Effect of oral naloxone on opioid-induced constipation in methadone maintenance treatment patients, a double-blind, placebo-control, clinical trial.

BACKGROUND: Opioid-induced constipation (OIC) is the most prevalent side effect of methadone maintenance therapy (MMT). Naloxone could reduce the OIC. METHOD: Fifty-six MMT cases (< 75 mg/day methadone, > 3 months) were entered randomly into four groups of a trial. They received placebo or naloxone tablets (0.5, 2, or 4 mg/day) once a day for 2 weeks. They continued their conventional laxative. Their constipation and opiate withdrawal (OWS) were evaluated by the Bristol Stool Form Scale (stool consistency and frequency), Patient Assessment of Constipation Symptoms (PAC-SYM) questionnaire, Constipation Scoring System (CSS), and the Subjective Opiate Withdrawal Scale (SOWS) before starting treatment and at the end of the first and second weeks. RESULTS: The dose of 4 mg/day naloxone was excluded from the study due to severe OWS. The precipitants of groups had similar ages, methadone dose and duration, laxative use, and constipation scores at the start of the trial. However, 2 mg of naloxone could change the stool consistency (PV = 0.0052) and frequency (P = 0.0133), 0.5 mg/day dose only improved the stool consistency (P = 0.0016). The patients' CSS and PAC-SYM scores were reduced by naloxone after the 1st week of treatment. However, there was no significant difference in the mean score of SOWS at different assessment times and groups. Also, 3 and 4 cases of 0.5 and 2 mg/day groups, respectively, withdrew from the study due to OWS. CONCLUSION: Oral naloxone at doses of 0.5 and 2 mg/day was significantly more effective than placebo on OIC in MMT. However, the dose of 4 mg induced intolerable OWS.

Neobaicalein, a flavonoid from the Scutellaria litwinowii Bornm. & Sint. ex Bornm. induced apoptosis in human leukemic cell lines.

Objectives: Neobaicalein is one of the rich plant flavonoids isolated from the roots of Scutellaria spp. In this study, we evaluated and compared cytotoxic activity and the related apoptosis mechanisms of neobaicalein from Scutellaria litwinowii Bornm. & Sint. ex Bornm on apoptosis-proficient HL-60 cells and apoptosis-resistant K562 cells. Materials and Methods: Cell viability, cell apoptosis, caspase activity, and apoptosis-related protein expression were measured using MTS assay, propidium iodide (PI) staining and flow cytometry, caspase activity assay, and western blot analysis, respectively. Results: Neobaicalein significantly reduced cell viability in a dose-dependent manner using the MTS assay (P<0.05). The IC50 values (µM) against HL-60 and K562 cells after 48 hr treatment were 40.5 and 84.8, respectively. Incubation of HL-60 and K562 cells with 25, 50, and 100 µM neobaicalein for 48 hr, significantly increased the number of apoptotic cells and showed cytotoxic effects compared with the control group. Treatment with neobaicalein significantly increased Fas (P<0.05) and the cleaved form of PARP (P<0.05), and decreased the Bcl-2 levels (P<0.05) in HL-60 cells, whereas neobaicalein significantly increased Bax (P<0.05) and the cleaved form of PARP (P<0.05), and the caspases of the extrinsic and intrinsic pathways including caspases-8 (P<0.0001), -9 (P<0.01), and effector caspase-3 (P<0.0001) levels in K562 cells compared with the control group. Conclusion: It seems neobaicalein might cause cytotoxicity and cell apoptosis through interaction with the different apoptosis-related proteins of apoptotic pathways in HL-60 and K562 cells. Neobaicalein may exert a beneficial protective effect in slowing the progression of hematological malignancies.

Evaluation of the Therapeutic Effects of the Hydroethanolic Extract of Portulaca oleracea on Surgical-Induced Peritoneal Adhesion.

OBJECTIVE: Peritoneal adhesion (PA) is an abnormal connective tissue that usually occurs between tissues adjacent to damaged organs during processes such as surgery. In this study, the anti-inflammatory and antioxidant effects of Portulaca oleracea (PO) were investigated against postoperative-induced peritoneal adhesion. METHODS: Thirty healthy male Wistar rats (220 ± 20 g, 6-8 weeks) were randomly divided into four groups: (1) normal, (2) control (induced peritoneal adhesion), and (3) and (4) PO extracts (induced peritoneal adhesion and received 100 or 300 mg/kg/day of PO extract for seven days). Finally, macroscopic and microscopic examinations were performed using different scoring systems and immunoassays in the peritoneal lavage fluid. RESULTS: We found that the levels of adhesion scores and interleukin- (IL-) 1ß, IL-6, IL-10, tumour necrosis factor- (TNF-) α, transforming growth factor- (TGF-) ß 1, vascular endothelial growth factor (VEGF), and malondialdehyde (MDA) were increased in the control group. However, PO extract (100 and 300 mg/kg) notably reduced inflammatory (IL-1ß, IL-6, and TNF-α), fibrosis (TGF-ß 1), angiogenesis (VEGF), and oxidative (MDA) factors, while increased anti-inflammatory cytokine IL-10, antioxidant factor glutathione (GSH), compared to the control group. CONCLUSION: Oral administration of PO improved postoperational-induced PA by alleviating the oxidative factors, fibrosis, inflammatory cytokines, angiogenesis biomarkers, and stimulating antioxidative factors. Hence, PO can be considered a potential herbal medicine to manage postoperative PA. However, further clinical studies are required to approve the effectiveness of PO.

Non-antibiotic adjunctive therapy: A promising approach to fight tuberculosis.

Tuberculosis (TB) is currently a clinical and public health problem. There is a concern about the emergence and development of multidrug-resistant (MDR-TB) and extensively drug-resistant (XDR-TB) species. Additionally, the lack of effective vaccines is another limitation to control the related infections. To overcome these problems various approaches have been pursued such as finding novel drug candidates with a new mechanism of action or repurposing conventional antibiotics. However, these strategies are still far from clinical application. Hence, the use of adjunctive therapy has been suggested for TB. In this paper, we review non-antibiotic adjunctive treatment options for TB. Natural products, vitamins, micronutrients, and trace elementals, as well as non-antibiotic drugs, are examples of agents which have been used as adjunctive therapies. The use of these adjunctive therapies has been shown to improve disease outcomes and reduce the adverse effects of antibiotic drugs. Employing these agents, either alone or in combination with antibiotics, might be considered as a promising approach to control TB infections and achieve better clinical outcomes. However, supportive evidence from randomized controlled trials is still scant and merits further investigations.

Drug utilization evaluation of albumin in a teaching hospital of Mashhad, Iran: an interventional pre-post design study.

Background Albumin is a protein colloidal solution with limited availability and high cost. It should be used in such approved indications as paracentesis, extensive burn, spontaneous bacterial peritonitis, and nephrotic syndrome. Objectives The aim of this study was to evaluate and compare the appropriateness of albumin usage before and after an evidence-based guideline. Setting Four wards of Imam Reza Hospital, Mashhad, Iran. Method An interventional pre-post design study was performed on 2 groups of patients; in gGroup 1 as a preparation phase group in 6 months from February 2015 to July 2015 and Group 2 as an interventional group from September 2015 to February 2016. A guideline for proper indications of albumin, designed and finalized based on the physicians' comments, was implemented in Group 2. Main outcome measure The pattern of albumin consumption. Results Fifty patients were evaluated in each group. The implementation of the guideline resulted in reduction of improper albumin use from 62 to 57.5%, which was not statistically significant; however., it reduced inappropriate dose and duration of albumin therapy (55.5-16.7%), the number of consumed albumin vial, and the average cost for each patient (317.78 ± 3.15-149.81 ± 1.91 USD) significantly, as well. Conclusion This study illustrated that in this hospital in most cases, albumin was used inappropriately and at an alarming rate. This improved after the introduction of an evidence-based guideline. Moreover, guideline implementation resulted in significant cost reduction.

Combination of anti-tuberculosis drugs with vitamin C or NAC against different Staphylococcus aureus and Mycobacterium tuberculosis strains.

BACKGROUNDS: Hepatotoxicity due to anti tuberculosis drugs, rifampin and isoniazid, is a major problem in tuberculosis patients. Vitamin C, an antioxidant, and N-acetyl cysteine (NAC), a scavenger of active metabolites, reduce the hepatotoxicity. The aim of present study was to investigate the effect of vitamin C and NAC individually on the antibacterial activity of anti tuberculosis drugs against Mycobacterium tuberculosis and Staphylococcus aureus strains. METHODS: The MICs of each compound against all strains were determined in 96 wells plate. Rifampin was tested at serial two fold concentrations alone or in combination with NAC or vitamin C. RESULTS: The MIC of rifampin against different strains of S. aureus was 0.008-0.032 µg/ml. The MIC of rifampin and isoniazid against M. tuberculosis strains were 40 and 0.2 µg/ml, respectively. Vitamin C and NAC had no antibacterial activity against all strains. MIC of rifampin was reduced two fold by combination with vitamin C for all S. aureus strains, while NAC did not affect the antibacterial activity of rifampin. Vitamin C and NAC had remarkable effects on the antibacterial activity of anti-tuberculosis drugs against M. tuberculosis. CONCLUSIONS: Synergistic effects were observed between rifampin or isoniazid and vitamin C against all tested strains. However, combination therapy of rifampin and isoniazid with NAC was not being effective. This study highlighted the advantages of combination of anti-tuberculosis drugs and vitamin C to eradicate the microbial infections.

Protective Effects of Vitamin C and NAC on the Toxicity of Rifampin on Hepg2 Cells.

Rifampin, an antibiotic widely used for the treatment of mycobacterial infections, produces hepatic, renal and bone marrow toxicity in human and animals. In this study, the protective effects of vitamin C and n-acetylcysteine (NAC) on the toxicity of rifampin on HepG2 cells were investigated. Human hepatoma cells (HepG2) were cultured in 96-well M of rifampin in the presence of microplate and exposed to 10, 20, 50 and 100 vitamin C (0.1 mg/mL) and NAC (0.2 mg/mL). Protective effect of the two drugs against rifampin toxicity was assessed by MTT assay. Results show that both vitamin C and NAC significantly inhibited HepG2 cellular damage due to rifampin, and vitamin C was relatively more potent than NAC. Rifampin is metabolized by the liver and its toxic metabolites are responsible for the drug>s hepatic toxicity. Based on our results, it seems that reactive metabolites are the main agents responsible for rifampin hepatotoxicity. The importance of this finding is that if vitamin C or NAC do not affect the antibacterial activity of rifampin, they could be used as preventive agents in rifampin users.

Inter-individual Variability of Coumarin 7-hydroxylation (CYP2A6 activity) in an Iranian Population.

OBJECTIVE(S): Coumarin hydroxylase (CYP2A6) is a polymorphic enzyme, and during the last decade has received a lot of attention because it is the principle human nicotine C-oxidase, which activates a number of procarcinogens, and metabolizes drugs. MATERIALS AND METHODS: 150 healthy Iranian volunteers, (96 male, 54 female) aged 19 to 63 years old, were given 5 mg coumarin orally after an overnight fast. Urine samples were collected before drug administration and 2, 4 and 8 h after that. The extent and rate of the formation of 7-OH-coumarin (7OHC) was determined by the urinary excretion of the metabolite as measured by the fluorometric method. RESULTS: The proportion of 7OHC excreted during the first 2 hr compared to the 7OHC excretion at 8 h was the constant and stable individual characteristic for the rate of the formation of 7OHC (2 hr coumarin test). The total amount of 7OHC formed was 32.7±12.4% (mean±SD) of the given dose. On average, 66.0% of 7OHC formed was excreted in 2 hr. No clear-cut polymorphism in the rate of 7OHC formation was found. The total amounts of 7OHC excreted were significantly lower in females. Also, the rate and amount of coumarin metabolism in Iranian population were lower than Turkish and Finnish populations. CONCLUSION: Because of the importance of enzyme activity in drug metabolism, caution should be exercised in prescribing compounds metabolized by CYP2A6 enzyme in Iranian population.

Scutellaria litwinowii induces apoptosis through both extrinsic and intrinsic apoptotic pathways in human promyelocytic leukemia cells.

Scutellaria is a genus of Lamiaceae with known antiproliferative potentials. Scutellaria litwinowii Bornm. & Sint. ex Bornm. is one of the Iranian species of Scutellaria. Although there are widespread reports about the cytotoxic and antitumor effects of some species of this genus, research on the molecular mechanism responsible for the anticancer effects of S. litwinowii has not yet been conducted. In the current study, the apoptotic effects of S. litwinowii on 2 myeloid cell lines, apoptosis-proficient HL60 cells and apoptosis-resistant K562 cells, were analyzed. An increase in the activity of caspases-3, -8, and -9, poly (ADP ribose) polymerase (PARP) cleavage, detection of phosphatidylserine on the outer layer of cell membrane and sub-G1 peak in the flow cytometry histogram of treated cells, suggested the induction of apoptosis. S. litwinowii also increased the Bax/Bcl-2 ratio. It could be concluded that S. litwinowii induced apoptosis in both apoptosis-proficient and apoptosis-resistant leukemic cells and it might be considered as a novel candidate in the treatment of hematological malignancies.

Protective effects of crocin against cisplatin-induced acute renal failure and oxidative stress in rats.

BACKGROUND: The major side effect of cisplatin, used in some tumours, is nephrotoxicity. Reactive oxygen species and oxidative damage are the most important factors in cisplatin-induced acute renal failure. The main purpose of this study is to investigate the protective effects of crocin against cisplatin-induced acute renal failure and oxidative stress in rat. METHODS: In this study, animals were randomly divided into 5 groups (6 each). Group one received normal saline (2 ml/day, i.p.). Group two received a single dose of cisplatin (5 mg/kg, i.p.). Groups 3 to 5 received crocin (100, 200 and 400 mg/kg, i.p., respectively, for 4 consecutive days one hour before a single dose of cisplatin (5 mg/kg) only at the first day. Blood samples were taken out (on the fifth day) for measuring the level of urea and creatinine. The kidneys were removed for histopathological and biochemical examinations. Furthermore, 24-hour urinary factors were measured. RESULTS: Blood urea, creatinine and urinary glucose and protein concentrations in crocin-treated groups were significantly lower than those of cisplatin-treated group in a dose-dependent manner. Histopathological studies showed a massive damage in S3 segment of proximal tubules in cisplatin-treated group. No damage was observed in crocin-treated groups. Crocin treatment resulted in a significant and dose-dependent reduction in malondialdehyde concentration as compared to the cisplatin-treated group. Moreover, crocin produced a significant elevation in total thiol and glutathione peroxidase concentrations, as compared with cisplatin-treated group. CONCLUSION: The results of the present study suggest that crocin has a protective effect against cisplatin-induced acute renal failure and relative oxidative stress.

Ethnic differences in the frequency of distribution of serum cholinesterase activity in the Iranian population.

One thousand Iranians belonging to 5 different Iranian ethnic groups were tested for butyrylcholinesterase (BChE) activity and phenotype. The phenotype was measured as percent inhibition in the presence of dibucaine. It was found that the Iranian population had an extraordinarily high frequency of the atypical variant of butyrylcholinesterase. 70% to 80% of Iranians carried the atypical mutation (Asp70Gly) on one allele. This contrasts with European and American populations where only 4% carry the atypical allele. The atypical variant of butyrylcholinesterase is known to be associated with prolonged apnea after administration of the muscle relaxants succinylcholine and mivacurium, and is also thought to be associated with abnormal sensitivity to cocaine toxicity. This study demonstrates that the ethnic background of a person has an important role in a person's response to drugs.

Mutation analysis of the human CYP3A4 gene 5' regulatory region: population screening using non-radioactive SSCP.

Human CYP3A4 is the major cytochrome P450 isoenzyme in adult human liver and is known to metabolise many xenobiotic and endogenous compounds. There is substantial inter-individual variation in the hepatic levels of CYP3A4. Although, polymorphic mutations have been reported in the 5' regulatory region of the CYP3A4 gene, those that have been investigated so far do not appear to have any effect on gene expression. To determine whether other mutations exist in this region of the gene, we have performed a new population screen on a panel of 101 human DNA samples. A 1140 bp section of the 5' proximal regulatory region of the CYP3A4 gene, containing numerous regulatory motifs, was amplified from genomic DNA as three overlapping segments. The 300 bp distal enhancer region at -7.9kb containing additional regulatory motifs was also amplified. Mutation analysis of the resulting PCR products was carried out using non-radioactive single strand conformation polymorphism (SSCP) and confirmatory sequencing of both DNA strands in those samples showing extra SSCP bands. In addition to detection of the previously reported CYP3A4*1B allele in nine subjects, three novel alleles were found: CYP3A4*1E (having a T-->A transversion at -369 in one subject), CYP3A4*1F (having a C-->G tranversion at -747 in 17 subjects) and CYP3A4*15B containing a nine-nucleotide insertion between -845 and -844 linked to an A-->G transition at -392 and a G-->A transition in exon 6 (position 485 in the cDNA) in one subject. All the novel alleles were heterozygous. No mutations were found in the upstream distal enhancer region. Our results clearly indicate that this rapid and simple SSCP approach can reveal mutant alleles in drug metabolising enzyme genes. Detection and determination of the frequency of novel alleles in CYP3A4 will assist investigation of the relationship between genotype, xenobiotic metabolism and toxicity in the CYP3A family of isoenzymes.