Factors affecting the performance of a pharmaceutical wastewater treatment plant: Characterization of effluent and environmental risk.

Pharmaceutical industries produce a huge volume of emerging pollutants (EPs) that pose a threat to the aqueous environment. Biological processes have shown their inefficacy in treating many pharmaceutical products. The study assessed physicochemical parameters, EPs, heavy metals in pharmaceutical industrial wastewater, and the removal efficiency (RE) of an aerobic biological treatment plant. The study also assessed the contamination levels and risk using several indices, such as the Canadian Council of Ministers of the Environment Water Quality Index (CCME-WQI), heavy metal pollution index (HPI), heavy metal evaluation index (HEI), and risk quotients index (RQs). The study found that the treated water quality was poor, having antibiotics, nonsteroidal anti-inflammatory drugs, and others, along with several transformation products (TPs) and heavy metals, which were unsafe for consumption with high environmental risk. The analysis results showed that the RE for TSS, BOD5, COD, TDS, and EC were found to be 91.80%, 86.81%, 72.29%, 72.20%, and 65.60%, respectively, where the values of BOD5, COD, NO3-, and PO43- in the effluent were still higher than the permissible limits of the ECR (2023). However, the RE for heavy metals was in the order of Cu (84.62%) > Fe (65.04%) > Mn (63.3%) > Zn (60.58%) > Cd (53.85%) > Ni (54.12%) > Pb (42.42%) > Cr (38%), where Cr and Cd concentrations were still higher than the permissible limit of DoE (2019). The Pearson correlation and PCA suggested that EC, TDS, TSS, DO, BOD5, and COD were the most correlating and contributing variables. This study argued that metal-ligand behaviors mainly affect the removal efficiency of the treatment plant by lowering the removal rate of heavy metals and pharmaceutical products.

Arsenic in drinking water and renal cancers in rural Bangladesh.

OBJECTIVES: Data on the role of arsenic in renal cancer are suggestive but inconclusive. The present analysis aimed to determine whether renal cancers were more likely in Bangladeshi villagers exposed to high arsenic concentration in well water and, if so, whether this excess was limited to transitional cell cancers (TCC) or occurred also for renal cell cancers (RCC). METHODS: Histology/cytology results from renal biopsies carried out at a single clinic in Dhaka, Bangladesh, from January 2008 to October 2011 were classified into four groups: RCC, TCC, other malignancy and benign. Patients aged ≥18 years using hand-pumped well water were identified by questionnaire, blind to diagnosis. Arsenic concentration was estimated from British Geological Survey reports for administrative area (thana) of residence. In a case-referent design (with benign results as referents), ORs were calculated by multilevel logistic regression adjusted for confounding. Time since well installation and smoking were examined by stratification. RESULTS: Among 1489 cases included, 896 were RCC, 90 TCC and 503 benign. Arsenic concentration was estimated for 301 thanas with 63% of cases and 40% referents with arsenic concentration ≥50 µg/L (p<0.001). Risk increased monotonically with arsenic concentration ≥50 µg/L for both cell types (RCC and TCC). Risk estimates were greater in thana with early well installation where risk was increased for RCC in exposure stratum 10<50 µg/L (OR=2.47 95% CI 1.52 to 4.01). Stratification by 'ever smoked' confirmed the presence of risk in non-smokers. CONCLUSIONS: The relationship between arsenic concentration and both RCC and TCC suggests that arsenic is a causal factor in renal cancer.

Budd-Chiari syndrome.

A 16 years old boy hailing from Comilla presented with sudden onset of upper abdominal pain, ascites and generalized muscle wasting for 3 months. Ultrasonogram (USG), Color Doppler and Venography was done and diagnosed him a case of Budd-Chiari syndrome. The patient was treated with salt and water restriction, diuretics, repeated palliative ascetic fluid aspiration with re-accumulation within 1-2 days. He was also given Low molecular weight Heparin for 7 days, overlapped and followed by warfarin 10mg/day with target INR 2.5-3.5. Consultation with hepatobiliary surgeon was done for shunt operation, but operation was not possible due to poor general condition. This patient improved satisfactorily with low molecular weight heparin, warfarin and supportive measures. Budd-Chiari syndrome is a rare veno-occlusive disorder involving hepatic vasculature.

Difficulty in diagnosis of nasopharyngeal carcinoma.

Due to difficult anatomical position nasopharyngeal carcinoma (NPC) is always challenging problems both from the diagnostic and therapeutic corner. A 24 years old lady came to our Department of Otolaryngology and Head-Neck Surgery with the complaints of epistaxis, right sided neck swelling, nasal obstruction and headache. On digital palpation Nasopharyngeal mass was found. We took biopsy from nasopharynx under indirect vision but report was not conclusive. Then we did CT scan, nasendoscopy. Nasendoscopy showed bilateral ethmoidal polyp with nasopharyngeal mass. We took biopsy from the nasopharyngeal mass and confirmed the diagnosis.

Predictors of Malignancy in Thyroid Nodules.

Thyroid swellings are common clinical problem throughout the world and also in Bangladesh. Most of thyroid swellings are multinodular, but a good percentage is solitary thyroid nodule. There is no robust, feasible method for malignancy differentiation has not been well established. The study evaluated thyroid nodules for risk of malignancy and compared history, clinical, sonographic features and FNAC findings with histopathology. This was a cross sectional study on 160 consecutive subjects of thyroid nodules done in the department of ENT and Head Neck Surgery of Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh during from July 2018 to December 2019. All patients were admitted and diagnosed by detail history, clinical examination, investigations and underwent thyroidectomy. Detailed history, clinical examination, ultrasonographic finding and FNAC variables were documented retrospectively and a mathematical model was established for malignancy prediction. In this study mean age of the patients of thyroid nodules was 37.54±11.49 years and majority of the patients were within 21-40 years of age. Frequency of thyroid nodules is more in female with male female ratio 1:7. Most of the thyroid nodules appeared in this study within 0-2 years (61.9%). In this series of thyroid nodules constituted 88.1% firm, 8.8% hard, 3.1% cystic. Among the patients 89(55.6%) cases have solitary thyroid nodule and 71(44.4%) cases have multinodular goitre Majority of the nodules were warm 57.5% followed by cold 42.5%. FNAC showed nodular goitre 72.5%, Follicular neoplasm 1.3%, Papillary carcinoma of thyroid 7.5%, colloid goitre 9.4%, suspicious papillary carcinoma 3.8% and lymphocytic thyroiditis 1.3%. In this study out of 85 solid nodule, 69(81.18%) were benign and 16(18.82%) was malignant and out of 3 cystic nodule 3(100%) were benign. In this study most of the benign and malignant nodules were predominantly solid. Study showed the malignancy is significantly (p=0.001) more in solid than cystic nodules. Final diagnosis in this study was done on the basis of histopathological reports. Out of 160 patients, histopathologically benign lesion was 120(75%) and malignant was 40(25%). Among malignant cases 36(22.5%) cases were papillary carcinoma, 1 case was medullary carcinoma and 3 cases were follicular carcinoma.

Meta-analysis and risk assessment of fluoride contamination in groundwater.

This study aimed to carry out a systematic review of meta-analysis and risk assessment of the global pooled concentration of fluoride and identify the influencing factors of fluoride loads in groundwater. The study extracted data from 36 most prevalent regions of 20 countries in the world through various search engines using keywords as well as Boolean operators and follows the PRISMA statement in every phase of literature searching. The study illustrated the pooled concentration of fluoride in the selected 20 countries was 2.1267 mg/L (1.650, 2.604) at 95% confidence interval, which was higher than the WHO standards limit of 1.5 mg/L. The results of the meta-analysis suggested that pH, Na, HCO3 and rainfall was significantly positively correlated (r = ~0.4; p Ë‚ 0.05) to fluoride and has a weak correction with the other parameters such as local temperature, altitude, water depth, EC, Ca, and Mg (r = -0.064 to +0.214; p Ë‚ 0.05). Concerning, the risk assessment through oral and dermal route exposure revealed that the consumers in most of the regions were at considerable risk, and the children were more vulnerable than the adults (THQ > 1). The study findings would help to take measures for safe water supply in the affected areas. PRACTITIONER POINTS: The calculated pooled concentration of fluoride was 2.1267 mg/L (1.650, 2.604) at 95% CI in groundwater of the study areas. Climatic conditions and lithological composition are the key controlling factors for groundwater fluoride contamination. Semi-arid and arid regions are significantly affected by fluoride rather than humid areas. Regarding fluorosis in selected regions, children (78%) are more vulnerable than adults (23%).

Comparison between Efficacy of Combined Use of Hyaluronidise and Triamcinolone versus Hyaluronidise, Triamcinolone Acetonide and Oral Colchicine in the Treatment of Oral Submucous Fibrosis.

Oral submucous fibrosis (OSF) is a chronic complex potentially pre-malignant condition caused by chewing areca nut and other irritants. It is an insidious process characterized by Juxta-epithelial deposition of fibrous tissue in the oral cavity and pharynx. OSF is very common in Southeast Asia and also now a days increase in Europe and North America. The aim of this study to compare the effectiveness of intralesional injection of triamcinolone and hyalurunidase versus intralesional injection of triamcinolone plus injection hyalurunidase with oral colchicine. The study included 60 patients of clinically diagnosed case of oral submucous fibrosis. Patients were divided into two Groups A and B. Group A patients received combination intralesionsl injection of triamcinolone acetonide 10mg/ml in 1ml with injection hyalurunidase 1500IU in 2ml with injection 2% lidocaine 7ml. 15 days interval in 3 months and Group B received intralesional injection of triamcinolone acetonide 10mg/ml in 1ml with injection hyalurunidase 1500IU in 2ml with injection 2% lidocaine 7ml in each 15 days interval for 3 months with oral colchicine 0.5mg twice daily for 3 months. Diagnosis based on burning sensation of mouth, blanching of mucosa, ulceration in oral cavity and also reduced mouth opening. Follow up assessment was done at intervals 1st follow up on 21st days after starting of treatment then 2nd follow up after 3 months and last 3rd follow up after 6 months. Before starting of treatment all patients were properly explained about the study and took their written consent. Much more improvement occurred in Group B patients, reducing in burning sensation and also increases in opening of mouth. In both groups blanching mucosae were improved. Treatment regimen of Group B is more effective in increasing mouth opening and improves burning sensation of oral cavity. No side effects were seen in both groups' patients.

Efficacy of Clotrimazole 1% Solution Compared to Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% Cream in Patient with Otomycosis.

Fungal infection of the ear canal is called Otomycosis. It is more common in hot and humid condition. There are many modalities of treatment or therapeutic agent for treatment of otomycosis. Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% cream is a topical antifungal agent described to be effective in the treatment of otomycosis. This study was performed to compare the efficacy of topical application clotrimazole 1% solution and Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% cream in the treatment of otomycosis. A controlled, randomized and open clinical trial was carried out in ENT department of Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2020 to July 2020. Patients diagnosed with fungal otitis externa who were treated with topical antifungals were included in this study. They were randomized into two treatment groups: i) Clotrimazole 1% solution, 2) Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% cream. Patients were microscopically evaluated at two weeks of treatment to determine resolution of disease. Recurrence and complications were recorded. Demographic and clinical variables were collected and analyzed, follow up and final outcomes (absence of infection) were compared between two groups. One hundred & two (102) patients were included, 51 in the clotrimazole 1% solution group and 51 in the Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% cream group. Predominant symptoms are pain, pruritus, aural fullness and hearing loss. Aspergillus organism was isolated most frequently (63.73%). Treatment with clotrimazole 1% solution groups resulted in 88.23% resolution vs. 80.39% resolution with Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% cream at 2 weeks of treatment. Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% cream group demonstrated higher treatment failure 11.76 and 19.60 respectively. Clotrimazole 1% solution is more effective than Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% cream for uncomplicated otomycosis. More study is needed to corroborate our results.

Adsorption and desorption properties of arsenate onto nano-sized iron-oxide-coated quartz.

This study was conducted to investigate the adsorption and desorption properties of arsenate [As(V)] on nano-sized iron-oxide-coated quartz (IOCQ) through batch experiments. The coating of nano-sized iron oxide on the quartz surface was performed using the heat treatment process which aimed to utilize the adsorption properties of the nano-sized iron oxide and the filtration properties of the quartz. Environmental SEM-EDAX and BET techniques were used to analyze the surface morphology, elemental composition, surface area and the porosity of the adsorbent. SEM-EDAX analyses confirmed that arsenate was adsorbed on the IOCQ surface. BET results showed that the IOCQ adsorbent had higher pore volumes and high specific surface areas compared with the pure quartz. The study revealed that the adsorption rate of As(V) ion was very rapid and reached the equilibrium within 5 min. This study also revealed that almost 100% of As(V) removal was achieved within 5 minutes of adsorption reaction from the initial solution containing 1,000 microg-As(V)/L. The Langmuir adsorption isotherm model suitably explained the sorption characteristics of As(V) onto IOCQ. This desorption study showed that the adsorbent could be reused after reacting with mild HCl solution but the concentration of acid eluant or pH has a great impact on the coated adsorbent surface. The results indicate that the nano-sized iron oxide-coated adsorbent is potentially suitable for removal of arsenate from drinking water.

Metastasis in differentiated thyroid carcinoma.

Seventy patients of differentiated thyroid carcinoma (DTC) irrespective of age and sex were selected in ENT Department of Bangabandhu Sheikh Mujib Medical University, Dhaka Medical College Hospital and Rangpur Medical College Hospital who were admitted from March 2003 to March 2005. Female were more commonly affected (2.6:1) Papillary carcinoma was more common in 31-50 years of age and follicular carcinoma (ca) common in 41-50 years of age. Among the differentiated thyroid carcinoma papillary carcinoma found 77.15% and follicular ca. found 22.85%. Lymph node metastasis was more common in papillary (35%) than follicular carcinoma (12.5%). But distant metastasis was more common in follicular (12.5%) than papillary carcinoma (3.70). Maximum lymph node metastasis was found in level 3(55%), level 2(45%).

MDM2 SNP 285 is Associated with Reduced Lung Cancer Risk in Bangladeshi Population.

The MDM2 gene is a negative regulator of p53, which has been linked to lung cancer. Here, we have evaluated the association of MDM2 SNP 285 G>C (rs117039649) and SNP 354 A>G (rs769412) with lung cancer risk in Bangladeshi population at the National Institute of Cancer Research and Hospital, Dhaka, Bangladesh from July 2015 to June 2017. We have genotyped 126 lung cancer patients and 133 healthy controls from Bangladesh by PCR-RFLP method for this study. Statistical analyses were performed to define the associations. Multivariate logistic regression revealed that MDM2 SNP 285 decreases the risk of lung cancer (GC+CC vs. GG: OR = 0.29, 95% CI = 0.15-0.56, p<0.005). A stratification analysis confirmed that this protective status is extended to younger people, male, overweight people, and smokers (GC+CC vs. GG: OR = 0.25-0.29, 95% CI = 0.11-0.69, p<0.01). However, we did not find any association of SNP 354 with lung cancer risk in Bangladeshi population (p>0.05). The present data indicated that MDM2 SNP 285 G>C (rs117039649) reduces the chance of lung cancer development in Bangladeshi population. However, MDM2 SNP 354 A>G (rs769412) has no such association in the same population.

Cartilage Ossiculoplasty from Stapes to Tympanic Membrane in One-Stage Intact Canal Wall Tympanoplasty for Cholesteatoma.

This prospective study was conducted at Department of ENT, Mymensingh Medical College Hospital, a tertiary care center in Bangladesh January 2017 to December 2018 to report hearing results and post operative complications of cartilage interposition ossiculoplasty in one-stage intact canal wall (ICW) tympanoplasty for cholesteatoma where ossicular chain is eroded or has to be removed either partially or totally. Total 42 patients underwent Intact canal wall (ICW) tympanoplasty for cholesteatoma with at least intact stapes footplate and in conjunction, cartilage ossiculoplasty was done during the same procedure. Patients were followed up regularly at 1 week, 1 month, 3 month, 6 month and at 1 year as usual follow up protocol to note complications and hearing status in 1 year follow up. In intact stapes suprastructure group, in the preoperative period, the mean air conduction thresholds (AC), bone conduction threshold (BC) and air-bone gap (ABG) were 48.3db, 9.5db and 38.8db respectively. Postoperatively, with a mean follow-up of 12 months, AC, BC and ABG were 27.6db, 9.7db and 17.9db respectively. In missing stapes supra structuregroup, in the preoperative period, the mean air conduction thresholds (AC), Bone conduction threshold (BC) and air-bone gap (ABG) were 57.4db 13.5db and 43.9db respectively. Postoperatively, with a mean follow-up of 12 months, AC, BC and ABG, were 33.9db, 14.2db and 19.7db respectively. For management of cholesteatoma cases, cartilage ossiculoplasty can be done effectively in conjunction with of intact canal wall tympanoplasty in a single setting. Complications are a few and easily manageable. Hearing results are at least as good as with other prosthesis and helps in avoiding subsequent surgery, discomfort and cost to the patients.

Comparison between Outcomes of Endoscopic Sinus Surgery and Surgical Excision in Case of Rhinosporiodiosis.

Rhinosporiodiosis is a chronic granulomatous infection of the mucus membranes caused by Rhino sporidium seeberi that manifest as vascular friable polyps and arise in the nasal mucosa. The mode of infection is probably trans-epithelial penetration. Rhinosporiodiosis is endemic in India, Pakistan and Srilanka. It occurs sporadically in the United States of America. The aim of this study was to compare betweenthe outcomes of endoscopic sinus surgery andsurgical excision in rhinosporiodiosis. The cross sectional comparative study was conducted among 40 patients with rhinosporiodiosis from January 2018 to April 2019 in the department of Otolaryngology and Head-neck surgery of Mymensingh Medical College Hospital, Bangladesh. All the patients were following up to 6 month after surgery. Most of them are male 24(60.0%) and female are 16(40.0%). Age of the patients in this study was (Mean±SD) 34.8±13.5 years. More than half of the patients had rhinosporiodiosis in the inferior turbinate (25, 62.5%) followed by 8(20.0%) in nasal septum and 7(17.5%) in the nasal floor. Endoscopic Sinus Surgery was done purposively among 20 patients and surgical excision was done purposively among another 20 patients. At the time of operation no complication occurs in case of endoscopic sinus surgery but in case of surgical excision small of amount bleeding was present. All the patients were followed up to 6 month after surgery. No recurrence was found in patients with endoscopic sinus surgery but 7(35.0%) patients who underwent surgical excision had recurrence of rhinosporiodiosis at follow up after six months of surgery. Chi-square test showed that the incidence of recurrence after 6 months of surgery was significantly lower in endoscopic sinus surgery (p=0.004). The study results concluded that endoscopic sinus surgery is better option for rhinosporiodiosis.

Bacteriology of Chronic Supporative Otitis Media (CSOM) at a Tertiary Care Hospital, Mymensingh.

Chronic suppurative otitis media (CSOM) is a notorious infection in developing countries causing serious local damage and threatening complications. It was a cross sectional observational study to isolate and identify aerobic bacteria and to analyze the susceptibility pattern of the aerobic bacterial isolates. It was carried out from March 2017 to July 2018 in the department of Microbiology, Mymensingh Medical College, Mymensingh, Bangladesh. Samples were collected from Outpatient of ENT department, MMCH. Out of a total 300 patients with CSOM were enrolled in this study and 209 were culture positive. Among them gram negative organisms were 129(61.72%) and gram positive organisms were 70(33.49%). The most frequently isolated organism in this study was Pseudomonas aeruginosa 72(34.44%), gram positive organisms S. aureus 63(30.14%), E. coli 21(10.04%), other Pseudomonas spp (other than P. aeruginosa) 15(7.17%), mixed bacterial infectios 10(4.78%), Proteus spp 9(4.30%), CoNS 7(3.34%), Klebsiela lspp 7(3.34%), Acinetobactor spp 5(2.39%). P. aeruginosa isolates had least resistant to imipenem and colistin, S. aureus were showed high sensitivity to Vancomycin and Linezolid and E. coli were sensitive to imipenem and amikacin, ciprofloxacin and amikacin respectively. Pseudomonas aeruginosa was the most common bacteria isolated from chronic discharging ears followed by Staphylococcus aureus. Piperacillin-Tazobactum, Ciprofioxacin, Gentamicin and Amikacin were found to be the most suitable drug for Pseudomonas aeruginosa, S. aureus and E. coli. The resistance against ceftriaxone and aztreonam was found to be very high.

Lung cancer and exposure to arsenic in rural Bangladesh.

BACKGROUND: Arsenic is a known carcinogen but the risk of lung cancer from the widespread contamination of drinking water in rural Bangladesh has not been estimated. OBJECTIVES: To determine whether estimated exposure of villagers in Bangladesh to arsenic in drinking water differed between those with lung cancer and those with non-malignant lesions. METHODS: Data were obtained from 7286 subjects who underwent lung biopsy in 2003-2006 at a diagnostic centre taking referrals from throughout Bangladesh. Analysis was limited to 5372 people living in villages for the last 10 years who reported using tube well water. Of these, 3223 with a primary lung tumour were enrolled as cases and 1588 with non-malignant lesions as referents in an unmatched analysis. Arsenic exposure was estimated by average concentrations for each of 64 districts. Logistic regression was used to test the effects of age, arsenic and smoking on risk and to investigate relationship to cell type. RESULTS: Male cases were older than referents and more likely to smoke, to smoke >20 units/day and to smoke bidi-small, hand-rolled cigarettes. Odds ratios for lung cancer increased steadily with mean arsenic concentration, but the confidence interval excluded 1.0 only at concentrations >100 mug/l (OR 1.45, 95% CI 1.16 to 1.80). This trend was seen only in smokers where the increased risk at >100 mug/l was 1.65 (95% CI 1.25 to 2.18). A similar trend was seen in women smokers. Squamous cell lung cancer was more frequent in smokers and, having adjusted for smoking, in districts with arsenic concentrations >100 mug/l. CONCLUSIONS: Among Bangladeshis who smoke, those whose drinking water is contaminated with arsenic at concentrations >100 mug/l are at increased risk of lung cancer. With high levels of exposure misclassification and short latency of exposure, the study cannot estimate or exclude the likely long term risk in non-smokers and at lower arsenic concentrations.

Membrane Distillation of Meat Industry Effluent with Hydrophilic Polyurethane Coated Polytetrafluoroethylene Membranes.

Meat rendering operations produce stick water waste which is rich in proteins, fats, and minerals. Membrane distillation (MD) may further recover water and valuable solids, but hydrophobic membranes are contaminated by the fats. Here, commercial hydrophobic polytetrafluorethylene (PTFE) membranes with a hydrophilic polyurethane surface layer (PU-PTFE) are used for the first time for direct contact MD (DCMD) on real poultry, fish, and bovine stick waters. Metal membrane microfiltration (MMF) was also used to capture fats prior to MD. Although the standard hydrophobic PTFE membranes failed rapidly, PU-PTFE membranes effectively processed all stick water samples to colourless permeate with sodium rejections >99%. Initial clean solution fluxes 5-6 L/m²/h declined to less than half during short 40% water recovery tests for all stick water samples. Fish stick water uniquely showed reduced fouling and up to 78% water recovery. Lost flux was easily restored by rinsing the membrane with clean water. MMF prior to MD removed 92% of fats, facilitating superior MD performance. Differences in fouling between stick waters were attributed to temperature polarisation from higher melt temperature fats and relative proportions to proteins. Hydrophilic coated MD membranes are applicable to stick water processing but further studies should consider membrane cleaning and longer-term stability.

Unusual perforating foreign body in the neck.

Penetrating injury in the neck is not an uncommon condition, but a perforating foreign body like bamboo in the neck is uncommon. A 36 years old young man was admitted in Otolaryngology and Head Neck surgery department, Mymensingh Medical College hospital, with a history of accidental perforating injury in the neck with a bamboo, while driving a vehicle (tempo). Clinical examination revealed a bamboo measuring 4.6 X 0.09 ft. perforated in his neck from left to right. Surprisingly great vessels and air way spared. Due to difficult intubation, elective tracheostomy was done. Neck was explored and foreign body removed under general anesthesia. Haemostasis ensured and wound closed in layers after putting drain tubes. Recovery was uneventful and was discharged after three weeks.

Repetitive transcranial magnetic stimulation in neuropathic pain secondary to malignancy: a randomized clinical trial.

BACKGROUND: Significant analgesic effects of repetitive transcranial magnetic stimulation (rTMS) have been found in several studies of patients with chronic pain of various origins, but never for malignancy. The objective of this study was to assess the efficacy of 10 sessions of rTMS over the primary motor cortex (M1) in patients suffering from malignant neuropathic pain. METHODS: Thirty-four patients were randomly allocated into one of two groups to receive real (20 Hz, 10 s, 10 trains with 80% intensity) or sham rTMS daily for 10 consecutive days. Patients were evaluated using a verbal descriptor scale (VDS), a visual analogue scale (VAS), Leeds assessment of neuropathic symptoms and signs (LANSS) and Hamilton rating scale for depression (HAM-D) at baseline, after the first, fifth and 10th treatment sessions, and then 15 days and 1 month after treatment. RESULTS: There were no significant differences between real and sham groups in the duration of illness or pain rating scores at the baseline. A significant 'Time × Group' interaction was recorded indicating that real and sham rTMS had different effects on the VDS, VAS, LANSS and HAM-D scales. Post-hoc testing showed that the group of patients treated with real rTMS had greater improvement in all scales that persisted up to 15 days, but were not present 1 month later. Significant positive correlations between the percentage of pain reduction and HAM-D after the 10th session and 15 days later were recorded. CONCLUSION: The results demonstrate that 10 rTMS sessions over the M1 can induce short-term pain relief in malignant neuropathic pain.

Doxorubicin, an RNA synthesis inhibitor, prevents vasoconstriction and inhibits aberrant expression of endothelin-1 in the cerebral vasospasm model of the rat.

A vasoconstrictor peptide, endothelin-1 (ET-1), has been identified as one of the causative substances in cerebral vasospasm after subarachnoid hemorrhage. We investigated whether doxorubicin, an RNA synthesis inhibitor, effectively suppresses induction of ET-1 in the rat vasospasm model. Blood was injected around the right femoral artery and the left one was used as an internal control. Seven days later (day 7), diameters of the right femoral arteries narrowed to about 60% and this vasoconstriction was prevented by clinical dose (0.6 mg/kg) or one third of its dose of doxorubicin injected on day 1. Reverse transcriptase-polymerase chain reaction analysis demonstrated that expression of ET-1 mRNA in the vasospastic artery was not detected in doxorubicin-treated rats. It is concluded that doxorubicin effectively inhibits aberrant expression of ET-1 in the vasospasm-destined artery in the rat.

Argatroban, a thrombin inhibitor, decreased mortality after 10 min of forebrain ischemia in the gerbil.

We investigated whether anticoagulant therapy with heparin or a selective thrombin inhibitor, argatroban, may ameliorate the postischemic cerebral circulation and attenuate mortality after 10 min of forebrain ischemia. Postischemic subcutaneous injection of argatroban (5 mg/kg) significantly attenuated mortality (9.1%) compared with non-treatment (45.5%) during 14 days' observation period. This effect coincided with: (1) increased cortical CBF after reperfusion; (2) attenuation of brain edema; and (3) less severe cell damages in the cerebral cortex. In contrast, nine of the 22 gerbils treated with heparin (830 IU/kg) were found dead on the next day due to massive bleeding in the surgical wound and 13 bleeding-avoided gerbils did not show significant amelioration in mortality (30.8%). These findings suggest that argatroban is an effective anticoagulant for prevention of cell damage after a relatively long forebrain ischemia.