In vitro biological assessment of the stability of cigarette smoke aqueous aerosol extracts.

OBJECTIVES: Cigarette smoke aqueous aerosol extracts (AqE) have been used for assessing tobacco products, particularly with in vitro models such as oxidative stress and inflammation. These test articles can be generated easily, but there are no standardised methods for the generation and characterisation or stability. We investigated the effects of pro-oxidant smoke-derived chemicals by using 3R4F AqE generated under standardised conditioning and smoking regimes and assessed the stability over 31-week timeframe. Twenty batches generated from ten puffs per cigarette bubbled through 20 ml cell culture media were used fresh and thawed from frozen aliquots stored at - 80 ºC. RESULTS: Nicotine levels quantified by gas chromatography/mass spectrometry and optical density at 260 nm showed chemical and physical stability from week 0 (fresh sample) to weeks 1, 4, 8 and 31 (frozen samples). No significant change in H292 human bronchial epithelial cell viability or oxidative stress were observed between fresh AqE at week 0 and frozen AqE at 31 weeks. AqEs generated by our protocol were stable for up to 31 weeks for all tested end points, suggesting that it may not be necessary to use freshly generated AqE for each study, thus reducing batch-to-batch variability.

Importance of Pharmacy Involvement in the Treatment of Sepsis.

Purpose: A review of the impact of pharmacists on appropriate medication selection, timing of administration, and as members of a multidisciplinary sepsis response team. Summary: Early goal-directed therapy (EGDT), currently recommended by the 2013 Surviving Sepsis Campaign guidelines for the management of patients with sepsis, includes the administration of appropriate antibiotics in patients with septic shock within the first hour. Multidisciplinary teams containing pharmacists have been shown to decrease time to antibiotic delivery, time to antibiotic administration, and patient mortality. The pharmacist can act as a drug information resource, expedite the medication verification and procurement process, and offer suggestions on how to better manage the patients. Pharmacists are often consulted for dosing and antibiotic selection recommendations for patients with sepsis, but they can also help increase the appropriateness of antibiotics selected. Additional recommendations and interventions made by pharmacists include fluid management and vasopressor facilitation for the more severe patients. A sepsis management team that included a pharmacist increased the number of patients receiving appropriate antibiotics within the first hour by as much as 22-fold. Another study has demonstrated that intensive care units with a pharmacist are associated with a 4% decrease in sepsis patient mortality compared to those without a pharmacist. Conclusion: Multidisciplinary teams containing pharmacists have been shown to decrease time to administration of antibiotics, increase appropriate selection of medications, and decrease mortality; they may also decrease overall health care costs.

Topiramate in the treatment of Prader-Willi syndrome: A case report.

BACKGROUND: Prader-Willi syndrome (PWS), a neurologic disorder caused by a mutation of chromosome 15, is characterized by such symptoms as hypotonia, hypogonadism, hyperphagia, cognitive impairment, and difficult behaviors. One of the most concerning symptoms is hyperphagia, which can lead to uncontrolled obesity. Obesity is a major cause of increased morbidity and mortality in patients with PWS; however, diagnosing PWS early in life improves the prognosis. CASE SUMMARY: An 11-year-old African American boy with a past medical history significant for PWS, attention deficit/hyperactivity disorder, oppositional defiant disorder, obesity, and asthma was admitted after he became violent and destructive at his foster home while trying to get food. The patient had a 28-day stay on the children's crisis intervention unit where quetiapine was discontinued and he was maintained on clonidine 0.1 mg 3 times daily, hydroxyzine 25 mg in the morning and 50 mg at bedtime, montelukast 5 mg daily and titrated on methylphenidate 10 mg in the morning and 5 mg in the afternoon, topiramate 100 mg twice daily, and aripiprazole 10 mg twice daily. The patient displayed improved behavior control and less food-related aggression; he denied any side effects of medications. DISCUSSION: This case demonstrates the positive effects of topiramate for reducing aggression and demand for food in a child with PWS most likely due to an increase in satiety. It is hard to definitively attribute the positive response directly to topiramate. Further research should be conducted to determine if topiramate is an effective treatment option in these individuals.