Therapeutic effects of oral liothyronine on aluminum phosphide poisoning as an adjuvant therapy: A clinical trial.

BACKGROUND: In aluminum phosphide (AlP) poisoning, death is mainly due to cardiovascular failure and refractory acute heart failure. There is a lot of evidence showing thyroid hormones have cardioprotective effects. OBJECTIVE: The purpose of this study was to evaluate the effect of oral liothyronine in the treatment of AlP poisoning. METHODS: Twenty-four patients from intensive care unit of Baharloo Hospital, Tehran, Iran, were included based on the inclusion and exclusion criteria. They were randomly divided into two parallel groups of 12 cases and 12 controls. Intervention in the case group was administration of 50 µg liothyronine via nasogastric tube after gastric lavage, in the first 6 h of poisoning. In both groups, the routine treatment of AlP poisoning was performed. Blood samples were prepared at the beginning of the study and after 12 h. Patients were followed up till discharge from the hospital or death. RESULTS: The findings demonstrated that oral liothyronine was able to significantly improve systolic blood pressure, arterial blood pH, and total thiol molecules and also could decrease lipid peroxidation, increase catalase activity, and prevent further decline in total antioxidant capacity. CONCLUSION: Liothyronine administration is effective in controlling AlP poisoning and can improve patients' outcome.

Pregnancy outcomes in women with inflammatory bowel disease following exposure to thiopurines and antitumor necrosis factor drugs: a systematic review with meta-analysis.

Several studies have indicated the harmful effect of flare-up periods in pregnant women with inflammatory bowel disease (IBD) on their newborns. Therefore, an effective and safe medical treatment during pregnancy is of great concern in IBD patients. The aim of this study was to perform a meta-analysis on the outcomes of thiopurines use and a systematic review of antitumor necrosis factor (anti-TNF) drugs used during pregnancy in women with IBD. The results of cohorts evaluating the safety of anti-TNF drugs during pregnancy up to July 2013 were collected and analyzed. In the meta-analysis, a total of 312 pregnant women with IBD who used thiopurines were compared with 1149 controls (women with IBD who were not treated with any medication and women who were exposed to drugs other than thiopurines) to evaluate the drug effect on different pregnancy outcomes, including prematurity, low birth weight, congenital abnormalities, spontaneous abortion, and neonatal adverse outcomes. Results of statistical analysis demonstrated that congenital abnormalities were increased significantly in thiopurine-exposed group in comparison with control group who did not receive any medicine for IBD treatment. The summary odds ratio was 2.95 with 95% confidence interval = 1.03-8.43 (p = 0.04). We observed no significant differences in occurrence of other adverse pregnancy outcomes between compared groups. The results of cohorts evaluated the safety of anti-TNF drugs during pregnancy demonstrated no increase in occurrence of adverse pregnancy outcomes in comparison with controls except for the significant decrease in gestational age of newborns of drug-exposed mothers in one trial. In conclusion, a benefit-risk ratio should be considered in prescribing or continuing medicinal therapy during pregnancy of IBD patients.

A systematic review on the nerve-muscle electrophysiology in human organophosphorus pesticide exposure.

This article presents a systematic review of the recent literature on the scientific support of electromyography (EMG) and nerve conduction velocity (NCV) in diagnosing the exposure and toxicity of organophosphorus pesticides (OP). Specifically, this review focused on changes in EMG, NCV, occurrence of intermediate syndrome (IMS), and OP-induced delayed polyneuropathy (OPIDN) in human. All relevant bibliographic databases were searched for human studies using the key words "OP poisoning", "electromyography", "nerve conduction study," and "muscles disorders". IMS usually occurs after an acute cholinergic crisis, while OPIDN occurs after both acute and chronic exposures. Collection of these studies supports that IMS is a neuromuscular junction disorder and can be recorded upon the onset of respiratory failure. Due to heterogeneity of reports on outcomes of interest such as motor NCV and EMG amplitude in acute cases and inability to achieve precise estimation of effect in chronic cases meta-analysis was not helpful to this review. The OPIDN after both acute and low-level prolonged exposures develops peripheral neuropathy without preceding cholinergic toxicity and the progress of changes in EMG and NCV is parallel with the development of IMS and OPIDN. Persistent inhibition of acetylcholinesterase (AChE) is responsible for muscle weakness, but this is not the only factor involved in the incidence of this weakness in IMS or OPIDN suggestive of AChE assay not useful as an index of nerve and muscle impairment. Although several mechanisms for induction of this neurodegenerative disorder have been proposed as were reviewed for this article, among them oxidative stress and resulting apoptosis can be emphasized. Nevertheless, there is little synchronized evidence on subclinical electrophysiological findings that limit us to reach a strong conclusion on the diagnostic or prognostic use of EMG and NCV for acute and occupational exposures to OPs.

Meta-analysis finds use of inhaled corticosteroids during pregnancy safe: a systematic meta-analysis review.

Inhaled corticosteroids (ICs) are the drug of choice for asthmatic women during pregnancy, but the results on the effects of these medications on obstetrical and perinatal outcomes are not conclusive. Meta-analysis is the statistical analysis of a collection of analysis results from individual studies for the purpose of integrating the findings. Meta-analysis techniques are necessary because only summary statistics are available in the literature. In order to determine the risk of exposure to ICs, we pooled data from all clinical studies that evaluated the pregnancy and perinatal outcomes in women exposed to this group of drugs during pregnancy by the meta-analytic technique. PUBMED, OVID, EMBASE and SCOPUS databases were searched for studies that investigated birth outcome following exposure to ICs during pregnancy. Data were collected from 1997 to 2005 (up to 31 December). Types of outcome investigated were major malformations, preterm delivery, low birth weight and pregnancy-induced hypertension. The criteria for inclusion of studies in this meta-analysis were exposure of women to any therapeutic dosage of any ICs (fluticasone, beclomethasone, budesonide, triamcinolone and flunisolide) during pregnancy. The results showed that ICs do not increase the risk of major malformations, preterm delivery, low birth weight and pregnancy-induced hypertension. In conclusion, ICs do not increase the rates of any obstetrical outcomes investigated in the present study and interestingly improve the symptoms and are helpful in the management of asthma and thus can be used comfortably during pregnancy.

Protection by Ziziphora clinopoides of acetic acid-induced toxic bowel inflammation through reduction of cellular lipid peroxidation and myeloperoxidase activity.

Inflammatory bowel disease (IBD) is a chronic condition of the intestine with unknown etiology involving multiple immune, genetic and environmental factors. We were interested in examining the effect of a total extract from Ziziphora clinopoides, an Iranian folk herbal medicine, in the prevention and control of experimental mouse IBD. Z. clinopoides was administered (75, 150, 300 mg/kg) through drinking water to mice, which dispensed a toxic dose of acetic acid intrarectally. Prednisolone was used as the standard drug for comparison. Biochemical, macroscopic and microscopic examinations of the colon were performed. Biochemical evaluation of the inflamed colon was carried out using assays of myeloperoxidase (MPO) activity and thiobarbituric acid reacting substances (TBARS) as indicators of free radical activity and cellular lipid peroxidation. Results indicated that the activity of MPO and lipid peroxidation products (TBARS) increased in acetic acid-treated groups, while recovered by pretreatment of animals with Z. clinopoides (75-300 mg/kg) and prednisolone. All doses of Z. clinopoides and prednisolone-treated groups showed significant lower score values of macroscopic and microscopic characters when compared to the acetic acid-treated group. The beneficial effect of Z. clinopoides (300 mg/kg) was comparable to that of prednisolone. It is concluded that Z. clinopoides inhibits acetic acid toxic reactions in the mouse bowel through inhibition of cellular oxidative stress. Proper clinical investigation should be carried out to confirm the same activity in human.

Evaluation of availability, accessibility and prescribing pattern of medicines in the Islamic Republic of Iran.

Prescribing, dispensing, availability and affordability of drugs were evaluated in 100 primary health care centres in 5 provinces of the Islamic Republic of Iran using WHO indicators. On average, 92% of the 12 essential drugs monitored were available in the health centre pharmacies and 95% of the drugs prescribed by the physician were dispensed by the health centre pharmacy. The stock-out duration was less than 1 month on average. A complete treatment for pneumonia cost only 2% of the lowest weekly government salary. The national average number of drugs per prescription was 3.4. Prescription of antibiotics and injectable drugs was very high (58% and 41% respectively). Although availability and affordability of essential drugs is good in this country, rational use of drugs needs to be emphasized.

Evaluation of availability, accessibility and prescribing pattern of medicines in the Islamic Republic of Iran

Prescribing, dispensing, availability and affordability of drugs were evaluated in 100 primary health care centres in 5 provinces of the Islamic Republic of Iran using WHO indicators. On average, 92% of the 12 essential drugs monitored were available in the health centre pharmacies and 95% of the drugs prescribed by the physician were dispensed by the health centre pharmacy. The stock-out duration was less than 1 month on average. A complete treatment for pneumonia cost only 2% of the lowest weekly government salary. The national average number of drugs per prescription was 3.4. Prescription of antibiotics and injectable drugs was very high [58% and 41% respectively]. Although availability and affordability of essential drugs is good in this country, rational use of drugs needs to be emphasized

Managing hypothyroidism during pregnancy.

QUESTION: One of my pregnant patients is taking levothyroxine for hypothyroidism. I prescribed her iron because she was anemic, but she continues to be weak and to have high levels of thyroid-stimulating hormone (TSH). Increasing her dose of levothyroxine did not seem to affect her TSH levels. ANSWER: Many women need higher doses of levothyroxine during pregnancy. You should continue to monitor her TSH levels carefully and be aware that iron given during pregnancy might form an insoluble complex with thyroxine in the gestational tract.

Potentiation by nitric oxide synthase inhibitor and calcium channel blocker of aspartame-induced antinociception in the mouse formalin test.

By applying a 12 day regimen of the non-calorific sweetener, aspartame, in combination with representative compounds of the calcium channel blocker and nitric oxide synthase inhibitor, we tried to investigate using a formalin-test in mice the relative role of aspartame on pain and its mechanism of action. Verapamil (2, 3.5, 5, 7.5 mg/kg) induced significant (P < 0.01) antinociception in both phases of the formalin test. L-Nitro-arginine-methyl-ester (L-NAME) at the doses used, induced significant (P < 0.01) antinociception in early phase (1, 2, 5, 10 mg/kg) and late phase (5, 10 mg/kg). Twelve days of treatment in animals by aspartame (0.16% w/v) significantly induced antinociception in both phases of the formalin test. Both verapamil (5 mg/kg) and L-NAME (10 mg/kg) significantly (P < 0.01) potentiated aspartame-induced antinociception in both phases of formalin test. The present findings support the hypothesis that the activation of NMDA receptors by aspartame modulates pain-related behaviour via a nitric oxide/cGMP/glutamate release cascade. It is concluded that aspartame would be a good analgesic agent if it would be used in combination with a calcium channel blocker or NOS inhibitor.

Saccharin effects on morphine-induced antinociception in the mouse formalin test.

This study was performed to investigate the role of sweetness and taste sensations of the non-caloric sweetener saccharin on pain and morphine antinociception by the formalin test in mice. The formalin test was chosen because it measures the response to a long-lasting nociceptive stimulus and thus may closely resemble clinical pain. The total time (seconds) spent licking and biting the injected paw (indices of nociception) during periods of 0-5 min (early phase) and 10-30 min (late phase) were measured as an indicator of pain and inflammatory responses. A 12 days pretreatment of animals with saccharin (0.04%, 0.08%, 0.16%) produced complex effects on the action of morphine. All doses significantly potentiated the low dose (1.5 mgkg(-1)) of morphine-induced analgesia in the early phase significantly but antagonized the effect of morphine (3 mgkg(-1)). The effect of high doses of morphine (6-9 mgkg(-1)) was antagonized by the low dose of saccharin (0.04%), but the effect of morphine (6 mgkg(-1)) was potentiated with high concentrations of saccharin (0.08% and 0.16%). All doses of saccharin decreased the analgesic effect of morphine at a dose of 9 mgkg(-1). Analgesic effects of low doses of morphine (1.5-3 mgkg(-1)) were decreased by all doses of saccharin in the late phase. Different concentrations of saccharin also affected the antagonistic effect of naloxone (0.4 mgkg(-1)) on morphine-induced analgesia in both phases of the formalin test. The high dose of saccharin (0.16%) potentiated the effect of naloxone in the late phase. The results obtained suggest that sweet sensation is an important factor in mediating morphine analgesic properties. It is therefore inappropriate to use different concentrations of sweet saccharin solutions interchangeably.

Cholecystokinin receptor mechanism(s) and morphine tolerance in mice.

In a previous work, the effects of cholecystokinin receptor agonists on tolerance to morphine antinociception were evaluated. In the present study, the influence of cholecystokinin antagonists on the inhibition of tolerance to morphine antinociception by cholecystokinin agonists has been investigated. Maximum tolerance to morphine antinociception was obtained by morphine administration (50 mg/kg) to mice once daily for 4 days. The cholecystokinin receptor agonists caerulein (0.005 mg/kg) or cholecystokinin-8 (0.01 mg/kg) but not unsulfated cholecystokinin-8 (0.01 mg/kg) decreased the development of tolerance to morphine (9 mg/kg). The cholecystokininA receptor antagonist MK-329 (1 mg/kg) or the cholecystokininB receptor antagonist L-365,260 (0.25, 0.5 and 1 mg/kg) also diminished the tolerance to morphine antinociception. When animals were challenged with different doses of MK-329 (0.25, 0.5 and 1 mg/kg) against cholecystokinin-8 (0.01 mg/kg), caerulein (0.005 mg/kg) or unsulfated cholecystokinin-8 (0.01 mg/kg) on day 4 in tolerant mice, different response were obtained. Higher doses of MK-329 (1 mg/kg) caused a small decrease in attenuation of the morphine tolerance induced by cholecystokinin-8 and caerulein. Low doses of L-365, 260 diminished the effect of cholecystokinin-8 on morphine tolerance. Conversely high doses of the drug potentiated the response of caerulein (0.005 mg/kg). When animals were treated with MK-329 or L-365,260 before unsulfated cholecystokinin-8, reduction of the tolerance to morphine antinociception was obtained. These data indicate that both cholecystokinin receptors may modulate morphine tolerance.

Interaction between calcium channel blockers and sweetening agents on morphine-induced analgesia in mice by formalin test.

1. Calcium is known to be an important ion in the modulation of nociception and inflammation. Previous research has shown that mice drinking sweet-tasting solutions such as sucrose, saccharin and aspartame exhibit significant changes in morphine-induced analgesia in both phases of the formalin test. 2. In this study, the role of calcium channel blockers on the effectivity of a 12-day regimen of different sweetening agents (sucrose 32%, saccharin 0.08% and aspartame 0.16%) on the alteration of the morphine response has been investigated. 3. Male albino mice weighing 20-27 g were used for experiments. Animals were given 12 days to adapt to dietary conditions. Animals were given morphine (1.5, 3, 6, 9 mg/kg) subcutaneously 30 min before observation. Nifedipine (5 mg/kg), verapamil (5 mg/kg) and diltiazem (10 mg/kg) were administered intraperitoneally 20 min before morphine injection. 4. Recording of the early phase started immediately and lasted for 10 min after formalin injection. Recording of the late response started 20 min after formalin injection and lasted for 10 min. 5. Calcium channel blockers potentiated the antinociceptive effects of sweetening agents and diminished the antagonistic effects of these compounds on morphine-induced analgesia in the early and late phases of the formalin test. 6. It is proposed that calcium has a role for the interactive effects of sweetening agents and morphine on pain sensitivity.

Effect of granisetron on morphine-induced analgesia in mice by formalin test.

1. In this investigation, the influence of a selective 5HT3 antagonist, granisetron, on morphine-induced antinociception in the formalin test has been studied. There is evidence that the 5HT3 receptor system takes part in analgesic response. 2. Male albino mice weighing 22-27 g were used in the experiments. All drugs were administered 30 min before formalin injection. Comparison between groups was made by analysis of variance and then Newman-Keuls test. 3. Different doses of morphine (1.5-9.0 mg/kg) subcutaneously induced antinociception in both phases of the formalin test. 4. Coadministration of granisetron (0.1-10.0 mg/kg) intraperitoneally had no effect on morphine analgesia, but granisetron injection alone induced dose-dependent analgesia in both phases of the formalin test. 5. Results of this study suggest a role for a new selective 5HT3 antagonist in analgesia.