have different effects on the sugar composition of chick-peas and lentils, but loss of oligosaccharides was slightly higher when kidney beans were boiled than when they were pressure-cooked. Loss of alpha-galactosides occurred in chick-peas and kidney beans that had been boiled and then held at 35 degrees C for 5 hours. The HPLC analysis showed that manninotriose was not one of the oligosaccharides present in these legumes.

[Hospitalizations because of drugs: a prospective study]

A study was carried out during five months in La Paz Hospital with the objective to know the proportion of admissions due to an adverse reaction to pharmaceutical drugs (RAM) or due to an acute drug intoxication. For this purpose the reports of all patients seen at the Medical Emergency Room were analyzed on a daily basis. Out of 1,847 patients who needed hospital admission during this time period, 88 (4.8%) were considered to need so due to RAM or an acute intoxication. Out of 145 acute intoxications treated, 16 patients (0.9% of total admissions) had to be hospitalized. RAM constituted 3.9% of admissions, with upper GI tract hemorrhages the most frequent cause (62.5%; 72 cases). The groups of drugs responsible in most RAM were the analgesics and NSAIDs, in particular acetylsalicylic acid, followed by hypoglycemic drugs and digoxin.

[Adverse reactions to drugs as a reason for consulting the emergency service of a general hospital]

The reports from the emergency service of La Paz General Hospital were daily reviewed for 4 months to investigate the number of consultations which, on the judgement of the physician on care, were due to adverse reactions to drugs. An overall number of 11,326 patients consulted. In 438 (3.9%) it was considered that the consultation was due to one or more definite, likely or possible adverse drug reactions. In 69 patients (15.8%), the reactions were considered to be severe, and 54 (12.3%) required admission; 59 reactions (13.4%) were moderate, and 310 (70.8%) were mild. The most common localizations were the skin and its appendages (37.7%) and gastrointestinal tract (25.3%). The most commonly implicated pharmacologic groups were analgesic and non-steroidal anti-inflammatory drugs (33.6%) and antimicrobials (22.1%). The incidence of adverse reactions was significantly higher in women (4.4% vs 3.3% in males, p less than 0.01). Depending on the age groups (14-29, 30-59, greater than or equal to 60 years) the incidence of nonallergic adverse reactions was significantly higher in patients aged 60 years or more (1.5%, 2%, 2.9%; chi 2 = 15.2, gl = 2, p less than 0.001). In presumably allergic adverse reactions, the incidence was significantly higher among those under 30 years (2.9%, 2.2%, 0.5%; chi 2 = 50.2; gl = 2, p less than 0.0001). The incidence of severe adverse reactions was significantly higher in patients over age 60 years (0.2%, 0.6%, 1.2%, chi 2 = 29.2, gl = 2, p less than 0.001). In 32% of cases the adverse reactions might have been prevented.