Shaping the future of antiviral Treatment: Spotlight on Nucleobase-Containing drugs and their revolutionary impact

Nucleobases serve as essential molecular frameworks present in both natural and synthetic compounds that exhibit notable antiviral activity. Through molecular modifications, novel nucleobase-containing drugs (NCDs) have been developed, exhibiting enhanced antiviral activity against a wide range of viruses, including the recently emerged SARS‑CoV‑2. This article provides a detailed examination of the significant advancements in NCDs from 2015 till current, encompassing various aspects concerning their mechanisms of action, pharmacology and antiviral properties. Additionally, the article discusses antiviral prodrugs relevant to the scope of this review. It fills in the knowledge gap by examining the structure-activity relationship and trend of NCDs as therapeutics against a diverse range of viral diseases, either as approved drugs, clinical candidates or as early-stage development prospects. Moreover, the article highlights on the status of this field of study and addresses the prevailing limitations encountered.

Anti-Amyloid β Aggregation Activity and Cell Viability Effect of Betacyanins from Red Pitahaya (Hylocereus polyrhizus) for Alzheimer's Disease

Betacyanin-rich extract from red beet (Beta vulgaris) was recently reported to inhibit amyloid β (Aβ) aggregation, a main pathological event in Alzheimer's disease. However, the anti-Aβ aggregation effect of individual betacyanin isolates has not been reported before. This study investigated the anti-Aβ aggregation activity and cytotoxicity of betacyanins from red pitahaya or red dragon fruit (Hylocereus polyrhizus). Betacyanin fraction (IC50 = 16.02 ± 1.15 µg/mL) and individual betacyanin isolates exhibited anti-Aβ aggregation activity in a concentration-dependent manner using a thioflavin T fluorescence assay. The highest to lowest IC50 was in the order of betanin (426.30 ± 29.55 µM), phyllocactin (175.22 ± 1.52 µM), and hylocerenin (131.73 ± 5.58 µM), following a trend of increase in functional groups of carboxyl, hydroxyl, and/or carbonyl. Further, the betacyanin fraction of 135.78 µg/mL and below, which were concentrations with an anti-Aβ aggregation effect, were validated as non-neurotoxic based on an in vitro cytotoxicity assay using human neuroblastoma (SH-SY5Y) cells. These findings highlight the potential neuroprotective activity of betacyanins for Alzheimer's disease.

The Role of Interferon-α in Neurodegenerative Diseases: A Systematic Review

BACKGROUND

Neurodegenerative diseases (NDs) impose significant financial and healthcare burden on populations all over the world. The prevalence and incidence of NDs have been observed to increase dramatically with age. Hence, the number of reported cases is projected to increase in the future, as life spans continues to rise. Despite this, there is limited effective treatment against most NDs. Interferons (IFNs), a family of cytokines, have been suggested as a promising therapeutic target for NDs, particularly IFN-α, which governs various pathological pathways in different NDs.

OBJECTIVE

This systematic review aimed to critically appraise the currently available literature on the pathological role of IFN-α in neurodegeneration/NDs.

METHODS

Three databases, Scopus, PubMed, and Ovid Medline, were utilized for the literature search.

RESULTS

A total of 77 journal articles were selected for critical evaluation, based on the inclusion and exclusion criteria. The studies selected and elucidated in this current systematic review have showed that IFN-α may play a deleterious role in neurodegenerative diseases through its strong association with the inflammatory processes resulting in mainly neurocognitive impairments. IFN-α may be displaying its neurotoxic function via various mechanisms such as abnormal calcium mineralization, activation of STAT1-dependent mechanisms, and increased quinolinic acid production.

CONCLUSION

The exact role IFN-α in these neurodegenerative diseases have yet to be determine due to a lack in more recent evidence, thereby creating a variability in the role of IFN-α. Future investigations should thus be conducted, so that the role played by IFN-α in neurodegenerative diseases could be delineated.

Linking Diabetes to Alzheimer's Disease: Potential Roles of Glucose Metabolism and Alpha-Glucosidase

Alzheimer's disease (AD) and type 2 diabetes mellitus (DM) are more prevalent with ageing and cause a substantial global socio-economic burden. The biology of these two conditions is well elaborated, but whether AD and type 2 DM arise from coincidental roots in ageing or are linked by pathophysiological mechanisms remains unclear. Research findings involving animal models have identified mechanisms shared by both AD and type 2 DM. Deposition of β-amyloid peptides and formation of intracellular neurofibrillary tangles are pathological hallmarks of AD. Type 2 DM, on the other hand, is a metabolic disorder characterised by hyperglycaemia and insulin resistance. Several studies show that improving type 2 DM can delay or prevent the development of AD, and hence, prevention and control of type 2 DM may reduce the risk of AD later in life. Alpha-glucosidase is an enzyme that is commonly associated with hyperglycaemia in type 2 DM. However, it is uncertain if this enzyme may play a role in the progression of AD. This review explores the experimental evidence that depicts the relationship between dysregulation of glucose metabolism and AD. We also delineate the links between alpha-glucosidase and AD and the potential role of alpha-glucosidase inhibitors in treating AD.

Modern vaccine development via reverse vaccinology to combat antimicrobial resistance

With the continuous evolution of bacteria, the global antimicrobial resistance health threat is causing millions of deaths yearly. While depending on antibiotics as a primary treatment has its merits, there are no effective alternatives thus far in the pharmaceutical market against some drug-resistant bacteria. In recent years, vaccinology has become a key topic in scientific research. Combining with the growth of technology, vaccine research is seeing a new light where the process is made faster and more efficient. Although less discussed, bacterial vaccine is a feasible strategy to combat antimicrobial resistance. Some vaccines have shown promising results with good efficacy against numerous multidrug-resistant strains of bacteria. In this review, we aim to discuss the findings from studies utilizing reverse vaccinology for vaccine development against some multidrug-resistant bacteria, as well as provide a summary of multi-year bacterial vaccine studies in clinical trials. The advantages of reverse vaccinology in the generation of new bacterial vaccines are also highlighted. Meanwhile, the limitations and future prospects of bacterial vaccine concludes this review.

Potential Roles of α-amylase in Alzheimer's Disease: Biomarker and Drug Target

Alzheimer's disease (AD), the most common form of dementia, is pathologically characterized by the deposition of amyloid-β plaques and the formation of neurofibrillary tangles. In a neurodegenerative brain, glucose metabolism is also impaired and considered as one of the key features in AD patients. The impairment causes a reduction in glucose transporters and the uptake of glucose as well as alterations in the specific activity of glycolytic enzymes. Recently, it has been reported that α-amylase, a polysaccharide-degrading enzyme, is present in the human brain. The enzyme is known to be associated with various diseases such as type 2 diabetes mellitus and hyperamylasaemia. With this information at hand, we hypothesize that α-amylase could have a vital role in the demented brains of AD patients. This review aims to shed insight into the possible link between the expression levels of α-amylase and AD. Lastly, we also cover the diverse role of amylase inhibitors and how they could serve as a therapeutic agent to manage or stop AD progression.

Current trends of benzothiazoles in drug discovery: a patent review (2015-2020)

INTRODUCTION

Benzothiazole is a bicyclic ring system composed of thiazole and benzene rings. It is present as an important pharmacophore in many marketed drugs. The notable potential of benzothiazoles as therapeutic agent for different target diseases has prompted a growing interest in benzothiazole-based drug development in recent years.

AREAS COVERED

This review of 55 benzothiazole-related patents, filed from 2015 to 2020, covers a wide range of pharmacological activities. These patents were collated from Google Patents and Lens search engines. The inventions were categorized and discussed based on their respective group of target diseases, including metabolic diseases, cancer, inflammation, neurodegeneration, viral diseases, bacterial infections, fibrosis and thrombosis.

EXPERT OPINION

Benzothiazole has shown to be a scaffold with great pharmacological importance and thus, serves as a building block for the development of derivatives having high therapeutic activity. Benzothiazole derivatives were patented for a range of therapeutic applications, with a special focus on cancer research. Several compounds have the potential to progress into the market, given that they exert both selectivity and in vivo efficacy. Others require a more thorough study to obtain adequate information on the compounds.

A rhodamine based chemosensor for solvent dependent chromogenic sensing of cobalt (II) and copper (II) ions with good selectivity and sensitivity: Synthesis, filter paper test strip, DFT calculations and cytotoxicity

A new chemosensor 1 was synthesized by reacting rhodamine B hydrazide and 2,3,4-trihydroxybenzaldehyde, which was then characterized by spectroscopic techniques and single crystal X-ray crystallography. Sensor 1 has the ability to sense Co²⁺/Cu²⁺ ions by "naked-eye" with an apparent colour change from colourless to pink in different solvent system, MeCN and DMF respectively. Furthermore, it can selectively detect Co²⁺/Cu²⁺ among wide range of different metal ions, and it exhibits low detection limit of 4.425 × 10^-8 M and 1.398 × 10^-7 M respectively. Binding mode of the two complexes were determined to be 1:1 stoichiometry for Co²⁺ complex and 1:2 stoichiometry for Cu²⁺ complex through Job's plot, IR spectroscopy, mass spectrometry and ¹H NMR spectroscopy. Moreover, reversibility of the sensor 1 as copper (II) ion detector was determined by using EDTA and the results showed that sensor 1 can be reused for at least 6 cycles. Other than that, a low cost chemosensor test strips were fabricated for the convenient "naked-eye" detection of Co²⁺ and Cu²⁺ in pure aqueous media. The MTT assay was conducted in order to determine the cytotoxicity of sensor 1 towards human cell lines.

A Patent Review on the Current Developments of Benzoxazoles in Drug Discovery

The benzoxazole moiety is widely found in various natural compounds, which are often found to be biologically active. Due to its versatile biological properties, benzoxazole has been incorporated as an essential pharmacophore and substructure in many medicinal compounds. In the past years, numerous benzoxazole derivatives have been synthesised and evaluated for their biological potential. The wide range in therapeutic potential of benzoxazole derivatives is related to the favourable interactions of the benzoxazole moiety with different protein targets. Herein we review the biological activities of benzoxazole derivatives patented within the past six years. Using the Lens database, granted patents issued from 2015 to 2020 were retrieved. The patented benzoxazole derivatives demonstrated excellent activity against various protein targets and diseases, with some reaching clinical trial stage. Pharmacological and medicinal aspects of patented benzoxazole derivatives are discussed. The recent development and drawbacks are also reviewed.

Repurposing Antihypertensive Drugs for the Management of Alzheimer's Disease

Alzheimer's disease (AD) is a neurodegenerative disorder that has affected millions of people worldwide. However, currently, there is no treatment to cure the disease. The AD drugs available in the market only manage the disease symptomatically and the effects are usually short-term. Thus, there is a need to look at alternatives AD therapies. This literature review aims to shed some light on the potential of repurposing antihypertensives to treat AD. Mid-life hypertension has not only been recognised as a risk factor for AD, but its relation with AD has also been well established. Hence, antihypertensives were postulated to be beneficial in managing AD. Four classes of antihypertensives, as well as their potential limitations and prospects in being utilised as AD therapeutics, were discussed in this review.

Monitoring of heavy metal pollution in urban and rural environments across Pakistan using House crows (Corvus splendens) as bioindicator

A widely distributed urban bird, the house crow (Corvus splendens), was used to assess bioavailable heavy metals in urban and rural environments across Pakistan. Bioaccumulation of arsenic (As), zinc (Zn), lead (Pb), cadmium (Cd), nickel (Ni), iron (Fe), manganese (Mn), chromium (Cr), and copper (Cu) was investigated in wing feathers of 96 crows collected from eight locations and categorized into four groups pertaining to their geographical and environmental similarities. Results revealed that the concentrations of Pb, Ni, Mn, Cu, and Cr were positively correlated and varied significantly among the four groups. Zn, Fe, Cr, and Cu regarded as industrial outputs, were observed in birds both in industrialized cities and in adjoining rural agricultural areas irrigated through the Indus Basin Irrigation System. Birds in both urban regions accrued Pb more than the metal toxicity thresholds for birds. The house crow was ranked in the middle on the metal accumulation levels in feathers between highly accumulating raptor and piscivore and less contaminated insectivore and granivore species in the studied areas,. This study suggests that the house crow is an efficient bioindicator and supports the feasibility of using feathers to discriminate the local pollution differences among terrestrial environments having different levels and kinds of anthropogenic activities.

Natural Sirtuin Modulators in Drug Discovery: A Review (2010 -2020)

There have been intense research interests in sirtuins since the establishment of their regulatory roles in a myriad of pathological processes. In the last two decades, much research efforts have been dedicated to the development of sirtuin modulators. Although synthetic sirtuin modulators are the focus, natural modulators remain an integral part to be further explored in this area as they are found to possess therapeutic potential in various diseases including cancers, neurodegenerative diseases, and metabolic disorders. Owing to the importance of this cluster of compounds, this review gives a current stand on the naturally occurring sirtuin modulators, , associated molecular mechanisms and their therapeutic benefits.. Furthermore, comprehensive data mining resulted in detailed statistical data analyses pertaining to the development trend of sirtuin modulators from 2010-2020. Lastly, the challenges and future prospect of natural sirtuin modulators in drug discovery will also be discussed.

From Nucleic Acids to Drug Discovery: Nucleobases as Emerging Templates for Drug Candidates

Nucleobases represent key structural motif in biologically active molecules including synthetic and natural products. Molecular modifications made on nucleobases or their isolation from natural sources are being widely investigated for the development of drugs with improved potency for the treatment of different diseases, such as cancer, as well as viral and bacterial infections. This review article focuses on the nucleobase analogue drug developments of the past 20 years (2000-2020). Various pharmacological and medicinal aspects of nucleobases and their analogues are discussed. The current state and limitations are also highlighted.

Sirtuins and Their Implications in Neurodegenerative Diseases from a Drug Discovery Perspective

Sirtuins are class III histone deacetylase (HDAC) enzymes that target both histone and non-histone substrates. They are linked to different brain functions and the regulation of different isoforms of these enzymes is touted to be an emerging therapy for the treatment of neurodegenerative diseases (NDs), including Parkinson's disease (PD), Alzheimer's disease (AD), and amyotrophic lateral sclerosis (ALS). The level of sirtuins affects brain health as many sirtuin-regulated pathways are responsible for the progression of NDs. Certain sirtuins are also implicated in aging, which is a risk factor for many NDs. In addition to SIRT1-3, it has been suggested that the less studied sirtuins (SIRT4-7) also play critical roles in brain health. This review delineates the role of each sirtuin isoform in NDs from a disease centric perspective and provides an up-to-date overview of sirtuin modulators and their potential use as therapeutics in these diseases. Furthermore, the future perspectives for sirtuin modulator development and their therapeutic application in neurodegeneration are outlined in detail, hence providing a research direction for future studies.

Sirtuin inhibition and anti-cancer activities of ethyl 2-benzimidazole-5-carboxylate derivatives

New benzimidazoles were synthesized based on the previously identified sirtuin inhibitor BZD9L1. The compounds were screened for their sirtuin (SIRT1, SIRT2 and SIRT3) inhibitory activities. Compound BZD9Q1 was determined to be a pan-SIRT1-3 inhibitor. Furthermore, the proliferation of various cancer cells was inhibited by BZD9Q1. It was shown that BZD9Q1 elicits a cytostatic effect by inducing cell cycle arrest at the G₂/M phase while also showing a prominent induction of apoptosis against oral cancer cells.

Discovery of gamma-mangostin from Garcinia mangostana as a potent and selective natural SIRT2 inhibitor

Studies have suggested that sirtuin inhibition may have beneficial effects on several age-related diseases such as neurodegenerative disorders and cancer. Garcinia mangostana is a well-known tropical plant found mostly in South East Asia with several positive health effects. Some of its phytochemicals such as α-mangostin was found to be able to modulate sirtuin activity in mice and was implicated with inflammation, diabetes and obesity. However, comprehensive studies on sirtuin activity by the prenylated xanthones extracted from Garcinia mangostana have yet to be reported. The present study led to the discovery and identification of γ-mangostin as a potent and selective SIRT2 inhibitor. It was demonstrated that γ-mangostin was able to increase the α-tubulin acetylation in MDA-MD-231 and MCF-7 breast cancer cells. It was also found to possess potent antiproliferative activity against both cell lines. In addition, it was able to induce neurite outgrowth in the N2a cells.

In silico studies, synthesis and pharmacological evaluation to explore multi-targeted approach for imidazole analogues as potential cholinesterase inhibitors with neuroprotective role for Alzheimer's disease

Alzheimer's disease (AD) is a progressive neurodegenerative disorder with multiple factors associated with its pathogenesis. Our strategy against AD involves design of multi-targeted 2-substituted-4,5-diphenyl-1H-imidazole analogues which can interact and inhibit AChE, thereby, increasing the synaptic availability of ACh, inhibit BuChE, relieve induced oxidative stress and confer a neuroprotective role. Molecular docking was employed to study interactions within the AChE active site. In silico ADME study was performed to estimate pharmacokinetic parameters. Based on computational studies, some analogues were synthesized and subjected to pharmacological evaluation involving antioxidant activity, toxicity and memory model studies in animals followed by detailed mechanistic in vitro cholinesterase inhibition study. Amongst the series, analogue 13 and 20 are the most promising multi-targeted candidates which can potentially increase memory, decrease free radical levels and protect neurons against cognitive deficit.

Contrasting sirtuin and poly(ADP-ribose)polymerase activities of selected 2,4,6-trisubstituted benzimidazoles

Both sirtuin and poly(ADP-ribose)polymerase (PARP) family of enzymes utilize NAD⁺ as co-substrate. Inhibitors of sirtuins and PARPs are important tools in drug discovery as they are reported to be linked to multiple diseases such as cancer. New potent sirtuin inhibitors (2,4,6-trisubstituted benzimidazole) were discovered from reported PARP inhibitor scaffold. Interestingly, the synthesized compounds have contrasting sirtuin and PARP-1 inhibitory activities. We showed that modification on benzimidazoles may alter their selectivity toward sirtuin or PARP-1 enzymes. This offers an opportunity for further discovery and development of new promising sirtuin inhibitors. Molecular docking studies were carried out to aid the rationalization of these observations. Preliminary antiproliferative studies of selected compounds against nasopharyngeal cancer cells also showed relatively promising results.

Method validation in quantitative analysis of phase I and phase II metabolites of mitragynine in human urine using liquid chromatography-tandem mass spectrometry

A method using solid phase extraction and liquid chromatography-tandem mass spectrometry to quantitatively detect mitragynine, 16-carboxy mitragynine, and 9-O-demethyl mitragynine in human urine samples was developed and validated. The relevant metabolites were identified using multiple reaction monitoring in positive ionization mode using nalorphine as an internal standard. The method was validated for accuracy, precision, recovery, linearity, and lower limit of quantitation. The intra- and inter-day accuracy and precision were found in the range of 83.6-117.5% with coefficient of variation less than 13%. The percentage of recovery for mitragynine, 16-carboxy mitragynine, and 9-O-demethyl mitragynine was within the range of 80.1-118.9%. The lower limit of quantification was 1 ng/mL for mitragynine, 2 ng/mL for 16-carboxy mitragynine, and 50 ng/mL for 9-O-demethyl mitragynine. The developed method was reproducible, high precision and accuracy with good linearity and recovery for mitragynine, 16-carboxy mitragynine, and 9-O-demethyl mitragynine in human urine.

Ethyl 2-[5-(4-fluoro-phen-yl)pyridin-3-yl]-1-[3-(2-oxopyrrolidin-1-yl)prop-yl]-1H-benzimidazole-5-carboxyl-ate

In the title compound, C28H27FN4O3·H2O, the benzimidazole ring system is essentially planar with a maximum deviation of 0.028 (1) Å. It makes dihedral angles of 47.59 (5) and 60.31 (5)°, respectively, with the pyridine and benzene rings, which make a dihedral angle of 22.58 (6)° with each other. The pyrrolidine ring shows an envelope conformation with one of the methyl-ene C atoms as the flap. In the crystal, the components are connected into a tape along the b-axis direction through O-H⋯O and O-H⋯N hydrogen bonds and a π-π inter-action between the pyridine and benzene rings [centroid-centroid distance of 3.685 (8) Å]. The tapes are further linked into layers parallel to the ab plane by C-H⋯O and C-H⋯F inter-actions.

Ethyl 2-[4-(di-methyl-amino)-phen-yl]-1-phenyl-1H-benzimidazole-5-carboxyl-ate

In the title compound, C₂₄H₂₃N₃O₂, the benzimidazole ring system makes dihedral angles of 7.28 (5) and 67.17 (5)°, respectively, with the planes of the benzene and phenyl rings, which in turn make a dihedral angle of 69.77 (6)°. In the crystal, mol­ecules are connected by C—H⋯N and C—H⋯O inter­actions, forming a layer parallel to the bc plane. A π–π inter­action, with a centroid–centroid distance of 3.656 (1) Å, is observed in the layer.

Single centre review of radiologically-guided percutaneous nephrostomies: a report of 273 procedures

INTRODUCTION

To evaluate the technical success and complications associated with radiologically-guided percutaneous nephrostomies (PCNs) in a single centre.

MATERIALS AND METHODS

A total of 273 PCNs performed in 190 patients in our hospital over a 3-year period from January 1997 to December 1999 were retrospectively reviewed. The study population consisted of 97 males and 93 females, ranging in age from 13 to 91 years. The main indications were urinary obstruction (77.7%), pyonephrosis (18.3%) and urinary diversion (4%). Demographic variables, technical and risk factors related to the procedure, complications, effect on urine cultures and body temperature; and subsequent patient management were examined.

RESULTS

The technical success rate was 99%. The 30-day mortality was 7.2%, none of which were procedure related. Haemorrhage requiring transfusion occurred in 4.3% while septicaemia affected 3.2% of patients. Drainage catheter complications included catheter dislodgement and blockage which were 11.9% and 4.1%, respectively. Thirty-one per cent of PCNs subsequently underwent ureteric stenting as the definitive treatment modality.

CONCLUSION

Radiologically-guided PCN is a safe procedure with a high technical success rate.

Indwelling catheters for the management of malignant ascites

Paracentesis is widely employed for palliation of symptomatic malignant ascites. In some patients, there is rapid re-accumulation of fluid necessitating frequent repeat procedures. Indwelling peritoneal drainage catheters can provide more durable symptom relief, avoiding the hazards and disadvantages of multiple repeat procedures. The goal of our study was to evaluate the technical success, complications and outcome associated with the use of these drainage catheters. We carried out a retrospective review of all patients who had indwelling catheters inserted for the management of symptomatic malignant ascites over a 4-year period. A total of 45 catheters were inserted in 38 patients. Insertion was technically successful in all patients, with immediate symptomatic relief. However, 2 cases of fatal hypotension were encountered in the first 24 h after catheter insertion (acute catheter-related mortality rate of 4.4%). These were attributed to rapid drainage of peritoneal fluid, although gastrointestinal tract bleeding was contributory in the second patient. Eight patients were lost to follow-up. Of the remaining 30, 13 (35.1%) patients developed catheter-related sepsis. The rate of infection was 1.6 episodes per 100 catheter-days. Thirteen tubes were removed prematurely, 6 (16.2%) due to sepsis, 5 (13.5%) because of tube blockage and 2 (5.4%) because of loculated ascites. The median length of time for which catheters were functional was 37 days (95% CI 14.1-59.6), with an average daily drainage of 539.5 ml (range 18-4000 ml). In conclusion, indwelling peritoneal drainage catheters provide a useful alternative to paracentesis in the management of symptomatic malignant ascites. Although it avoids the need for repeated paracentesis, it is not without risks. We discuss and propose some precautions to be observed in the use of these catheters.

Postoperative intra-abdominal free gas after open colorectal resection

PURPOSE

An erect chest radiograph for subdiaphragmatic free gas can be a useful adjunct in detecting a defect in gastrointestinal continuity. The usefulness of this test after laparotomy has not been defined, because the period of persistence of free gas is unknown. We set out to determine the length of time for natural absorption of postlaparotomy pneumoperitoneum in a prospective cohort study.

METHOD

Plain erect chest radiographs were performed on the second and fourth postoperative day and daily thereafter until the disappearance of subdiaphragmatic free gas after laparotomy.

RESULTS

Seventy-five consecutive patients were studied after informed consent. The mean age was 62.1 (standard error of the mean, 1.7) years. On the fifth postoperative day, sixth postoperative day, and seventh postoperative day, 71.6, 80, and 89 percent of patients, respectively, had no visible subdiaphragmatic gas. Five patients had gas persisting beyond the tenth postoperative day. Two of these patients did not have an anastomosis. The use of drainage tubes did not affect significantly the mean time to disappearance of subdiaphragmatic free gas (4.5 vs. 4.9 days; P = 0.45: t-test). The duration of surgery, body mass index, and time to resume bowel function had no significant effect on gas disappearance. Two patients had a clinical leak on the fifth postoperative day. This was manifested as an increase in the collection of subdiaphragmatic gas during the course of a day.

CONCLUSION

By the sixth postoperative day 80 percent of patients had no subdiaphragmatic free gas on an erect chest radiograph regardless of the presence of a drainage tube. The erect chest radiograph may therefore be a simple and readily available adjunct in the evaluation of postoperative abdominal pain, especially after the sixth postoperative day when a similar prior examination is done routinely on the fourth postoperative day for comparison.

Outcome of tunnelled central venous haemodialysis catheters inserted by radiologists

Radiologists have only recently been involved in the percutaneous placement of tunnelled central venous haemodialysis catheters. We report our initial experience with our first 60 catheters. All catheters were successfully inserted. Immediate complications encountered included puncture site haemorrhage in 3 patients (5%) and puncture of the left brachiocephalic vein in 1 patient (1.7%). These were managed conservatively without any clinical sequelae. About 80% of the catheters were uncomplicated and removed electively. Slightly more than 80% of the catheters were in place for more than 30 days. Infection and blocked catheters were the most common short-term complications. Ten catheters (17%) were infected resulting in premature removal of 9. There was 1 death from presumed line sepsis. Mean duration before the onset of infection was 53 days; the rate of infection was 0.28 episodes per 100 catheter days. Five catheters (8%) were blocked or had poor flow. The mean duration before the onset of blockage was 39 days and the rate of blockage was 0.14 episodes per 100 catheter days. A higher proportion of catheters inserted from the left encountered complications. In conclusion, percutaneous insertion of tunnelled haemodialysis catheters by radiologists is safe and effective. The right internal jugular vein should be the preferred access site. Precautions should be taken to avoid infectious complications given the high rate of catheter removal amongst infected catheters.

Radiological placement of 211 central venous catheters: outcome and complications

A prospective study of 211 central venous catheters consecutively placed in 186 patients under radiological guidance was conducted over an 18-month period. The majority (64%) of our patients were at risk for acute complications or failure. These risks included bleeding tendency, distorted anatomy, or previous complicated lines and failed "blind" percutaneous attempts. We employed the subtraction angiographic technique for venous mapping or ultrasound localisation to guide our initial puncture. The accumulated catheter experience was 15,295 days and the median catheter survival time was 166 days. The success rate was 100%. Our acute complications included 1 case of arterial puncture (0.5%), 2 pneumothoraces (1.0%), and 13 patients (6.1%) with haematoma or prolonged oozing at the puncture site. The calculated infection rate was 0.25 episodes per 100 catheter days at risk. These results are comparable to those reported in the literature. We conclude that central venous catheterisation using imaging guidance is accurate and safe, and should be the method of choice especially in high-risk patients.

Angiographic demonstration of primary aorto-enteric fistula--a case report

Primary aorto-enteric fistula is an uncommon but lethal disease. The key to patient survival is early diagnosis and treatment. Angiography may be diagnostic. However, angiographic documentation of this condition is rare as the patients are usually very ill when the decision for angiography is made. A case of primary aorto-enteric fistula with fatal haemorrhage is described with angiographic documentation. This is the first angiographically demonstrated case reported locally.

The use of metallic stents in the treatment of malignant superior vena caval obstruction

Superior vena caval obstruction due to malignancy is conventionally treated by radiotherapy and/or chemotherapy. In patients with unresolved or recurrent obstruction after treatment, expandable metallic stents can be percutaneously placed within the vena cava for relief of symptoms. In this series, metallic stents were successfully deployed in 11 consecutive patients with bronchial carcinoma. Gianturco Z stents were used in 10 patients and Strecker stents in one. There were 2 minor procedural complications of no sequelae. All patients had partial or full relief of symptoms after the procedure. On follow-up (mean 3.9 months), 9 patients had no recurrent symptoms up till the time of death or the present time. Two patients had recurrent obstruction, both within a week of the procedure. Based on our experience, percutaneous stenting was an effective means of palliation in this group of patients when other treatment modalities failed.

Defecating proctography: local experience

Between October 1990 to November 1991, defecating proctography was performed on a select group of patients with complaints of persistent constipation or sensation of incomplete evacuation. Out of the 27 patients studied, a high percentage (88.8%) showed some form of anatomical or functional abnormality of the defecating mechanism. As defecating proctography is a relatively new mode of investigation locally, we briefly describe our method and results. These include rectocele formation, intrarectal mucosal prolapse, intussusception and pubo-rectalis paradox. Some of these cases may be amenable to surgical correction.