Two new 11alpha,12alpha-epoxy-ursan-28,13beta-olides and other triterpenes from Cecropia catharinensis.

Three new triterpenes, 2alpha-acetoxy-3beta,19alpha-dihydroxy-11alpha,12alpha-epoxy-ursan-28,13beta-olide, 3beta-acetoxy-2alpha,19alpha-dihydroxy-11alpha,12alpha-epoxy-ursan-28,13beta-olide and 2-O-acetyl-euscaphic acid together eight known triterpenes were isolated from the roots and stems of Cecropia catharinensis. Their structures were determined by detailed analysis of NMR spectra and the relative configurations established by difference nOe experiments. In addition, four flavonoid glucosides (vitexin, isovitexin, orientin and isoorientin) were found in the leaves.

First Report of Citrus leprosis virus on Citrus in Santa Cruz, Bolivia.

The citrus crop is rapidly expanding in the Province of Santa Cruz de la Sierra, Bolívia. Citrus, mostly planted by small growers, currently comprises approximately 15,000 ha. Sweet oranges (Citrus sinensis) and mandarins (C. reticulate) are the main citrus-types grown primarily for internal consumption. Recently, there has been an increase in incidence of leprosis-like symptoms (round to elliptic lesions on the leaves, chlorotic to necrotic lesions in young twigs, and depressed small lesions on the fruits). These symptoms were associated with infestations by the tenuipalpid mite Brevipalpus sp. To verify if Citrus leprosis virus was the causal agent of the observed symptoms, leaf and fruit samples (mostly from Valencia sweet orange) were collected from commercial groves in El Torno, 32 km south of Santa Cruz, and Yapacani and Colónia San Juan, 130 km northwest of Santa Cruz. Small fragments of these samples were placed immediately in a mixture of glutaraldehyde and paraformaldehyde in cacodylate buffer and later processed with transmission electron microscopy at ESALQ, Piracicaba, SP, Brazil. Some of the leaf samples were dried at 35°C and used for reverse transcription-polymerase chain reaction (RT-PCR) with primers that specifically amplify portions of the genome of Citrus leprosis virus, cytoplasmic type (CiLV-C) (1) at Centro APTA Citros, Cordeirópolis, SP, Brazil. Brevipalpus sp. mites were also collected and kept in 90% ethanol for further identification at the University of Florida, Gainesville and ESALQ. In the samples from the three surveyed areas, transmission electron microscopy confirmed the presence of short bacilliform particles within endoplasmic reticulum cisternae and electron dense viroplasms in the cytoplasm, typical of infection by CiLV-C (2). CiLV-C specific primers amplified DNA fragments of expected sizes in RT-PCR from dried leaf samples that came from these three localities. Direct sequencing of at least three amplicons of each sample confirmed the identity of the virus. The consensus sequence of the putative movement protein gene in samples from Yapacani and Colónia San Juan (GenBank Accessions Nos. AY960216 and AY960215, respectively) were identical and exhibited 99% nucleotide and 98% amino acid homology with the Brazilian isolate sequence available at GenBank (Accession No. AY289190). The consensus sequence of the putative replicase gene found in the sample from El Torno (GenBank Accession No. AY960214) exhibited 96 and 93% nucleotide and amino acid homology, respectively with the Brazilian isolate (GenBank Accession No. AY289191). Sampled mites were identified as B. phoenicis (Geijskes), the known vector of CiLV-C (2). The symptomatology, particle morphology and cytopathology, detection by molecular methods and the association with infestation by B. phoenicis, together indicate that the foliar, stem, and fruit lesions in sweet orange observed in the Santa Cruz region were caused by CiLV-C. To our knowledge, this is the first report of this virus in Bolivia. References: (1) E. C. Locali et al. Plant Dis. 87:1317, 2003. (2) J. C. V. Rodrigues et al. Exp. Appl. Acarol. 30:161, 2003.

[Schizophrenia. Nursing approach. Current perspectives]. / Esquizofrenia. Abordaje de enfermería. Perspectivas actuales.

OBJECTIVES: To review recent publications which deal with the role nurses have regarding schizophrenia. Besides strict pharmacological treatment, the authors place value on the need to get involved with the deficit provoked by this disease and the usefulness of providing aid and support to patients' families, due to a belief that nurses can play a more decisive, innovating role in these areas. SOURCES: Publications about nurses' roles with patients diagnosed as schizophrenics published from 1995 to 2000 and listed in the Medline data base.

[Depression 1. Clinical aspects and nurses' evaluation]. / Depresión (I). Clínica y valoración de enfermería.

OBJECTIVES: To review the recent advances made in evaluation and treatment procedures in cases of depression and their repercussions in nursing care. The growing efficiency of antidepressive medication, together with the importance given to community awareness of the upheavals which affect mental health, have modified the role nursing plays in evaluation of patients suffering depressive episodes. In this changing context, the therapeutic relationship between nurse and patient has developed into one of the pillars which sustain a correct and long-lasting stability in the depressed patient's state of mind. SOURCES: Primary source information on treatment methods by nurses handling depressed patients published from 1995 through 1999 and identified in the Medline data base. In a second article, these same authors will evaluate the intervention and the follow-up procedures carried out by nurses caring for patients suffering from depression.

[Depression. 2. Treatment and nursing interventions]. / Depresión y (II). Tratamiento e intervenciones de enfermería.

OBJECTIVES: To review the recent advances in the evaluation and treatment procedures for depressive episodes and their repercussions on nursing care. The growing effectiveness of anti-depressive medication, together with the importance provided by community understanding of mental health disorders, have modified the role nurses play in evaluation (Part One in Revista ROL de Enfermeria 23(4):265-270), intervention and follow up (Part Two) for patients suffering from depressive episodes. In this context of change, the therapeutic relationship between nurse and patient has developed into one of the pillars which maintains a correct and long-lasting stabilization of a depressed patient's state of mind. SOURCES: Cases identified by Medline database referring to nursing treatment of patients suffering from depression, published from 1995 until 1999.

[Addicted patients. Attitude of nursing personnel]. / Pacientes toxicómanos. Actitud de enfermería.

Inside the realm of therapeutic relationships, one recognizes the importance of the nurse's attitude towards patients as one of those elements bearing influence on the objectives desired by the nursing profession. This study compares the attitudes towards via parenteral drug addicts held by nursing students and non specialized nurses. By means of a pilot study which used a selfadministered Litcker scale questionnaire developed by the study authors, two samples were selected: a student sample (n = 40) and a non specialized nurse sample (n = 40). These variables were evaluated in the two samples: age, professional experience, and the frequency in sporadic care for via parenteral drug addicts. The conclusion drawn from this study is that the attitude of nursing students is significantly more positive towards via parenteral drug addicts than the attitude held by non specialized nurses. The adoption of a more negative attitude towards these patients occurs at the start of a nurse's professional career.

Selective decontamination of the digestive tract in intensive care patients: review and commentary.

OBJECTIVE: To evaluate the benefits, risks, and costs of antimicrobial regimens used for selective decontamination of the digestive tract (SDD) in intensive care unit (ICU) patients. DATA SOURCES: Information was obtained from clinical trials, review articles, abstracts, and textbooks. Key indexing terms included antibiotics, selective decontamination, and infections. STUDY SELECTION: Research articles describing controlled clinical trials of SDD in medical or surgical ICU patients were reviewed. Trials that investigated transplant, cirrhotic, leukemic, or oncology patient populations were excluded. DATA EXTRACTION: The details of studies that evaluated nosocomial infection or nosocomial pneumonia rates were extracted. These included study design, demographics, SDD regimens, severity of illness scores, and colonization, infection, and mortality rates. DATA SYNTHESIS: The use of SDD in mechanically ventilated surgical or trauma ICU patients reduces the incidence of colonization, nosocomial pneumonia, and overall infection rates, but does not change the overall mortality rate. Administration of antibiotic and antifungal agents in a nasogastric suspension is required for SDD. The addition of systemic prophylactic antibiotics or oropharyngeal paste was not required to decrease nosocomial infections. The most frequently studied SDD regimen (colistin/amphotericin B/tobramycin) is not feasible for use in the US because of exorbitant drug costs. Less expensive alternatives include norfloxacin/nystatin, or colistin/nystatin/gentamicin. CONCLUSIONS: Additional research is required before SDD regimens can be routinely recommended in surgical and trauma ICU patients. A multicenter study is warranted to determine the long-range benefits, potential for resistance, and cost-effectiveness of SDD.

Neurotropic melanoma. A case report and review of the literature.

Neurotropic melanoma is a rare tumor with a biphasic growth pattern associated with a change in morphology from melanocytic features toward Schwann cell features. The tumor thereby develops a capacity for infiltrating nerves which may result in clinically evident cranial neuropathies, most commonly of the fifth and seventh cranial nerves. The histology of this lesion is difficult to interpret; it often erroneously appears fibrous in origin and may be considered to be benign. Despite this benign appearance histologically, the tumor behaves aggressively with multiple local recurrences and possible CNS invasion by either direct perineural growth or distant metastases. We review the literature of neurotropic melanomas and report a 46th case which describes a typical course with neural invasion. Although a rare cause of cranial neuropathies, the neurologist should consider this entity in the differential diagnosis and the history of a recurrent skin lesion of the face should be sought whenever examining such a patient.

Quantitative in vitro assessment of phototoxicity by a fibroblast-neutral red assay.

We have adapted the neutral red uptake assay for quantitative assessment of injury to fibroblast cultures by potential phototoxins. Tetracycline derivatives, quinolone derivatives, and chlorpromazine were used as model compounds for development of the assay. Human fibroblasts were incubated with potential phototoxins, the cell cultures irradiated with UV, and the capacity for neutral red uptake determined. Demeclocycline and doxycycline, two known photosensitizers, showed a 94% and 95% decrease of neutral red uptake, respectively, indicating photo-induced cytotoxicity. Minocycline, a non-photosensitizing tetracycline derivative, showed no decrease in uptake. Tetracycline, a weak phototoxin, showed minor (10%) decrease at equivalent concentrations (20 micrograms/ml). Microscopic observation of neutral red uptake and cell damage paralleled the spectrophotometric findings. Chlorpromazine, a non-tetracycline phototoxin, showed 91% decrease. An additional group of phototoxic drugs, quinolone antibacterials, were studied. Nalidixic acid, ofloxacin, ciprofloxacin, and norfloxacin all demonstrated phototoxicity, with nalidixic acid showing the greatest decrease in neutral red uptake. This methodology may provide a useful rapid method to quantify phototoxic potential of new drugs or suspected phototoxins.

Efficacy of tolciclate solution in patients with tinea pedis.

Forty patients with tinea pedis were treated for six weeks in a double-blind study with a tolciclate or placebo solution. The tolciclate solution demonstrated moderate efficacy compared with placebo. The finding of positive KOH preparations in a significant number of tolciclate-treated patients with persistently negative cultures suggests that the vehicle used (polyethylene glycol-400) may not provide adequate penetration of this effective antifungal agent. No adverse effects were noted.

The aging skin.

The anatomic, biochemical, and physical changes occurring in the skin with aging are reviewed and discussed. An attempt is made to distinguish between changes resulting from accumulated injury from environmental factors and the changes of aging per se.

Excess granulation tissue responses associated with isotretinoin therapy.

Multiple polypoid projections of granulation tissue developed in two patients receiving isotretinoin for acne. Histological study of the lesions revealed increased amounts of non-sulphated acid mucopolysaccharides in the ground substance of the granulation tissue stroma. Complete resolution occurred following curettage with or without chemical cautery. The role of isotretinoin in the development of these lesions is discussed.

Generalized staphylococcal scalded skin syndrome in an anephric boy undergoing hemodialysis.

Generalized staphylococcal scalded skin syndrome (SSSS) is a toxin-related epidermolytic disease that predominantly affects previously healthy infants and children younger than 5 years. In contrast, the majority of the reported adult cases have been associated with underlying diseases, suggesting that immunosuppression and renal insufficiency are important predisposing conditions for this age group. We report herein a case of adult-type SSSS in an anephric 10-year-old boy. Patients undergoing hemodialysis who have chronic renal failure may be uniquely predisposed to the SSSS by virtue of their decreased glomerular filtration rate, associated uremic immunodeficiency, and a high incidence of Staphylococcus aureus bacteremia.

In-vitro testosterone metabolism in the mouse preputial gland: intercellular co-operation and changes with cell maturation.

In-vitro [14C]testosterone metabolism was investigated in isolated cells of adult male mouse preputial sebaceous glands. Labelled steroids were extracted and chromatographed after a 2-h incubation, and were identified as 5 alpha-dihydrotestosterone, androstenedione, 5 alpha-androstane-3,17-dione, 5 alpha-androstane-3 alpha,17 beta-diol and 5 alpha-androstane-3 beta,17 beta-diol, androsterone and 3-epiandrosterone. In cells separated according to state of maturity (lipid content) by isopycnic centrifugation in a metrizamide gradient, maximal testosterone metabolism occurred in large, nearly mature cells. In this population, mean hydroxysteroid 5 alpha-reductase and 17 beta-hydroxysteroid dehydrogenase activities were 3.8 and 2.3 nmol/10(6) cells per 2h respectively, more than 100-fold greater than in the densest population, comprised of undifferentiated and early differentiating cells. It was also found that the profile of testosterone metabolites was dependent on the proportion of the label metabolized. The metabolite index (MI), i.e. the average number of enzymatic steps undergone per molecule of metabolite, increased with increasing substrate utilization. Metrizamide showed reversible, non-specific inhibition of testosterone metabolism and reduction of the MI. Thus, it was postulated that testosterone is metabolized sequentially by different cells, with metrizamide inhibiting cellular uptake and intercellular substrate transport. This suggested that most of the metabolites would be found in the medium, rather than in the cellular compartment. Further, in incubations run without cell disaggregation, efficient substrate cycling among cells should result in a high MI, independent of metrizamide concentration and substrate utilization. These predictions were all confirmed, providing strong evidence that testosterone metabolism is a co-operative effort among several cells in this tissue.

Ultrasonic assessment of cutaneous atrophy caused by intradermal corticosteroids.

A noninvasive technique of pulsed ultrasound was used to determine the long-term changes in skin thickness resulting from intradermal injections of triamcinolone acetonide (TA). Injections of 0.1 ml of either saline or a suspension containing 5 mg/ml or 10 mg/ml of TA were made at selected sites on the forearms of two human volunteers. The corticosteroid-treated sites showed a maximal decrease of 30% to 40% of the original skin thickness at 4 to 8 weeks after a single injection. A transient thinning was observed at control sites injected with saline. A greater degree of thinning was seen at the site injected with 10 mg/ml of TA as compared to the site injected with 5 mg/ml of TA. The thinning at the corticosteroid injection sites persisted at least 18 weeks after the single corticosteroid injection but had approached normal thickness values by 44 weeks following treatment. Pulsed ultrasound may be useful as a noninvasive technique for monitoring the effects of intradermally injected corticosteroids on human skin thickness and may also be useful in assessing intrinsic atrophogenic potentials of different corticosteroid molecules in human skin and the duration of action of various injectable formulations of a corticosteroid.

Actions of isotretinoin and etretinate on the pilosebaceous unit.

Isotretinoin administered subcutaneously to male hamsters results in marked involution of the sebaceous glands of the flank organ without discernible effort on the other androgen-dependent structures, pigmented hair follicles, and dermal melanocytes. Treatment of androgen-stimulated female hamsters with isotretinoin prevented the androgen-induced growth of the sebaceous glands but not the formation of large pigmented hairs and dermal pigment cells. Etretinate, in comparable dosage, did not show the inhibitor effect on sebaceous gland growth. The hamster flank organ seems a promising system for assessment of the sebaceous gland inhibitory activity of retinoids and may be predictive for therapeutic activity in acne.

Differential effect of 13-cis-retinoic acid and an aromatic retinoid (Ro 10-9359) on the sebaceous glands of the hamster flank organ.

The effect of subcutaneously administered 13-cis-retinoic acid and an aromatic retinoid (Ro 10-9359) on the sebaceous glands of the hamster flank organ were compared. As previously reported, 13-cis-retinoic acid caused a marked diminution of sebaceous gland size without affecting other androgen dependent structures. The aromatic retinoid derivative showed no effect upon any of the flank organ components. Studies utilizing androgen stimulated female confirmed our previous finding that 13-cis-retinoic acid prevented the growth of sebaceous glands without affecting the development of dermal pigmentation or large pigmented hair follicles. The aromatic retinoid derivative showed slight, if any, effect upon sebaceous gland size and no effect upon pigmentation or pigmented follicle development. The findings with this model system suggest that any efficacy of Ro 10-9359 in the treatment of acne would be by some mode other than the inhibition of sebum production.

Effect of topical diflumidone on ultraviolet-light-induced erythema.

The relative topical efficacy of indomethacin and diflumidone, a novel non-steroidal antiinflammatory drug, for the suppression of ultraviolet-light (290-320 nm region; UVB)-induced erythema has been compared in a randomized, double-blind, placebo-controlled study in man. During the early phases of erythema development (3-6 h) following the administration of 3 minimal erythema doses (MED) of UVB, a single topical application of diflumidone and of indomethacin were found to be equal in their ability to inhibit the development of erythema compared to untreated or placebo-treated sites. At 24 h after application, the indomethacin-treated sites had significantly less erythema than did the diflumidone-treated sites. Pigmentation of test sites at 5 and 14 days following irradiation was indistinguishable at the diflumidone, placebo, or untreated sites, but relatively less pigment developed at the indomethacin-treated sites.

Effect of 13-cis-retinoic acid on the hamster flank organ.

Administration of 13-cis-retinoic acid subcutaneously to mature male hamsters produced a marked decrease in the size of the sebaceous glands of the flank organ, without diminution of other hormonally dependent structures of the flank organs. Subcutaneous administration of 13-cis-retinoic acid to female hamsters treated simultaneously with injections of testosterone enanthate prevented the androgen-induced growth of the flank organ sebaceous glands but did not prevent the growth of other hormonally dependent structures such as the dermal pigment cells and large pigmented hair follicles. The sebaceous gland progressively decreased during 3 weeks of treatment and the effect persisted at least 3 weeks after cessation of treatment but was completely reversed by 6 mos after treatment. In vitro studies of testosterone metabolism by hamster flank organ indicated the lack of inhibition of 5 alpha-reduction by 13-cis-retinoic acid. It seems likely that systemically administered 13-cis-retinoic acid, unlike antiandrogens, exerts a specific extrahormonal effect on the sebaceous glands of the hamster flank organ without affecting other androgen dependent cells.