Pharmacy faculty experiences with student academic entitlement: a multinational study from the Arab world

Academic Entitlement (AE) is the expectation by students to receive high grades or preferential treatment without significant effort. Exploring AE from faculty perspective has not been investigated in Arab colleges of pharmacy. The aim of this study was to explore experiences and perceptions towards student AE among pharmacy faculty in the Arab World. A cross-sectional, self-administered, anonymous, electronic survey was sent to pharmacy faculty across pharmacy colleges in Arab countries. The survey collected demographic data, an AE measure including 17 items reflecting seven AE components, and faculty perceptions and perceived reasons for AE. A total of 345 responses were collected. The AE level was moderate (46.05 ±7.29), and the highest scores among its components were for customer service expectation (62%) and responsibility avoidance (59%). In multiple linear regression, AE showed positive significant association with faculty in clinical pharmacy departments and those having fewer years of experience. Most common complaints heard by faculty from students were requests to turn in assignments late (90%), while the most common communication issues faculty faced with students were unprofessional verbal communication (58%) and unprofessional messages on social media (57%). Poor admission criteria (40%) and existence of multiple private colleges of pharmacy (37%) were the most common perceived reasons for AE by participating faculty. This study reveals moderate AE experienced by pharmacy faculty in the Arab World, as well as common complaints, communication issues, and AE reasons. In collaboration with other stakeholders, faculty play an important role in indicating expectations from students regarding AE, and research is warranted to check if such interventions reduce AE among pharmacy students.

Transforming pharmaceutical education: A needs-based global analysis for policy development

Background

A needs-based approach is desirable for the transformation of pharmaceutical education, and to link pharmaceutical education with the health needs of populations and national priorities. There are varying levels of data in the literature on the status of pharmaceutical education in all six World Health Organization (WHO) regions, especially in the context of needs identification and evidence-based policy interventions. The framework for this study was the FIP Development Goals.

Objectives

The aim of the study was to develop evidence-based policies through a needs-based approach for pharmaceutical education transformation nationally, regionally and globally by addressing the following objectives: 1. Identify global and regional needs in pharmaceutical education, through a regional SWOT analysis and prioritization of FIP development goals; 2. Develop valid and credible regional roadmaps for pharmaceutical education advancement according to the identified prioritized goals and 3. Develop a global call to action as a policy intervention for advancing pharmaceutical education.

Methods

This study was conducted between 2020 and 2021 using a mixed methods approach. Surveys of higher education institutions and a series of qualitative interviews were conducted with national professional leadership organizations, with further regional workshops having 284 participants recruited from the International Pharmaceutical Federation (FIP) membership base, spanning all six WHO regions.

Results

Eleven out of 21 FIP DGs were identified as priorities for regional roadmaps and FIP DG 1 (Academic capacity) was identified as a priority in four regions. All regions had distinctive results with an area of commonality between them. There were common weaknesses in the adoption of competency-based education and inter-professional education.

Conclusions

It is critical for every country and region to develop needs- and evidence-based policies for the transformation of pharmaceutical education, for which FIP DGs provide a systematic framework.

Genetic polymorphisms of MASP2, TG5, and DQA1 genes in Holstein and Brown Swiss dairy cows

The objective of this study was to investigate polymorphisms of MASP2, TG5 and DQA1 genes using PCR-DNA sequencing in seventy Holstein, and Brown Swiss dairy cows (35 cows each). Under complete aseptic condition, blood samples were collected from each animal into tubes containing disodium EDTA as an anticoagulant for DNA extraction. PCR was carried out for amplification of 305-bp of MASP2, 545-bp of TG5, and 373-bp of DQA1 genes. DNA sequencing assessment elaborated nucleotide sequence variations in forms of single nucleotide polymorphisms (SNPs) between two breeds. The SNPs identified in the investigated genes for Holstein breed were A46G in MASP2 gene and C371T in TG5 gene. A characteristic T53C SNP was also reported for Brown Swiss breed in DQA1 gene. Chi-square revealed a significant variation in distribution of all identified SNPs (P < 0.001). Consequently, identified SNPs could be used as candidates and a reference guide for efficient characterization of Holsteins, and Brown Swiss breeds; therefore, developing a marker assisted selection (MAS) for production and immunity traits in breeds of dairy cattle.

Career Satisfaction among Physicians, Dentists and Pharmacists: A study from Jordan

Objective: Career satisfaction experienced by healthcare professionals has an impact on the quality of health care. This study aims to evaluate career satisfaction perceived by physicians, dentists and pharmacists working in Jordan. Design: The study utilized an online questionnaire distributed among a sample of pharmacists, dentists and physicians working in Jordan. The questionnaire addressed career satisfaction as well as satisfaction regarding family and workplace aspects, relations with patients, colleagues, and society. Setting: Healthcare institutions in Jordan. Main outcome measures: Physicians, dentists and pharmacists were surveyed for factors influencing their career satisfaction. Results: A total of 294 healthcare personnel participated in this study with a mean age of 37.65±11.7 years (range= 23-68 years). Participants included 46 (15.6%) pharmacists, 128 (43.5%) physicians and 120 (40.8%) dentists with a female majority (76.9%). Only 165 (56.1%) expressed career satisfaction. Marriage, having children, a high monthly income, and house ownership were associated with a significantly higher career satisfaction (≤0.050). Moreover, professionals working in academic or non-governmental organizations had a significantly higher career satisfaction (P=0.001). Most practitioners were not satisfied with a work- family relation (51.8%), however, they were mostly satisfied with relationships with colleagues (65.9%), and perceived they received appreciation from patients and society (60.5%). Conclusions: Social and financial stability are associated with career satisfaction among healthcare professionals working in Jordan. Further, participants are generally satisfied with relationships with colleagues, supporting staff and patients. They are also satisfied with respect and appreciation offered from society. More attention is warranted for assessment of challenges and problems faced by practitioners in the private sector, particularly economic aspects to improve career satisfaction and mitigate turnover intention.

The design and evaluation of the antimicrobial activity of a novel conjugated penta-ultrashort antimicrobial peptide in combination with conventional antibiotics against sensitive and resistant strains of S. aureus and E. coli

Background and purpose

Antimicrobial resistance still constitutes a major health concern to the global human population. The development of new classes of antimicrobial agents is urgently needed to thwart the continuous emergence of highly resistant microbial pathogens.

Experimental approach

In this study, we have rationally designed a novel conjugated ultrashort antimicrobial peptide. The peptide named naprolyginine was challenged against representative strains of wild-type and multidrug-resistant bacteria individually or in combination with individual antibiotics by employing standard antimicrobial and checkerboard assays.

Findings / Results

Our results displayed that the peptide exhibits potent synergistic antimicrobial activity against resistant strains of gram-positive and gram-negative bacteria when combined with individual antibiotics. Additionally, the peptide was evaluated for its hemolytic activity against human red blood cells and displayed negligible toxicity.

Conclusion and implications

Naprolyginine could prove to be a promising candidate for antimicrobial drug development.

Dynamic right ventricular structural and functional changes in acute decompensated heart failure, new insights from serum sST2 and speckle-tracking echocardiography imaging

Background

Right ventricular (RV) mechanics are affected by volume/pressure overload in acute decompensated heart failure (ADHF) which can be detected using biomarkers and echocardiography. ST2 (suppression of tumorigenicity 2) is a biomarker of myocardial fibrosis and remodeling, that has been studied in patients with ADHF. Although baseline serum soluble ST2 (sST2) values at ADHF admission have been proved to predict outcomes, serial measurements are even of greater value.

Purpose

To evaluate the right ventricular dynamic structural and functional changes in ADHF patients during hospitalization, using serum sST2 and speckle-tracking echocardiography imaging.

Methods

We prospectively enrolled 61 ADHF patients with LV ejection fraction less than 50% and serum NT-proBNP more than 900 pg/ml. All patients received intravenous diuretics and did not require inotropic support during hospital stay. Blood samples were collected to measure serum sST2 levels on hospital admission and discharge. All patients underwent serial conventional and speckle tracking echocardiography on admission, at 48 hours and on hospital discharge. RV speckle tracking echocardiography analysis was done using 2D Cardiac Performance Analysis version 4.6.

Results

Serum sST2 had significant strong positive correlation with serum NT-proBNP on admission (r=0.84, P&lt;0.0001) and showed significant reduction from 2.47 (1.27–4.05) ng/ml on admission to 1.86 (1.06–3.24) ng/dl at hospital discharge (P&lt;0.0001) denoting successful decongestion. There was significant decrease in inferior vena cava diameter (P&lt;0.0001) and estimated pulmonary artery systolic pressure (EPASP) (P=0.002) throughout hospital stay, however this was not associated with significant change in RV dimensions (P&gt;0.05) or contractility assessed by trans-annular plane systolic excursion (TAPSE) (P=0.09) and S-wave velocity at lateral tricuspid annulus (P=0.9). There was significant improvement in RV free wall strain (RVFWS) (P=0.005) assessed by speckle tracking echocardiography which was mainly noticed after the first 48 hours till discharge, but RV 4-chamber strain (RV4CS) did not change significantly (P=0.06).

Conclusions

RVFWS assessed by speckle tracking echocardiography can detect improvement in RV systolic function not detected by other conventional echocardiographic parameters in ADHF patients. Improvement in RVFWS together with decline in serum sST2 levels can be used as marker of improved cardiac mechanics and successful decongestion.

Funding Acknowledgement

Type of funding sources: None.

Newly Substituted Anilino-Fluoroquinolones with Proliferation Inhibition Potential against a Panel of Cancer Cell Lines

BACKGROUND

From a chemistry point of view, we hypothesized that superlative dual cytotoxicity-radical scavenging bioefficacies of series 4 FQs correlate to their acidic groups and C8-C7 ethylene diamine Chelation Bridge.

METHODOLOGY

Newly synthesized 16 lipophilic-acid chelating FQs have been screened for in vitro duality of proliferation inhibition and radical scavenging capacities.

RESULTS

Substantially in LPS prompted RAW264.7 macrophages inflammation, IC50 values (µM) in the ascending order of  new FQs' NO scavenging/antiinflammation capacity were 4e<4b<3d<4f<5c0.05). In comparison to classical and robust antineoplastic agent cisplatin and unlike triazoloFQs; nitroFQs (3a, 3b and 3f) and the reduced FQs (4a, 4c, 4d and 4e) exerted antiproliferation IC50 values <50 µM in leukaemia K562. Besides nitroFQ 3, the reduced FQs (4c and 4f) exhibited antineoplastic IC50 values <50 µM in lung A549 carcinoma. NitroFQ 3c and reduced FQs 4b, 4c, and 4f in breast MCF7 and reduced 4c in pancreatic PANC1 had reduction of viability IC50 values <50 µM. NitroFQ 3e, reduced FQs 4b and, 4c and triazoloFQ 5a exerted antiproliferation IC50 values <50 µM in breast T47D cells. Also nitroFQ 3e, reduced FQ 4c and triazoloFQ 5f exhibited antineoplastic IC50 values <50 µM in PC3 prostate cancer cells. Exceptionally triazoloFQ 5a, but neither nitro- nor reduced FQs, had cytotoxicity IC50 value <50 µM in resistant melanoma A375 cells. Unequivocally 4b antineoplastic effectiveness linked with its radical scavenging and antiinflammation effects while 3d and 5c lacked matching antiproliferation potentialities to their exquisite antiinflammation capacities. Explicitly reduced 4e and 4f exerted antiinflammation-selective cytotoxicity duality in vitro.

CONCLUSION

Collectively, this work reveals lipophilic-acidic chelator FQs as authentic agents for the repurposing approach in anticancer chemotherapy/prevention.

Synthesis and Characterization of Yttrium-Doped Hydroxyapatite Nanoparticles and Their Potential Antimicrobial Activity

This study reports a detailed analysis of the yttrium doping effects into hydroxyapatite (HAp) nano-structures at different amounts (e.g., 0, 1, 2.5, 5, 7.5, 10, and 15%) on the structural, spectroscopic, dielectric, and antimicrobial properties. For this purpose, seven HAp samples having the Y-contents mentioned above were prepared using the microwave-assisted sol-gel precipitation technique. The structure of synthesized samples was fully described via X-ray diffraction (XRD), scanning electron microscopy (SEM), and Fourier transforms infrared (FTIR). Raman spectroscopy and dielectric measurements were used to characterize the spectroscopic properties. Furthermore, the samples’ antimicrobial features have been assisted through the agar disk diffusion technique. This study showed that the crystallinity decreased with the adding of Y-ions inside the HAp matrix. The Y-contents have influenced the crystallite size, lattice parameters, dislocation density, lattice strain, and unit cell volume. The surface morphology is composed of the agglomerated smaller particles. Remarkable changes in the dielectric properties were observed with the adding of Y-ions. The alternating current conductivity obeys the Jonscher’s relation. Y-doped hydroxyapatite nanoparticles have a considerable inhibitory effect against bacteria and fungi (Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, and Candida albicans). The Y-doped hydroxyapatite nanoparticles are a promising material for bone cement engineering with a potential bio-activity

Two-year incidence of PPMI post SAVR, modified SAVR and TAVR

Background

Moderate and high risk patients presenting with aortic stenosis are offered surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) as therapeutic options. However, both techniques are associated with postoperative conduction abnormalities necessitating permanent pace maker implantation (PPMI).

Many factors have been implicated in increasing the risk of atrioventricular (AV) block and subsequent PPMI. The stress on the conduction system seems to be a major cause of this complication.

Methods

We conducted a study to compare the incidence of PPMI between two groups of patients. In group A, 62 patients underwent the classic SAVR and in group B, 92 patients underwent a simple modified SAVR technique (3–4 pledgeted ethibond sutures were placed above the annulus, at the commissure between the right and non coronary sinuses) that aims to decrease the mechanical trauma to the conduction system.

Results

The results revealed a significant lower PPMI rate in group B as compared to group A,at thirty days (2.17% versus 14.5%) as well as at two years (2.17% versus 17.7%) postoperatively. The statistical analysis showed that the operative technique was a strong predictor of the need for PPMI. The odds of needing pace maker implantation was significantly lower in the group of patients who underwent the simple modified SAVR technique. Of note is that the reported incidence of PPMI in the literature, at thirty days and two- years post classic SAVR were 6.1% and 11%. In addition, the rate observed in group B, was lower than the post-TAVR incidence of PPMI (9.3% at thirty days and 13% at two years post procedure), as reported by numerous studies, whether self expandable or balloon expandable valves were used.

Conclusion

This reproducible and reliable simple technique should be recommended whenever SAVR is performed.On the other hand,the low incidence of PPMI (2.17%) observed after a modified SAVR technique should be adopted as a benchmark whenever TAVR is offered as a therapeutic option. Moreover, this less traumatic procedure may be taken into consideration whenever stent design modifications for TAVR are considered.

Funding Acknowledgement

Type of funding sources: None.

Complementary and alternative medicine use for weight management among females in Jordan: a community-based survey

Background

The relationship between obesity and various chronic diseases is well documented. In Jordan, the prevalence of overweight (30.0%) and obesity (38.8%) among females is on the rise, encouraging many adults to rely on alternative health care methods to manage their weight.

Aims

We explored the status of complementary and alternative medicine use for weight management among adult females in Jordan and the possible relationship between complementary and alternative medicine use and body mass index.

Methods

An interviewer-administered, structured questionnaire was used to collect data on the use and safety of complementary and alternative medicine for weight management from 858 women in 2015. Responses were coded and analysed using SPSS, version 20.

Results

Around 40% of the respondents reported using some form of complementary and alternative medicine for weight management. Commercial dietary supplements (31.2%), herbal remedies (26.7%) and folk remedies (18.0%) were commonly used. Green tea and fibre tablets were the most widely used herbal supplements. Logistic regression analysis indicated that overweight participants are more frequent complementary and alternative medicine users compared to obese. Relatives and friends were the main sources of information about complementary and alternative medicine. Only 31.9% of women believed that complementary and alternative medicine modalities were safe; around half believed they were not safe during pregnancy (52.5%) and lactation (48.0%). Only 49.7% were aware of side-effects and 41.5% of drug interactions.

Conclusion

This study revealed that complementary and alternative medicine is often used for weight management. Awareness of the safe use of complementary and alternative medicine with other medications and during pregnancy and lactation should be addressed.

Cesarean delivery to prevent anal incontinence: a systematic review and meta-analysis

BACKGROUND

Cesarean delivery (CD), is increasingly recommended as a mode of delivery that prevents the anal incontinence (AI) that arises in some women after vaginal delivery (VD). The assessment of the efficacy of CD in this regard was the subject of this systematic review.

METHODS

Searches were conducted in Medline, EMBASE and the Cochrane Library. Both randomized (RCTs) and non-randomized trials (NRTs) comparing the risk of sustained fecal and/or flatus incontinence after VD or CD were sought from 1966 to 1 January, 2019. Studies were eligible if they assessed AI more than 6 months after birth, and had statistical adjustment for at least one of the three major confounders for AI: age, maternal weight or parity. In addition, each study was required to contain more than 250 participants, more than 50 CDs and more than 25 cases of AI. Data after screening and selection were abstracted and entered into Revman for meta-analysis. Analyses were done for combined fecal and flatus incontinence (comAI), fecal incontinence (FI), gas incontinence (GI), CD before or during labor, time trend of incontinence after delivery, assessment of both statistical and clinical heterogeneity, parity and late incident AI.

RESULTS

Out of the 2526 titles and abstracts found, 24 eligible studies were analyzed, 23 NRTs and one RCT. These included women with 29,597 VDs and women with 6821 CDs. Among the primary outcomes, VD was found not to be a significant predictor of postpartum comAI compared to CD in 6 studies, incorporating 18,951 deliveries (OR = 0.74; 0.54-1.02). VD was also not a significant predictor of FI in 14 studies, incorporating 29,367 deliveries, (OR = 0.89; 0.76-1.05). VD was not a significant predictor of GI in six studies, incorporating 6724 deliveries (OR = 0.96; 0.79-1.18). The strength of the grading of recommendations, assessment, development and evaluations (GRADE) evidence for each of these was low for comAI and moderate for FI and GI (upgrade for lack of expected effect). Time trend FI showed incontinence at 3 months often resolved at 1 year. Other secondary analyses assessing parity, delayed incidence of FI, clinical and statistical heterogeneity, spontaneous VD only, late risk of incidence of AI, and CD in or prior to labor all had similar results as in the primary outcomes.

CONCLUSIONS

There are three components of pelvic floor dysfunction that are thought to be caused by VD and hopefully prevented by CD: AI, urinary incontinence and pelvic floor prolapse. Of these, AI was not found to be reliably prevented by CD in this review.

Antimicrobial Activity of Ga-Doped Hydroxyapatite Nanostructures: Synthesis, Morphological, Spectroscopic, and Dielectric Properties

In the present paper, seven samples of hydroxyapatite (HAp) nanoparticles doped with different amounts (e.g., 0%, 1%, 3%, 6%, 9%, 12%, and 15% [wt.]) of Ga-ions were synthesized at low temperature using the microwave-assisted sol–gel technique. FT-Raman/Fourier-transform infrared (FTIR) technique, X-ray diffraction (XRD), dielectric/alternating current conductivity measurements, scanning electron microscopy, and antimicrobial tests were utilized in order to characterize the synthesized samples. The Ga content was observed to affect the crystallite size as well as the crystallinity of HAp. Variations were observed in the lattice parameters, lattice strain, and dislocation density. FTIR analysis revealed that HAp structure possessed the carbonate group. Thus all samples have promising medical applications, as this group improves the bioactivity of HAp. Dielectric properties, as well as the alternating current electrical conductivity, were also observed to be affected by the Ga content. Furthermore, the present study demonstrated that the Ga-doped HAp nanostructures exerted a considerable inhibitory effect on bacteria (Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli) and fungi (Candida albicans). Therefore, the Gadoped HAp nanostructures are proposed as a promising candidate for applications in the field of bone cement engineering.

Rapid, cost-effective and organic solvent-free production of biologically active essential oil from Mediterranean wild Origanum syriacum

BACKGROUND

Origanum syriacum (O. syriacum) is a very popular edible and medicinal plant in the East Mediterranean countries. The aims of the current study were to use microwave-ultrasonic assisted hydrodistillation (MUAHD) method to produce essential oils (EOs) from wild O. syriacum samples collected from four different geographical areas in The West Bank using water as a solvent, determine the phytochemical profile using GC-MS analysis and assess their antioxidant and antibacterial potential.

METHODS

Essential oils were produced using MUAHD method. Gas chromatography coupled with mass spectrometer detector (GC-MS) was employed for phytochemical analysis. In vitro antibacterial and antioxidant potentials were carried out.

RESULTS

Differences in the EOs yield among the four Origanum samples were observed. GC-MS analysis of EOs revealed terpenes as the major constituents; monoterpenes (22-56%) and oxygenated monoterpenes (28-57%). Thymol, α-terpinene and carvacrol represent the bulk of all phytochemicals detected by GC-MS analysis. γ-Terpinene-rich EOs, exhibited the highest antioxidant capacity. Thymol-rich EOs were found to be most effective against Staphylococcus aureus and Methicillin-Resistant Staphylococcus aureus (MRSA) (MIC 390 µg/mL). Alpha-terpinene-rich chemotype EOs exhibited the highest inhibitory effect of Pseudomonas aeruginosa (MIC of 1560 µg/mL). Interestingly, γ-terpinene-rich EO showed promising antibacterial properties against Enterococcus faecium (MIC 97 µg/mL) and a powerful anti-oxidant effect (91.45% ±2.30).

CONCLUSION

The current study supports the use of MUAHD as a time-saving, cost-effective, environment-friendly method for production of high quality O. syriacum EO for potential use as a natural complementary treatment and in the prevention of bacterial infections as well as oxidation by free radicals without compromising the quantity.

Synthesis of 1,2,3-Triazolo[4,5-h]quinolone Derivatives with Novel Anti-Microbial Properties against Metronidazole Resistant Helicobacter pylori

Helicobacter pylori infection can lead to gastritis, peptic ulcer, and the development of mucosa associated lymphoid tissue (MALT) lymphoma. Treatment and eradication of H. pylori infection can prevent relapse and accelerate the healing of gastric and duodenal ulcers as well as regression of malignancy. Due to the increasing emergence of antibiotic resistance among clinical isolates of H. pylori, alternative approaches using newly discovered antimicrobial agents in combination with the standard antibiotic regimens for the treatment of H. pylori are of major importance. The purpose of the present study was to investigate the effect of newly synthesized 8-amino 7-substituted fluoroquinolone and their correspondent cyclized triazolo derivatives when either alone or combined with metronidazole against metronidazole-resistant H. pylori. Based on standard antimicrobial susceptibility testing methods and checkerboard titration assay, all of the tested compounds showed interesting antimicrobial activity against 12 clinical strains of H. pylori, with best in vitro effect for compounds 4b and 4c. Fractional inhibitory concentration (FIC) mean values showed synergistic pattern in all compounds of Group 5. In addition, additive activities of some of the tested compounds of Group 4 were observed when combined with metronidazole. In contrast, the tested compounds showed no significant urease inhibition activity. These results support the potential of new fluoroquinolone derivatives to be useful in combination with anti-H. pylori drugs in the management of H. pylori-associated diseases.

Synthesis of New Nitrofluoroquinolone Derivatives with Novel Anti-Microbial Properties against Metronidazole Resistant H. pylori

One of the major therapeutic approaches to preventing relapse and accelerating the healing of duodenal and gastric ulcers is the eradication of Helicobacter pylori. Due to the emergence of antibiotic resistance among clinical strains of H. pylori, alternative approaches using newly discovered antimicrobial agents in combination with the standard regimens for the treatment of H. pylori are increasingly needed. The purpose of the present study was to investigate the effect of newly synthesized 8-nitroflouroqunolone derivatives when used either alone or when combined with metronidazole against metronidazole-resistant H. pylori. Based on the standard antimicrobial susceptibility testing methods and checkerboard titration assay, all of the tested compounds showed interesting antimicrobial activity against 12 clinical strains of H. pylori, with the best in vitro effect for compound 3c. In addition, synergistic and additive activities of some of the tested compounds were observed when combined with metronidazole. Furthermore, among the tested nitroflouroquinolone derivatives, compound 3b showed significant urease inhibition activity with IC₅₀ of 62.5 µg/mL. These results suggest that 8-nitroflouroquinolone derivatives may have a useful role in combination with anti-H. pylori drugs in the management of H. pylori-associated diseases.

New form of administering chlorhexidine for treatment of denture-induced stomatitis

Background:

The purpose of this study was to evaluate the release of chlorhexidine as an antifungal drug from doped self-cured poly (methyl methacrylate) (PMMA) acrylic resin and the effect of the drug released on the growth of Candida albicans.

Methods:

Release of chlorhexidine was evaluated using liquid chromatography, and the effect of the drug on the growth of C. albicans was investigated microbiologically using a “well” technique on Saboraud culture medium inoculated with a resistant strain of C. albicans.

Results:

Chlorhexidine leached steadily out of the acrylic resin into distilled water at mouth temperature, and the sustained drug release continued throughout the 28-day test period. The drug released also demonstrated antifungal activity against the resistant strain of C. albicans.

Conclusion:

The findings of this study support the use of chlorhexidine-impregnated self-cured PMMA chair-side resin as a new dosage form for the treatment of denture-induced stomatitis.

Embolization of a Cavernous Sinus Dural Arteriovenous Fistula with Onyx via Direct Puncture of the Cavernous Sinus through the Superior Orbital Fissure: Asystole Resulting from the Trigeminocardiac Reflex. A Case Report

SUMMARY

Treatment of cavernous sinus dural arteriovenous fistula (CSDAVF) may be challenging.We describe a patient who had presented with progressive ocular symptoms due to CSDAVF requiring urgent interventional therapy. Initial attempts to embolize the fistula utilizing a transvenous approach through the inferior petrosal sinus failed because of difficult anatomy. Successful occlusion of the fistula was subsequently achieved with injection of ethylene vinyl alcohol copolymer, Onyx (EV3 Neurovascular, Irvine, CA, USA), via direct percutaneous puncture of the cavernous sinus through the superior orbital fissure.A brief period of asystole during the initial injection of Onyx may be the result of the trigeminocardiac reflex.

Treatment of arteriovenous malformations with hydrocoils in a Swine model

SUMMARY

Arteriovenous malformations (AVM) of the brain are the most common symptomatic congenital vascular malformation of the central nervous system, with significant associated morbidity and mortality. This study compared the feasibility and efficacy of treating AVMs by embolization with hydrocoils with similar treatment with bare platinum coils, using the swine rete mirabile as a model. A right carotid-jugular fistula was created in ten swine.A microcatheter was positioned into the rete mirabile, which was unilaterally (contralateral to the fistula) embolized with hydrocoils in six and bare platinum coils in four swine. Angiograms were evaluated during and immediately after embolization. Embolization with complete cessation of bloodf low in the unilateral rete mirabile was achieved in all animals treated with hydrocoils. The number of coils needed varied from four to seven (diameter 2-4 mm; mean coil length 22.3 cm). Embolization with platinum coils of similar number (seven) and slightly longer length (mean 37.75 cm) had a minimal effect on blood flow, resulting in occlusion of only small compartments. No immediate complications were noted with either coil. Hydrocoils are more effective in achieving embolization than bare platinum coils. Expansion of the hydrocoil over only a few minutes allows precise placement and stabilization of the coil before detachment. Hydrocoilscan be safely placed into small vessels. This approach may be particularly useful to decrease the flow rate, as a first stage of AVM embolizationin high flow AVMs that contain arteriovenous fistulae.

Evaluation of an enrofloxacin-treatment program against Mycoplasma gallisepticum infection in broilers

Three chicken broiler breeder flocks, 7 months of age, were confirmed to have Mycoplasma gallisepticum (MG) infection, based on culture of tracheal swabs. A total of fifty-five 7-day-old embryos from the three MG-positive flocks had an average 27.4% prevalence of MG-infection in their vitelline membrane. Sixty randomly selected MG isolates (30 from individual tracheas of breeders and another 30 from individual vitelline membrane of embryos) were highly sensitive in vitro to enrofloxacin (100%). Three broiler flocks (averaging 15,000 birds per flock) from the same three MG-infected chicken boiler breeders were divided into halves. The first halves were subjected to an enrofloxacin-treatment program and the other halves were controls. Sera collected at different ages of the broiler flocks were tested by the enzyme-linked immunosorbent assay for antibodies to MG. The absence of MG titers at 45 days of age in birds subjected to the enrofloxacin-preventive program was compared to an average prevalence of 15.9% in the controls (p < 0.05). The lack of MG titers in 45-day-old birds subjected to the enrofloxacin-treatment program was associated with lower better feed-conversion ratios (p < 0.05).

The hemodynamic effects of isoflurane before and after sternotomy in patients undergoing coronary artery bypass grafting

The hemodynamic effects of isoflurane were studied in 30 patients undergoing coronary artery bypass grafting, and receiving high dose of fentanyl (40 micrograms/kg). In 15 patients, isoflurane 2% was administered for ten minutes before sternotomy, while the same concentration of isoflurane was administered in the other 15 patients after sternotomy for the same interval of time. Isoflurane administration before sternotomy produced a significant decrease in cardiac index and mean arterial pressure, without a significant change in systemic vascular resistance or other hemodynamic variables. On the other hand, when isoflurane was used to counteract sternotomy-induced hypertension, it produced a significant decrease of systemic vascular resistance, associated with a significant increase in cardiac index.

De-Nol in the treatment of reflux esophagitis

Twenty-eight patients with histologically proven reflux esophagitis were randomly allocated to receive either De-Nol (tripotassium dicitrate bismuthate) or placebo for three weeks. Significant decreases in symptoms frequency and severity were noted in De-Nol group comparing with placebo group (p less than 0.01). Objective improvement in esophageal endoscopic appearance was obtained in 78.5% of the patients treated with De-Nol and only in 14.2% of those receiving placebo. De-Nol appears to be an effective drug in the treatment of reflux esophagitis, but this should be confirmed by further studies.

Dialysis hypoxemia. Role of dialyzer membrane and dialysate delivery system

Arterial blood gas values, carbon monoxide diffusion capacity, oxygen consumption, carbon dioxide production, respiratory quotient, minute ventilation, and pulmonary capillary blood flow were determined before and during hemodialysis. In addition, the effect of single passage through the dialyzer on blood carbon dioxide tension, pH, and bicarbonate concentration was evaluated. Acetate-based dialysate was used in all experiments. Cellulosic dialyzer with single-pass dialysate delivery system was used in one group, and polyacrylonitrile dialyzers with recirculating delivery system in another. Although hypoxemia occurred in both groups, it was more severe in the former group. Dialyzer carbon dioxide loss was significantly greater with single-pass dialysate delivery system and cellulosic dialyzers than with recirculating delivery system and polyacrylonitrile dialyzer. To differentiate the role of dialysate delivery system from that of the membrane, the experiments were repeated using recirculating delivery system and cellulosic dialyzer. This resulted in marked attenuation of hypoxemia and dialyzer carbon dioxide tension losses. Since other experimental conditions were the same, the observed differences were thought to be due to the difference in the mode of dialysate delivery. It thus appears that the mode of dialysate delivery per se can modify the changes in arterial oxygen tension during hemodialysis and should be added to the list of factors implicated in the genesis of dialysis hypoxemia.

Acquired deficiency and urinary excretion of antithrombin III in nephrotic syndrome

The published data concerning changes of antithrombin III (ATIII) in nephrotic syndrome (NS) are contradictory. While increased ATIII activity has been reported by some investigators, decreased concentration has been shown by others and normal values by yet another group of authors. We determined plasma and urine concentrations of ATIII in a group of 20 patients with NS using an immunologic assay. In addition, plasma ATIII activity was determined. The results were compared with those obtained in a group of normal volunteers. Plasma concentration and activity of ATIII were both greatly reduced in the patients with NS. In addition, substantial quantities of ATIII were recovered in the urine of all tested patients. The present study, therefore, substantiates the low plasma concentrations of ATIII and its urinary losses in NS. In addition, a parallel reduction in plasma ATIII activity is demonstrated providing functional evidence of acquired ATIII deficiency in this condition.

Urinary excretion and deficiency of prothrombin in nephrotic syndrome

Plasma and urinary prothrombin concentration and plasma prothrombin activity were measured in a group of 17 patients with the nephrotic syndrome. An immunologic assay using a monospecific antibody against human prothrombin was employed in the measurement of prothrombin concentration in the plasma and urine. Prothrombin-deficient plasma was used as the substrate in the measurement of plasma prothrombin activity. A control group consisting of five normal volunteers was included for comparison. Both the activity and concentration of prothrombin were significantly lower in the nephrotic group as compared with the control group. Significant quantities of immunoreactive prothrombin were detected in the urine of the majority of nephrotic patients. This study has provided unequivocal evidence of urinary excretion and acquired deficiency of prothrombin in the nephrotic syndrome.

Focal renal cortical necrosis associated with zomepirac

Anaphylactoid shock, disseminated intravascular coagulation, and anuric renal failure requiring dialysis occurred in a patient receiving zomepirac sodium for toothache. Although renal function showed gradual improvement after seven days of anuria, the recovery was slow and incomplete. Renal biopsy three weeks after the onset of renal failure revealed evidence of focal renal cortical necrosis. Association of zomepirac administration with renal cortical necrosis is not known to have been previously demonstrated. This observation adds another dimension to the previously reported renal complications of nonsteroidal anti-inflammatory agents, especially zomepirac. The proportions of lymphocyte subsets, as defined with monoclonal antibodies, and the proliferative response to mitogens were normal. The patient's lymphocytes showed no proliferative response to zomepirac. Serum complement components and immunoglobulin levels were within normal limits, and radioallergosorbent testing gave negative results. The mechanism of anaphylactoid reaction to zomepirac in this case, therefore, remains unclear.

Role of immunologic mechanisms in tubulointerstitial nephropathies

The immunologic basis of various glomerulonephropathies has been widely investigated and highly publicized. Little recognition, however, has been given to the possible role of the immune system in the genesis of tubulointerstitial nephropathies. Considerable clinical and experimental data have recently appeared suggesting the possible role of immunologic mechanisms in the genesis of various tubulointerstitial nephropathies. This article is intended to review the available clinical and experimental data pertaining to this issue.

Acquired renal cystic disease in renal transplant recipients

End-stage kidneys are known to undergo cystic transformation in patients treated with long-term hemodialysis. Little has been published, however, on the occurrence of acquired renal cystic disease (ACD) in renal transplant recipients. The available clinical and histopathological data were gathered on 22 renal transplant recipients who had undergone either necropsy or nephrectomy. None of our patients exhibited cystic changes in their donor kidneys. However, 11 patients (50%) had ACD of the native kidneys while the remaining patients lacked ACD. The duration of dialysis prior to transplantation was significantly longer and the life of the functional transplant kidney was significantly shorter in the ACD group as compared to the noncystic group. The combined duration of ESRD (dialysis + transplantation), however, was comparable in the two groups. It thus appears that the presence of a functioning renal allograft somehow retards the evolution of cystic changes in the diseased native kidneys. 1 of the patients in the ACD group exhibited superimposed multifocal clear cell carcinoma of the affected kidney, while none of the patients in the noncystic group exhibited renal neoplasm.

Plasma and urinary catecholamines and their metabolites in chronic renal failure

The effect of chronic renal failure (CRF) on the plasma concentration and urinary excretion of catecholamines and their metabolites was studied in 14 patients with varying degrees of chronic renal failure who had creatinine clearances of 19 to 77 mL/min. The results were compared with those obtained in a group of age-matched normal controls. Plasma catecholamine concentrations were significantly higher in the CRF patients compared with age-matched normal controls (456.9 +/- 303.1 v 278.5 +/- 81.1 pg/mL). The urinary metanephrine (0.6 +/- 0.6 mg/g creatinine) and vanillylmandelic acid (VMA) (6.6 +/- 4.2 mg/g creatinine) were within the normal range. No significant correlations were found between creatinine clearance and urinary metanephrine and VMA excretion or with the plasma catecholamine concentrations. Our observations indicate that, despite the decrease in creatinine clearance, urinary VMA and metanephrine determinations are valid screening tests for pheochromocytoma in patients with compromised renal function. Plasma catecholamine concentrations, however, show moderate elevation with decreasing renal function.

Susceptibility of Trichomonas vaginalis strains to metronidazole: response to treatment

The effect of the susceptibility of Trichomonas vaginalis strains to metronidazole on response to treatment was determined from minimal inhibitory concentrations (MICs) for organisms isolated during a clinical trial in which single 1- and 2-g doses of metronidazole were compared. Fifty-seven strains were isolated from patients receiving 1 g of metronidazole, and 75 from those receiving 2 g. The mean MIC for all strains was 1.50 microgram/ml (range, 0.5-4.5 microgram/ml) and was similar in both groups. The mean MICs for isolates from patients who were cured were significantly less than the mean MICs of isolates from those who were treatment failures. The cure rates, compared to the MICs for the strains isolated, varied from 84% (MIC, 0.5 microgram/ml) to 16% (MIC, greater than or equal to 3.0 microgram/ml) for the group given the single 1-g dose and from 94% (MIC, 0.5 microgram/ml) to 43% (MIC, greater than or equal to 3.0 micrograms/ml) for those given the 2-g dose. The data demonstrate a direct relationship between susceptibility of T. vaginalis isolates and response to treatment with single-dose regimens of metronidazole.

Inhibition of basal and stimulated gastric acid secretion by an enkephalin analogue

The effect of a synthetic enkephalin analogue (Sandoz FF33-824: DAMME) on basal and submaximally stimulated gastric acid secretion was investigated in six healthy hypersecretors. Basal acid secretion was markedly inhibited by the enkephalin analogue. When gastric secretion was stimulated by a continuous intravenous infusion of 100 ng/kg/h of pentagastrin the enkephalin analogue reduced acid output by 50%. Intravenous naloxone reversed the subjective effects of the enkephalin analogue but did not reverse the inhibitory effect on basal and stimulated acid secretion.

Metronidazole in a single dose for the treatment of trichomoniasis. Failure of a 1-g single dose

To determine the minimum effective dose of metronidazole in the treatment of vaginal trichomoniasis, a randomised clinical trial comparing single 1-g and 2-g doses was carried out on 163 patients attending sexually transmitted diseases and family planning clinics. Seventy-two of 86 (84%) patients receiving a single 2-g dose of metronidazole were cured compared with only 42 of 77 (55%) receiving a 1-g dose. The body weight of the patient was a significant variable affecting treatment outcome only in the latter group; 69% of patients weighing more than 57 kg or less when cured compared with only 43% of those weighing more. Patients who failed after either dose regimen were retreated with a single 2-g dose. Eighteen of 21 (86%) and seven of 10 (70%) failures with the initial 1-g and 2-g doses respectively were cured. A single 1-g dose of metronidazole is not recommended as routine treatment for vaginal trichomoniasis.

Carnosinase activity of human gastrointestinal mucosa

Carnosinase, the dipeptidase which hydrolyses carnosine and other histidine-containing dipeptides, was assayed in mucosal tissues of the human and of the rat gut. Kinetic properties of the intestinal enzyme were found to be similar to carnosinase of other animal tissues. Little or no activity was detected in human gastric or colonic mucosa, and the levels were lower in duodenal than jejunal mucosa. The distribution of carnosinase is similar to that of the disaccharidases. Mean carnosinase activity was 8-8 units/g weight in 15 patients with histologically normal mucosa compared with 5-7 units in five with villous atrophy. The enzyme levels increased with histological improvement of the mucosa in patients with coeliac disease on a gluten-free diet. Tolerance curves for carnosine and its constitutent amino acids showed malabsorption of the dipeptide in a patient with carnosinase deficiency. It is concluded that the intestinal mucosa has much less hydrolase activity for carnosine than for glycylglycine and other dipeptidases, and the relatively slow hydrolysis appears to be the rate-limiting step in the total absorptive process.