Consent from new patient at first registration

Just as the patient can take a proper decision only if full information is available to him/her, the doctor can take the most appropriate decision for a patient only if the patient provides full and up-to-date information. Unfortunately this does not happen all the time. The Ministry of Health and Family Welfare recommends the Charter of Patients Rights which also includes a specific section on responsibilities of patients and their family members. Based on the legal principle that consent is a contract between two parties, we followed a systematic procedure to develop consensus recommendation for obtaining patient consent in the normal practice setting at first registration/ presentation.

Extranodal Follicular Dendritic Cell Sarcoma Involving Tonsil

Follicular dendritic cell sarcoma (FDCS) is a rare neoplasm arising from lymph nodes as well as extranodal sites. Despite the characteristic histopathological features and distinctive immunophenotype, extranodal FDCS are often misdiagnosed initially as undifferentiated carcinoma, inflammatory pseudotumour, meningioma, metastatic malignant melanoma, ectopic thymoma, etc., because of its rarity and lack of awareness. Correct diagnosis of this tumour is imperative given its potential for recurrence and metastasis. We report a case of tonsillar FDCS in a 30-year-old lady who presented with slowly progressing throat pain and dysphagia for a duration of one year. Local examination showed an enlarged left tonsil with an ulceroproliferative growth. The right tonsil was normal. There was no regional lymphadenopathy. Histopathological examination of the tonsillectomy specimen showed a 2.2 x 1.5 cm infiltrative tumour composed of ovoid to spindle cells arranged in characteristic storiform, interlacing fascicular and diffuse patterns. The tumour cells were immunopositive for CD21, CD23, CD35, and S-100 protein and negative for cytokeratin. The Ki-67 antigen-labelling index (Ki-67 LI) was 6%. The EBV status was negative. It was classified as a low risk FDCS. The patient was lost to follow-up after 6 months.

Development of time and pH dependent controlled release colon specific delivery of tinidazole

Tinidazole is used in treatment of amoebiasis and other protozoal infections in doses of 2.0 g/ day [60 mg/kg] for three days. In the present paper, controlled release formulation of tinidazole was developed with an objective to achieve colon specific drug delivery with reduced frequency of dosing, to minimize gastric side effects and thus to increase patient compliance. Matrix systems of tinidazole [500 mg] were prepared by using swellable and pH dependent polymers like hydroxypropyl methylcellulose [HPMC K4M and K15M] and eudragit [eudragit L-100 and S-100]. Prepared tablets were enteric coated in order to overcome variability in gastric emptying time and delay in the release, to reduce gastric side effects and to provide prolonged localized action in colon. Process of manufacture was optimized during the scale up studies. Bioavailability study [using parallel group design] was carried of on conventional marketed, developed uncoated and enteric coated tablets in healthy human volunteers. Bioavailability study showed that greater portion of tinidazole was released in the large intestine and drug level in plasma was above 4 micro g/mL in blood for 24 hours. From the results of this study it appears that, the proposed single enteric coated tinidazole [500 mg] tablet per day could be used in place of 3-4 doses of 500 mg tinidazole conventional tablet with better control of drug release for targeted drug delivery. In addition developed colon-specific drug delivery system [CDDS] was relatively inexpensive and easy to manufacture using conventional pharmaceutical coating technique

Stimulatory response to the oxidation of benzidine and other xenobiotics mediated by lipoxygenase in the presence of phenothiazines / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To test the possibility that certain efficient substrates for lipoxygenase (LOX) produce shuttle oxidants that stimulate the generation of reactive oxygen species from other chemicals.</p><p><b>METHODS</b>Metabolic interactions were conducted in vitro between chlorpromazine (BZ) or other phenothiazines and benzidine or other xenobiotics mediated by soybean lipoxygenase (SLO) or purified human term placental lipoxygenase (HTPLO) in the presence of hydrogen peroxide, and the rates of xenobiotics oxidation were measured by spectroscopic analysis.</p><p><b>RESULTS</b>Chlorpromazine cation radical (CPZ(*+)) generated by lipoxygenase triggered a rapid oxidation of benzidine to benzidine diimine cation. Under the experimental conditions used, the metabolic interaction resulted in a 42-fold greater stimulation than BZ alone in the rate of BZ oxidation. The magnitude of stimulation of benzidine oxidation exhibited a dependence on the pH of the reaction medium, amount of the enzyme, and concentration of chlorpromazine, BZ, and hydrogen peroxide. A number of other phenothiazines were also found to stimulate BZ oxidation, albeit to a lesser degree. Chlorpromazine cation radical stimulated the oxidation of all six other xenobiotics tested. The highest stimulation (94-fold) was noted in the oxidation of tetramethyl phenylenediamine to Wursters blue radical, while the lowest stimulatory response (2-fold) was observed in guaiacol. Preliminary data showed that purified HTPLO also displayed a similar stimulatory response to benzidine oxidation in the presence of chlorpromazine.</p><p><b>CONCLUSION</b>Both soybean lipoxygenase and purified human term placental lipoxygenase can mediate stimulatory response to the oxidation of benzidine and other xenobiotics in the presence of phenothiazines.</p>

Lipoxygenase-mediated N-demethylation of pesticides in vitro / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>In order to explore the pathway of dealkylation of pesticides other than cytochrome P450 monocoxygenases, lipoxygenase (LOX)-mediated demethylation of aminocarb and some other pesticides were measured.</p><p><b>METHOD</b>Formaldehyde generated in the reaction was estimated by Nash reaction to express the rate of demethylation of pesticides mediated by soy lipoxygenase (SLO).</p><p><b>RESULTS</b>N-demethylation of aminocarb mediated by SLO was found to depend on the incubation time, concentration of the enzyme, concentration of aminocarb and hydrogen peroxide. Under optimal conditions, Vmax value of 18 nmol of formaldehyde.min-1.nmol-1 of lipoxygenase was observed. The reaction exhibited Km values of 3.4 mmol/L for aminocarb and 235 mumol/L for hydrogen peroxide. A strong inhibition of the reaction by nordihydroguaiaretic acid, gossypol, and phenidone clearly implicated the lipoxygenase involvement as the protein catalyst. A significant decline in the formaldehyde accumulation in the presence of either reduced glutathione or dithiothreitol suggested generation of a free radical species as an initial oxidation intermediate during the demethylation of aminocarb by SLO. The inhibition of formaldehyde generation by butylated hydroxyanisole(BHT) and butylated hydroxy toluene(BHA) further supported this contention. In addition to aminocarb, seven other pesticides were also found to undergo N-demethylation, albeit at relatively low rates.</p><p><b>CONCLUSION</b>Certain pesticides may oxidatively undergo dealkylation via the lipoxygenase pathway in animals and plants.</p>