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The tautomerism of 4-methyldihydro-1,3,4-benzotriazepin-5-ones (2,3) is re-investigated by means of X-ray diffraction and quantum chemical calculations. The data revealed that the model compound (2a) exists in the amidrazone 1,4-dihydro tautomeric form (A), but not in the alternate 3,4-dihydro tautomer (B) as was previously reported.
Treatment of the N-P ligand ArPN(SiMe3)2 with TiCl4 affords the imido-bridged binuclear titanium complex [TiCl2(THF)(micro-NArP)]2 (ArP = m-C6H4PR2) which reacts with Ni(0) or Pd(ii) to give heterotrinuclear compounds, while activation with methylaluminoxane generates a new type of imido-based ethene polymerisation catalyst that is tolerant of -PR2 functional groups.
Banana pulps at any ripening stage can be completely dissolved in solvent systems based on the ionic liquid (IL) 1-n-butyl-3-methylimidazolium chloride ([C4mim]Cl), and variations in the carbohydrate composition of the fruit analyzed directly on the resulting solutions using high-resolution 13C NMR spectroscopy.
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Fusarium is a newly emerging fungal pathogen associated with significant morbidity and mortality in the immunocompromised host. We have reviewed our hospital's experience with Fusarium between 1985 and 1995. Fusarium species were isolated from 22 specimens, representing 11 patients. Cases were not clustered by time period. The median age of the patients was 36.5 years (range 17-69 years). The sources of the organism were 12 skin lesions from eight patients, seven blood cultures from two patients and one specimen each from a Hickman catheter tip, nail clippings and a bronchoalveolar lavage. Seven of the patients had chemotherapy-induced neutropenia when the Fusarium was isolated. Five of them developed invasive fusarosis during acute leukaemia induction treatment. They remained neutropenic, and none survived. The other two patients recovered from neutropenia and were treated successfully for this infection. The remaining four patients were not neutropenic or immunocompromised. Three grew Fusarium from skin or nail clippings and one from bronchial alveolar lavage (BAL). There was no evidence of invasive disease in any of the four. None of them received antifungal therapy, and they were all alive at last follow-up. We conclude that Fusarium is a newly emerging infection in neutropenic patients. A high index of suspicion, especially for skin lesions, will help in early diagnosis before systemic and visceral dissemination. Excision of the initial focus of infection and antifungal therapy, aided by speedy neutrophil recovery, are likely to protect patients threatened with these fatal infections. Fusarium isolated from non-neutropenic, non-immunosuppressed patients is not significant and does not merit systemic antifungal treatment.
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BACKGROUND: The period immediately following discharge after hospitalization for a first-time myocardial infarction (MI) is stressful. Recovery-related stressors include anticipation of or actual difficulties in resuming social and physical activities, and adopting recommended health actions. RATIONALE: Stress level and sources of stress in the early discharge period need to be evaluated. Identifying patient charcteristics that contribute to high stress is essential to facilitate patients' adjustment. AIMS: To evaluate stress level, identify sources of stress, and examine the significance of sociodemographics and health characteristics in predicting stress in MI patients in the early discharge period. METHODS: In this cross-sectional study, data were collected from 84 MI patients 2-16 weeks after discharge. The patients, aged 20-70 years, were attending cardiology clinics of four Jordanian public hospitals and had experienced myocarial infarction for the first time. INSTRUMENTS: A structured interview guide including a stress discharge assessment tool was used to identify stress level and sources of stress experienced after discharge. FINDINGS: Most patients experienced a moderate level of stress, with 20% reporting high stress levels. They perceived 'having many persons to provide care to, worrying about having another heart attack, and my partner worries too much about me' as their most important concerns. Age, gender, income, frequency of chest pain episodes, and physicians' recommendations to quit smoking were the most significant predictors of stress. CONCLUSION: The findings suggest that in the early discharge period MI patients worry about their social role, interpersonal relations and personal health, which can exacerbate symptoms and complicate their future care.
Access to adequate supplies of good quality drinking water continues to be limited among many rural and peri-urban communities in Africa, despite several decades of water improvement programmes. The present study investigated water quality at the source and point of consumption among rural and peri-urban communities in northern Sudan. Faecal coliform counts were determined by the membrane filtration technique and geometric mean counts compared in different seasons and among the different communities. Among nomadic pastoralists and riverine villages, both water sources and water stored for consumption had faecal coliform counts grossly in excess of WHO standards, with higher counts at the end of the rainy season. In the peri-urban community on the outskirts of Omdurman, while water quality from the distribution system had faecal coliform counts generally below 10 dl - 1, after storage, water was of considerably lower quality, with faecal coliform counts up to 1000 d1 - 1. The highest counts again occurred in the rainy season. Rates of diarrhoeal disease for Khartoum province were also greatest towards the end of the rainy season. The study has shown that poor quality water continues to be a major risk factor for public health in these communities.
The masticatory cycle is a complex process and it depends on many factors. In our study we wanted to prove to what extent various types of food consistency influence the masticatory motions, especially the extent of forward, downward and lateral motions of the mandible. Nineteen study subjects aged from 20 to 37 years and with intact teeth rows were asked to chew three types of food of various consistency (banana, bread and carrot). The motions of the mandible were recorded by stereo-photo-grammetric system. Study results have shown that in all 19 study subjects the increase in food consistency increases the extent of masticatory motions. The average size of forward mandibular motion in all 19 study subjects when chewing banana amounts to 2.65 mm, when chewing bread it is 2.96 mm and 3.64 mm when chewing carrot. The average size of downward mandibular motion for all 19 study subjects amounts to 6.79 mm when chewing banana, 7.17 mm when chewing bread and 8.09 mm when chewing carrot. The average size of lateral mandibular motion in all 19 study subjects amounts to 2.46 mm when chewing banana, 2.80 mm when chewing bread and 3.40 mm when chewing carrot. Although varying from subject to subject, the masticatory cycle significantly depends on food consistency. By increasing the consistency of a mouthful, the extent of mandibular motion increases in every single study subject.
The worldwide destructive epidemic of the fungus Mycosphaerella fijiensis on banana started recently, spreading from South-East Asia. The founder effects detected in the global population structure of M. fijiensis reflected rare migration events among continents through movements of infected plant material. The main objective of this work was to infer gene flow and dispersal processes of M. fijiensis at the continental scale from population structure analysis in recently invaded regions. Samples of isolates were collected from banana plantations in 13 countries in Latin America and the Caribbean and in Africa. The isolates were analysed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and microsatellite molecular markers. The results indicate that a high level of genetic diversity was maintained at the plantation and the plant scales. The loci were at gametic equilibrium in most of the samples analysed, supporting the hypothesis of the existence of random-mating populations of M. fijiensis, even at the plant scale. A low level of gene diversity was observed in some populations from the Africa and Latin America-Caribbean regions. Nearly half the populations analysed showed a significant deviation from mutation-drift equilibrium with gene diversity excess. Finally, a high level of genetic differentiation was detected between populations from Africa (FST = 0.19) and from the Latin America-Caribbean region (FST = 0.30). These results show that founder effects accompanied the recent invasion of M. fijiensis in both regions, suggesting stochastic spread of the disease at the continental scale. This spread might be caused by either the limited dispersal of ascospores or by movements of infected plant material.
OBJECTIVES: Combination therapy using existing anti-malarials together with artesunate (AS) has been advocated as a method to slow the spread of drug resistance. We assessed the effect on Plasmodium falciparum transmissibility of the addition of AS to chloroquine (CQ) in an area of The Gambia where resistance to CQ is increasing. METHODS: Gambian children with acute uncomplicated P. falciparum malaria were treated with either CQ monotherapy (n=120) or the combination of CQ plus three doses of AS (CQ/AS; n=352). Post-treatment sexual-stage parasitaemia was assessed during a 4-week follow-up period. Experimental infections of Anopheles gambiae s.s. mosquitoes were performed with blood from patients who were carrying gametocytes 7 days after starting treatment (n=69). RESULTS: The addition of AS significantly reduced post-treatment prevalence and mean density of gametocytes in the first 14 days (day 7: 43.7% vs. 12.4%, 62.4/microl vs. 6.2/microl; day 14: 32.9% vs. 3.7%; 21.9/microl vs. 5.2/microl; CQ vs. CQ/AS), although by day 28 the benefits of the combination were substantially less marked (40.5% vs. 21.8%; 23.0/microl vs. 63.1/microl; CQ vs. CQ/AS). The duration of gametocyte carriage over the study period was significantly lower in the CQ/AS group (5.2 days vs. 1.5 days; CQ vs. CQ/AS). The estimated infectious proportion of children at day 7 was also lower in the combination group (19.2% vs. 3.4%; CQ vs. CQ/AS), as were the proportion of mosquitoes infected and mean oocyst density (11.5% vs. 0.9%; 0.3 vs. 0.01; CQ vs. CQ/AS). Treatment failure was associated with threefold and twofold higher gametocyte carriage rates during follow-up in CQ and CQ/AS groups, respectively (P<0.001 in both cases), and 26-fold and 2.3-fold higher intensity of infection at day 7 among CQ- and CQ/AS-treated children, respectively (P=0.002 and 0.30, respectively). CONCLUSION: The benefits of adding AS to CQ monotherapy in lowering gametocyte prevalence and density were transient, suggesting that the addition of AS delayed, but did not prevent, the emergence of gametocytes. This is consistent with our finding that treatment failure, and thus the presence of CQ-resistant parasites, was significantly associated with a higher gametocyte carriage rate in both treatment groups. At day 7, CQ monotherapy significantly favoured transmission of resistant infections, which showed an 11-fold greater intensity of transmission compared with infections that were successfully treated. In contrast, the combination of CQ/AS did not significantly favour resistant infections at day 7. We conclude that significant transmission-reduction is achieved by the combination but is not maintained because of the recrudescence of CQ-resistant parasites.
Different papers have emphasized the presence of visual-evoked potential (VEP) abnormalities in metabolic disorders. The aim of this study was to perform pattern VEP (PVEP) recordings in patients with chronic renal failure just before and 24 h after dialysis to test the effect of this procedure on visual pathway generated parameters. Twenty-four haemodialysis patients (M/F:14/10; mean age: 48.8 +/- 14.1 years) were examined. None of them were complaining from visual difficulties or from visual loss. The recording sessions were performed just before and 24 h after dialysis. The control group consisted from 27 healthy subjects matched for age and sex. Eight (33%) patients demonstrated abnormal P100 latency prolongation in at least one tested eye (six patients in one tested eye, two in both eyes) in the recording session just prior to dialytic treatment. In the post-treatment session, it was found that the abnormal P100 latencies that were present in six patients (75%) before dialysis had returned to normal, while in the remaining two (25%), the latency abnormality persisted. No correlation was found between VEP parameters and dialysis duration, serum blood urea nitrogen (BUN), creatinine, parathyroid hormone and haematocrit levels. However, a positive correlation in the intradialytic percentage variation of bodyweight with P100 latencies was found. Visual evoked potential is a reliable, simple and non-invasive technique that can be used for the investigation and follow up of subclinical involvement of visual pathways in patients with chronic renal failure. Detected abnormalities in some uraemic patients are reversible by using dialysis.
The 24-h patterns of tissue thyroid hormone concentrations and type II 5'- and type III 5-iodothyronine deiodinase (5'D-II and 5D-III, respectively) activities were determined at 4-h intervals in different brain regions of male euthyroid rats entrained to a regular 12-h light/12-h dark cycle (lights on at 6:00 a.m.). Activity of 5'D-II, which catalyzes the intracellular conversion of thyroxine (T4) to 3,3',5-triiodo-L-thyronine (T3) in the CNS, and the tissue concentrations of both T4 and T3 exhibited significant daily variations in all brain regions examined. Periodic regression analysis revealed significant circadian rhythms with amplitudes ranging from 9 to 23% (for T3) and from 15 to 40% (for T4 and 5'D-II) of the daily mean value. 5'D-II activity showed a marked nocturnal increase (1.3-2.1-fold vs. daytime basal value), with a maximum at the end of the dark period and a minimum between noon and 4:00 p.m. 5D-III did not exhibit circadian patterns of variation in any of the brain tissues investigated. Our results disclose circadian rhythms of 5'D-II activity and thyroid hormone concentrations in discrete brain regions of rats entrained to a regular 12:12-h light-dark cycle and reveal that, in the rat CNS, T3 biosynthesis is activated during the dark phase of the photoperiod. For all parameters under investigation, the patterns of variation observed were in part regionally specific, indicating that different regulatory mechanisms may be involved in generating the observed rhythms.
BACKGROUND: There is growing evidence of improved healing of full- and partial-thickness cutaneous wounds in wet and moist environments. Retention of biologic fluids over the wound prevents desiccation of denuded dermis or deeper tissues and allows faster and unimpeded migration of keratinocytes over the wound surface. It allows also the naturally occurring cytokines and growth factors to exert their beneficial effect on wound contracture and re-epithelialization. Despite all of these documented benefits, applying the moist healing principles to large surface areas, in particular to large burns, is hindered by the major technical handicap of creating and maintaining a sealed moist environment over these areas. METHODS: From January to September 2001, healing of partial-thickness skin graft donor sites was studied in a prospective comparative study of two types of moist dressings, Tegaderm (3M Health Care, St. Paul, MN), a semipermeable membrane occlusive dressing, and moist exposed burn ointment (MEBO) (Julphar; Gulf Pharmaceutical Industries, United Arab of Emirates), an ointment that can provide a moist environment without the need of an overlying occlusive dressing. Healing was assessed both clinically and with serial measurements of transepidermal water loss (TEWL) and moisture. Following healing, scar quality was evaluated by two members of the team separately using a visual analog scale. Results were statistically analyzed. RESULTS: Faster healing was observed clinically with MEBO application. Physiologic healing as determined by TEWL measurements occurred at an extremely significant earlier stage for MEBO, and this was associated with better scar quality, demonstrating a positive relationship between function and cosmetic appearance. Moreover, the ointment is definitely easier to apply than the occlusive self-adhesive membrane, which requires some degree of dexterity and expertise. CONCLUSION: MEBO application is an effective and valid alternative to conventional occlusive dressings. Moreover, the observed improved anatomic and physiologic healing indicates that MEBO may have a positive effect on healing more that the mere fact of passive moisture retention.
Toxic epidermal necrolysis (TEN) is a rare condition that was described by Lyell in 1956. It is a severe, acute, adverse, primarily drug-induced, potentially fatal, cutaneous reaction that is characterized by large areas of skin desquamation and sloughing, similar in many aspects to second-degree burns. The treatment of cutaneous drug reactions rests essentially on immediate diagnosis and recognition of the disease process, accurate history, thorough physical examination, prompt discontinuation of the offending drug, and supportive care. TEN patients are best managed in specialized burn units. Nevertheless, the management remains very much individualized, based on the clinical setting. Topical wound care remains an essential factor in the treatment of burn-like syndromes and is a main determining parameter for morbidity and mortality. As the value of moist environment in wound healing is being fully appreciated, we report on the use of a newly introduced ointment, the Moist Exposed Burn Ointment (Julphar; Gulf Pharmaceutical industries, Ras El-Khaymah, United Arab of Emirutes), a moisture-retentive ointment, in the successful management of a case of TEN.
Patients with chronic renal failure (CRF) often have signs and symptoms related to fluid and electrolyte disturbances, anemia, malnutrition, bone disease, and gastrointestinal problems. Vascular and neurologic impairment in particular remain an important source of morbidity and mortality in this vulnerable patient population. Sagliker syndrome is a novel syndrome that was recently described in 2004 in patients with CRF and severe and late secondary hyperparathyroidism who suffered from severe skull and facial bone changes, particularly from uglifying human face appearances and neuropsychiatric disorders. The goal of this study was to assess neuropsychiatric manifestations occurring in CRF patients with Sagliker syndrome. Four female and 8 male patients with CRF on regular dialysis at the hemodialysis units of the Internal Medicine Departments around southern Turkey participated in the study. All patients underwent a clinical neurologic examination performed by the same neurologist. Neuropsychiatric signs and symptoms were found in all cases. The results showed that the most frequent neurologic manifestations in CRF patients with Sagliker syndrome were headache, polyneuropathy, cranial neuropathy, fatigue, and psychiatric disorders.
It is well known that secondary hyperparathyroidism may be an extremely severe condition in chronic renal failure, and almost all patients with chronic kidney disease, even in the well-developed countries, encounter every kind of bone abnormalities if they are not treated properly. Although some sporadic cases have been reported of unique facial bone changes, the largest collection of this phenomenon has been reported by Sagliker et al. We also have found 6 of 9 patients who have these changes (Sagliker syndrome) to manifest class II malocclusion of the upper and lower jaws according to dental universally accepted criteria by performing cephalometric studies, x-ray plain films, tomographic procedures, and drawing technology.
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