Anti-urolithiatic activity of Bryophyllum pinnatum Lam. hydroalcoholic extract in sodium oxalate-induced urolithiasis in rats.

BACKGROUND AND AIM: Despite advances in modern medicine, the development and growth of calculi continues to be a source of concern for mankind, as there is no effective treatment for kidney stones. In the present study we investigated antiurolithiatic activity of Bryophyllum pinnatum Lam against sodium oxalate (NaOx) induced urolithiasis in rats. EXPERIMENTAL PROCEDURE: In rats with renal calculi caused by sodium oxalate (NaOx, 70 mg/kg, i.p.); the antiurolithiatic action of Bryophyllum pinnatum hydroalcoholic extract (BPHE) was studied. BPHE was given every day orally at doses of 50, 200 mg/kg for 14 days to rats to examine activity against sodium oxalate (NaOx) mediated urolithiasis, with Cystone (500 mg/kg, p.o.) as a reference standard. The effect of the extract on urine oxalate, creatinine and phosphate retention and excretion in the kidney, as well as serum and biochemical analysis of kidney homogenate and histopathological examinations were studied. RESULTS AND CONCLUSION: Oral administration of BPHE at doses of 50,100, and 200 mg/kg to rats with sodium oxalate-mediated renal calculi showed dose-dependent substantial (P<0.05) antiurolithiatic potential, with notable reversal of NaOx-induced ion excretion and urinary CaOx concentration. These findings justify the traditional use of Bryophyllum pinnatum hydroalcoholic extract (BPHE) in the treatment of renal calculi.

A pharmacokinetic analysis of posaconazole oral suspension in the serum and alveolar compartment of lung transplant recipients.

Invasive fungal infections cause significant morbidity and mortality after lung transplantation. Fungal prophylaxis following lung transplantation is not standardised, with transplant centres utilising a variety of regimens. Posaconazole is a broad-spectrum antifungal triazole that requires further investigation within the setting of lung transplantation. This prospective, single-centre, observational study explored the pharmacokinetics of posaconazole oral suspension (POS) in the early perioperative period following lung transplantation in 26 patients. Organ recipients were scheduled to receive 400mg POS twice daily for 6 weeks as primary antifungal prophylaxis. Therapeutic drug monitoring (TDM) of serum posaconazole levels was performed in accordance with local clinical protocols. Bronchoalveolar lavage fluid (BALF) was sampled during routine bronchoscopies. Posaconazole levels were measured both in serum and BALF using mass spectrometry. Posaconazole levels were highly variable within lung transplant recipients during the perioperative period and did not achieve 'steady-state'. Serum posaconazole concentrations positively correlated with levels within the BALF (r=0.5527; P=0.0105). Of the 26 patients, 10 failed to complete the study for multiple reasons and so the trial was terminated early. Unlike study findings in stable recipients, serum posaconazole levels rarely achieved steady-state in the perioperative period; however, they do reflect the concentrations within the airways of newly transplanted lungs. The role of POS as primary prophylaxis in the perioperative period is uncertain, but if used TDM may be helpful for determining attainment of therapeutic levels.

"Hanging donors": are we still skeptical about the lungs?

BACKGROUND: Suicidal hanging may cause compression of the neck blood vessels and the airway leading, to hypoxic brain damage caused by cerebral ischemia and respiratory distress. Hanging engenders global tissue hypoxia, particularly affecting the lungs as the result of pulmonary edema and barotrauma. There is scant evidence about outcomes of transplantation with the use of lungs from "hanging donors." This study evaluates the outcomes of lung transplantations (LTx) that use organs from this group. METHODS: We retrospectively analyzed lung "organ offers" and LTx at our center between January 2007 and November 2013. The outcomes of LTx with lungs from donors with hanging as the cause of death ("hanging group") were compared with those with donors having other causes of death (control group), with the use of an unadjusted model as well as propensity score matching. RESULTS: LTx (n = 302) were performed during this period and were grouped on the basis of the cause of death in donors: the hanging group (n = 8) and the control group (n = 294). No statistically significant difference was found in the donor characteristics except for the incidence of cardiac arrest, which was significantly higher in hanging donors. Preoperative characteristics in recipients in both groups were comparable. Intra-operative and post-LTx variables including PaO2/FiO2 ratios, duration of mechanical ventilation, and intensive care unit and hospital stays were comparable. One-year and 3-year survival rates were also comparable in both groups. Two recipients in the hanging group required extracorporeal life support after LTx and could not survive. CONCLUSIONS: Suicidal hanging is a relatively rare cause of death for potential organ donors. Because it does not appear to negatively affect outcomes after LTx, it should not be considered per se a contraindication for lung donation. A word of caution is necessary until we gather larger experience with lungs from hanging donors.

Utilization of the organ care system as ex-vivo lung perfusion after cold storage transportation.

The Organ Care System (OCS) allows perfusion and ventilation of the donor lungs under physiological conditions. Ongoing trials to compare preservation with OCS Lung with standard cold storage do not include donor lungs with suboptimal gas exchange and donor lungs treated with OCS following cold storage transportation. We present a case of a 48-yr-old man who received such lungs after cold storage transportation treated with ex-vivo lung perfusion utilizing OCS.

Utilization of the Organ Care System Lung for the assessment of lungs from a donor after cardiac death (DCD) before bilateral transplantation.

In this manuscript, we present the first experience of evaluating donation after circulatory death (DCD) lungs, using the normothermic preservation Organ Care System (OCS) and subsequent successful transplantation. The OCS could be a useful tool for the evaluation of marginal lungs from DCD donors as it allows a proper recruitment and bronchoscopy in such donations in addition to continuous ex-vivo perfusion and assessment and treatment during transport. The OCS could potentially be a standard of care in the evaluation of marginal lungs from DCD.

Oxy-RVAD: rescue in pulmonary complications after LVAD implantation.

Pulmonary complications after left ventricular assist device (LVAD) implantation seldom occur; however, if present, they may prove catastrophic. An Oxy-RVAD (oxygenator in right VAD circuit) is a lifesaving technique in such cases and allows freedom of introducing and removing an oxygenator into the RVAD circuit without opening the chest and competing with LVAD flow.

Outcomes in patients receiving HeartMate II versus HVAD left ventricular assist device as a bridge to transplantation.

OBJECTIVE: Ventricular assist devices have become a standard treatment for patients with advanced heart failure. We present data comparing results after implantation of HeartMate II (HM II) versus HVAD (HW) left ventricular assist devices (LVADs) for the past 7 years at our institution. METHODS: From July 2006 to August 2012, 121 consecutive patients underwent LVAD implantation: 70 (57.9%) received HM II and 51 (42.1%) HW. Patient demographics, perioperative characteristics, and laboratory parameters as well as postoperative outcome were compared retrospectively. RESULTS: Patients in the HM II group were significantly younger (P < .01), with more deranged liver function (higher bilirubin [P = .02] and alanine aminotransferase [P = .01] levels), and had a significantly higher rate of preoperative infections requiring antibiotic treatment (P = .02) and a higher body core temperature (P < .01). Other demographic and preoperative parameters did not show statistical differences. Most postoperative characteristics were also similar between the two groups. HM II patients had a significantly higher transfusion rate, but there were no differences in incidence of resternotomy (P = .156). Recovery and VAD explantation were more likely in the HM II group (P = .02). Although there was no significant difference in survival (log rank test: P = .986; Breslow test: P = .827), HM II patients were more likely to develop a percutaneous site infection (P = .01). CONCLUSIONS: Both HM II and HW provide similar early postoperative outcome and good long-term survival. The differences observed between the groups may be related to demographic and preoperative factors rather than the type of the device used.

In vitro evaluation of tetrazoles as a novel class of Antimycobacterium tuberculosis agents.

PURPOSE: We report here the antimycobacterial activity of some already synthesized tetrazole derivatives containing tetrazole against Mycobacterium tuberculosis strain H37Rv. METHODS: In vitro evaluation of the antitubercular activity was carried out within the Tuberculosis Antimicrobial Acquisition & Coordinating Facility (TAACF) screening program for the discovery of novel drugs for the treatment of tuberculosis. Under the direction of the US National Institute of Allergy and Infectious Diseases (NIAID), Southern Research Institute that coordinates the overall program. The method of TAACF was followed for evaluation of activity. RESULTS: This new structural class of compounds showed high activity against the bacilli. The activity depends on the substituent's present in azatidinone core. Compounds having a 4-MeOC6H4 4-N(CH3)2C6H4 group as the substituent on ß-lactam ring were active. The highest activity was registered for compounds having 4-MeOC6H4 as substituent. CONCLUSION: The new compounds showed high potency and promising antitubercular activity and should be regarded as new hits for further development as a novel class of Antimycobacterium tuberculosis agents.

Age assessment from mandible: comparison of radiographic and histologic methods.

Age assessment is an integral and important aspect of forensic odontology. The use of long bones and teeth has been documented since decades. The aim of this study was to use both radiographic and histologic methods of age estimation and to determine which method gives a near actual age. Orthopantomograph (OPG) was used to study the radiographic changes and ground sections were made for histologic study. Of the various parameters studied, we concluded that the histologic parameters recorded ages, which were closer to the actual age. Of the histologic parameters, two to three parameters when combined were still better.

Triple reinforcement of bronchial stump.

Various methods are used to prevent bronchopleural fistula following anatomical lung resection, as bronchopleural fistula constitutes a life-threatening complication. Pleural flaps are less vascularized, whereas an intercostal muscle flap, although well vascularized, does not offer enough strength for repair. We describe here the use of pleural flaps to strengthen a bronchial closure and cover the defect. Subsequently, an intercostal muscle flap is buttressed over the bronchial stump.