Synthesis, characterization, and biological evaluation of novel cinnamic acid derivatives: cinnamoyl-metronidazole ester and cinnamoyl-memantine amide

In this study, two derivatives, namely the ester derivative cinnamoyl metronidazole and the amide derivative cinnamoyl memantine, were synthesized from cinnamic acid and respective drugs for the purpose of exploring their potential as novel and efficient antimicrobial agents in the quest of prevailing the global antimicrobial resistance challenge. The synthesis process involved two steps: first, the chlorination of cinnamic acid using thionyl chloride, and second, the esterification of metronidazole or the amidation of memantine. These steps resulted in the formation of cinnamoyl metronidazole/memantine. Optimal reaction conditions were established, and chromatographic techniques were used to separate the synthesized compounds. Confirmation of successful synthesis was achieved through FT-IR analysis, which readily distinguished the chlorinated product and derivatives based on distinctive bands, including mainly the one of carbonyl group. Additionally, molecular structures were validated using 1H NMR and 13C NMR, with all peaks further confirming the successful esterification/amidation of cinnamoyl and drug moieties. Upon evaluating the biological activity, the parent compounds exhibited negligible effects within the tested concentration range. However, the derivatives demonstrated significant activity. The ester derivative exhibited potent activity against the Gram-positive bacterium Staphylococcus aureus, as evidenced by a zone of inhibition measuring 12-15 mm in diameter. Conversely, the amide derivative displayed appreciable biological activity against Candida fungi, with an inhibition zone measuring 11-14 mm.

Splenic Rupture Secondary to Metastatic Undifferentiated Pleomorphic Sarcoma of the Spleen: A Rare Presentation of an Exceptionally Rare Entity

Splenic malignancies are uncommonly encountered in routine practice, and they are often only detected incidentally, posing a clinical challenge. Primary malignant neoplasms of the spleen are rare, and sarcomas are by far the rarest. The undifferentiated pleomorphic sarcoma type is an exceptionally rare and aggressive type with only a handful of cases reported in literature thus far. Herein, we present the case of a 49-year-old, with a previous finding of a heterogeneous splenomegaly on imaging for an unrelated medical complaint, presenting with an acute abdomen secondary to a ruptured spleen. The diagnosis of high-grade primary undifferentiated pleomorphic sarcoma of the spleen was made, and with further investigations, suspicious hepatic lesions were identified and later confirmed to be metastases.

AB0805 PREMATURE ATHEROSCLEROSIS IN PSORIATIC ARTHRITIS (PsA) PATIENTS AND ITS POSSIBLE ASSOCIATION WITH INSULIN RESISTANCE & SERUM LEPTIN LEVEL

Background:

PsA is a heterogeneous inflammatory arthritis. Patients (pts) with PsA suffer from associated cardiovascular disease, obesity, metabolic syndrome, diabetes (DM), osteoporosis. In psoriasis, leptin has been shown to stimulate keratinocyte proliferation, expression of adhesion molecules and angiogenesis.

Objectives:

To detect the presence of premature atherosclerosis in PsA pts, measure HOMA-IR as a reflection of insulin resistance (IR) and serum leptin (LEP) level & to detect their association with the presence of premature atherosclerosis in PsA pts.

Methods:

45 PsA pts (classified according to CASPAR Criteria) & 45 healthy subjects as controls were included. Pts were subjected to history taking, clinical examination to determine body mass index (BMI), the clinical type of PsA, distribution, involved body surface area (BSA), measuring the Psoriasis Area and Severity Index (PASI) and Disease Activity in PSoriatic Arthritis: DAPSA score. Routine laboratory, fasting insulin (FI), fasting blood glucose (FBG) to calculate HOMA-IR,total cholesterol (TC), HDL, LDL, Triglycerides (TG), serum LEP, carotid Doppler to determine Carotid intima–media thickness (CIMT) & presence or absence of plaques were done. Exclusion: DM, RA, SLE, smoking, postmenopausal females, HCV infection, morbid obesity

Results:

MeanBMI22.51±1.69 and 23.46±1.82 kg/m2, no statistical significance (P =0.205).

MeanBSA5.9±3.1%,DAPSA score(13.98±4.7),PASI score:88.9% (40 pts) had mild to moderate PASI, 5 had severe disease (8.6±4.8).

TC, LDL and TG were higher in pts, while HDL was higher in controls (P =0.0003, 0.0001, 0.00001 & 0.05).

A significance between 2 groups regarding LEP (P =0.00001), ranging from 2-16.99 (9.7±4.5) in group I and 1.35-1.78 (1.6±0.1) µg/ml in controls.Normal: 2.6-8.35

FI & HOMA IR were significantly higher in PsA group (P = 0.001, 0.00001)

The mean CIMT 1.1±0.3 mm and in group II 0.8±0.1 mm. 14 pts (31.1%) had plaque, while 68.9 % & all controls had no plaques, with a significance regarding CIMT & presence of plaques (P=0.011 & 0.0041).

A positive statistical significance between LEP and dd (P=0.001), BSA, PASI and DAPSA (P =0.007, 0.003, 0.001) but not with age, BMI (P=0.98 & 0.88).

There was no statistical significance between LEP and FBG, HbA1C, HOMA IR, FI, CBC (P > 0.05), or between LEP and TC, TG, HDL, LDL (P=0.438,0.390, 0.699, 0.050), liver enzymes, renal functions, ESR and CRP.

There was statistical positive correlation between LEP and CIMT (P =0.0001), but not with the presence of plaques (P=0.846).

CIMT and other variables: Table 1

DAPSA: there was no statistical significance with TC, HDL, LDL and TG (P=0.51, 0.876, 0.717 & 0.255), but a statistically significance with LEP and CIMT(p=0.001& 0.009). Pts with higher score had higher LEP and increased CIMT.

PASI: there was no significance between TC, HDL, LDL, TG (P=0.724, 0.157, 0.651& 0.374) or CIMT (p=0.290) in mild-moderate and severe PASI. LEP was significantly higher in severe PASI score (P= 0.001).

Conclusion:

The presence of abnormal lipid profile, IR, increased CIMT, high disease activity and increased LEP may be considered as useful criteria for early recognition and thus prevention of atherosclerosis in PsA pts.

References:

[1]Miller I M, et al. Meta-analysis of psoriasis, cardiovascular disease and associated risk factors. J Am Acad Dermatol 2013

CIMTPerson correlation coefficientp-valueBMI0.0950.371Duration of disease (years)0.1790.239BSA score0.120.434PASI0.1860.221FBG0.0590.582WBC-0.1040.329Platelet0.0220.835Hb-0.1060.319HDL0.5050.000**LDL0.3820.000**TC0.2750.009**Triglyceride0.060.577SGOT0.030.776SGPT0.0330.754Serum leptin0.5370.0001**HOMA IR0.4460.000**ESR0.3510.001**CRP0.3200.002**Urea0.4450.784Creatinine0.3920.954Uric acid0.0340.748FI0.4310.000**

Disclosure of Interests:

None declared

Gingival health status in individuals using different types of toothpaste

OBJECTIVES

To examine the relationship between the medium term use (>1 year) of a toothpaste containing natural enzymes and proteins (Zendium™) upon gingival index, plaque index and bleeding index compared to medium term use of toothpastes without antimicrobial/antiinflammatory ingredients.

METHODS

A total of 305 participants eligible for inclusion were grouped according to their toothpaste use and matched with regard to gender and age (18-30, 31-55 and 56+ years of age). A total of 161 persons were using a toothpaste which contained enzymes and proteins (Zendium™, test group), and 144 persons were using a toothpaste without these ingredients (control group). The amount of dental plaque and the gingival condition were assessed at six sites of each tooth using the modified gingival index (MGI), plaque index (Modified Quigley and Hein plaque index, PI), and bleeding index (BI). Mean values of MGI, PI and BI were compared using analysis of covariance.

RESULTS

The test group had significantly less gingival inflammation than the control group (adjusted mean scores (SD); 1.80 (0.65) vs. 2.27 (0.63),p < 0.0001), as well as lower levels of plaque (2.03 (0.33) vs. 2.12 (0.33), p = 0.0168) and gingival bleeding (0.74 (0.45) vs. 1.08 (0.45), p < 0.0001). Females had significantly less gingival inflammation (p < 0.0001), plaque (p = 0.0005) and bleeding (p = 0.0118) than males. Participants aged 18-30 years had significantly higher levels of inflammation and bleeding than the older age groups (p < 0.001), and also higher plaque levels compared to participants aged 31-55 years (p = 0.0069). Potential confounding factors including oral hygiene practices and consistency of dental visits did not differ between groups.

CONCLUSIONS

Our findings indicate that medium term use of fluoride toothpaste containing enzymes and proteins (Zendium™) is associated with a better gingival health than the use of other types of fluoride toothpastes without antimicrobial active ingredients.

CLINICAL SIGNIFICANCE

Medium term (> 1 year) use of toothpaste containing naturally occurring enzymes and proteins (Zendium™) in an unsupervised home setting is associated with better gingival health compared to the unsupervised use of other commercially available toothpastes without antimicrobial/antiinflammatory active ingredients.

GUide sheath Advancement and aspiRation in the Distal petrocavernous internal carotid artery (GUARD) Technique during Thrombectomy Improves Reperfusion and Clinical Outcomes

BACKGROUND AND PURPOSE

Adjunctive techniques to stent retriever thrombectomy include balloon-guide catheters and/or distal access catheters for aspiration. We describe a novel technique using a flexible, 6 French 088 distal guide sheath advanced past the skull base to augment mechanical thrombectomy. We studied the relative safety and efficacy of this technique in the setting of a combined stent retriever-distal access catheter aspiration thrombectomy protocol.

MATERIALS AND METHODS

We performed a retrospective case-control study of intracranial internal carotid artery or M1-M2 middle cerebral artery occlusions requiring mechanical thrombectomy. Patients were divided into 2 groups based on thrombectomy techniques: conventional stent retriever with distal access catheter aspiration without (standard) and with adjunctive GUide sheath Advancement and aspiRation in the Distal petrocavernous internal carotid artery (GUARD). Using propensity score matching, we compared procedural safety, reperfusion efficacy using the modified Thrombolysis in Cerebral Infarction scale and clinical outcomes with the modified Rankin Scale.

RESULTS

In comparing the GUARD (45 patients) versus standard (45 matched case controls) groups, there were no significant differences in demographics, NIHSS presentations, IV rtPA use, median onset-to-groin puncture times, procedural complications, symptomatic intracranial hemorrhage, or mortality. The GUARD group demonstrated significantly higher successful mTICI ≥2b reperfusion rates (98% versus 80%, P = .015) and improved functional mRS ≤2 outcomes (67% versus 43%, P = .04), with independent effects of the GUARD technique confirmed in a multivariable logistic regression model.

CONCLUSIONS

The GUARD technique during mechanical thrombectomy with combined stent retrieval-distal access catheter aspiration is safe and effective in improving reperfusion and clinical outcomes.

The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry

Aims 

The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI.

Methods and results 

Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission.

Conclusion 

The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.

Simultaneous removal of cationic methylene blue and anionic reactive red 198 dyes using magnetic activated carbon nanoparticles: equilibrium, and kinetics analysis

For the simultaneous adsorption of cationic dye (methylene blue, MB) and anionic dye (reactive red 198, RR198) from aqueous solution, magnetic activated carbon (MAC) nanocomposite as a promising adsorbent was prepared and used. The concentration of MB at different time intervals was determined using a UV-Vis spectrophotometer while the concentration of RR198 was determined using a high performance liquid chromatography (HPLC) system. The effect of solution pH, contact time, adsorbent amount, and dye concentration were investigated. Also, both kinetic and isotherm experiments were studied. The optimum pH was 10 and 5.5 for adsorption of MB and RR198, respectively, and the equilibrium status was achieved after 120 min. The adsorption kinetics was controlled by the pseudo-second order kinetic model more than pseudo-first order. The best-fitted isotherms were Freundlich and Langmuir models for MB and RR198, respectively. The higher values of Freundlich adsorption capacity (K_f) for MB in comparison with RR198 refer to MAC affinity to remove cationic dyes more than anionic dyes. Apparently, there was no substantial change in the adsorption efficiency among the 10 adsorption-desorption cycles. Overall, MAC can be considered as an effective and efficient viable adsorbent for cationic and anionic dyes removal from industrial wastewaters.

Integration of nickel doping with loading on graphene for enhanced adsorptive and catalytic properties of CdS nanoparticles towards visible light degradation of some antibiotics

Water dispersible, highly efficient nickel doped CdS nanoparticles anchored on graphene nanosheets as a photocatalyst for cephalexin and sulfamethoxazole photodegradation have been prepared in a facile microwave-furnace assisted method. Each one of the two modifications has played a critical role in nanocomposite functioning. Defects originated by dopant boosted the lifetime of carriers and thereupon graphene matrix transferred them to contribute effectively the photocatalytic process. Characterization results revealed the formation of monocrystalline hexagonal phase of all products and that both doping and loading on graphene have red-shifted the absorption edge of CdS towards the visible light region. Furthermore, FTIR confirmed the successful reduction of graphene oxide by the subsequent preparation steps. Adsorption isotherms revealed the role of graphene in enhancing substrate adsorption. Nevertheless, dissimilar pathways of catalytic degradation were observed on the doped composite as cephalexin oxidation was principally mediated by the hole-hydroxyl radical mechanism, sulfamethoxazole oxidation favored the superoxide radical mechanism. This composite has shown, however, a high photostability and minimized ions release of the composite.

Effect of buccal dwell time on the pharmacokinetic profile of fentanyl buccal tablet

BACKGROUND

The time fentanyl buccal tablet (FBT) takes to completely dissolve after placement on the buccal mucosa (i.e., 'dwell time') could exceed the time to onset of analgesia.

OBJECTIVE

To examine the relationship between FBT dwell time and fentanyl pharmacokinetic parameters.

RESEARCH DESIGN AND METHODS

This was a post hoc exploratory analysis of data from two randomized, open-label, crossover, pharmaco-kinetic studies that were designed to assess dose proportionality within the anticipated therapeutic dose range. Healthy adults received single FBT doses of 200-1080 microg in Study 1 (n = 28) and 270-1300 microg in Study 2 (n = 42).

MAIN OUTCOME MEASURES

Assessments included buccal dwell time, defined as the duration of FBT presence in the oral cavity, and the following pharmacokinetic measures: maximum serum concentration (C(max)), time to C(max) (T(max)) and area under the concentration-time curve (AUC; exposure) from 0 minutes to median T(max) adjusted for the dose (T(max')) (AUC(0 T(max'))). Spontaneously reported adverse events were recorded.

RESULTS

Mean buccal dwell time for FBT across the dose range varied from 14 to 25 minutes (range 3 - 62 minutes). There was no evidence of an association between FBT dwell time and values for T(max) (medians 45 - 60 minutes), dose-normalized C(max) (means 0.42-0.66 pg/ml/200 microg) or dose-normalized AUC(0 T(max')) (means 0.24-0.38 pg x h/ml/200 microg) over the range of FBT doses delivered. All adverse events reported were mild to moderate; none were unexpected or serious.

CONCLUSION

The pharmacokinetic parameters of FBT did not appear to be related to its buccal dwell time.

Absorption profile, safety, and tolerability of a 200 μg dose of fentanyl buccal tablet (FBT) in opioid-tolerant cancer patients with or without oral mucositis

9053

Background: Fentanyl buccal tablet (FBT) is an effervescent formulation of fentanyl indicated for the management of breakthough pain in opioid-tolerant cancer patients. This open-label study investigated the absorption profile, safety, and tolerability of FBT in cancer patients with or without oral mucositis. Methods: Patients self-administered a single 200 μg dose of FBT. Pharmacokinetic assessments, oral mucosal examinations, and measurements of vital signs were performed at intervals of up to 8 hours following FBT placement. Adverse events (AEs) were monitored throughout the study. Results: 16 patients (8 with, 8 without mucositis) received FBT and completed the study. Mucositis was mild (functional/symptomatic grade 1 for 7 patients, grade 2 for 1 patient; clinical grade 1 for all patients). The absorption profile of FBT was similar in patients with and without mucositis. Mean±SD Cmax values were 1.25±0.78 ng/mL and 1.24±0.77 ng/mL in patients with or without mucositis, respectively. Maximum plasma concentrations of fentanyl were achieved rapidly, and were not significantly different in the two groups: median (range) tmax 25.0 (15.0–45.0) min in patients with mucositis, 22.5 (10.0–121.0) min in patients without (p=0.79). FBT was well tolerated; 4 patients experienced =1 treatment-emergent AE. Dizziness (mild) was reported by 1 patient in each group, and resolved. One patient in each group experienced a treatment-related AE (dizziness). There were no deaths, serious AEs, or withdrawals due to AEs. No application site AEs or changes in oral mucosal assessments were reported. Conclusions: The absorption profile of FBT was similar in patients with or without oral mucositis, which suggests that dose adjustment of FBT is not required when mild oral mucositis is present. FBT was generally safe and well tolerated, and not associated with adverse changes in the oral mucosa. Further studies in patients with grade 3–4 mucositis are warranted.

No significant financial relationships to disclose.

Tacrolimus (FK506) Versus Cyclosporine Microemulsion (Neoral) as Maintenance Immunosuppression Therapy in Kidney Transplant Recipients

The effects of the calcineurin inhibitors tacrolimus (FK506) and cyclosporine (Neoral) on graft survival, function, and metabolic profile were evaluated in 69 patients receiving Neoral (group 1) and 54 patients receiving FK506 (group 2) for maintenance immunosuppression following kidney transplantation. Recipient and donor demographics and induction therapy were comparable, except for a higher number of sensitized patients in group 2 (n = 13). Acute rejection timing, severity, and infection rates and types were similar in both groups. During hospitalization, at 6 months, and at 1 year following transplantation, no significant differences were noted between groups in fasting glucose, serum cholesterol levels, triglyceride levels, or need for insulin or antihypertensive therapy. Mean serum creatinine levels on discharge (1.42 mg/dL +/- 0.14 vs 1.68 mg/dL +/- 0.3), at 1 month (1.45 mg/dL +/- 0.1 vs 1.39 mg/dL +/- 0.11), 3 months (1.46 mg/dL +/- 0.09 vs 1.32 mg/dL +/- 0.14), and 1 year (1.29 mg/dL +/- 0.08 vs 1.19 mg/dL +/- 0.09), but not at 6 months (1.42 +/- 0.37 vs 1.10 +/- 0.07; P = .001), were comparable between groups. The 1-year patient and graft survival rates were 98.3% for group 1 and 94.5% for group 2. When evaluated for acute rejection, infection, and metabolic differences, we conclude that both tacrolimus and cyclosporine are effective and safe calcineurin inhibitors for short-term use in kidney transplantation. A similar study is proposed to evaluate the long-term effects of both agents.

Intravenous indometacin in preterm infants with symptomatic patent ductus arteriosus. A population pharmacokinetic study

AIMS

To characterize the population pharmacokinetics of indometacin in preterm infants with symptomatic patent ductus arteriosus and to investigate the influence of various factors on the response to treatment.

METHODS

Data were collected from 35 infants (gestational age 25-34 weeks; postnatal age 1-77 days) in neonatal units in Belfast and Copenhagen. Infants received an initial course of up to three doses of intravenous indometacin (0.1-0.2 mg kg(-1)) as considered appropriate by the treating physician. For those infants who did not respond to therapy or in whom the ductus reopened, a second course was sometimes given. Population analysis of the 185 plasma concentrations obtained was conducted using NONMEM and pharmacokinetic and demographic differences between responders and nonresponders were compared.

RESULTS

The concentration-time course of indometacin was best described by a one-compartment model. The final population parameter estimates of clearance (CL) and volume of distribution (V) (standardized to the median weight of 1.17 kg) were 0.00711 l h(-1) and 0.266 l, respectively. CL increased from birth by approximately 3.38% per day and V by approximately 1.47% per day. Concomitant digoxin therapy resulted in a 30% decrease in V. Interindividual variability in CL and V was 41% and 21%, respectively. Interoccasion variability for CL was 43%. Residual variability corresponded to a standard deviation of 0.148 mg l(-1). Closure occurred in 75% of infants with a plasma concentration > or = 0.4 mg l(-1) 24 h after the last dose.

CONCLUSIONS

Dosing regimens for indometacin should take into account the weight and postnatal age of the infant and any concomitant digoxin therapy. The population estimates can be used to determine typical values of CL and V allowing the prediction of individualized doses of indometacin that should increase the probability of achieving a 24 h plasma concentration > or = 0.4 mg l(-1). Although the pharmacokinetic estimates will be affected by both interindividual and within-individual variation, it is anticipated that this approach will decrease the variability of exposure and optimize treatment outcome.

Gender differences in the regulation of 3 alpha-hydroxysteroid dehydrogenase in rat brain and sensitivity to neurosteroid-mediated stress protection

The enzyme 3 alpha-hydroxysteroid dehydrogenase (3 alpha-HSD) is involved in the generation of neuroactive steroids through ring-A-reduction of hormonal precursors. We examined the developmental regulation of, gender differences in, and effects of hormonal manipulations on the expression of 3 alpha-HSD in the rat hippocampus. High levels of 3 alpha-HSD mRNA were found on postnatal day 7, coinciding with the stress hyporesponsive period in the rat. Gender differences in 3 alpha-HSD expression were documented during puberty, but not in adulthood. Adrenalectomy and gonadectomy, and supplementation with individual steroid hormones influenced 3 alpha-HSD expression in a gender-specific mode. We also demonstrate that the manifestation of behavioral and endocrine consequences of early life stress depends on the individual's gender and gonadal status. Males are liable to aftereffects of neonatal maternal deprivation, regardless of their adult gonadal status. In females, however, anxiogenic aftereffects of neonatal stress become apparent only after gonadectomy. These data suggest that (i) transient increase of neurosteroid biosynthesis may contribute to stress hyporesponsiveness during early infancy; (ii) gonadal steroids regulate 3 alpha-HSD expression in the hippocampus in a sex-specific mode; (iii) physiological sex steroid secretions in females may mask behavioral consequences of adverse early life events, and (iv) concomitant treatment with the neurosteroid THP counteracts behavioral and endocrine dysregulation induced by neonatal stress in both genders.

Field investigations of brucellosis in cattle and small ruminants in Syria, 1990-1996

The authors present the epidemiological status of brucellosis in cattle and small ruminants in Syria from 1990 to 1996, based on laboratory findings at the Brucellosis Centre, Damascus. Initial investigations using the Rose Bengal plate test, the complement fixation test and a miniaturised variant of the slow agglutination test were conducted throughout the country in 1990 and 1991, revealing an overall herd seroprevalence rate of 3.14% in cattle herds and 2.94% in small ruminant flocks. Although partially biased by previous vaccination of young female cattle with S19 vaccine, these figures indicate that brucellosis in cattle is widespread, particularly in the urban governorates (provinces) of Damascus, Aleppo and Suwaydah. Brucellosis seroprevalence in sheep and goats was relatively high in the governorates of Damascus, Aleppo and Dara'a. The results of a second series of investigations, performed between 1992 and 1996, show that herd seroprevalence in cattle decreased steadily from 17.48% in 1992, to 2.59% in 1996, in the Government-owned farms, while seroprevalence increased in the private sector during the same period. The difference may be explained by the restriction of brucellosis vaccination to public farms (although this was far from systematic), combined with partial application of a 'test-and-slaughter' policy. In sheep and goats, brucellosis seroprevalence fluctuated in the two sectors, but was higher in the private sector where husbandry is principally extensive. Bacteriological investigations led to the isolation of Brucella melitensis biovars 2 and 3 in sheep and B. abortus biovar 9 in cattle. Although no specific methodology was employed, particularly with regard to sampling, this study is significant as the first international report of the distribution of brucellosis in Syria. Further, well-structured studies are required, the results of which could be used to plan an appropriate national control programme for brucellosis.

Exposure to a novel stimulus reduces anxiety level in adult and aging rats

Male Wistar rats aged 3, 15 and 24 months were isolated and housed individually for 72 h prior to being subjected to inanimate objects (two objects per rat, each 1.5 cm in diameter and 4 cm in length, made of surgical gauze). Following the exposure to the objects, rats were subsequently tested in an elevated plus-maze. The inanimate objects induced locomotor activity, chewing and transportation of the object. This changed to social interaction and play-like behavioral activity in rats of all ages that were kept in small groups with a latency of 1 to 2 min. One hour after the start of exposure, the animals were tested in the elevated plus-maze to measure anxiety behavior. It was found that all age groups spent significantly more time in the open arm of the elevated plus-maze than the corresponding controls. Latencies to first entry into open arms were also significantly lowered. The number of entries to the open or to the dark arm, however, did not show statistical difference, indicating that the novel object-induced activity failed to exert influence on gross motor activity in the elevated plus-maze. In conclusion, the stimulation elicited by the exposure to novel stimulus (inanimate objects) resulted in a significant reduction of anxiety level both in adult and in aging rats.

Effect of zaleplon on digoxin pharmacokinetics and pharmacodynamics

The pharmacokinetics and pharmacodynamics of digoxin alone and digoxin plus zaleplon were studied. Healthy, nonsmoking men between 18 and 45 years of age were given a single oral dose of digoxin 0.375 mg daily on days 1 through 9. On days 10 through 14, the subjects received digoxin 0.375 mg plus oral zaleplon 10 mg daily. Blood samples were obtained on days 3, 5, 8, 9, and 14, and serum digoxin concentration data were analyzed by model-independent pharmacokinetic methods. Blood pressure, heart rate, PR interval, and QTc interval were recorded to determine the effect of zaleplon on digoxin pharmacodynamics. A total of 20 men completed the study. Maximum serum digoxin concentration and area under the serum digoxin concentration-versus-time curve from 0 to 24 hours met bioequivalence test criteria. There were no significant differences in QTc or PR interval between days 9 (digoxin alone) and 14 (digoxin plus zaleplon), and there were no clinically important changes from baseline to the study's end in vital signs, physical examination findings, or ECG results for individual subjects. Eighteen percent of the subjects who received digoxin alone and 35% of those who received digoxin plus zaleplon reported one or more adverse effects; all were mild and resolved quickly. Zaleplon had no significant effects on selected pharmacokinetic and pharmacodynamic properties of digoxin.

Pharmacokinetics, pharmacodynamics, and relative pharmacokinetic/pharmacodynamic profiles of zaleplon and zolpidem

OBJECTIVE

This study compared the pharmacokinetics, pharmacodynamics, and pharmacokinetic/pharmacodynamic (PK/PD) profile of zaleplon, a new pyrazolopyrimidine hypnotic, with those of zolpidem and placebo.

METHODS

This was a double-blind, 5-period crossover study in which healthy volunteers with no history of sleeping disorder were randomized to 10- or 20-mg oral doses of zaleplon, 10- or 20-mg oral doses of zolpidem, or placebo. The pharmacokinetic characteristics of the active drugs were estimated using a noncompartmental method and NONMEM. Pharmacodynamic characteristics were determined using psychophysical tests, including measures of sedation, mood, mental and motor speed, and recent and remote recall. Results of these tests were used to compare the drugs' relative PK/PD profiles.

RESULTS

Ten healthy male and female volunteers, aged 23 to 31 years, took part in the study. The apparent elimination half-life of zaleplon (60.1+/-8.9 min) was significantly shorter than that of zolpidem (124.5+/-37.9 min) (P < 0.001). Zaleplon produced less sedation than zolpidem at the 2 doses studied (P < 0.001). The sedation scores of the zaleplon groups returned to baseline in less time than those of the zolpidem groups (4 vs 8 hours; P < 0.05). Zaleplon had no effect on recent or remote recall, whereas zolpidem had a significant effect on both measures (P < 0.05).

CONCLUSIONS

In this study in 10 young, healthy volunteers, zaleplon was eliminated more rapidly, produced no memory loss, and caused less sedation than zolpidem at the same doses.

Psychomotor effects of zaleplon and thioridazine coadministration

OBJECTIVE

To assess the potential pharmacokinetic and pharmacodynamic interaction of zaleplon and thioridazine administered concomitantly in healthy volunteers.

METHODS

A three-period, double-blind, randomized crossover study of the psychomotor effects of single oral doses of zaleplon 20 mg alone, thioridazine 50 mg alone, or the two drugs administered concomitantly was performed in 12 healthy subjects. Pharmacodynamic testing was performed before, and at 1, 2, 4, and 8 h after drug administration. Critical flicker fusion (CFF), tapping rate (TR), reaction time (RT) with dominant and nondominant hands, and digit symbol substitution test (DSST) were used to assess psychomotor performance.

RESULTS

Pharmacokinetic results showed that coadministration of zaleplon and thioridazine did not alter the pharmacokinetic profile of either drug. In both CFF and TR tests, values for change from baseline with combined treatment were not significantly different from those with thioridazine at any time point, indicating no pharmacodynamic interaction. RT test values with coadministered treatment were significantly different from those with thioridazine alone at 1 h after administration, indicating additivity. Supra-additivity was observed in DSST results at 1, 2, and 4 h. There was no interaction at 8 h.

CONCLUSION

The results of single-dose administration showed an additive pharmacodynamic interaction between zaleplon and thioridazine at 1 h in one of four tests and supra-additivity for 4 h in another test. This interaction is relatively short in duration due to the short half-life of zaleplon.

Rapid disappearance of zaleplon from breast milk after oral administration to lactating women

Five lactating mothers were administered the therapeutic dose of zaleplon (10 mg) orally in an open-label, single-dose, pharmacokinetic study. Plasma and breast milk were sampled through 8 hours after dose administration for subsequent determinations of zaleplon and its major, though inactive, plasma metabolite 5-oxo-zaleplon. Zaleplon concentrations peaked in plasma and milk approximately 1 hour after dosing and then disappeared rapidly. The mean terminal half-life was slightly greater than 1 hour. Milk concentrations "mirrored" plasma concentrations closely with no discernible delay between peak times. The average milk-to-plasma (M/P) concentration ratio for zaleplon was approximately 0.50 over the time course. 5-oxo-zaleplon was undetectable in all but one milk sample. The maximum exposure of an infant to zaleplon during a feeding at peak milk concentrations was estimated to range from 1.28 micrograms to 1.66 micrograms, corresponding to 0.013% to 0.017% of the maternal dose or 0.320 microgram/kg to 0.415 microgram/kg for a 4 kg infant. The results indicate that zaleplon taken by a nursing mother is transferred through breast milk to her infant in very small quantities that are unlikely to be clinically important.

Zaleplon pharmacokinetics and absolute bioavailability

The pharmacokinetics and absolute oral bioavailability of zaleplon were assessed to evaluate the extent of presystemic metabolism of this new nonbenzodiazepine hypnotic agent. A partially randomized, single-dose, four-period crossover study was conducted in 23 healthy subjects. Subjects received 1 and 2.5 mg intravenous (i.v.) infusions of zaleplon during the first and second periods, respectively, and then were randomly assigned to receive a 5 mg oral dose or 5 mg i.v. infusion of zaleplon in a crossover design during the final two periods. Zaleplon pharmacokinetics were determined in 20 subjects (ten men and ten women) after the two 5 mg treatments. The oral and i.v. doses of zaleplon administered in this study were safe and well-tolerated. Following i.v. administration, zaleplon had a moderate to high systemic clearance (mean +/- S.D., 0.94 +/- 0.20 L/h/kg), rapid elimination (half-life, t1/2 = 1.05 +/- 0.13 h), and a steady-state volume of distribution of 1.27 +/- 0.25 L/kg, indicating substantial distribution into extravascular tissues. Zaleplon was rapidly absorbed after oral administration, and the mean apparent elimination t1/2 was similar to that obtained after i.v. infusion. The absolute bioavailability was 30.6 +/- 10.2%.

Comparative kinetics and dynamics of zaleplon, zolpidem, and placebo

PURPOSE

This study evaluated the relationship of dose, plasma concentration, and time to the pharmacodynamics of zaleplon and zolpidem, 2 structurally distinct benzodiazepine receptor agonists.

METHOD

Ten healthy male volunteers received single oral doses of placebo, 10 mg zaleplon, 20 mg zaleplon, 10 mg zolpidem, and 20 mg zolpidem in a double-blind, 5-condition crossover study, with 48 hours elapsing between trials. Plasma drug concentrations and pharmacodynamic effects were measured during the 8 to 24 hours after administration.

RESULTS

Kinetics of zaleplon and zolpidem were not significantly related to dose. However, zaleplon had more rapid elimination (apparent elimination half-life [t1/2] of 1 hour) and higher apparent oral clearance (approximately 4300 mL/min) than zolpidem (t1/2, 2.0 to 2.2 hours; apparent oral clearance, 340 to 380 mL/min). Active treatments produced pharmacodynamic effects consistent with benzodiazepine agonist activity: self- and observer-rated sedation, impairment of digit symbol substitution test (DSST) performance, impaired memory, and increased electroencephalographic activity in the beta frequency range. The overall order of agonist potency was as follows: placebo < 10 mg zaleplon < 20 mg zaleplon < 10 mg zolpidem < 20 mg zolpidem; on a number of measures, 20 mg zaleplon was comparable to 10 mg zolpidem. Quantitative effects of zolpidem 20 mg far exceeded those of other treatments. Dynamic effects of both drugs were significantly related to plasma concentration.

CONCLUSIONS

Benzodiazepine agonist effects of zaleplon and zolpidem were dose and concentration dependent. At the usual clinically effective hypnotic dose (10 mg of either drug), agonist effects of zolpidem exceeded those of zaleplon.

Prevalence of certain sexually transmitted viruses in Egypt

The magnitude of Sexually Transmitted Diseases (STD) in the Eastern Mediterranean Region is not exactly known but considered to be not insignificant. A realistic estimate of the problem is necessary, to design an effective control program. This present study aimed to identify the most prevalent sexually transmitted viral agents among patients attending the STD clinic at Cairo Hospital for Skin and Venereal Diseases (El-Haud El-Marsoud). From persons attending this clinic whether complaining or visiting for screening, between October 1993 to April 1995, 95 cases were studied by history taking, clinical examination, bacteriological and serological examination for the detection of the most prevalent sexually transmitted organisms. Certain demographic and socio-economic factors interacting with sexual attitudes and practices were also studied. All the collected data for each patient were recorded. Antibodies (IgG) to cytomegalovirus (CMV) were detected in 86.3%, HBsAg in 10.5%, and antibodies to HBcAg were detected in 45.3%. Antibodies to HCV were detected in 8.4%, and antibodies to HIV in 5.3%.

Abdominal ultra sonographic findings detected in the course of a hepatitis survey in an Egyptian rural area

The objective of this study was to determine the prevalence of abnormal findings detected by abdominal ultrasonography (US) in an Egyptian rural area. This study was a part of a community based cross sectional survey for virus hepatitis carried out at Kalama village in Nile Delta, 40 kilometers north of Cairo. People above 10 years of age living in a 10% systemic random sample of houses in the village were subjects of this study. A member of the team carried out US examination of the liver, biliary tree, spleen, kidneys, pancreas, para aortic areas and the pelvis. Examination included morphological assessment and organometry. All results are recorded on images by videoprinter. Abnormalities in abdominal US was detected in 34% of examined cases. Abnormal liver impressions were detected in 28.3% of cases. Ascites was detected in 13 cases (1.8%). Diseases of the gall bladder and kidneys were detected in 2.7% and 2.1%, respectively. US diagnosed pregnancy in 5 women, one of them had a blighted ovum. Some of these abnormalities were detected in subjects with no complaint. It is concluded that abdominal US may be a tool for early detection of asymptomatic disease.

Clinical value of squamous cell carcinoma antigen (SCC-A) in Egyptian gynecologic cancer patients

Squamous cell carcinoma (SCC) antigen levels were measured by immunoparticle assay (IMx) in the sera of 32 patients with gynecologic malignancies, 15 with benign diseases of the genital system and 14 normal healthy controls. At a cut-off value of 4.8 ng/ml (100% specificity), the rate of SCC antigen elevation was 100% in vulvar and vaginal cancer (n = 5), 90% in ovarian cancer (n = 10), 60.0% in endometrial cancer (n = 10) and 57.2% in cervical cancer (n = 7). The benign disease's group had 80.0% false positivity at the same cut-off value. Serum SCC-A was found to correlate directly with the clinical stage of disease. A sensitivity of 73.3% was obtained at stage I which gives SCC-A a role in screening the high risk population for gynecological cancer. Concerning the histopathologic type of tumor, serum SCCA was highly sensitive in SCC tumors, in ovarian serous cystadenocarcinoma and in patients with recurrent ovarian cancer.