Open Access Method Article

Reproducible, Repeatable and Clinically-relevant Hemostasis Scoring

Julianne M. Siegel, John F. Cummings, Jeffrey W. Clymer

Journal of Advances in Medical and Pharmaceutical Sciences, Page 30-39
DOI: 10.9734/JAMPS/2014/11653

Background: Although the assessment of hemostasis is frequently performed during stapling procedures, and is necessary during product development, there is currently no widely-accepted scoring system for its evaluation. In order to better measure stapler performance, we developed a 5-point Likert-type scale to evaluate intra-operative bleeding in stapling applications.

Methods: The scale was evaluated internally by novice and experienced appraisers, and then used by 154 surgeons that viewed video segments of stapling in pig that displayed varying levels of hemostasis.

Results: Reproducibility and repeatability of the scale among internal appraisers, as well as the surgeons, was excellent with Kendall’s W of 0.94-0.98 (repeatability) and 0.93-0.95 (reproducibility) internally and 0.85 and 0.95, respectively for surgeons. More than 90% of surgeons felt the hemostasis scale was clinically relevant for evaluating hemostasis during stapling.

Conclusions: The scale should be a useful tool in assessing hemostasis with high confidence in its repeatability and reproducibility.


Open Access Short Communication

Levels of Oxidized Low-Density Lipoprotein and High Sensitive C-Reactive Protein in Retinal Vascular Occlusions: A Pilot Study

Zubair Idrees, Ian Dooley, Brian Power, Aaron Yeung, Marie Hickey Dwyer

Journal of Advances in Medical and Pharmaceutical Sciences, Page 24-29
DOI: 10.9734/JAMPS/2014/11341

Background: Oxidized low-density lipoprotein (OX-LDL) is believed to be a key trigger factor in the genesis of atherosclerosis. It has been postulated that it can activate inflammatory mediators such as high sensitive C-reactive protein (hs-CRP), interleukin 6 (IL6), and tumour necrosis factor (TNF). These mediators have been demonstrated to have an atherogenic effect.

Aims: This pilot study examined levels of OX-LDL and hs-CRP in patients with retinal vascular occlusive disorders.

Methods: We enroled 7 patients with retinal vascular occlusions during a two-month period. A high sensitive CRP of greater than 3mg/l was considered significantly elevated and a median oxidised LDL value greater than 59 U/L was considered significantly elevated.

Results: There were 4 cases of retinal vein occlusion, 1 case of amaurosis fugax, 1 case of cilioretinal artery occlusion and a case of cholesterol embolus in the retinal vasculature. Mean OX-LDL (55.6±21.1 U/L) was borderline, but within the normal range (<59 U/L) but hs-CRP (3.9±3.1 mg/l) were elevated compared to the normal range (0 -3 mg/l). Oxidized LDL was elevated in three patients (43%), and bordeline (between 55 and 59 U/L) in two patients (28%). No significant correlation was found between hs-CRP and OX-LDL values (Pearson’s correlation: r = 0.256; p = 0.456).

Conclusion: This study is the first to suggest that OX-LDL and hs-CRP may be elevated in retinal vascular disease. Further investigations are required to determine the significance of these findings.


Open Access Original Research Article

Zidovudine-Induced Anaemia in Human Immunodeficiency Virus Infected Children on Highly Active Anti-Retroviral Therapy in Jos, Nigeria

Emeka U. Ejeliogu, Stephen Oguche, Augustine O. Ebonyi, Sylvanus E. Okpe, Esther S. Yiltok, Olukemi Ige, Martha O. Ochoga, Placid Ugoagwu, Christy Dady, Lucy Ogwuche, Oche O. Agbaji, Prosper Okonkwo

Journal of Advances in Medical and Pharmaceutical Sciences, Page 1-10
DOI: 10.9734/JAMPS/2014/11241

Aims: To determine the incidence and severity of zidovudine-induced anaemia in HIV-infected children initiated on anti-retroviral therapy in Jos, Nigeria.

Study Design: This was an observational cohort study.

Place and Duration of Study: AIDS Prevention Initiative in Nigeria (APIN)-supported HIV clinic of Jos University Teaching Hospital, Jos, Nigeria between April 2008 and March 2013.

Methodology: We followed up HIV-infected children initiated on highly active anti-retroviral therapy (HAART) for 12 months. We compared the haemoglobin level at baseline, 3 months, 6 months and 12 months after initiation of HAART. We also compared the haemoglobin level of those on zidovudine (ZDV) and stavudine (d4T)-containing regimens.

Results: Three hundred and fifty-two (92.1%) patients were on zidovudine-containing regimen while 30 (7.9%) were on stavudine-containing regimen. Three hundred and sixty-five (95.6%) were on cotrimoxazole while 17 (4.4%) were not on cotrimoxazole. The mean haemoglobin level at baseline was 10.8±2.1g/dl for the ZDV group and 6.9±1.3g/dl for the d4T group (P = .001). At baseline, 232 (60.7%) of the patients had anaemia while 26 (6.8%) had severe anaemia. At the end of the 12 months evaluation period, fifty-nine (16.8%) of the patients on ZDV had Hb <8g/dl and were switched to d4T while 16 (4.6%) received blood transfusion. The mean Hb level of ZDV group decreased from 10.8±2.1g/dl to 9.3±1.8g/dl (P = .03) while that of d4T group increased from 6.9±1.3g/dl to 11.2±1.5g/dl (P <.001).

Conclusion: ZDV-induced anaemia was common in HIV-infected children on HAART in this study. Regular clinical and laboratory monitoring is necessary for early detection in order to mitigate the harmful effect anaemia has on the health and survival of such children.


Open Access Original Research Article

Two Novel Alkylating Structural Analogues of Chloramphenicol Suitable for Topical Treatment of Dermal Neoplasms

Ronald Bartzatt

Journal of Advances in Medical and Pharmaceutical Sciences, Page 11-23
DOI: 10.9734/JAMPS/2014/11838

Aims: To evaluate the efficacy of two alkylating structural analogues of chloramphenicol that have potential for application for treatment of dermal sited neoplasms.

Study Design: Two compounds have been shown to alkylate guanosine-5’-diphosphate (GDP) at physiological conditions. These same compounds are evaluated for dermal penetration based on Kp and compared to other alkylating agents applied for treatment of skin cancer.

Place and Duration of Study: University of Nebraska, Omaha Nebraska from December 2013 to May 2014 and March to August of 2002.

Methodology: Two analogues of chloramphenicol were synthesized and shown to alkylate GDP at pH 7.4 and 37ºC. Various pharmacological properties of these two analogues, such as Log P, molecular weight, polar surface area, etc, were determined and compared.  The dermal permeability coefficient Kp was determined for two analogues based on their molecular weight and partition coefficient Log P. The numerical values of Kp were used to prediction of the distance each analogue is expected to travel in penetration of a dermal barrier. Result was plotted and compared to the anticancer agent’s carmustine, mustargen, and 5-fluorouracil. Evaluation of the analogues included findings of previous studies.  

Results: Two analogues of chloramphenicol alkylate sites on GDP. The properties of compound 1 and compound 2 were determined and when compared to the parent structure chloramphenicol were found to have favorable drug likeness.  Values of Log P and permeability coefficient Kp for compounds 1 and 2 are; 3.343, 3.312, 0.00244 cm/hour, 0.000768 cm/hour, respectively.  Values of Kp for both compound 1 and 2 were greater than that of chloramphenicol at 0.000131 cm/hour. Plots of skin penetration showed compounds 1 and 2 to be superior to 5-fluorouracil.

Conclusion: Analogues 1 and 2 were shown to have alkylation activity and properties suitable for drug likeness. Both compounds have high penetration rates of dermal layers.