International journal of clinical pharmacology research最新文献

Cellular adhesion molecules are expressed by activated endothelial cells in severe bum. The release of these molecules can lead to organ damage. We measured E-selectin levels in the blood of 20 severe-burn patients. Then the patients were divided into two groups of 10 patients each. In the study group, atorvastatin 20 mg/day was administered orally for 14 days. In the control group, an equal volume of placebo was administered orally for 14 days. In both groups, following the last dose of the agents, serum E-selectin levels were measured again. Mean burn size and the percentage of third-degree bums of total burned area were not significantly different between the groups. Serum E-selectin level obtained at the beginning of the treatment was 23.69 +/- 2.71 ng/ml in the atorvastatin group and 18.08 +/- 0.97 ng/ml in the control group. Serum E-selectin level obtained at the end of the treatment was 10.86 +/- 1.36 ng/ml in the atorvastatin group and 21.69 +/- 2.11 ng/ml in the control group. The difference between the two groups was statistically significant (p < 0.05). In the comparison of early and late serum E-selectin levels in the atorvastatin group, a significant decrease was obtained (p < 0.05). In the control group, serum E-selectin levels were found to be increased in the late period. However, the difference between the early and late values was nonsignificant (p > 0.05). We concluded that atorvastatin is effective in the prevention of E-selectin release in severely burned patients.

Several studies have demonstrated that matrix metalloproteinases (MMPs) are frequently implicated in the destruction of articular cartilage in arthritis. The control of MMP activity is dependent on the local concentration of tissue inhibitors of metalloproteinases (TIMPs), and the imbalance of the enzyme-to-inhibitor ratios plays an important role in the remodeling of articular tissues. Some cytokines such as interleukin (IL)-1 and tumor necrosis factor (TNF)-alpha which regulate leukocyte activities, promote MMP secretion and, as a consequence, cartilage degradation. The aim of the present study was to investigate whether a natural treatment is effective in reducing cartilage inflammation and degradation by influencing MMP and TIMP serum levels. Eighty patients with osteoarthritis (OA) were enrolled in the trial and were divided into group A (30 patients who did not undergo mud bath therapy), group B (28 patients repeating mud bath therapy more than 5 times and less than 10) and group C (22 patients repeating mud bath therapy more than 10 times). Blood samples were obtained from all the patients for assay of MMP-1, -2, -3, -8 and -9 and TIMP-1 and -2. The parameters were determined by an ELISA technique. Statistical indexes were calculated for each parameter and mean values were compared. The differences between mean values of MMP-3, -8 and -9 were statistically significant between group A and the treated groups (B and C). Analysis of variance established a significant difference (p < 0.05) between groups A and C in mean serum levels of MMP-8, MMP-9 showed a statistically significant difference (p < 0.05) in mean serum concentration between groups A and B. Regression analysis showed a very high R2 between MMP-2 and TIMP-2. One of the most interesting findings in this study was that MMP-3 serum levels were significantly lower in the treated groups, since this enzyme plays an important role in cartilage degradation, suggesting that mud bath therapy contributes to matrix integrity in OA cartilage. In contrast, MMP-8 and -9 were higher in the treated subjects and no correlation with TIMPs was evident. One possible explanation is that these enzymes are required for the efficient degradation and removal of already compromised cartilage matrix and that they operate as part of a matrix turnover and repair process. In conclusion, our data suggest that mud bath therapy alone is not able to influence chondrocyte metabolic activity in the advanced phases of OA. There could be a synergic and sequential association with pharmacologic therapy and/or interventions.

Psoriasis is a chronic inflammatory skin disorder. Recent advances in the understanding of its immunological basis have led to its redefinition as being T-cell mediated. New biological agents have been developed as effective selective target therapies and promise to be an alternative to conventional systemic medications. Etanercept is a recombinant human protein recently approved for psoriatic arthritis treatment that has activity against tumor necrosis factor-alpha (TNF-alpha). It is composed of the human TNF receptor linked to the Fc portion of human IgG1. TNF-alpha seems to play a key role in the pathogenesis of psoriasis and psoriatic arthritis. Therefore, etanercept TNF antagonism is an effective approach for severe psoriasis. We describe two case reports of severe recalcitrant psoriasis, also with arthritis, that showed a remarkable improvement with etanercept, with no adverse events.

We report a case of guttate psoriasis in a 28-year-old woman who had been suffering from scalp psoriasis from the age of 14. After an upper respiratory infection she presented with the typical exanthema of guttate psoriasis. Despite initial treatment with antibiotics and emollients, the rash continued to spread. Two months after the flare of psoriasis we decided to treat the patient with calcipotriol and betamethasone dipropionate ointment applied once daily, using an intermittent treatment modality. The lesions disappeared and despite two small recurrences on the legs we managed to maintain clearance after a 2-year follow-up. Although the application of calcipotriol and betamethasone dipropionate ointment was cumbersome, due to the extent of the eruption, the result was highly effective and safe without any lesional/perilesional adverse reaction during application and with normal blood examinations.

This retrospective study was carried out to evaluate the seropositivity of hepatitis B surface antigen (HbsAg), anti-hepatitis C virus (HCV), anti-human immunodeficiency virus (HIV) and syphilis in blood donors in Manisa Government Hospital. Data were evaluated in 10,189 blood donors between April 1, 1997, which is the time from which regular records began to be collected, and April 1, 2003. The blood samples of the blood center from April 1, 1997, to January 1, 1998, were examined via the card method, those between January 1, 1998, and January 1, 2002, were examined via micro enzyme-linked immunosorbent assay (ELISA) method and the rest were evaluated with macro ELISA methods. In blood donors, the positivity of HbsAg, anti-HCV anti-HIV and the rapid plasmin reagin test were 2.95%, 0.68%, 0.00% and 0.16%, respectively.

Bisphosphonates are a potential therapy for osteoclast-mediated bone disease, such as renal osteodystrophy. This study evaluated ibandronate bone-binding in patients with secondary hyperparathyroidism and renal osteodystrophy and examined whether there is a correlation with bone metabolism parameters. Sixteen patients with end-stage renal disease and secondary hyperparathyroidism receiving regular hemodialysis were recruited to this 12-week trial. Intravenous ibandronate 2 mg was administered for 5 min every 4 weeks directly after hemodialysis. Ibandronate levels were measured 15 min after infusion and at trough levels before the next hemodialysis. Serological markers of bone metabolism were also measured. After the first infusion, the peak ibandronate level was 154 +/- 75.1 ng/ml and the trough level was 2.7 +/- 1.7 ng/ml. At week 12, peak and trough ibandronate levels were 164.8 +/- 89.9 ng/ml and 3.2 +/- 2.6 ng/ml, respectively. Ibandronate bone uptake was 98.0% at first application and 98.4% at week 12. In patients with remaining diuresis, ibandronate urine excretion was < 0.001% of the administered dose. There was no correlation of ibandronate bone-binding with parameters of osteoclast activity or parathyroid hormone (PTH). The correlation with markers of osteoblast activity was significant but weak. Ibandronate had a bone-binding capacity of approximately 98% in hemodialysis patients. After repeated dosing ibandronate bone-uptake remained stable and was independent of osteoclast activity or PTH levels. Due to the high bone-binding of ibandronate in these patients, a 2 mg dose of intravenous ibandronate is equivalent to a 4-5 mg dose of ibandronate in patients with normal renal function.

The purpose of this study was to evaluate the prevalence of life-threatening renal failure (RF) caused by vasomotor nephropathy associated with nonsteroidal anti-inflammatory drug (NSAID) treatment (NSAID-RF) and risk factors for this renal impairment in an inception cohort of patients with recently diagnosed uremia treated by emergency hemodialysis in a prospective regional study. There are few published data on this phenomenon. Two hundred fifty-six patients (137 men, 119 women, mean age 68 years [22-95 years]) with acute uremia were treated with emergency hemodialysis in the intensive care unit over a period of 70 months. The patients were from an area of 231,000 inhabitants. Of the 256 patients, clinical data from a group of 79 patients with medical-type renal failure were analyzed in detail. The prevalence of NSAID-RF was 8%. This prevalence decreased to 4% when patients without any other medication affecting compensatory renal hemodynamics were considered. Moreover when nonpharmacological insults were not taken into account the prevalence decreased to only 1.6%. In 80% of the patients with NSAID-RF, nonpharmacological insults contributed to renal impairment. Both hypotension of cardiac etiology and dehydration/hypovolemia were present in 25% of the patients with this type of RF while urinary tract obstruction was seen in 1%. In 75% patients with NSAID-RF the underlying nephropathies were identified. NSAID-RF was not frequent. The population at greatest risk for renal functional alteration associated with NSAID therapy included patients with dehydration/hypovolemia, hypotension of cardiac etiology and those with pre-existing renal impairment, especially with vascular and analgesic nephropathy.

Spa therapy is an ancient approach to degenerative diseases such as osteoarthritis, but until today this tradition has been predominantly empiric and intuitive and few studies have focused on the biological changes derived from this treatment. We assessed the clinical efficacy and variations in amino acid concentrations in serum samples from patients with knee osteoarthritis who underwent spa therapy and put forward an explanation of their role in clinical improvement. Thirty-one patients with knee osteoarthritis who underwent spa therapy underwent a clinical evaluation, and serum amino acid levels were assayed before and after a cycle of balneotherapy and mud-pack therapy. The thermal treatments were carried out in Sciacca. Analysis of the data showed a significant reduction in pain and improvement in joint motility. Serum concentrations of tryptophan, cysteine and citrulline were significantly higher than at baseline. No significant differences were observed in serum levels of the remaining free amino acids. The results of this study confirm the efficacy of spa therapy in the treatment of osteoarthritis. A possible role for changes in serum amino acid concentration is discussed.

The glomerular filtration rate (GFR) is the main indicator of kidney function. In clinical practice the GFR is often estimated from serum creatinine. In the elderly, serum creatinine is notoriously unreliable as an estimator of GFR. Recently, serum cystatin C has been proposed as a new endogenous marker of glomerular filtration rate. A total of 144 patients, aged more than 60 years (mean age 70.4 years), who had undergone 51CrEDTA clearance, were enrolled in our study. In each patient serum creatinine and serum cystatin C were determined. The reciprocal of serum creatinine, the reciprocal of serum cystatin C and creatinine clearance (from Cockcroft and Gault formula) were calculated. Serum cystatin C was measured with the particle-enhanced immunonephelometric method. The mean 51CrEDTA clearance was 34.5+/-25.55 ml/min/1.73 m2, the mean serum creatinine was 312+/-210 micromol/l and the mean serum cystatin C 3.15 mg/l+/-1.62 mg/l. We found a significant correlation between 51CrEDTA clearance and serum creatinine, serum cystatin C, the reciprocal of serum creatinine and the reciprocal of serum cystatin C as well as with creatinine clearance. In comparison of the correlation coefficients we found that the correlation between 51CrEDTA clearance and serum cystatin C was significantly better than that with serum creatinine (p < 0.05). The correlation between 51CrEDTA clearance and the reciprocal of serum cystatin C was superior to that with the reciprocal of serum creatinine (p < 0.003) and calculated creatinine clearance (p < 0.003). Our results indicate that serum cystatin C is a more reliable marker of GFR in the elderly than serum creatinine or creatinine clearance.

The aim of this study was to analyze the job-related risks nurses face during training such as needle-stick injuries, contaminated blood and infectious fluids. From May to July 2003 we conducted a survey of a sample of 242 nurses who were working in the the Pediatric Hospital, Government Hospital, the Training Hospital of Celal Bayar University, the Gynecology Hospital and the Psychiatric Hospital in Manisa City in Turkey. Two hundred sixteen nurses (89.3%) had needlestick injuries and 107 (44.2%) had injuries by contaminated cutting utensils. A total of 104 nurses (43.0%) used gloves, while 65 (26.9%) used gloves and mask. In medical and surgical staff nurses, injuries due to contaminated cutting utensils were statistically significant (p < 0.05). Awareness of accidents was significant between the two groups (p < 0.05).