Evaluation of serum cardiac troponin I and N-terminal pro-B-type natriuretic peptide levels in patients with alopecia areata.

Alopecia areata (AA) is a recurrent, immune-mediated, hair-loss disorder. It is associated with other autoimmune disorders that carry a high risk of cardiovascular disease (CVD). However, there is a lack of reports on the association of cardiovascular comorbidities and AA. Cardiac troponin I is a biomarker of myocardial ischaemia and inflammation, while N-terminal pro-B-type natriuretic peptide is used in the diagnosis of congestive heart failure. This study was conducted to assess the serum level of both markers by ELISA in 44 patients with AA compared with 44 healthy controls (HCs). None of the participants had CVD, CVD risk factors or other diseases associated with elevation of either marker. The study revealed that serum levels of both markers were significantly higher in patients with AA compared with HCs (P < 0.001). The inflammatory milieu encountered in AA may be associated with subtle myocardial inflammation that causes elevation of levels of both of these cardiac markers.

[Management of NSTEMI in a hospital without interventional cardiology and without use of GRACE score: Does the clinician appreciation match the GRACE score calculated retrospectively for the coronarography delay?] / Prise en charge des syndromes coronaires aigus sans sus décalage du ST dans un hôpital sans cardiologie interventionnelle : l'appréciation du clinicien rejoint-elle le score de GRACE dans le délai de réalisation de la coronarographie ?

PURPOSE: The management of non-ST segment elevation acute coronary syndromes (NSTEACS) remains an issue for mobidity, mortality, and an economic stake. The first aim of the study was to evaluate the additional value of the GRACE score for the compliance with the recommended times to coronary angiography in an hospital without interventional cardiology. We also analysed the in-hospital and 6-month mortality and the predictive factors of compliance for the coronarography delays. METHODS: Retrospective monocenter cross-sectional study including consecutive patients with chest pain suggestive of a NSTEACS during 1 year. Data of the delay to coronarography were collected and GRACE score was calculated a posteriori. RESULTS: The time to perform coronary angiography was non-compliant in 49% of cases (27 patients out of 55). The calculation of the GRACE score would have allowed correcting the delay for two patients of our cohort. Clinical appreciation, troponin elevation, ECG modifications were associated with the delay compliance. Age <75 years predisposed to recommended delays. Renal failure and history of coronaropathy were significantly associated with non compliant delays. A non-compliant delay was significantly associated with higher mortality. CONCLUSION: In our experience, the knowledge of the GRACE score had little impact on the timing of coronary angiography. However, as a predictor of mid and long term mortality, GRACE score remains SCA ST+ useful to intensify surveillance of high-risk patients.

Impact of Interleukin-28B gene polymorphism (rs12979860) on Egyptian patients infected with hepatitis C virus genotype-4.

Single nucleotide polymorphisms (SNPs) in the Interleukin (IL)-28B gene, namely rs12979860, could predict response to pegylated interferon-α-ribavirin (PR) therapy in hepatitis C virus genotype 1 (HCV-1)-infected patients. A similar role was investigated in a case-control study conducted on 93 Egyptian patients chronically infected with HCV-4 in comparison to 22 individuals with spontaneous HCV clearance and 70 healthy volunteers. The homozygous C allele genotype (CC) was associated with sustained viral response (SVR) to therapy compared with the homozygous T allele genotype (TT) and the heterozygous genotype (CT). In the SVR group, the response rate was statistically significantly higher in CC genotypes (58.6%) compared with CT/TT (20.3%). There was no correlation between SVR patients' genotypes and early response to therapy or HCV baseline viral load. Our findings describe how IL-28B SNP genotyping may guide appropriate selection of HCV-4-infected patients for PR therapy.

Impact of Interleukin-28B gene polymorphism (rs12979860) on Egyptian patients infected with hepatitis C virus genotype-4

Single nucleotide polymorphisms [SNPs] in the Interleukin [IL]-28B gene, namely rs12979860, could predict response to pegylated interferon-?-ribavirin [PR] therapy in hepatitis C virus genotype 1 [HCV-1]-infected patients. A similar role was investigated in a case-control study conducted on 93 Egyptian patients chronically infected with HCV-4 in comparison to 22 individuals with spontaneous HCV clearance and 70 healthy volunteers. The homozygous C allele genotype [CC] was associated with sustained viral response [SVR] to therapy compared with the homozygous T allele genotype [TT] and the heterozygous genotype [CT]. In the SVR group, the response rate was statistically significantly higher in CC genotypes [58.6%] compared with CT/TT [20.3%]. There was no correlation between SVR patients' genotypes and early response to therapy or HCV baseline viral load. Our findings describe how IL-28B SNP genotyping may guide appropriate selection of HCV-4-infected patients for PR therapy. We underscore IL28B genotyping as a tool that might increase PR cost-benefit in Egypt

Production of interleukin-10 in serum and erythropoietin sensitivity in ESRD patients on hemodialysis.

One of the clinical consequences of aberrant cytokines production in patients with end stage renal disease (ESRD) may be impaired erythropoiesis. To determine the interleukin (IL)-10 levels in ESRD patients on regular hemodialysis (HD) with good and poor response to recombinant human erythropoietin (Epo). Two groups of ESRD-HD patients were evaluated; 48 high epo HD patients and 32 low epo HD patients were evaluated for some laboratory tests and Interleukin-10 by ELISA. The production of IL-10 is decreased in HD with low epo group than high epo group 32.4 +/- 7.9 vs. 45 +/- 6.9 pg/ml (P < 0.001). IL-10 level is well correlated with CRP, ESR, Ferritin, Epo dose, and EPO/Hb ratio in ESRD-HD patients. These findings suggest that IL-10 is playing a part in affecting the response to EPO, even in the absence of any obvious infection or inflammatory condition.

Detection of circulating antierythropoietin antibodies in patients with end stage renal disease on regular hemodialysis.

Recombinant human erythropoietin (rHuEPO) has been successfully and safely used to treat anemia in patients with end stage renal disease (ESRD). The safety profile of rHuEPO had been considered to be excellent with possible exception of hypertension and increased risk of dialysis access thrombosis. Recently, antibody-mediated pure red cell aplasia associated with administration of rHuEPO has been identified as a cause of major concern; we aimed to detect and evaluate the presence of anti-EPO antibodies in patients with ESRD on regular dialysis who are using rHuEPO. Serum anti-EPO antibodies were detected by enzyme-linked immunosorbant assay technique in a total of 90 patients who are currently on regular hemodialysis and using rHuEPO alpha subcutaneously for more than 6 months. All patients were subjected to full history taking and clinical examination. Complete blood count, reticulocytes count, serum creatinine, blood urea, serum albumin, serum ferritin, and hepatitis markers were performed for all patients. Our results showed that 35 patients (38.9%) had the anti-EPO antibodies in their blood, while 55 patients (61.1%) did not have the circulating antibodies. The mean hemoglobin (Hb) level was significantly lower in the antibody positive group (8.8 g/dl +/- 1.35) than in the antibody negative group (9.42 g/dl +/- 1.32) (P = 0.000). The reticulocytes count was also significantly much lower in the patients who had anti-EPO antibodies with mean of (1.99 +/- 1.14) vs. (3.15 +/- 0.89) in the antibody negative (P = 0.000). The dose of EPO administrated in both studied groups was insignificantly different. The incidence of anti-EPO antibodies is high in ESRD patients on maintenance hemodialysis. Its presence is associated with increased incidence of anemia possibly due to immune-mediated inhibition of erythropoiesis as evidenced by reticulocytopenia.

Prothrombin gene G20210A mutation in acute deep venous thrombosis patients with poor response to warfarin therapy.

AIM: The pathogenesis of deep venous thrombosis (DVT) involves an interaction between hereditary and acquired factors. Prothrombin gene mutation is one of the hereditary risk factors. We evaluated the frequency of the prothrombin gene mutation in patients with DVT and its relation to oral warfarin anticoagulant therapy response. METHODS: Prothrombin gene mutation was looked for in 40 DVT patients with poor response to warfarin. The results were compared with 40 DVT patients with a normal response to warfarin and 30 healthy blood donors. Blood samples were also assessed for protein C, protein S, anti-thrombin III and anticardiolipin antibodies (ACA) levels. RESULTS: Prothrombin gene mutation was found in normal and poor DVT responders (6/40 and 13/40, respectively; p = NS) as well as in healthy controls (1/30). Patients with recurrent DVT or a family history of DVT were significantly (p<0.0001) more likely to have the prothrombin mutation than other DVT patients. Non prothrombin abnormalities (protein C, anti-thrombin III and ACA) were more common in poor responders than controls (p<0.0037) as were ACA (p<0.034). CONCLUSIONS: Prothrombin gene mutation is present in several DVT patients, especially those with recurrent DVT or a family history of DVT. This mutation may contribute to a poor response to warfarin.

Quantitative determination of some pharmaceutical piperazine derivatives through complexation with iron(III) chloride.

A simple, accurate and sensitive spectrophotometric method has been developed for the determination of three pharmaceutical piperazine derivatives, namely ketoconazole (KC), trimetazidine hydrochloride (TMH) and piribedil (PD). This method is based on the formation of yellow orange complexes between iron(III) chloride and the investigated drugs. The optimum reaction conditions, spectral characteristics, conditional stability constants and composition of the water soluble complexes have been established. The method permits the determination of KC, TMH and PD over a concentration range 1-15, 1-12 and 1-12 microg ml(-1), respectively. Sandell sensitivity is found to be 0.016, 0.013 and 0.013 microg cm(-2) for KC, TMH and PD, respectively. The method was sensitive, simple, reproducible and accurate within +/-1.5%. The method is applicable to the assay of the three drugs under investigation in different dosage forms and the results are in good agreement with those obtained by the official methods (USP and JP).

Reusable biopsy forceps: a prospective evaluation of cleaning, function, adequacy of tissue specimen, and durability.

BACKGROUND: Recent studies have indicated that reusable biopsy forceps remain contaminated after reprocessing and can only be used a mean of 12 to 25 times without malfunction. Because this contradicts traditional endoscopic practice, our study investigated the ability to sterilize a type of commercially available biopsy forceps and prospectively evaluated their function in vivo until malfunction and/or breakage. METHODS: Thirty reusable biopsy forceps were studied, 15 of which were contaminated for 5 trials each with 10(6) Bacillus stearothermophilus, and 15 of which were prospectively evaluated clinically over an 18-month period (9/98-3/00). Contaminated forceps were reprocessed by using a standard protocol and placed in a sterile bag containing soy broth. The latter was passed through a 0.2 micron filter and was subsequently cultured. In vivo data included biopsy site, size, adequacy, problems obtaining a biopsy specimen, and reasons for ultimate forceps failure. RESULTS: After contamination, all biopsy forceps yielded a heavy growth of B stearothermophilus. No forceps, including 5 that were piecemeal dismantled with a wire cutter, had residual bacteria after reprocessing. In the in vivo study, 1507 biopsy sessions were undertaken in 1339 procedures. Forceps were categorized as new or like-new in 1259 of 1339 (94%) procedures, some loss of function but usable in 72 of 1339 (5.4%), and inadequate function or broken at use in 8 of 1339 (0.6%). Histologically, 1501 specimen sets were adequate (99.6%) and mean specimen size was 2.7 +/- 0.1 mm. Mechanical problems were noted in only 38 of 1507 (3%) sessions to include such things as sticky forceps, and the mean number of uses to malfunction or breakage was 91 +/- 15 (SEM) (range 19-132). CONCLUSIONS: This reusable biopsy forceps can be sterilized and used a mean of 91 times with adequate tissue sampling. Mechanical problems were minor to time of breakage. Contingent on acquisition and reprocessing costs as well as the number of procedures performed, this reusable forceps has the potential for significant cost savings.

AAS and spectrophotometric determination of propranolol HCl and metoprolol tartrate.

Two simple and accurate spectrophotometric methods are described for the determination of propranolol hydrochloride (I) and metoprolol tartrate (II). The methods are based on the reaction of each drug as a secondary amine: (a) with carbon disulphide, the formed complex extracted into iso-butyl methyl ketone (IBMK) after chelation with Cu(II) ions at pH 7.5, followed by measuring the absorbance at 435.4 nm or indirectly for the drug by flame atomic absorption spectrophotometry (AAS). The calibration graph is linear up to 40 and 60 microg ml(-1) with apparent molar absorptivities of 6.89 x 10(3) and 1.08 x 104 l mol(-1) cm(-1) and correlation coefficients of 0.9994 and 0.9995 for propranolol and metoprolol, respectively; (b) with pi-acceptors, tetracyanoethylene (TCNE), or chloranilic acid (CLA) to give highly coloured complex species. The coloured products are quantitated spectrophotometrically at 415 or 510 nm for the two drugs with TCNE and CLA, respectively, and obey Beer's Law with RSD less than 2.0. The methods were applied to the determination of these drugs in pharmaceutical preparation without interferences.

Indirect determination of captopril by AAS.

An indirect method is described for the determination of captopril (KPL) in pharmaceutical preparations by atomic absorption spectrometry (AAS). The procedure is based on the complexation of KPL with an excess of Pd(II) ion. The unreacted Pd(II) was resoluted on a cationic ion-exchanger resin, while Pd(II)-KPL sequestrate was not retained. The effluent Pd(II) sequestrade was measured by AAS. The absorbance is found to increase linearly with increasing KPL concentration, because the amount of Pd(II) is related to the concentration of KPL, which is corroborate by the calculated correlation coefficient value of 0.9939. The system obeys Beer's law for 1-40 microg ml(-1), S.D. was found to be 0.039 (n = 5). The Pd(II)-KPL complex was obtained in the solid phase. Characterization of the complex was performed by elemental analysis, TG, conductance measurements and IR, 1H-NMR spectroscopy.

Mechanisms for the formation of glycoxidation products in end-stage renal disease.

BACKGROUND: Advanced glycation end products (AGEs) accumulate on tissue and plasma proteins in patients with renal failure far in excess of normal aging or diabetes. The aim of these studies was to elucidate the nature of the precursors and the pathways that lead to an accelerated formation of two structurally identified AGEs [pentosidine and Nepsilon(carboxymethyl)lysine (CML)] in the uremic milieu. METHODS: Serum levels of the glycoxidation products, pentosidine and CML, were quantitated by high-performance liquid chromatography in uremic patients treated by dialysis. The formation of early glycation products (as furosine) and late glycoxidation products was modeled in uremic serum and in spent peritoneal dialysate. RESULTS: Clinical factors that affect circulating levels of AGEs included dialysis clearance and dialyzer membrane pore size, but not the presence or absence of diabetes. Both pentosidine and CML form at an accelerated rate in serum from uremic patients. Chelating agents most effectively slow the formation in vitro. In uremic fluids, the primary mechanism of formation of pentosidine is through the Amadori pathway. The primary mechanism of formation of CML is through metal-chelated autoxidation of reducing sugars generating reactive carbonyl precursors. In uremic serum, the presence of an unidentified reactive low molecular weight precursor accelerates the formation of pentosidine. CONCLUSIONS: The formation of the two glycoxidation products, pentosidine and CML, proceeds by different pathways and is enhanced by different precursors in the uremic milieu. The formation of both AGEs is markedly enhanced by metal-catalyzed reactions, evidence for the presence of increased metal-ion mediated oxidant stress in uremia.

Use of charge-transfer complex formation for the spectrophotometric determination of nortriptyline.

Three simple and selective methods are proposed for the determination of nortriptyline hydrochloride in bulk form and in tablets. The first two methods are based on the formation of charge-transfer complexes between the drug base as a n-donor and quinhydrone or p-chloranil as pi-acceptor. The products exhibit absorption maxima at 497 and 560 nm in acetonitrile for quinhydrone and p-chloranil, respectively. The third method is based on the interaction of N-alkylvinylamine formed from the condensation of the free secondary amine group and acetaldehyde with p-chloranil to give a vinylamino substituted quinone. The coloured product exhibits an absorption maximum at 650 nm in dioxane. All variables were studied to optimize reaction conditions. Beer's law was obeyed and the relative standard deviations were found to be less than 1.5%. The methods have been applied to the analysis of nortriptyline hydrochloride in the bulk drug and in tablets.

Protective effects of vitamin e and probucol against gentamicin-induced nephrotoxicity in rats.

Gentamicin (GM) is widely used as a bactericidal agent for the treatment of severe gram negative infections, however, its clinical use is partially limited due to its nephrotoxicity. Recent evidence suggests a role of reactive oxygen metabolites in GM nephrotoxicity. The present study was designed to investigate a possible potential protective role of vitamin E and/or probucol against GM nephrotoxicity. GM was administered to rats in a single dose of (150 mg kg(-1)i.p.), while vitamin E (250 mg kg(-1)i.m.) and/or probucol (60 mg kg(-1)i.m.) were given once daily for 3 consecutive days prior to GM administration. GM-induced nephrotoxicity was evidenced by marked elevations in serum urea and creatinine levels, urinary activity of N-acetyl-beta- d -glucosaminidase (NAG) and gamma-glutamyl-transferase (gamma-GT). Also, GM caused significant increases in kidney content of malondialdehyde (MDA), and significant decreases in kidney content of reduced non-protein sulphydryls (NPSH) and superoxide dismutase (SOD) activity. Vitamin E pretreatment significantly lowered the elevated serum urea and creatinine levels, and urinary activity of NAG and gamma-GT. In addition, vitamin E ameliorated the rise in renal content of MDA and enhanced the renal NPSH content as well as SOD activity. Similarly, probucol significantly inhibited the elevations in urea and creatinine levels and enhanced renal NPSH content and SOD activity. Simultaneous use of vitamin E and probucol was more effective in mitigating disturbances in the assessed parameters. The present work indicates that, due to their antioxidant activity, vitamin E and probucol have potential protective effects against GM nephrotoxicity.

Posterior chamber lens implantation for primary repair of corneal lacerations and traumatic cataracts in children.

Children older than 3 years of age rarely tolerate contact lenses for unilateral surgical aphakia. This problem is even more pronounced following repair of corneal lacerations or perforations that are associated with traumatic cataracts. Even if surgery is successful, such eyes are functionally doomed because of deep anisometropic amblyopia. We evaluated prospectively in 15 children (3 to 8 years) the results of combined operation of corneal repair, aspiration of traumatic cataract, and primary posterior chamber lens implantation. Postoperative occlusion treatment was carefully monitored. Follow up ranged from 6 to 60 months, with an average of 39.2 months. The final best corrected visual acuity at the patient's last visit was 20/40 or better in 11 of 15 children (73.3%). The most frequent complication was a nonfunctional pupil due to traumatic iris damage or posterior synechiae in 13 cases. The most visually significant complication was posterior membrane formation and/or posterior capsule opacification, which required additional surgeries in six children.