Pulse carboxyhemoglobin-oximetry and cigarette smoking.

PURPOSE: We used a pulse carbon monoxide (CO)-oximeter to measure the levels of carboxyhemoglobin (COHb) in smokers and non-smokers. Our goal was to determine if this device could not only define smoking status, but also to increase accuracy of self-reported data at various surveys on smoking. METHODS: Thirty-four healthy volunteers participated in this study. Twenty-two of them were current daily smokers; 12 participants were non-smokers who lived alone or with a nonsmoker, and who worked in non-smoking environment. Nicotine dependency level was determined by the modified Fagerstrom questionnaire. Blood COHb levels were measured with a pulse CO-oximeter (Masimo, Radical 7). RESULTS: The COHb levels in both moderate/heavy smokers and light smokers increased significantly after they smoked a single cigarette. This increase persisted for more than 6 h in the moderate/heavy smokers, while in the light smokers COHb levels returned to the baseline level after one hour. The pulse rate of all smokers increased significantly 20 min after smoking. CONCLUSION: We conclude that the CO-oximeter can detect smoking by moderate/heavy smokers and light smokers if they smoked 6 h or 20 min earlier, respectively. We concluded that it could be used as a validation test for smoking at the time of admission to the surgical facility and to increase smoking abstinence during preoperative and postoperative periods. This noninvasive, simple and inexpensive test may also be used at various surveys to increase accuracy of self-reports on smoking.

Statistical presentation of data in biomedical publications.

Scientists rely upon statistics to report their findings accurately and to interpret the published findings of others. The proper application of this discipline provides confidence in statements based upon experimental results. Professional statisticians may help at some phases of planning experiments even before results are obtained, but not all scientists avail themselves of such services. As a result, errors can occur in presentation of variability of data, and more often than not, such errors are ultimately published in biomedical journals. This paper examines the most common descriptive statistics for quantitative and categorical data. Standard deviation (SD), standard error of the mean (SEM), confidence intervals (CI), and various technical details, including how to present data in publications, and when to use particular statistical tools, are discussed as well.

Antioxidant and free-radical scavenging activities of Allium roseum and Allium subhirsutum.

This study was designed to examine the antioxidant and free-radical scavenging activities of two Allium species, Allium roseum and Allium subhirsutum. This study reports the results concerning bulb, stalk and leaf antioxidant enzyme activities (superoxide dismutase, catalase, guaiacol peroxidase and glutathione peroxidase), quantities of malonyldialdehyde, (*)OH and O(2) (*-) radicals and total antioxidant capacity determined by the FRAP method. Scavenging activities were determined by ESR method. The total antioxidant capacity was the highest in the leaves of Allium roseum. Among the investigated organs the leaves exhibited the highest antioxidant activities in all investigated Allium species. The highest ESR (84.61%) scavenger activity was observed in the leaves of Allium roseum.

Cigarette smoking in Serbia. Impact of the 78-day NATO bombing campaign.

PURPOSE: To estimate short-term and long-term influence of protracted stress caused by the NATO bombing of Serbia on self-reported cigarette smoking, we performed and analyzed smoking survey data. MATERIALS AND METHODS: The survey included 320 adult citizens from Sombor, Novi Sad, and Belgrade, three cities that were bombed during the NATO campaign along with other Serbian target cities. We queried participants about their smoking habits before, during, and 8 years after the military intervention. We recorded smoking prevalence rates, intentions to stop smoking, and the age at which smoking began. We also recorded smoking history and cessation attempts. RESULTS: Prior to bombing, 48% of the women and 63% of the men were smokers. During the bombing period, smoking prevalence in male smokers increased significantly. During this period, 32% of the women and 36% of the men increased their smoking by as much as two packs of cigarettes per week. A month after the bombing, the rate of consumption returned to the prewar levels. At present, 44% of the women, and 59% of the men smoke. The average age of current smokers is 43 years (standard deviation /SD/, 14.4) for women and 45 (SD, 16.3) years for men. Female smokers expressed greater interest in quitting smoking than their male counterparts, and they were slightly more successful than men at maintaining abstinence (20 vs. 18%). The participants in our study acknowledged that a compounding factor for successful abstinence was information on depleted uranium (DU) and other pollutants introduced into the environment by the war. CONCLUSION: Prolonged stress imposed by war causes a short-term increase in smoking prevalence in male smokers and higher cigarette consumption both in male and female smokers. Even though these increases dissipated after the war was over, the prevalence of smoking within the population of urban Serbia remains very high. Counseling and pharmacological support for abstinence relapse in Serbia ere insufficient to sustain smoking cessation during the 8-year period after the NATO bombing. Motivation for smoking cessation stems primarily from governmental regulatory measures and awareness of the dangers to health posed by tobacco smoking.

Comparative study of antioxidant properties of wild growing and cultivated Allium species.

Allium species are cultivated for the edible bulb, which is used mainly as flavoring in foods. Besides that, they could prevent tumor promotion and some processes that are associated with free radicals, such as cardiovascular diseases and aging. Therefore, different Allium species, both cultivated (Allium nutans L., A. fistulosum L., A. vineale L., A. pskemense B. Fedtsch, A. schoenoprasum L., A. cepa L. and A. sativum L.) and wild (A. flavum L., A. sphaerocephalum L., A. atroviolaceum Boiss, A. vineale L., A. ursinum L., A. scorodoprasum L., A. roseum L. and A. subhirsutum L.), were investigated in order to evaluate the antioxidant properties of their bulbs. This study reports on the results obtained for the bulb antioxidant enzyme activities (superoxide dismutase, catalase, guaiacol peroxidase, glutathione peroxidase), the quantities of non-enzymatic plant antioxidants (reduced glutathione and total flavonoids), the contents of soluble proteins, vitamin C, carotenoids, chlorophylls a and b, as well as for the quantities of malonyldialdehyde and .OH and O2.- radicals.

Twenty five years of antismoking movement started by medical students: some further goals.

Twenty five years ago, medical students of the former Yugoslavia accepted an idea that emerged from the Medical School in Tuzla to carry out a national preventive campaign "January 31st, a Day without Cigarette". This campaign was soon recognized by the World Health Organization (WHO) as one of "the most successful preventive achievement of medical students in Europe". The only contribution that the government made was printing and releasing a postal stamp on January 31st, 1990. During the war in Bosnia, the UN sanctions imposed to Serbia, and the NATO bombing campaign of the F.R. Yugoslavia (Serbia & Montenegro) weakened this antismoking campaign. At the time of the civil war in several Yugoslav republics, more citizens, including children and youth, started to smoke than in previous years. In 2002, January 31st was proclaimed as the National Antismoking Day in Serbia and the "Republic of Srpska" in Bosnia & Herzegovina; the Republic of Slovenia, and to a smaller extent the rest of the "Bosnian Federation", continued to observe this antismoking campaign. In the future, the medical professionals have to look for new ways to help smokers quit smoking and to maintain abstinence. In addition to education and professional advice, they may use smoking cessation interventions, especially to smokers that require elective surgery. Medical students should continue to participate in the national antismoking campaigns, and they could be included in the comprehensive smoking intervention programs to improve their smoking cessation counseling skills. However, the governments should plan and rigorously realize needed measures to control smoking at public places, offices, and other closed working places. Such measures are especially needed in poor and developing countries where many people die unnecessarily.

Neurophysiologic approach to pruritus and pain in cancer patients.

Itch and pain, like other sensations, serve as physiological self-protective mechanisms. However, in many clinical conditions, unrelieved itch and pain have potentially devastating effects on body functions. Thus, these two sensations present maladaptive phenomena. In this review, we present the neurophysiologic mechanisms of pruritus and pain, including their mutual interactions, but the accent is on causes, consequences and assessment of pruritus and pain in cancer patients. Understanding the mechanisms of pain and itch may optimize pain control in cancer patients amd enhance their quality of life.

The influence of the American environment on cigarette smoking among the immigrants from the former Yugoslavia.

PURPOSE: We tested the hypothesis that the American environment influences the immigrants from developing countries with high incidence of smokers to quit smoking. METHODS: The sample included 218 immigrants who came as adults from the former Yugoslavia. A total of 275 persons were randomly selected, and the overall study response was 79.2%. The survey included questions about current smoking, smoking history, and demographic data, such as year of immigration to the USA, education, and employment status. RESULTS: Upon their arrival, 34.8% of the adult Yugoslav immigrants were smokers; now 20.2% of these immigrants smoke(p<0.001). Smoking prevalence for women was 9.1% higher than for men. The number of cigarettes that men and women smoke per day was similar. CONCLUSION: For an immigrant smoker, the best chance of quitting smoking was within 5 years of acculturation. The local media in their languages may provide the best health education to immigrants, including information on the effects of cigarette smoking. To reduce smoking prevalence in the former Yugoslav republics and other developing countries, rigorous antismoking measures may effectively reduce smoking prevalence and contribute to better health of their citizens.

Metabolism of angiotensin I by guinea pig aqueous humor.

We investigated the degradation of angiotensin I (Ang I) by guinea pig aqueous humor at physiological pH (pH 7.4) and assessed the activity of responsible enzymes using various enzyme inhibitors. The aqueous humor was incubated with Ang I in the presence or absence of an enzyme inhibitor at 37 degrees C for the appropriate time period. The resulting peptides were analyzed by a Beckman HPLC system with a Waters microBondapak C18 analytical column using a 30-min increasing linear gradient of 10 to 40% acetonitrile containing 0.05% trifluoroacetic acid (TFA) and H2O containing 0.05% TFA at a flow rate of 1 mL/min. Detection was done by absorbance at 214 nm. Angiotensin II (Ang II) was a major product (39.3+/-4.10 nmol x h(-1) mL(-1), n = 5) of Ang I hydrolysis. Traces of angiotensin 1-9, angiotensin IV, and angiotensin 1-7 were also produced. Chymostatin (0.05 mmol/L), EDTA (1 mmol/L), enalaprilat (0.1 mmol/L), and ebelacton B (0.01 mmol/L) inhibited generation of Ang II from Ang I by guinea pig aqueous humor by 89+/-4.6, 56+/-7.6, 33+/-5.1, 20+/-6.5%, respectively. Our findings indicate that guinea pig aqueous humor contains several enzymes that can form Ang II. The chymostatin-sensitive type of enzyme was the most active one found in guinea pig aqueous humor. Angiotensin I converting enzyme, carboxypeptidase A, and deamidase may also contribute to angiotensin II formation in guinea pig ocular fluid.

Simultaneous determination of mepivacaine, tetracaine, and p-butylaminobenzoic acid by high-performance liquid chromatography.

INTRODUCTION: The purpose of the present study was to develop a simple method for the simultaneous determination of mepivacaine, tetracaine, and p-butylaminobenzoic acid (BABA) in human plasma using high-performance liquid chromatography (HPLC) with a multiwavelength detector. METHODS: Human blood samples containing heparin, as an anticoagulant, and physostigmine (100 microg/ml), as an anticholinesterase, or human plasma containing physostigmine were spiked with various concentrations of mepivacaine, tetracaine and, in some cases, BABA. Blood samples were centrifuged and plasma was deproteinized with trifluoroacetic acid (TFA; 7%). After centrifugation, the pH was adjusted to 4.5 and an aliquot of 20, 50 or 100 microl was injected into the HPLC apparatus. The detection was done simultaneously at wavelengths of 214 and 300 nm. Analytical chromatography was done on a Waters microBondapak C(18) reverse-phase column (3.9 x 300 mm; particle size 10 microm) with a 30-min increasing linear gradient of 20-40% acetonitrile+0.05% TFA in H(2)O+0.05% TFA at a flow rate of 1 ml/min. The Waters HPLC system included two pumps, an automatic injector, a column oven, and a M490 multiwavelength detector. Quantification was done using integration of peak areas with peaks of authentic mepivacaine, tetracaine, and BABA standards. RESULTS: Calibration curves for standards of mepivacaine, tetracaine, and BABA were linear in the concentration ranges from 0.1 to 100 microg/ml, and the correlation coefficients exceeded.99 for all compounds. The lower limits of detection were 100 ng/ml for mepivacaine and 50 ng/ml for tetracaine and BABA. The yields for mepivacaine, tetracaine, and BABA were 91+/-2.1%, 82+/-3.3%, and 88+/-2.0% (mean+/-S.E.M., n=6), respectively. Degradation of tetracaine by human plasma at 37 degrees C was inhibited by physostigmine. DISCUSSION: The method is sensitive enough to allow blood concentration determinations of mepivacaine and tetracaine or its metabolite, BABA, following local anesthesia induced by these two drugs, especially when their toxic effect may be present. This method also may be useful in forensic medicine for determination of the cause of death after local anesthesia with mepivacaine and/or tetracaine.

Potentiation of the effects of bradykinin on its receptor in the isolated guinea pig ileum.

Angiotensin I-converting enzyme (ACE/kininase II) inhibitors potentiated guinea pig ileum's isotonic contractions to bradykinin (BK) and its analogues, shifting the BK dose-response curve to the left. ACE inhibitors added at the peak of the contraction immediately enhanced it further (343 +/- 40%), although the ileum inactivated BK slowly (t(1/2) = 12-16 min). Chymotrypsin and cathepsin G also augmented the activity of BK up to three- or four-fold, but in a manner slower than that of ACE inhibitors. The BK B(2) receptor blocker HOE 140 inhibited all effects. Histamine and angiotensin II were not potentiated. ACE inhibitors potentiate BK independent of blocking its inactivation by inducing crosstalk between ACE and the BK B(2) receptor; proteases activate the receptor by different mechanism.

Doctors and smoking.

The objective of this paper is to present cigarette smoking as the greatest risk factor for premature death, the nature of smoking dependence, the methods for its cessation, and to establish the importance of the leadership of health care providers in smoking prevention. Because smoking as a risk factor is preventable, it is necessary to conduct rigorous preventive measures, including educational programs and various legal actions, such as restrictions on the purchase of tobacco products to teenagers and creation of smoke-free areas. Reduction in the prevalence of smoking among physicians and other health care professionals also significantly influences willingness of society to recognize the health consequences of smoking and perhaps lead to the decline of the smoking epidemic. Therefore, a special attempt should be made to reduce smoking among health professionals, including medical students. An effort of medical students in Yugoslavia to promote prevention of smoking in the public by introducing "January 31st--A Day Without a Cigarette" is described. The best way to discourage smoking is by approaching children and adolescents since most people start smoking in their teenage years. This age group must recognize the harmful effects of smoking. Banning advertising and other promotional activities of tobacco producers, as well as smoking in hospitals, workplaces, restaurants, and public transportation is a very strong weapon against smoking.

Wall stress-induced dysrhythmias in the isolated working rat heart perfused through a cannula placed in the left ventricle via aorta.

The purpose of the present study was to determine if our recently introduced novel working rat heart preparation could be used to study wall stress-induced dysrhythmias. A double cannula, which consisted of an outer cannula that, was inserted in the aorta and an inner cannula that was advanced into the left ventricle was used. The perfusion flowed through the inner cannula into the left ventricle and was ejected from there into the aorta. Afterload was changed suddenly from 60 to 160 Hg of pressure by turning a valve so that the fluid was diverted to a column set at a different height. A sudden increase of aortic pressure that lasted for 10 sec caused cardiac ectopic beats. Wall stress-induced dysrhythmias were more sustained during perfusion with low potassium and low magnesium Krebs-Henseleit solution. Bradykinin (1 microg) or epinephrine (10 microg) was injected as a bolus via an in-line injection port placed at the inner cannula. Bradykinin significantly reduced the incidence of ectopic beats and epinephrine increased the incidence of nonsustained runs of VT. This "working" heart preparation is a convenient tool to study wall stress-induced dysrhythmias.

[Drugs in the physician's bag for emergency conditions]. / Lekovi u lekarskoj torbi za histna stanja.

The list of drugs for the physician's bag depends on several factors, including practice location, conditions most likely to be found, costs and availability of drugs, organization of the emergency medicine in the region, shelf life and climatic vulnerability of certain drugs, population age, and size and design of the bag. Most of the drugs carried should be in an injectable form. However, the non-injectable drugs with relatively rapid systemic onset may be also included. Separation of drugs in the bag according to their usage may help in providing an organized treatment. For example, one could separate drugs for treatment of the following emergencies: cardiovascular, altered mental status, respiratory, gastrointestinal, bleeding, infections, and toxicological emergencies. The list of drugs needed for medical emergencies when physician makes house-calls is presented with short notes on their usage. Oncologic, toxicologic and pediatric emergencies are commented.

Attenuation of epinephrine-induced dysrhythmias by bradykinin: role of nitric oxide and prostaglandins.

Cardiac dysrhythmias are common during anesthesia and surgery. An important precipitating factor of clinically relevant arrhythmias is the introoperative use of epinephrine. Bradykinin acts as an endogenous cardioprotective substance because it suppresses ventricular dysrhythmias induced by ischemia. In this study, we investigated whether bradykinin has a protective effect, preventing the development of dysrhythmias after epinephrine infusion in rats. Because kinins are potent stimulators of the release of nitric oxide and prostaglandins from the endothelium, we investigated whether the protective effect of bradykinin is mediated by these 2 autacoids. Male Sprague-Dawley rats anesthetized with sodium pentobarbital had catheters placed into a carotid artery and both jugular veins. Arterial blood pressure and lead II of the electrocardiogram (ECG) were continuously monitored and recorded. After a steady state was achieved, 1 mg/kg enalapril, an inhibitor of angiotensin I-converting enzyme/kininase II, was given intravenously to all groups except the one treated with losartan. Bradykinin was infused at the initial rate of 0.5 microg/kg per min. Cardiac arrhythmia was induced with 7.5 microg/kg epinephrine intravenously. Dysrhythmia was assessed by counting the number of premature ventricular contractions (PVCs), runs of ventricular tachycardia (V Tach), and missing beats during the first minute after epinephrine. In untreated, control rats, epinephrine caused 10.8 +/- 2.7 PVCs, 0.8 +/- 0.2 runs of V tach, and 11.6 +/- 7.4 missing beats/min. In rats pretreated with bradykinin, the same dose of epinephrine elicited 1.2 +/- 0.5 PVCs, no runs of V tach, and 0.4 +/- 0.4 missing beats/min. This beneficial effect of bradykinin was partially reversed by N-nitro-L-arginine methyl ester (L-NAME) or indomethacin, and completely by L-NAME plus indomethacin or icatibant, but it was not affected by des-Arg9[Leu8]-bradykinin. We conclude that bradykinin, acting on the B2 receptor, attenuates epinephrine-induced dysrhythmia via a mechanism that involves the release of NO and prostaglandins. Although the mechanism is not clear, NO and prostaglandins may prevent epinephrine-induced dysrhythmia and protect the myocardium via a direct action on cardiac neurons.

The isolated perfused "working" rat heart: a new method.

This paper presents a "working" isolated perfused rat heart. A special double cannula was designed consisting of an outer cannula that is inserted in the aorta and an inner cannula that is advanced into the left ventricle. The perfusion fluid flows through the inner cannula into the left ventricle, and is ejected from there into the aorta. If the outer cannula system is closed, the fluid perfuses the coronary vessels and drips off outside the heart. When the outer cannula is open and certain pressure resistance is applied, a fraction of the ejected fluid perfuses coronary vessels and the rest is expelled. Because the inner cannula can easily be retracted into the outer cannula, which is placed in the aorta, this preparation provides an opportunity to use the same heart as a "working" or "non-working" model for investigating functions of the heart. The effects of epinephrine and yohimbine were tested on this model. This preparation is simple, durable, and reliable.