Patterns of drug prescribing in a hospital in dubai, United arab emirates.

To determine the pattern of drug prescription by consultants in a private hospital in Dubai, United Arab Emirates, 1190 prescriptions were collected from the hospital's pharmacy over 30 days. In total, 2659 drugs were prescribed. The mean number of drugs per encounter was 2.2. Only 4.4% of all drugs prescribed were generic. Polypharmacy was observed in only 7.5% of all encounters. Information about the prescribing physician and the patient was invariably deficient. Name of patient, age, and gender were absent in 2.9%, 9.7%, and 12% of prescriptions, respectively. In addition, none of the prescriptions mentioned address, diagnosis, or allergy of the patient. Name of physician, signature, speciality and license or registration number were omitted in 12.2%, 10.3%, 20.3%, and 54.9% of prescriptions. The most commonly prescribed therapeutic classes of drugs (and principal drug in each class) were as follows: 23.4% non-steroidal anti-inflammatory drugs (NSAIDs, Diclofenac sodium being 51.6%), 21.4% antibiotics (amoxicillin-clavulanate 13.5%), and 11.5% gastrointestinal drugs (GI, Hyoscine-N-butylbromide 28.1%). Other therapeutic classes included endocrine drugs (6.1%), vitamin supplements (5.9%), nasal decongestants (4%), antihistaminics (3.8%) and cardiovascular drugs (2.6%). Antibiotic injections accounted for 7.4% of all antibiotics prescribed, which was equivalent to 1.6% of all prescriptions. Other agents prescribed in small proportions of encounters collectively amounted to 21.3%. This study reveals the prescription trends, and indicates possible areas of improvement in prescription practice.

Dysbindin-1 is reduced in intrinsic, glutamatergic terminals of the hippocampal formation in schizophrenia.

Eleven studies now report significant associations between schizophrenia and certain haplotypes of single-nucleotide polymorphisms in the gene encoding dysbindin-1 at 6p22.3. Dysbindin-1 is best known as dystrobrevin-binding protein 1 (DTNBP1) and may thus be associated with the dystrophin glycoprotein complex found at certain postsynaptic sites in the brain. Contrary to expectations, however, we found that when compared to matched, nonpsychiatric controls, 73-93% of cases in two schizophrenia populations displayed presynaptic dysbindin-1 reductions averaging 18-42% (P = 0.027-0.0001) at hippocampal formation sites lacking neuronal dystrobrevin (i.e., beta-dystrobrevin). The reductions, which were not observed in the anterior cingulate of the same schizophrenia cases, occurred specifically in terminal fields of intrinsic, glutamatergic afferents of the subiculum, the hippocampus proper, and especially the inner molecular layer of the dentate gyrus (DGiml). An inversely correlated increase in vesicular glutamate transporter-1 (VGluT-1) occurred in DGiml of the same schizophrenia cases. Those changes occurred without evidence of axon terminal loss or neuroleptic effects on dysbindin-1 or VGluT-1. Our findings indicate that presynaptic dysbindin-1 reductions independent of the dystrophin glycoprotein complex are frequent in schizophrenia and are related to glutamatergic alterations in intrinsic hippocampal formation connections. Such changes may contribute to the cognitive deficits common in schizophrenia.

A consensus model for molecular packing of type I collagen.

In this review, recent results from X-ray diffraction studies of tendon are used to develop an understanding of the molecular packing of type I collagen in tendon fibrils. These cover the definition of the unit cell as triclinic, the lateral architecture of molecular packing in a fibril and the molecular packing topology of a structure that gives good agreement with X-ray diffraction data. The proposed model is a 1D staggered left handed microfibril; the molecular orientation of the telopeptides indicates that there are interconnections between microfibrils that may explain the difficulty in isolating individual microfibrillar structures. This is the first structure that defines the absolute molecular packing of molecular segments based on X-ray diffraction data. These results are discussed in the light of direct and indirect evidence relating to molecular packing such as mineralization, natural crosslink position, and biomechanical evidence. The ability of the proposed structure to fulfill many of the structural and biochemical criteria point towards the structure providing a basis for a consensus model of collagen packing.

Molecular packing of type I collagen in tendon.

X-ray diffraction of rat tail tendon shows that type I collagen fibrils contain regions of three-dimensional crystalline arrays; where molecular packing is speculated to be by a staggered sheet or microfibril arrangement. The X-ray diffraction pattern also contains a significant amount of diffuse scatter indicative of static and thermal disorder in fibrils. Removal of the diffuse scatter from the equatorial region of X-ray diffraction patterns obtained using synchrotron radiation allowed the Bragg intensities to be viewed on a flat background. Indexing of Bragg peak intensity on the 10, -10, 0 -1, 01, -11 and 1-1 row-lines of the triclinic unit cell have been used here to test possible sheet and microfibril packing arrangements. The relative translation of molecular segments in the gap and overlap regions as well as the telopeptide orientation have been investigated. A global search through combinations of molecular packing and molecular translation revealed that the sheet-type conformations cannot account for the observed low-angle off-meridional Bragg peak intensity distribution. A superior fit is obtained with D-staggered left-handed microfibril structures. The orientation of the telopeptides may indicate that there are interconnections between microfibrils that may explain the difficulty in isolating individual microfibrillar structures.

The structure of avian cartilage: a combined X-ray and biochemical analysis.

The antitrochanter is a cartilaginous extension of the avian hip joint that is susceptible to degenerative changes. This study consisted of X-ray diffraction and complementary biochemical examination of collagen in the turkey antitrochanter from the articulating surface through to the bone. X-ray diffraction was performed by means of synchrotron radiation with a 200 microns collimated beam to examine the antitrochanter from three 24-week-old, large, male turkeys. The arced distribution of intensity from equatorial reflections was used to determine the parameter g(psi), the probability distribution of fibril angular orientation. Analysis of five distinct regions showed a variety of fibril orientation profiles. The surface of the cartilage exhibited a near isotropic profile. The superficial fibrous region contained well-aligned fibrils parallel to the surface. The middle hyaline region was less well organized, but fibrils were orientated in a direction similar to that of fibrils in the superficial fibrous region. The deep hyaline region exhibited a bimodal distribution of fibril orientation. The ossified front (decalcified) showed an alignment similar to that seen in the middle hyaline region. Biochemically, two main regions were found. The first, 1.2 mm from the surface, consisted of type I collagen and the deeper region (1.26-3.0 mm) consisted of type II collagen. The change from type I to type II was abrupt (less than 80 microns).

An association between maternal diet and colonic diverticulosis in an animal model.

BACKGROUND/AIMS: Maternal diet may have an effect on the health of the offspring in middle and later life. This study used the laboratory rat as an animal model to examine whether the fibre content of the maternal diet during pregnancy affected subsequent development of colonic diverticula in the offspring fed lifelong fibre deficient or higher fibre diets. METHODS: The parents of experimental animals were fed either a diet that was known to predispose to colonic diverticulosis or a control diet for one month prior to mating. The offspring were fed one of these diets for 18 months. The incidence of colonic diverticulosis, submucosal collagen content, collagen solubility in weak acid, and the composition of intestinal contents were then measured. RESULTS: Offspring of rats fed a higher fibre diet from higher fibre diet fed parents had 0% incidence of colonic diverticulosis. When offspring (regardless of parental diet) were fed a low fibre diet for life the acid solubility was lowered compared with rats fed lifelong higher fibre diet mean (SD) (0.044 (0.0007) v 0.073 (0.0015) sigmoid colon (ratio of soluble:insoluble collagen)); 21.1% had diverticulosis and there was reduced fibre fermentation. However, when the diet of the parents of the fibre deficient diet fed rats was considered, the animals whose mothers had a fibre deficient diet had lower acid solubility (0.032 (0.0007)) and an increased incidence of colonic diverticulosis (42.1%) than the animals fed a fibre deficient diet from higher fibre diet fed parents (p < 0.01 in all instances). CONCLUSION: Maternal diet and the subsequent nutrition of the progeny seem to be of importance in the development of colonic diverticulosis in the rat.

Collagen alteration in an animal model of colonic diverticulosis.

BACKGROUND: Changes in the structure and integrity of the colon dependent on collagen content and crosslinkage occur with age. AIMS: This study using an animal model examines colonic collagen content and crosslinkage over the lifetime of rats on fibre deficient and higher fibre diets. METHODS: Two groups of 20 rats were fed either a fibre deficient diet (1.7 g NSP (non-starch polysaccharide)/100 g) or a higher fibre diet (13.3 g NSP/100 g) for 18 months. Diverticula were identified by postmortem examination. Caecal and colonic contents were weighed and assayed for short chain fatty acids. Collagen solubility in weak acid was measured to give an indication of the nature and amount of crosslinks in the collagen of the bowel wall. RESULTS: The incidence of colonic diverticula was greater (42.1% fibre deficient rats; 0% higher fibre rats). Colonic collagen solubility index in fibre deficient rats was significantly lower than higher fibre diet fed rats (p < 0.001 in all four sections of the large bowel). Rats with diverticula had the lowest solubility index (p < 0.001 in all four sections of the large bowel). Higher fibre diet rats had increased caecal and colonic contents, caecal and colonic tissue wet weights, and greater caecal short chain fatty acids. Fibre deficient diet fed rats had more pathological abnormalities. CONCLUSIONS: This animal model permits a study of the relation between collagen crosslinkage and the development of colonic diverticulosis. A higher fibre diet protects against collagen crosslinking and this is related to a decreased incidence of diverticula.

The chemical reactivity and structure of collagen studied by neutron diffraction.

The chemical reactivity of collagen can be studied using neutron diffraction (a non-destructive technique), for certain reaction types. Collagen contains a number of lysine and hydroxylysine side chains that can react with aldehydes and ketones, or these side chains can themselves be converted to aldehydes by lysyl oxidase. The reactivity of these groups not only has an important role in the maintenance of mechanical strength in collagen fibrils, but can also manifest pathologically in the cases of aging, diabetes (reactivity with a variety of sugars) and alcoholism (reactivity with acetaldehyde). The reactivity of reducing groups with collagen can be studied by neutron diffraction, since the crosslink formed in the adduction process is initially of a Schiff base or keto-imine nature. The nature of this crosslink allows it to be deuterated, and the position of this relatively heavy scattering atom can be used in a process of phase determination by multiple isomorphous replacement. This process was used to study the following: the position of natural crosslinks in collagen; the position of adducts in tendon from diabetic rats in vivo and the in vitro position of acetaldehyde adducts in tendon.

Cross linking of collagen is increased in colonic diverticulosis.

Development of colonic diverticulosis is a function of age and declining colonic wall mechanical strength. The latter is partly a consequence of changes in the collagen structure. Collagen from unaffected human colons (n = 20, age range 20-80 years) and those with colonic diverticulosis (n = 5, age range 67-80 years) were obtained at necropsy. The total collagen content was measured as the hydroxyproline content and cross linkage by collagen solubility in weak acid was studied. The colonic total collagen content was constant with age (mean (SD) 15.8 (0.3) mg/100 mg wet weight of tissue). The acid solubility of the collagen, however, increased after the age of 40 years: at over 60 years, colonic diverticulosis was associated with an increased acid solubility ratio compared with values in unaffected colons (15.3 (0.2); compared with 9.2 (0.2), p < 0.001). The cross linking of colonic collagen increases with age. These changes seem to be a factor in the aetiology of colonic diverticulosis.

Type I collagen packing, conformation of the triclinic unit cell.

The X-ray diffraction pattern of tendon collagen can contain a number of sharp Bragg peaks indicating three-dimensional crystallinity of the sample. Optimal diffraction images have been obtained with a high flux synchrotron X-ray source and a carefully maintained sample environment and staining techniques. The Bragg peaks are always superimposed on a diffuse background. This makes interpretation of data difficult and a number of conflicting models of collagen packing have been proposed. The removal of the diffuse scatter from the images allows the Bragg peaks to be seen on a relatively flat background. This was conducted by modelling the background points as a series of two-dimensional polynomial functions. The resultant set of observed Bragg reflections serves as an excellent basis to test the validity of two contradictory packing modes; (1) the triclinic model, Fraser et al., (2) the microfibril model, Kajava. From this it can easily be seen that the model proposed by Kajava is inappropriate, since there is limited agreement between predicted positions of reflections and the positions of observable reflections on film. The packing of collagen molecules on a triclinic lattice is favoured by this criterion.

The in vitro binding of acetaldehyde to collagen studied by neutron diffraction.

The location of acetaldehyde binding sites in the axial unit cell of tendon collagen was investigated by neutron diffraction. Acetaldehyde forms spontaneous cross-links with specific residues in collagen. The use of deuterated acetaldehyde increased the neutron scattering length of these groups. The introduction of deuterated acetaldehyde at specific locations allowed the acetaldehyde-reacted collagen to be treated as multiple isomorphous derivatives for neutron fibre diffraction. The low resolution axially projected structure was determined using amplitudes of the first eight meridional reflections (d = 67 nm). Results indicate that the process of acetaldehyde labelling takes place at different rates at different sites within the collagen fibril. The position of acetaldehyde attachment correlates well with the position of lysine and hydroxylysine residues especially in the regions of the molecular termini. This information is relevant to the process of cirrhosis and fibrosis of the liver since adduction of collagen by acetaldehyde may interfere with normal Schiff base cross-link formation at the C- and N-termini. This may result in subsequent alterations in the intra- and inter-molecular cross-linking pattern of collagen molecules.

The in vivo glycation of diabetic tendon collagen studied by neutron diffraction.

Glycation (non-enzymatic glycosylation) sites in the axial unit cell of diabetic tendon collagen were investigated by neutron diffraction. Samples of diabetic and control tendon were reacted with sodium borodeuteride and sodium cyanoborodeuteride. This facilitated deuteration at aldimine, aldol or ketoimine groups in the molecule. These are natural collagen cross-links and sites where non-enzymatic glycation had occurred. The introduction of a deuteron at specific locations allowed the diabetic glycation collagen to be treated as multiple isomorphous derivatives for neutron fibre diffraction. Neutron diffraction was conducted at the Institut Laue Langevin, Grenoble. Standard crystallographic refinement techniques (modified for axial projections) were used to determine the structure of the control (non-diabetic) and diabetic samples. The results are shown as difference maps, these indicate that glycation takes place at different rates within the collagen axial unit cell. The position of glycation correlates well with the position of hydroxylysine residues. The reactions of periodate with enzymatically attached sugars, proteoglycan, natural cross-links and glycation products lead to complications in map interpretation.