Acute generalised exanthematous pustulosis induced by Pneumocystis jirovecii pneumonia prophylaxis with dapsone

We describe the case of HIV-1 infected patient presenting to hospital with a severe cutaneous adverse drug reaction shortly after commencing dapsone therapy as Pneumocystis jirovecii pneumonia prophylaxis. To the best of our knowledge, acute generalised exanthematous pustulosis has not been reported as a reaction to dapsone in the setting of HIV.

Correlation between crossed cerebellar diaschisis and clinical neurological scales

BACKGROUND

A common consequence of unilateral stroke is crossed cerebellar diaschisis (CCD), a decrease in regional blood flow (CBF) and metabolism (CMRglu) in the cerebellar hemisphere contralateral to the affected cerebral hemisphere. Former studies indicated a post-stroke time-dependent relationship between the degree of CCD and the clinical status of acute and sub-acute stroke patients, but no study has been performed in post-stroke patients.

OBJECTIVES

The objective of this investigation was to evaluate the quantitative correlation between the degree of CCD and the values of clinical stroke scales in post-stroke patients.

MATERIALS AND METHODS

We measured with positron emission tomography (PET) regional CBF and CMRglu values in the affected cortical regions and the contralateral cerebellum in ten ischaemic post-stroke patients. Based on these quantitative parameters, the degree of diaschisis (DoD) was calculated, and the DoD values were correlated with three clinical stroke scales [Barthel Index, Orgogozo Scale and Scandinavian Neurological Scale (SNS)].

RESULTS

There were significant linear correlations between all clinical stroke scales and the CCD values (Barthel Index and Orgogozo Scale: P < 0.001, for both CBF and CMRglu; SNS: P = 0.007 and P = 0.044; CBF and CMRglu, respectively).

CONCLUSIONS

The findings indicate that DoD can be used as a quantitative indicator of the functional impairments following stroke, i.e. it can serve as a potential surrogate of the severity of the damage.

Autoimmune encephalitis: a case series and comprehensive review of the literature

Encephalitic syndromes are a common medical emergency. The importance of early diagnosis and appropriate treatment is paramount. If initial investigations for infectious agents prove negative, other diagnoses must be considered promptly. Autoimmune encephalitides are being increasingly recognized as important (and potentially reversible) non-infectious causes of an encephalitic syndrome. We describe four patients with autoimmune encephalitis--3 auto-antibody positive, 1 auto-antibody negative--treated during the last 18 months. A comprehensive review of the literature in this expanding area will be of interest to the infectious diseases, general medical and neurology community.

Harmonisation of ethics committees' practice in 10 European countries

BACKGROUND

The Directive 2001/20/EC was an important first step towards consistency in the requirements and processes for clinical trials across Europe. However, by applying the same rules to all types of drug trials and transposing the Directive's principles into pre-existing national legislations, the Directive somewhat failed to meet its facilitation and harmonization targets. In the field of ethics, the Directive 2001/20/EC conditioned the way of understanding and transposing the "single opinion" process in each country. This led to a situation in which two models of research ethics committees organisation systems exist, being the model in which the "single opinion" is considered to be the decision made by a single ethics committee more effective and simpler in terms of administrative and logistic workload.

METHOD

A survey was conducted in 10 European countries. Members of the European Clinical Research Infrastructures Network working party number 1, with expertise in the field of ethics, responded.

RESULTS

There is a major heterogeneity in the composition of ethics committees among the surveyed countries based on the number of members, proportion of experts versus lay members and expertise of the scientific members. A harmonized education of the ethics committees' membership based in common curricula is recommended by the majority of countries.

CONCLUSIONS

Despite the efforts for harmonization of the European Clinical Trial Directive, from an ethical point of view, there remains a plurality of ethics committees' systems in Europe. It is important to comprehend the individual national systems to understand the problems they are facing.

Autoradiographic evaluation of [11C]vinpocetine binding in the human postmortem brain

The main objective ofthe study was to evaluate with autoradiographic technique whether or not [11C]vinpocetine, a compound widely used in the prevention and treatment of cerebrovascular diseases (Cavinton, Gedeon Richter Ltd., Budapest), binds to specific sites in the human brain in post mortem human brain sections. Binding was assessed under four conditions: the incubation was performed using Tris-HCl buffer with or without the addition of salts (0.1% (weight/vol) ascorbic acid, 120 mM NaCl, 5 mM KCl, 2 mM CaCl2 and 1 mM MgCl2), with or without the addition of excess (10 microM) unlabelled vinpocetine. Measurements on digitized autoradiograms indicated that [11C]vinpocetine labelled all grey matter areas in the human brain to a similar extent and no significantly heterogeneous binding could be demonstrated among cortical or subcortical regions. The addition of excess unlabelled vinpocetine lowered the binding slightly in all regions. Although these results indicate that [11C]vinpocetine does not bind to human brain transmitter receptors or transporters with a high affinity (Ki < 10 nM), it cannot be ruled out that the compound binds to receptors and/or transporters with lower affinity.

PET studies on the brain uptake and regional distribution of [11C]vinpocetine in human subjects

OBJECTIVES

Vinpocetine is a compound widely used in the prevention and treatment of cerebrovascular diseases. It is still not clear whether the drug has a direct and specific effect on neurotransmission or its effects are due to extracerebral actions, such as changes in cerebral blood flow. The main objective of the present investigation was to determine the global uptake and regional distribution of radiolabelled vinpocetine in the human brain in order to explore whether it may have direct central nervous system effects.

MATERIAL AND METHODS

Three healthy subjects were examined with positron emission tomography and [11C]vinpocetine. The regional uptake was determined in anatomically defined volumes-of-interest. The fractions of [11C]vinpocetine and labelled metabolites in plasma were determined using high pressure liquid chromatography.

RESULTS

The uptake of [11C]vinpocetine in brain was rapid and 3.7% (mean; n = 4) of the total radioactivity injected was in brain 2 min after radioligand administration. The uptake was heterogeneously distributed among brain regions. When compared with the cerebellum, an a priori reference region, the highest regional uptake was in the thalamus, upper brain stem, striatum and cortex. Following an initial peak, the total concentration of radioactivity in blood was relatively stable with time, whereas the concentration of the unchanged compound decreased with time in an exponential manner.

CONCLUSION

Vinpocetine, administered intravenously in humans, readily passes the blood-brain barrier and enters the brain. Its regional uptake and distribution in the brain is heterogeneous, indicating binding to specific sites. The brain regions showing increased uptake in the human brain correspond to those in which vinpocetine has been shown to induce elevated metabolism and blood flow. These observations support the hypothesis that vinpocetine has direct neuronal actions in the human brain.

Control of DNA rereplication via Cdc2 phosphorylation sites in the origin recognition complex

Cdc2 kinase is a master regulator of cell cycle progression in the fission yeast Schizosaccharomyces pombe. Our data indicate that Cdc2 phosphorylates replication factor Orp2, a subunit of the origin recognition complex (ORC). Cdc2 phosphorylation of Orp2 appears to be one of multiple mechanisms by which Cdc2 prevents DNA rereplication in a single cell cycle. Cdc2 phosphorylation of Orp2 is not required for Cdc2 to activate DNA replication initiation. Phosphorylation of Orp2 appears first in S phase and becomes maximal in G(2) and M when Cdc2 kinase activity is required to prevent reinitiation of DNA replication. A mutant lacking Cdc2 phosphorylation sites in Orp2 (orp2-T4A) allowed greater rereplication of DNA than congenic orp2 wild-type strains when the limiting replication initiation factor Cdc18 was deregulated. Thus, Cdc2 phosphorylation of Orp2 may be redundant with regulation of Cdc18 for preventing reinitiation of DNA synthesis. Since Cdc2 phosphorylation sites are present in Orp2 (also known as Orc2) from yeasts to metazoans, we propose that cell cycle-regulated phosphorylation of the ORC provides a safety net to prevent DNA rereplication and resulting genetic instability.

[The effect of a single-dose intravenous vinpocetine on brain metabolism in patients with ischemic stroke]

The effect of a single-dose i.v. infusion of vinpocetine on the cerebral blood flow (CBF) and glucose metabolism of post-stroke patients was studied by measuring the regional and global cerebral metabolic rates of glucose (CMRglu) and the corresponding kinetic constants before and after treatment. Transcranial Doppler (TCD) and single photon emission tomography (SPECT) measurements were also performed. The cerebral glucose metabolism was significantly higher in the contralateral hemisphere than in the affected one before therapy. In the affected hemisphere the regional glucose metabolism was inhomogenous: relatively low values were measured in the stroke region, whereas it was increased in the peristroke region. Although a single-dose vinpocetine treatment did not affect significantly the regional or global metabolic rates of glucose, the glucose transport (both intracellular up-take and release) was strongly affected in the whole brain, in the contralateral hemisphere and in the peri-infarct area of the symptomatic hemisphere. A slightly increased (not significant, N. S.) cerebral blood flow could be observed in the contralateral and a decreased flow (N. S.) in the symptomatic hemisphere.

Role of sodium channel inhibition in neuroprotection: effect of vinpocetine

Vinpocetine (ethyl apovincaminate) discovered during the late 1960s has successfully been used in the treatment of central nervous system disorders of cerebrovascular origin for decades. The increase in the regional cerebral blood flow in response to vinpocetine administration is well established and strengthened by new diagnostical techniques (transcranial Doppler, near infrared spectroscopy, positron emission tomography). The latest in vitro studies have revealed the effect of the compound on Ca(2+)/calmodulin dependent cyclic guanosine monophosphate-phosphodiesterase 1, voltage-operated Ca(2+) channels, glutamate receptors and voltage dependent Na(+)-channels; the latest being especially relevant to the neuroprotective action of vinpocetine. The good brain penetration profile and heterogenous brain distribution pattern (mainly in the thalamus, basal ganglia and visual cortex) of labelled vinpocetin were demonstrated by positron emission tomography in primates and man. Multicentric, randomized, placebo-controlled clinical studies proved the efficacy of orally administered vinpocetin in patients with organic psychosyndrome. Recently positron emission tomography studies have proved that vinpocetine is able to redistribute regional cerebral blood flow and enhance glucose supply of brain tissue in ischemic post-stroke patients.

Taste- and odor-reactivity in heroin addicts

Opiates in general, and heroin in particular, are known to induce compulsive drug-seeking and drug-taking behavior. Addiction is accompanied by psychobiological processes which may distort perception of sensory stimuli. Gustatory and olfactory stimuli are hedonically polarized and therefore most appropriate for the assessment of the organism's reactivity to "useful" and "harmful" chemosensory events. Previous studies revealed that psychophysical self-estimates and reflectory facial expressions mirror with comparable reliability the hedonics of the perceived taste and odor sensations. In the present study both cognitive verbal and reflectory facial expressions of a group of: a) heroin addicts were recorded and compared to those of a group of b) detoxified former addicts and to c) a group of matching controls. Results show that all three groups differentiate between pleasant, indifferent and aversive tastes and odors. Active addicts estimated sweet taste and savory smells as being somewhat more pleasant, and bitter and sour tastes and a putrid odor as less unpleasant than did the other two groups. The reflectory facial displays of addicts were less expressive and discriminative than those of the two other groups. Taste- and odor-induced facial displays are known to be controlled primarily by the brainstem. The findings indicate that heroin-addiction affects brain-mechanisms, which mirror taste- and odor-hedonics. Modulation of the phylogenetically ancient, sensory-motor coordinations was found to be of a different pattern than that of the cortically-controlled cognitive reactions.

Comparison of a novel thin-layer chromatographic-fluorescence detection method with a spectrofluorometric method for the determination of 7-hydroxycoumarin in human urine

A novel method for the determination of 7-hydroxycoumarin in human urine which combines thin-layer chromatography (TLC) with fluorescence detection (FD) has been devised. The limit of detection (1 ng/ml) enables determination of 7-hydroxycoumarin after both administration of coumarin and environmental exposure to this fragrance material. When compared to a spectrofluorometric method of analysis, the TLC-FD method proved to be more selective for the analysis of 7-hydroxycoumarin in human urine.

Clinical pharmacology in Hungary: past, present and future

The authors outline the development of the clinical pharmacological network in Hungary. They describe some problems encountered during the development and discuss future plans.

Pantothenic acid, acute ethanol consumption and sulphadimidine acetylation

The effect of pantothenic acid and acute ethanol loading on the genetically determined N-acetyltransferase activity has been studied using sulphadimidine as a test substance. The administration of 1100 mg pantothenic acid daily (600 mg orally, 500 mg iv) for seven days did not significantly alter sulphadimidine kinetics in the primarily elderly 21 subjects we investigated. Acute ethanol loading (0.73 g/kg pure alcohol at start and 0.11 g/kg pure alcohol hourly for 8 hours afterwards, stock solution: 20% v/v ethanol in fruit juice) did not change sulphadimidine acetylation in 10 healthy male volunteers. It is concluded that despite theoretical assumptions exogenous factors like pantothenic acid and ethanol do not significantly influence the cytosolic N-acetyltransferase activity. Consequently they do not interfere with the acetylator phenotyping procedure.

Pharmacogenetic differences in the inhibitory effect of cimetidine on the metabolism of antipyrine

The relationship between acetylator phenotype and the inhibitory effect of cimetidine on the hepatic metabolism of antipyrine has been studied in 20 subjects. Cimetidine, 1,0 g/day resulted in a significant decrease in the metabolic clearance rate of antipyrine, but only in slow acetylators, as fast acetylators were less affected. No sex difference was observed. No major change occurred in the urinary excretion of D-glucaric acid, which means that cimetidine had not-affected that Phase II reaction. It did significantly decrease the urinary partial clearance rate of norantipyrine, leaving that of antipyrine and 4-OH-antipyrine unchanged, which suggests that cimetidine had preferentially inhibited the P450 isozyme that catalyses norantipyrine formation.

Effect of digoxin on human erythrocyte glucose-6-phosphate dehydrogenase activity. A link to natriuretic hormone?

The authors studied the effect of a 0.5 mg intravenous bolus injection of digoxin on human red blood cell glucose-6-phosphate activity under in vivo circumstances. Digoxin administration resulted in a small but statistically significant rise in the enzyme activity. This effect of digoxin seems to support the hypothesis that the circulating sodium transport inhibitor substance or natriuretic hormone found in a group of patients with essential hypertension may be an endogenous digitalis because the two substances act similarly in this respect.

Chemical reception mechanisms at a low level of phylogeny. Influence of polypeptide hormones and non-hormone polypeptides on the growth of Tetrahymena

The polypeptide hormones insulin, glucagon, thyrotropin (TSH), pregnant mare serum gonadotropin (PMSG) and adrenocorticotropin (ACTH) stimulated the growth of the Tetrahymena, and the non-hormone polypeptides (bovine serum albumin (BSA), protamine) had a similar effect. Re-exposure after 24 h accounted for a greater growth stimulation than pre-exposure alone in cultures treated with TSH and PMSG, and re-exposure after 7 days had such effect in all polypeptide-treated cultures. It follows that the non-hormone polypeptides had a similar imprinting potential to the polypeptide hormone. The non-hormone polypeptides were also able to cross-imprint for one another, i.e. pre-exposure to one enhanced the binding capacity of the cells for the other on re-exposure, and vice versa. A single treatment with a polypeptide hormone or a non-hormone polypeptide did in itself stimulate the growth of the Tetrahymena for as long as 1 week.

Effect of a non-steroid anti-inflammatory agent on the drug metabolizing activity of the human liver

Results of animal experiments indicate that indomethacin has a marked inhibitory effect on the activity of the hepatic microsomal mixed function monooxygenase (MFO) enzyme system. In order to verify this effect of indomethacin in humans, the authors studied antipyrine kinetics and D-glucaric acid excretion in 14 patients before and after 7 days treatment with two different doses of the drug. In contrast to the results obtained from animal experiments, there was no change in the activity of MFO in man. This can possibly be explained by species difference.

Acetylator phenotypes: effect of age

The distribution of acetylator phenotypes in a Hungarian population of 253 Caucasian was studied. The patients were divided into two age groups - the elderly over 60 years, and young below that age. The individuals below the age of 60 years contained an equal proportion of the two acetylator phenotypes. The same distribution was observed in the population as a whole. In the elderly subjects the slow acetylator phenotype was predominant. The finding supports the hypothesis that age has an influence on hepatic drug acetylation rate.

Combined effect of alpha-methyldopa and a new enzyme inducer, Zixoryn, on the hepatic mixed-function monooxygenase system in humans

Based on previous studies with alpha-methyldopa (inhibitor of hepatic mixed-function monooxygenase system) and m-trifluoromethyl-alpha-ethylbenzhydrol, a new enzyme inducer Zixoryn, the authors studied the effect of the combined treatment of the two compounds on the hepatic drug-metabolizing enzyme activity in ten patients. There was no change in antipyrine half-life and its apparent volume of distribution (aVd) in the amount of D-glucaric acid excreted in the urine (indirect parameters of the mixed-function monooxygenase system's activity) after 1-week administration of 1000 mg alpha-methyldopa together with 300 mg Zixoryn per day. The two compounds counteracted each other's effects in the applied doses.

Effect of alphamethyldopa on the half-lives of antipyrine, tolbutamide and D-glucaric acid excretion in man

Alphamethyldopa has been found to prolong the biological half-lives of Antipyrine and Tolbutamide and to decrease D-glucaric acid excretion in man. These observations suggest that the liver microsomal enzyme system metabolizing drug in man is inhibited by alphamethyldopa. No side effects were found during treatment with alphamethyldopa at the dose levels used in this study.