The association of pre-operative STOP-BANG scores with postoperative critical care admission.

The STOP-BANG questionnaire screens for obstructive sleep apnoea. We retrospectively analysed the independent association of pre-operative variables with postoperative critical care admission using multivariable logistic regression for patients undergoing elective surgery from January to December 2011. Of 5432 patients, 338 (6.2%) were admitted postoperatively to the critical care unit. In multivariate analysis, the odds ratios (95% CI) for critical care admission were: 2.2 (1.1-4.6), p = 0.037; 3.2 (1.2-8.1), p = 0.017; and 5.1 (1.8-14.9), p = 0.002, for STOP-BANG scores of 4, 5 and ≥ 6, respectively. The odds ratio was also independently increased for: each year of age, 1.015 (1.004-1.026), p = 0.019; asthma, 1.6 (1.1-2.4), p = 0.016; obstructive sleep apnoea, 3.2 (1.9-5.6), p < 0.001; and for ASA physical status 2, 3 and ≥ 4, 2.1 (1.4-3.3), 6.5 (3.9-11.0), 6.3 (2.9-13.8), respectively, p < 0.001 for all.

Gastrointestinal behavior of orally administered radiolabeled erythromycin pellets in man as determined by gamma scintigraphy.

The behavior of single 250-mg doses of a multiparticulate form of erythromycin base (ERYC(R)), each including five pellets radiolabeled with neutron-activated samarium-153, was observed by gamma scintigraphy in seven male subjects under fasting and nonfasting conditions. The residence time and locus of radiolabeled pellets within regions of the gastrointestinal tract were determined and were correlated with plasma concentrations of erythromycin at coincident time points. Administration of food 30 minutes postdosing reduced fasting plasma erythromycin Cmax and area under the plasma erythromycin versus time curve (AUC) values by 43% and 54%, respectively. Mean peak plasma concentration of erythromycin (Cmax) in the fasting state was 1.64 micrograms/mL versus 0.94 micrograms/mL in the nonfasting state. Total oral bioavailability, as determined by mean AUC (0-infinity) of the plasma erythromycin concentration versus time curve, was 7.6 hr/micrograms/mL in the fasted state, versus 3.5 hr/micrograms/mL in the nonfasting state. Mean time to peak plasma erythromycin concentration (tmax) in the fasting state was 3.3 hours, versus 2.3 hours in the nonfasting state. Plasma concentrations of erythromycin in both fasting and nonfasting states were within acceptable therapeutic ranges. Evidence provided by this study: 1) indicates that pellet erosion and absorption of active erythromycin base begins when the enteric-coated pellets reach the highly vascular mucosa of the jejunum and proximal ileum, and is essentially completed within the ileum, with a significant portion absorbed in the medial-to-distal ileum; 2) confirms that acceptable therapeutic plasma levels of erythromycin are attained in nonfasting subjects (Cmax = 0.94 microgram/mL) and that superior plasma erythromycin concentrations (Cmax = 1.64 micrograms/mL) are achieved by administration of the dose on an empty stomach 1 to 2 hours before or after meals; 3) corroborates other comparative studies reporting greater fasting bioavailability with this multiparticulate dosage form of erythromycin base than with reference single tablet or particle-in-tablet formulations; and 4) indicates that neutron activation of stable isotopes incorporated as a normal excipient in industrially-produced formulations provides an effective means for in vivo evaluation of dosage forms through gamma scintigraphy.

Danaparoid sodium.

Danaparoid sodium (Orgaran, Organon) is a heparinoid glycosamino-glycuronan antithrombotic agent approved for the prophylaxis of post-operative deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE) in patients undergoing elective hip replacement surgery. Danaparoid is a low molecular weight heparinoid consisting of a mixture of heparan sulphate (84%), dermatan sulphate (12%) and small amounts of chondroitin sulphate (4%), whose antithrombotic activity has been well established. Its pharmacological effect is exerted primarily by inhibiting Factors Xa (FXa) and IIa (FIIa) at a ratio greater than heparin, with a minimal effect on platelet function. Danaparoid exhibits low cross-reactivity with heparin-induced antibodies when compared with heparin or low molecular weight heparins (LMWH), thereby making it an excellent choice for the management of heparin-induced thrombocytopenia (HIT). It has excellent bioavailability following s.c. injection. Danaparoid has little effect on routine coagulation tests (activated partial thromboplastin time [aPTT], prothrombin time [PT], and thrombin time [TT]). Patients with elevated serum creatinine should be monitored carefully. For its FDA approved indication (DVT prophylaxis during hip replacement surgery), its cost per day is approximately eight times more than LMWH. Even though monitoring is not routinely necessary according to the manufacturer for its approved indication, monitoring is frequently necessary when it is used in other clinical scenarios. Its higher cost than comparable therapies for DVT prophylaxis and the low availability of the FXa assay in most non-tertiary care hospitals has limited the widespread use of danaparoid. Danaparoid has been found to be effective in the treatment of HIT although this is an off label use, despite being the most frequent reason why danaparoid is used.

Hypocholesterolemic effect of spirulina in patients with hyperlipidemic nephrotic syndrome.

In nephrotic syndrome, large amounts of plasma proteins are lost in urine, causing a decrease in the plasma oncotic pressure. This leads to enhanced hepatic synthesis of albumin and other proteins, including lipoproteins, causing a secondary hyperlipidemia. Essential fatty acids such as gamma-linolenic acid (GLA) can prevent accumulation of cholesterol in the body, and spirulina has an appreciable amount of GLA. In this study 23 patients (age 2 to 13 years) with nephrotic syndrome received either medication (group I) or medication plus 1 g/day Spirulina (group II). Height, weight, and serum levels of fasting blood sugar, triglycerides, total cholesterol (TC), and low- and high-density cholesterol fractions (LDL-C and HDL-C, respectively) were measured before and after the 2-month study period. Mean height and weight were normal compared with healthy, age-matched Indian children. Lipoprotein cholesterol levels were significantly increased at baseline. TC significantly decreased by 116.33 mg/dl, LDL-C by 94.14 mg/dl, and triglycerides by 67.72 mg/dl in group II; in control group I, these values fell by 69.87, 61.13, and 22.62 mg/dl, respectively. The LDL-C:HDL-C ratio also decreased significantly, by 1.66 in group II and 1.13 in group I. TC:HDL-C decreased by 1.96 in group II and 1.19 in group I. HDL-C:LDL-C also improved significantly in both the groups. It can be concluded that spray-dried Spirulina capsules, rich in antioxidants, GLA, amino acids, and fatty acids, helped reduce the increased levels of lipids in patients with hyperlipidemic nephrotic syndrome.

Antibody drug conjugates - Trojan horses in the war on cancer.

Antibody drug conjugates (ADCs) consist of an antibody attached to a cytotoxic drug by means of a linker. ADCs provide a way to couple the specificity of a monoclonal antibody (mAb) to the cytotoxicity of a small-molecule drug and, therefore, are promising new therapies for cancer. ADCs are prodrugs that are inactive in circulation but exert their cytotoxicity upon binding to the target cancer cell. Earlier unsuccessful attempts to generate ADCs with therapeutic value have emphasized the important role each component plays in determining the efficacy and safety of the final ADC. Scientific advances in engineering antibodies for maximum efficacy as anticancer agents, identification of highly cytotoxic molecules, and generation of linkers with increased stability in circulation have all contributed to the development of the many ADCs that are currently in clinical trials. This review discusses parameters that guide the selection of the components of an ADC to increase its therapeutic window, provides a brief look at ADCs currently in clinical trials, and discusses future challenges in this field.

Perioperative risk factors in obese patients for bariatric surgery: a Singapore experience.

INTRODUCTION: Morbid obesity and obstructive sleep apnoea (OSA) are increasingly encountered in anaesthetic practice today. Difficult intubation may be seen more frequently in our practice. This high-risk group may also be more prone to complications in the postoperative period. METHODS: We reviewed a consecutive series of patients who had undergone laparoscopic gastric banding at our institution from 2001 to 2006. The incidence of difficult intubation, early postoperative complications and its attendant risk factors were studied. RESULTS: Severe OSA and neck circumference greater than 44 cm were factors associated with difficult intubation in morbidly obese patients who presented for bariatric surgery. Asthma and increasing age may be associated risk factors for adverse events in the postoperative period. CONCLUSION: It is important to anticipate and prepare for a difficult intubation scenario in patients with severe OSA and a larger neck circumference. Close monitoring is recommended for patients with respiratory comorbidities and advanced age.

Studies on the effect of curry leaves supplementation (Murraya Koenigi) on lipid profile, glycated proteins and amino acids in non-insulin-dependent diabetic patients.

Curry leaves powder supplementation (12g providing 2.5 g fibre) was carried out for a period of 1 month in 30 non-insulin dependent diabetes mellitus patients. The parameters monitored at 1, 15 and 30 days were fasting and 2 h post-prandial blood sugar levels, serum total cholesterol and its lipoprotein fractions, triglycerides, total amino acids, uronic acid, glycosylated serum proteins and glycosylated low density lipoprotein cholesterol fraction. The results indicated a transient reduction in fasting and post-prandial blood sugar levels at 15-day period with no appreciable changes in serum glycosylated protein levels, glycosylated low density lipoprotein cholesterol fraction, serum lipids, lipoprotein cholesterol levels, uronic acid and total amino acids were observed during the supplementation period, i.e, either at 15 days or 30 days.

Effect of Tulasi (Ocimum sanctum) leaf powder supplementation on blood sugar levels, serum lipids and tissue lipids in diabetic rats.

Tulasi leaf powder was fed at the 1% level in normal and diabetic rats for a period of one month to explore the effect on fasting blood sugar, uronic acid, total amino acids, and the lipid profile in serum and tissue lipids. The results indicated a significant reduction in fasting blood sugar, uronic acid, total amino acids, total cholesterol, triglyceride, phospholipids and total lipids. In liver, total cholesterol, triglyceride and total lipids were significantly lowered. Total lipids were significantly reduced in kidney. In heart, a significant fall in total cholesterol and phospholipids was observed. All these observations indicate the hypoglycemic and hypolipidemic effect of Tulasi in diabetic rats.

Duplication of the pinna (polyotia) in a case of Brachmann-de Lange syndrome.

A rare case of polyotia in Brachmann-de Lange syndrome (Goodman and Gorlin, 1977) is presented and a method for the surgical correction of the duplicated auricle briefly outlined. A review of relevant literature is included in the discussion.

Studies on the effect of dry Sundakai (Solanum torvum) powder supplementation on lipid profile, glycated proteins and amino acids in non-insulin dependent diabetic patients.

The effect of dry Sundakai powder supplementation (7 g providing 1.23 g of crude fibre) on glycemic control, lipidemic control, total amino acids and uronic acid was studied on 30 non-insulin dependent diabetes mellitus patients. All the patients were on hypoglycemic drugs. The above parameters were monitored at day 1, 15 and 30 days. After one month of fibre supplementation, no significant changes were observed with respect to glucose, lipid profile, glycated proteins, total amino acids and uronic acid levels in these subjects.

Effect of colocasia leaves (Colocasia antiquorum) on serum and tissue lipids in cholesterol-fed rats.

Dried colocasia powder (10% and 20%) was fed to hypercholesterolemic rats for a period of one month to explore the effect on serum lipids and tissue lipids. The results indicated that there was a significant increase in total lipids, total cholesterol, and triglycerides levels in the cholesterol fed rats. Liver cholesterol showed a slight reduction which was non-significant, while an increase in liver triglyceride was observed in rats fed with 10% and 20% colocasia leaves diet with or without cholesterol. All these observations indicate an aggravating effect of colocasia leaves on serum and tissue lipids in cholesterol-fed rats.

Glycaemic index of conventional carbohydrate meals.

The glycaemic index (GI) and the triacylglycerol response were measured in thirty non-insulin-dependent diabetes mellitus patients given 50 g portions of five different conventional Indian meals containing semolina (Triticum aestivum) cooked by two different methods, or combinations of semolina and pulse (black gram dhal (Phaseolus mungo), green gram dhal (Phaseolus aureus) or Bengal gram dhal (Cicer arietum)). There were no significant differences among meals in mean GI except for meals based on roasted semolina or semolina-black gram dhal. Compared with the blood glucose response for a 50 g glucose load, only meals based on steam-cooked semolina and semolina-Bengal gram dhal elicited a significantly lower response at 1 h postprandially, and only meals based on semolina-black gram dhal at 2 h postprandially. No significant differences were found among the meals in the triacylglycerol-response.

Manufacture and properties of erythromycin beads containing neutron-activated erbium-171.

To evaluate the effects of a neutron activation radiolabeling technique on an enteric-coated multiparticulate formulation of erythromycin, test quantities were produced under industrial pilot scale conditions. The pellets contained the stable isotope erbium oxide (Er-170), which was later converted by neutron activation into the short-lived gamma ray-emitting radionuclide, erbium-171. In vitro studies indicated that the dissolution profile, acid resistance, and enteric-coated surface of the pellets were minimally affected by the irradiation procedure. Antimicrobial potency was also unaffected, as determined by microbiological assay. Neutron activation thus appears to simplify the radiolabeling of complex pharmaceutical dosage forms for in vivo study by external gamma scintigraphy.