Mycoplasma pneumoniae-associated mucositis--case report and systematic review of literature.

BACKGROUND: Mycoplasma pneumoniae, a bacterium known to be a common cause of pneumonia, has been documented to cause complications such as debilitating mucositis previously described as an atypical Stevens-Johnson syndrome without skin lesions. However, in the spectrum of epidermal dermatopathies, the condition is increasingly recognized as a separate entity, now termed M. pneumoniae-associated mucositis (MPAM). OBJECTIVES: We present a case of MPAM and systemically review the literature to discuss diagnostic and therapeutic options. METHODS: A systematic literature search was performed to find studies reporting MPAM in adults. We extracted and analysed patient demographics, disease symptomatology, diagnostic testing and treatment. RESULTS: Eleven articles, describing 12 patients and our own patient met the predefined criteria and were analysed. Respiratory, ocular and oral symptoms were present in all patients. Therapies predominantly included antibiotics (10 of 13) and immunosuppressive treatment (9 of 13) leading to complete resolution of symptoms in all patients. CONCLUSION: Our findings highlight that MPAM should be recognized as a distinct disease entity within the spectrum of epidermal dermatopathies. We discuss and show in our patient why M. pneumoniae IgA serum levels could prove to be more reliable diagnostic tools in the MPAM diagnosis than the widely used IgG and IgM titre levels.

Synthesis and antifertility activity of some oximinoandrostenes.

PIP: 3-aza-A-homo steroids have been of interest to these authors in their efforts to develop novel progestational agents. Because it exhibits antifertility activity both in humans and animals, 17alpha-ethynyl-19-nortestosterone (norethindrone) was chosen to undergo molecular modification. The syntheses of a number of oximino and 3-aza-A-homoandrostenes are described in the experimental section of the article. The progestational responses of the compounds were tested through the observation of rabbit uteri. The capacity of a compound to inhibit fertility in rate was noted from the minimum effective dose, i.e., the amount of compound in mg/kg per day which completely suppressed litter production (compound given to both male and female). Because of the suspicion that the oximino steroids were acting postcoitally, 17-beta-acetoxy-19-norandrost-4-en-3-one oxime was studied for its postcoital activity in rats. The postcoital antifertility action of the compound appears to be due to lytic degeneration of zygotes and/or their rapid expulsion from the reproductive tract. Some structure-function observations are made concerning the various compounds.^ieng

High-pressure liquid chromatographic analysis of triflubazam and its metabolites in human and animal blood and urine.

A high-pressure liquid chromatographic method is described for analyzing triflubazam [1-methyl-5-phenyl-7-trifluoromethyl-1H-1,5-benzodiazepine-2,4(3H,5H)-dione] and its primary metabolites in blood and urine. Adsorption chromatography, using pellicular silica gel as the stationary phase and dioxane-isooctane as the mobile phase, permitted rapid sample analysis. After extraction of blood and urine samples with toluene, quantitation is achieved using liquid chromatography with an internal standard. The method is sensitive above 50 ng/ml of triflubazam and its known metabolites. Recoveries for all compounds from blood or urine averaged above 95 percent. The specificity of the method was established by collecting samples separated by liquid chromatography and characterizing them by mass spectrometry. Human and animal data are presented to illustrate the utility of the method.

Rapid analysis of individual tablets by high pressure reverse phase liquid chromatography.

A high pressure liquid chromatographic determination of a steroidal oxime in the pharmaceutical dosage form is reported. The reversed phase liquid-liquid partition chromatography employing ODS-Permaphase as support allows thirty to forty individual tablets to be analyzed per hour at a dose level of 50 micrograms to 1 milligram per tablet. The method is simple, rapid, accurate and sensitive.

Effects of intrathecal opioid on extubation time, analgesia, and intensive care unit stay following coronary artery bypass grafting.

STUDY OBJECTIVE: To determine if intrathecal opioid decreases time to extubation after coronary artery bypass surgery without compromising postoperative analgesia. DESIGN: Prospective randomized trial. SETTING: Veterans Affairs Hospital. PATIENTS: 21 ASA physical status III and IV men scheduled for elective coronary bypass surgery, who had not received medications that would impair anticoagulation at the time of surgery. INTERVENTIONS: Patients were randomized to receive 10 micrograms/kg morphine and 25 micrograms fentanyl intrathecally preoperatively (n = 12) or no intrathecal opioid (n = 9). The latter group received 25 to 50 micrograms/kg fentanyl and 0.05 to 0.1 mg/kg midaxolam intraoperatively, whereas the intrathecal opioid group received intravenous (i.v.) fentanyl and midazolam only as needed. Both groups were administered i.v. morphine and midazolam postoperatively as needed by intensive care unit (ICU) personnel who were blinded to the treatment group. MEASUREMENTS AND MAIN RESULTS: For the first 24 hours postoperatively, pain levels (0 = none, to 10 = most severe) and sedation levels (1 = none, to 5 = unconscious) were measured hourly. The time to extubation and discharge from the ICU was recorded. ECG evidence of myocardial ischemia was noted. Pain scores were low for both groups (1.5), but the intrathecal opioid subjects exhibited less sedation than the high-dose fentanyl subjects [means +/- standard deviation (SD) of 2.3 +/- 0.4 vs. 2.8 +/- 0.5, p = 0.03]. Extubation time was 12 hours shorter in the intrathecal opioid group (2.9 +/- 5.3 vs. 14.7 +/- 6.8, p = 0.001). The five subjects with a one day ICU stay were all in the intrathecal opioid group (p = 0.04). The incidence of myocardial ischemia did not differ between the two groups. CONCLUSIONS: Intrathecal opioid can facilitate early extubation and discharge from the ICU without compromising analgesia or increasing myocardial ischemia.

Properties of HTLV-I transformed CD8+ T-cells in response to HIV-1 infection.

HIV-1 infection studies of primary CD8(+) T-cells are hampered by difficulty in obtaining a significant number of targets for infection and low levels of productive infection. Further, there exists a paucity of CD8-expressing T-cell lines to address questions pertaining to the study of CD8(+) T-cells in the context of HIV-1 infection. In this study, a set of CD8(+) T-cell clones were originated through HTLV-I transformation in vitro, and the properties of these cells were examined. The clones were susceptible to T-cell tropic strains of the virus and exhibited HIV-1 production 20-fold greater than primary CD4(+) T-cells. Productive infection resulted in a decrease in expression of CD8 and CXCR4 molecules on the surface of the CD8(+) T-cell clones and antibodies to these molecules abrogated viral binding and replication. These transformed cells provide an important tool in the study of CD8(+) T-cells and may provide important insights into the mechanism(s) behind HIV-1 induced CD8(+) T-cell dysfunction.