Search

Background: Hyperuricaemia is defined as an elevation of the uric acid level in the blood to more than 0.38 mmol/l. This increased uric acid gets deposited in the form of monosodium urate crystals in joint tissue to form a micro trophi complex. An increased uric acid level is associated with increased gouty risk. Antigout drugs such as allopurinol, Colchicine, probenecid, and Benzbromarone. The main action of these drugs is to decrease uric acid levels and symptoms of gouty arthritis. The main aim of our study is to detect a suitable mono-drug therapy for the treatment of gouty arthritis. Aim: To study the effect of allopurinol, probenecid, and Benzbromarone mono-drug therapy in gouty arthritis patients in tertiary care hospitals. Material and method: The present study was conducted on 150 gout patients. All the patients were equally divided into three groups; group -1, 50 patients were treated with allopurinol, group 2, 50 patients treated with probenecid, and group -3, 50 patients were treated with Benzbromarone. All these patients were monitored with symptoms and also tested with blood pressure, serum creatinine, blood urea, and blood uric acid. Results: In our study majority of the patients were male followed by female (p 0.342). With the age group of 61 - 65 years in all the groups (groups - 1, 2 & 3) respectively. On the basic characteristics of the gouty patients, 45.33% were alcoholic abuse, 35.33% were smokers, 52.66% were hypertensive, 80.66% were diabetic patients, 17.33% were Hypertriglyceridaemia, 45.33% were obesity, 21.33% positive family history and 58.66 % chronic tophaceous gout respectively. Based on the location of gouty arthritis and symptoms toes and swelling was observed in the majority of patients in all group - 1, 2 & 3. Based on biochemical parameters after 3 months of treatment, no significance was observed in serum creatinine in groups -1, 2 & 3 (p. >0.05) On blood urea no significance was observed in group -1(p>0.05), and significance was observed in blood urea in group 2 & 3 (p<0.05). Based on uric acid levels significance (p< 0.05) was observed in all three groups (group - 1, 2 & 3) respectively. Conclusion: Benzbromarone followed by is the better drug of choice in lower urea and uric acid levels compared with Probenecid and allopurinol group. [ABSTRACT FROM AUTHOR]

Early treatment for SARS-CoV-2 infection is essential to limit the clinical progression of COVID-19. However, limited therapeutic options are available for standard-risk patients, including those under age 50 who have received the primary series of COVID-19 vaccination as well as a bivalent booster. Metformin is a widely used, inexpensive antihyperglycemic for the treatment of diabetes mellitus type 2 as well as polycystic ovarian syndrome, with a well-described safety profile. Although the mechanism of action has not been fully elucidated, metformin is known to alter glucose metabolism and is under investigation as an antiviral agent, demonstrating in vitro and in vivo activity against SARS-CoV-2. Recent work suggests metformin may also serve as a therapeutic option for patients with COVID-19 as well as those with post-acute sequelae of SARS-CoV-2 infection, known more commonly as 'long COVID-19.' This manuscript examines what is known about metformin for the treatment of COVID-19 and explores how this drug may be used in the future to address the SARS-CoV-2 pandemic. [ABSTRACT FROM AUTHOR]

Total synthesis of taiwanin C was realised efficiently in a global yield of 52%. Taiwanin C in aggregation assays inhibited platelet aggregation in a concentration-dependent manner with an IC50 of 0.46 μM after exposure of human platelet to AA. Similarly, to AA, taiwanin C inhibited significantly TRAP-6-induced platelet aggregation with IC50 of 0.56 μM. Molecular docking studies were carried out using the molecular target the COX-1, COX-2 and PAR-1 proteins. These studies suggest that taiwanin inhibits COX-1 more strongly than COX-2. Taiwanin C showed better antiplatelet action in the presence of TRAP-6 than indomethacin and molecular docking studies suggest different mechanisms of action for the two compounds on PAR-1. These results demonstrate that taiwanin C acts very efficiently in two different signaling pathways of platelet aggregation. Although preliminary, these results indicate that taiwanin C has potential for further studies on its use for the development of new antiplatelet. [ABSTRACT FROM AUTHOR]

Aims: Poor adherence to allopurinol among people with gout contributes to suboptimal gout management. This study sought to understand the facilitators and barriers to allopurinol adherence across the three stages of medication adherence, and patient perspectives on strategies to improve adherence, including self‐monitoring urate concentration. Methods: Semi‐structured interviews were conducted with 26 people with gout, previously or currently taking allopurinol. De‐identified verbatim transcripts were thematically analysed using an inductive and deductive approach. Results: Facilitators of adherence during allopurinol initiation were motivation to prevent gout flares and trust in the advice of their healthcare professionals (HCPs). Reluctance to commence long‐term medication was a barrier to allopurinol initiation. Believing in the effectiveness and necessity of allopurinol and reminder systems were facilitators of implementation. Barriers to implementation included forgetfulness, gout flares and limited feedback on allopurinol's effectiveness. Patients discontinued therapy when allopurinol was perceived as ineffective or unnecessary. Discontinuation coincided with patients experiencing gout flares while adhering to allopurinol and receiving suboptimal advice about gout management. Patients identified receiving accurate advice from HCPs and regular urate monitoring for feedback on allopurinol's effectiveness as potential strategies to improve adherence. Perceived benefits of self‐monitoring urate as a strategy to promote adherence included the ability to self‐manage gout and make informed decisions about allopurinol therapy with their HCP. Conclusion: Patient perceptions of the effectiveness and necessity of allopurinol influenced intentional adherence during medication initiation, implementation and discontinuation. Strategies that inform patients of their urate control and provide accurate medical advice have the potential to improve adherence to allopurinol. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to develop and evaluate an allopurinol adherence tool based on steady‐state oxypurinol plasma concentrations, allopurinol's active metabolite. Methods: Plasma oxypurinol concentrations were simulated stochastically from an oxypurinol pharmacokinetic model for allopurinol doses of 100‐800 mg daily, accounting for differences in renal function, diuretic use and ethnicity. For each scenario, the 20th percentile for peak and trough concentrations defined the adherence threshold, below which imperfect adherence was assumed. Predictive performance was evaluated using both simulated low adherence and against data from 146 individuals with paired oxypurinol plasma concentrations and adherence measures. Sensitivity and specificity (S&S), negative and positive predictive values (NPV, PPV) and receiver operating characteristic (ROC) area under the curve (AUC) were determined. The predictive performance of the tool was evaluated using adherence data from an external study (CKD‐FIX). Results: The allopurinol adherence tool produced S&S values for trough thresholds of 89‐98% and 76‐84%, respectively, and 90%‐98% and 76‐83% for peak thresholds. PPV and NPV were 79‐84% and 88‐94%, respectively, for trough and 80‐85% and 89‐98%, respectively, for peak concentrations. The ROC AUC values ranged from 0.84 to 0.88 and from 0.86 to 0.89 for trough and peak concentrations, respectively. S&S values for the external evaluation were found to be 75.8% and 86.5%, respectively, producing an ROC AUC of 0.8113. Conclusion: A tool to identify people with gout who require additional support to maintain adherence using plasma oxypurinol concentrations was developed and evaluated. The predictive performance of the tool is suitable for adherence screening in clinical trials and may have utility in some clinical practice settings. [ABSTRACT FROM AUTHOR]

Based on the hypothesis that the digestibility of quinua seed is the limiting factor in the utilization of nutrients from this staple, two quinua-based diets were prepared using quinua seeds and quinua flour. Theses diets were offered to children recovering from malnutrition. The digestibility and protein quality of the quinua diets were compared to those of a casein control diet by analyzing the children's metabolic balance. Results showed that digestibility of the quinua diets were compared to those of a casein control diet by analyzing the children's metabolic balance. Results showed that digestibility of the quinua seed is the limiting factor in the protein and energy utilization, and that milling improves significantly the digestibility of fat and carbohydrates. Findings also confirmed that the protein quality of quinua seeds is adequate for human consumption.

The effect of enteric coating of aspirin tablets on the gastrointestinal blood loss associated with high dose aspirin therapy was investigated in 12 patients with rheumatoid arthritis. Occult blood loss was measured after labelling the patients' red blood cells with Cr51. Three salicylate preparations were used: enteric coated tablets of aspirin ("Rhusal", G.P. Laboratories, 7 x 650 mg per day), uncoated tablet cores of aspirin from the same batch (7 x 650 mg per day) and enteric coated tablets of sodium salicylate (7 x 600 mg and 1 x 300 mg per day). Daily blood loss during a salicylate-free period was (0.7 +/- 0.15 ml, mean +/- SE). Blood loss was significantly increased during dosage with all three salicylate preparations. Daily blood loss during dosage with the uncoated tablets of aspirin (5.3 +/- 0.3 ml) was significantly greater than during dosage with the enteric coated tablets of aspirin (2.3 +/- 0.3 ml) and enteric coated tablets of sodium salicylate (2.1 +/- 0.4 ml). The bioavailability of the salicylate preparations was studied in seven of the 12 patients. Mean plasma salicylate concentration two hours after the second daily dose during dosage with the enteric coated tablets of aspirin was 118 +/- 15 microgram/ml compared to 131 +/- 16 microgram/ml during dosage with the uncoated tablets. Urinary recoveries of the daily dosage of aspirin in the two formulations were also similar.

Two varieties of cassava, processed as Nigerian fermented flour (gari) or as Brazilian flour (farinha), were fed to two groups of eight infants and young children, each group receiving both forms of one variety, with preceding, intervening and following casein control diets. The flours provided 50% of diet energy, with casein added to make 8% energy as protein, vegetable oils to make 20% as fat and corn syrup solids and sugar to make 72% carbohydrate (CHO) energy. Fecal wet weight increased (P less than 0.05) from approximately 100 g/d (casein diets) to means (+/- SD) of 202 +/- 72, 171 +/- 58, 154 +/- 46 and 190 +/- 67 g/d; dry weights from means of 14.7-18.3 g/d to means of 22.9-24.4 g/d (P less than 0.05); fecal energy from means of 50-60 kcal/d to means of 89-94 kcal/d (P less than 0.01); fetal fat was generally not affected; and fecal CHO nearly tripled (P less than 0.01) from approximately 4 to 12 g/d. Apparent nitrogen absorptions and retentions from the cassava + casein diets were modestly lower than from casein diets. Rates of weight gain were very variable and not significantly different by diet; serum albumin levels were essentially unchanged. The results with these flours were indistinguishable from each other and from those previously found with freeze-dried cassava flour in otherwise identical diets. Variety and processing method had no effect on the digestibility of cassava starch and oligosaccharides and on the great resistance to digestion and the water-holding capacity of cassava fiber.

The usefulness of a mixture of wheat noodles and a casein-based formula in the early management of 11 children with second or third degree malnutrition and of ten better nourished children with acute diarrhea was studied. Response of the malnourished children, gauged by clinical course and balance studies, paralleled that previously documented using only casein-based formula diets. Children with acute diarrhea recovered well but had expectedly higher fecal energy losses than previously seen in healthy children consuming the same diet. Diets containing substantial amounts of wheat noodles, a low cost widely available staple, can be appropriately used in the refeeding of chronic malnutrition and acute infectious enteritis.

Infants consumed 75% of calories as 82% extraction wheat flour with satisfactory short-term protein and energy digestion. Protein needs, represented by N retentions from casein, probably were not satisfied. Long-term (3+ months) studies in four infants showed that 50% calories and 80% protein from wheat (casein added to 8% protein calories) supported weight gain and linear growth more than expected. Prolonged feeding of 75% calories and 100% protein from wheat attempted in three infants. In the oldest (15.5 months), digestibility and growth was satisfactory; in one, despite good digestion, weight gain and growth was inadequate and serum albumin fell until 0.2% lysine was added; and in another, weight gain was satisfactory but albumin fell to 3.25 g/dl and growth was inadequate. In six other infants, lysine addition during the 2nd of 3 months was associated with significant increase in N retention and weight gain and stabilization of albumin; lysine withdrawal resulted in significant decrease in weight gain with no effect on N retention or albumin; growth was barely adequate during 3-month study. Serum cholesterol fell only when dietary protein was inadequate. It is practically impossible for unsupplemented wheat to satisfy protein needs of infants and most small children.

Fifty-eight patients with rheumatoid arthritis (RA) entered a double blind trial of auranofin (AF) designed to assess dose response relationships and longterm outcome. Multivariate analysis of repeated measures with trend analysis and discriminant function analysis of standard measures of RA activity were applied to a randomized double blind trial of AF at daily doses of 4, 6 and 8 mg over 6 months. Improvement occurred in each group. There was a highly significant (p less than 0.001) linear trend in the 6 mg group, 73% of whom showed linear improvement. A significant correlation (p less than 0.05) was found between response of individual patients and AF dose (mg/kg/day), but there was no significant correlation between dosage and mean steady state serum gold concentration. No significant correlation was seen between outcome and pretreatment demographic and disease variables. In a subsequent 6 month phase of dosage adjustment, aiming for optimal dosage, no advantage resulted from increasing the dose above 6 mg/day. Patients apparently benefiting from treatment continued an open long-term trial of AF. By 45 months, 33.5% had stopped treatment due to lack of efficacy and 14.5% due to toxicity, mainly rash and diarrhea.

The pharmacokinetics of chlorbutol were studied after oral administration in 4 healthy subjects on two occasions. Following the rapid attainment of peak concentrations, plasma concentrations fell by approximately 50 per cent in 24 h. After the first dose of chlorbutol, the terminal elimination half-life was 10.3 +/-1.3 days (mean +/- S.E.M), the volume of distribution was 233 +/- 141 and the plasma clearance was 11.6 +/- 1.0 ml min-1. The binding to plasma proteins was 57 +/- 3 per cent. In 3 of the 4 subjects, there was a small but significant decrease in the terminal half-life of chlorbutol after the second dose. The mean urinary recovery over 17 days in two of the subjects accounted for only 9.6 per cent of the dose, 7.4 per cent of the total as the glucuronide and sulphate conjugates and 2.2 per cent as unchanged chlorbutol. A significant factor in the elimination of chlorbutol may be its instability under physiological conditions. Its half-life in vitro is 37 days at pH 7.4. The long terminal half-life of chlorbutol makes it unsuitable as a sedative drug because of the considerable accumulation which will occur when the drug is taken in multiple doses.

The effects of chronic treatment with allopurinol and clofibrate on the elimination from plasma of warfarin and dicoumarol were examined in man. In addition, the binding of warfarin to human serum proteins was measured with and without clofibrate and its metabolite chlorophenoxyisobutyric acid (CPIB), both present in therapeutic concentrations. Treatment with allopurinol and clofibrate did not alter the rate of elimination of warfarin from plasma. In addition, clofibrate and CPIB caused no significant displacement of warfarin from serum proteins. This evidence supports the conclusion that the clinically significant potentiation of warfarin activity by clofibrate in man is due to an interaction at the receptor site. In contrast, treatment with allopurinol resulted in significant prolongation of the plasma half-life of dicoumarol in one of three subjects. These data are consistent with inhibition of the metabolism of dicoumarol by allopurinol in some individuals.

A case of chlorbutol toxicity and dependence is presented. A very long elimination half-life (13.2 days) was found in the patient. The data suggest that chlorbutol is an unsuitable sedative to be available freely to the public.

The effect of decortication and extrusion on the apparent protein quality and digestibility of sorghum (S. vulgare) was evaluated in comparative balance studies in nine children 7-24 months of age. Sorghum provided (as kilocalories) 8% protein and 62% carbohydrate in the study diet. Lysine was supplemented to 3% of protein. Casein provided 6.4% protein kilocalories in the control diet. A mixture of sucrose, dextrimaltose and cornstarch provided carbohydrate. Both diets contained 30% fat kilocalories as soybean-cottonseed oil blend. Balance studies were carried out during the last 6 days of three 9-day dietary periods: control-sorghum-control. Apparent N absorption from sorghum was 81 +/- 4% and did not differ from control. Apparent N retention, 21 +/- 6%, was expectedly lower than the preceeding control (27 +/- 8%, P less than 0.05) and following control (33 +/- 7%, P less than 0.01) values. The control values differed significantly from each other (P less than 0.05). Fecal weights and energy losses showed only minor differences between the two diets. These data contrast sharply with previous results obtained with whole-grain sorghum and suggest that the use of decortication and low cost extrusion processing can markedly improve the apparent protein quality and digestibility of sorghum.

The protein quality and digestibility of two high lysine (2.9-3.0 g/100 g protein) and tow conventional varieties (lysine content 2.1-2.2 g/100 g protein) of whole grain sorghum milled as flour were assessed through balance studies in 13 children 6-30 months of age. Sorghum protein provided 6.4 or 8.0% of dietary energy. Control diets contained 64% kcal protein as casein. Children consumed 100-150 kcal/kg body weight/day. Sorghum consumption was associated with weight loss or poor weight gain. We found no difference by variety in apparent nitrogen absorption or retention. Mean absorption and retention of nitrogen (+/- SD) from 26 six-day sorghum dietary periods were 46 +/- 17% and 14 +/- 10% of intake, respectively (corresponding preceding casein control values: 81 +/- 5% and 38 +/- 3%). Stool weight and energy losses during sorghum periods averaged 2.5 to 3 times control values. Plasma amino acids were determined in eleven children after 16 days of sorghum consumption. Fasting concentration of total amino acids (TAA) was similar to values previously obtained with wheat protein at similar levels of intake. Total concentration of essential amino acids (TEAA) was low as were concentrations of lysine (Lys) and threonine (Thr). Analysis of postprandial changes of the Lys/TEAA and Thr/TEAA molar ratios confirmed that Lys was the first limiting amino acid.

Whole grain sorghum flour was fermented into Nasha, a traditional Sudanese food, and freeze-dried or drum-dried. It was cooked and fed to convalescent malnourished infants and small children as 61% of total diet calories and all of 6.4% protein calories, with (Lys+) and without lysine supplementation to 3% of protein. Apparent absorptions of nitrogen were 73 +/- 5 and 74 +/- 6% of intake, significantly (P less than 0.01) less than those from preceding (Cas-1, 86 +/- 3%) and following (Cas-2, 85 +/- 3%) isonitrogenous casein diets. Apparent retentions of nitrogen from Nasha (26 +/- 10%) were significantly lower than those from Lys + (34 +/- 9%, P less than 0.05), Cas-1 (35 +/- 11%, P less than 0.01) or Cas-2 (49 +/- 9%, P less than 0.01). Retentions from Cas-2 were higher than those from Cas-1 or Lys + (P less than 0.01). Fecal wet and dry weights were higher (P less than 0.02) during both Nasha diets and Cas-2 than during Cas-1. Fecal energy and carbohydrate were significantly (P less than 0.01) higher from either Nasha diet than from either casein diet; fecal fat was not different. Two children received drum-dried Nasha without further cooking; digestibilities were not different from those of the cooked product but biological value was much lower. When properly cooked and consumed along with small amounts of a good source of lysine, Nasha is a satisfactory weaning food.

Six diets were prepared based on commonly used Peruvian foods, mainly of vegetable origin, which were offered to eight infants (mean age: 12.8 +/- 8.2 months) recovering from malnutrition. The purpose of this study was to evaluate the acceptability, tolerance and digestibility of the diets in question. Five were prepared with a potato and wheat base (noodle) and the sixth with a quinua-oats base. The acceptability and tolerance was satisfacotry, allowing maintenance of an adequate calorie and protein intake in all patients except one. On the quinua-oats based diet, the mean apparent absorption of nitrogen and fat was significantly lower (P less than 0.05) than in the case of the other diets. The increase in height coefficient (height age/chronological age X 100) and weight/age proved to be adequate during the study, except in the three youngest patients. The authors consider that this type of diets (potato-wheat based) can be recommended for infant feeding after the first year of life, and that the quinua-oats based diet still needs a more thorough evaluation prior to recommending its use.

Seven-day individual weighed dietary intakes and anthropometric measurements were determined in 123 children, 2 to 19 yr of age, from 26 poor families in Lima: each included one child who had been malnourished, six were adopting families. Heights and weights were converted to "ages" based on Boston reference data and local data, then to "quotients" as percentages of actual ages. Mineral and vitamin intakes were expressed as amounts per day and per 1000 kcal, calories and protein as percentages of FAO/WHO recommendations for age and height age and of modified recommendations based on size of Peruvian children. Regression analyses identified common sources of nutrients and greater dependence of intakes on body size than on age. Analysis of covariance for sex identified different nutrient-growth correlations. Polynomial regression analysis identified percentage protein from animal sources and percentage fat calories as having significant quadratic as well as linear correlations with achieved growth. In males, multiple regression analysis identified percentage protein from animal sources and beta-carotene intakes as strongly associated with achieved height and weight, and percentage fat calories as strongly associated with weight quotient/height quotient ratios. In females the correlations were not as strong, possibly because a significant percentage had reached the menarche some time before the survey and were probably no longer growing. Nevertheless, calorie intake, as a percentage of the recommendation for height age, was prominent in the regressions for height quotient and percentage fat calories in that for weight quotient. The very strong association of animal protein intake with male height, despite seemingly generous total protein intakes, is difficult to reconcile with current recommendations. The possible role of vitamin A (as beta-carotene) has potentially important implications for food policies.

Eighteen Peruvian children with protein-calorie malnutrition were studied to evaluate the usefulness of the limulus assay for endotoxin in detecting gram-negative sepsis. Nine of the children had at least one positive Limulus assay, and eight of this group had bacteriologic cultures indicative of gram-negative infection. Four of these nine children with positive Limulus assays died, whereas only one of the nine children with negative assays died. This preliminary study suggests the usefulness of the Limulus assay as an adjunct to bacteriologic cultures in the early detection of significant gram-negative infection in severely malnourished children.

Cyanide markedly increased the rate of uptake of gold by red blood cells when incubated with sodium aurothiomalate, a polymeric gold complex. Thiocyanate had no significant effect on gold uptake. The effect of cyanide was demonstrated to be due to the conversion of aurothiomalate to the complexion, aurocyanide, which is rapidly taken up by red blood cells. At a low ratio (1:20) of cyanide to aurothiomalate, cyanide appeared to act as a shuttle to carry gold into red blood cells. Tobacco smoking is known to increase the concentrations of gold in red blood cells in patients treated with aurothiomalate. The present data indicate that this effect of smoking is most likely due to cyanide inhaled in tobacco smoke and not to thiocyanate, a circulating metabolite of cyanide. An effect of cyanide on the uptake of polymeric gold complexes to target cells such as polymorphonuclear leukocytes and monocytes is suggested.

Normal infants exhibited circadian rhythmicity of plasma F concentration. Infants from 2.1 to 3.2 months of age had CSR significantly higher than those of older infants. THF/THE urinary excretion ratios increased with age. The 17OHCS excretion was higher in the younger infants. Urinary excretions of free corticoids and cortisol were similar in all age groups. In marasmus, plasma F concentrations in the morning and evening were significantly elevated. Normal diurnal variation returned following therapy. CSR and 17OHCS excretions were not different from age controls, but were significantly lower than size controls, THF/THE ratios, urinary excretion of free corticoids and cortisol were normal. In marasmic kwashiorkor, plasma F concentrations were significantly elevated in the morning and evening. There was a suggestive decrease with therapy. CSR was low before and after treatment. THF/THE ratios, urinary 17OHCS excretion, and urinary free corticoids and cortisol were not significantly different from infants matched for size or patients with marasmus.

Forty-one children were studied in order to provide information on antibody responses to H. influenzae type b polyribophosphate (PRP), given in combination with diphtheria-pertussis-tetanus vaccine (DPT). When PRP was administered alone, 9 of 15 children demonstrated fourfold or greater increases in titres of anti-PRP antibody. In contrast, in the group receiving a combination vaccine consisting of DPT and PRP only 1 of 13 children showed a similar rise in anti-PRP antibody. It was concluded that, in the population studied, the combination vaccine was less effective than PRP alone. The reasons for this difference and its potential significance are discussed.

Boiled fresh cassava or oven-dried cassava flour provided 50% of the energy and less than 10% of the protein in diets of convalescent malnourished infants; casein was added to complete 8% of energy as protein, and vegetable oil (soybean-cottonseed) was added to make 20% of energy as fat. Despite high wet weights of feces (172 +/- 42 and 214 +/- 41 g/d), their dry weights (20 +/- 3 and 22 +/- 2 g/d) and their energy (6.9 +/- 0.7 and 7.6 +/- 0.5% of intake) and nitrogen (17 +/- 3 and 20 +/- 3% of intake) contents were low, and their fat content (4.4 +/- 1.3 and 5.2 +/- 1.2% of intake) was very low. Cassava is a surprisingly effective source of energy which interferes little or not at all with digestion of added protein and fat in weaning diets. For its safe use, it is important that home or industrial processing almost completely eliminate its potential hydrocyanic acid content, and that a good quality protein supplement be consumed regularly in nutritionally adequate amounts.

Amaranthus caudatus L. toasted flour, popped grain and flakes were each fed to nine young children as the source of all diet protein and fat and 50% of diet energy, preceded and followed by casein control diets. All provided 6.4-6.7% of energy as protein and 9.3-10.1% as fat. Balances were carried out during the last 6 d of the three 9-d amaranth periods and during the four control periods. Fecal wet and dry weights during amaranth diets were 129-157% of those during casein control diets; fecal energy, fat and carbohydrate from the toasted flour periods were 193, 268 and 256%; from the popped grain 253, 586 and 195%; and from the flakes 225, 356 and 255% of those during casein diets. Apparent N absorptions were 84.1-84.6% of the casein values (P less than 0.001); apparent retentions from toasted, popped and flaked amaranth were 70.9, 65.9 and 59.0% of casein (P less than 0.001). The last of these was significantly lower than the first (P less than 0.05). Fecal fat was much higher (P less than 0.001) from the popped than from the flaked grain and the toasted flour. Toasted flour was then added to maize meal so that amaranth provided 20 or 30% of the protein. Seven young children received diets in which 6.4% of total energy came from one of the above mixes, or from casein, as protein. Soya-cottonseed oils completed 25% lipid energy in all three diets; balance of energy was from sucrose in the experimental diets and from sucrose, corn syrup solids and cornstarch in the casein diet.(ABSTRACT TRUNCATED AT 250 WORDS)

A sensitive and specific high-performance liquid chromatographic assay for the optical isomers of ibuprofen in plasma is reported. The isomers were converted to their diastereoisomeric S(+)-2-octyl esters and were resolved with two silica columns in series and a mobile phase containing 0.05% isopropyl alcohol in heptane. The lower limit of sensitivity was 0.5 micrograms/mL. The plasma concentrations of the optical isomers in a normal volunteer following administration of racemic, S(+)-, and R(-)-ibuprofen are reported. Following administration of R(-)-ibuprofen, there was stereoselective inversion of R(-)- to S(+)-ibuprofen.

The nutritional quality of lupins (Lupinus mutabilis) for infants and children was evaluated in two sets of balance studies. In the first the digestibility and protein quality of diets based on lupin flour, with and without methionine supplementation, were compared with those of a control diet consisting of casein, sucrose and vegetable oil. Apparent nitrogen absorption from lupin flour (81.8 and 84.3% of intake) was slightly but significantly less than that during casein control periods (87.2 and 86.8% of intake, P less than 0.05 and less than 0.001). Apparent nitrogen retention from unsupplemented lupin (15.6 +/- 5.8% of intake) was significantly less than that from casein in the corresponding control periods (29.8 +/- 4.9%, P less than 0.001); a small but significant (P less than 0.05) increase in nitrogen retention was observed during the control period following the lupin diet when compared with that preceding it. Methionine supplementation of lupin produced a marked improvement in apparent nitrogen retention (to 22.2 +/- 6.9%, P less than 0.05). In the second set of studies the digestibility of lupin oil was compared with that of a blend of soybean and cottonseed oils (50:50). Excretion of fecal fat (9.8 +/- 3.0% of intake) and fecal energy (6.7 +/- 1.2% of intake) with the diet containing lupin oil were similar to those observed with the control diet. Both the protein quality and oil digestibility of Lupinus mutabilis are very similar to those from soybeans processed in a similar manner. For certain countries the lupin could be a valuable source of protein and edible oil for human consumption.

The effect of increasing expenditure on the nature and the amounts of foods consumed by children from an urban population was estimated by studying the diets of 111 children from 20 typically poor families and those of 12 children from six economically better off families who had a much more satisfactory growth status. Total calories and protein, fat, and carbohydrate calories were expressed as a fraction of each individual's estimated energy requirement, thus adjusting for sex, age, and size. No important sex differences were found. Calorie intake was 87.2 +/- 17.3% and 111.4 +/- 18.1% of requirement for the two groups, respectively. Differences were found between the groups in protein calories which were totally due to milk and meat. Differences in fat calories were due to milk, meat, and separated fats. There was no significant difference between groups in total carbohydrate calories, although there were shifts in its components with increasing expenditure. Regression analysis of calorie adequacies as a function of per capita expenditure for food, both in the poorer group and in the combined population, were performed and yielded highly significant (p less than 0.001) results. These were due to significant gradual increases in the consumption of milk, meat, separated fats, fruits and vegetables on top of an almost constant consumption of the staple cereals, roots and tubers.

Fasting and postprandial plasma free amino acids were studied in nine children on the 9th day of consumption of a diet in which potato protein provided all nitrogen at a marginal level of protein intake (5.03-5.10% protein-calories). The analysis of the potato utilized indicated that 49% of total amino acids (TAA) were free amino acids (AA) and 40% essential amino acids (EAA). Fasting values of TAA and total essential amino acids (TEAA) and the ratios of EAA/TEAA were similar to those obtained previously with milk or casein diets. The low percentage of protein-calories in the diet and relatively poor nitrogen absorption of the potato were reflected in a low (0.236) fasting TEAA/TAA ratio. Met/TEAA and Trp/TEAA ratios were significantly (P less than 0.05) but not markedly lower 3 hours postprandially compared to fasting values, returning to the initial levels 4 hours postprandially. Thr/TEAA ratio was significantly higher (p less than 0.05) at 3 hours but not so at 4 hours. The results suggest that potato protein has an adequate ratio of TEAA/TAA and the balance among individual EAA concentrations should be able to meet the EAA requirements of growing infants and small children if fed and absorbed in sufficient amounts to meet total nitrogen needs.

The effect of consumption of wheat-based diets on serum cholesterol and triglyceride levels was studied in eight previously malnourished children. While consuming a control diet of casein, soy-cottonseed oil blend, and a mixture of sucrose and starch, the serum cholesterol level was 169 +/- 42 mg/dl (mean +/- SD). This decreased significantly (P less than .001) to 108 +/- 30 mg/dl after nine days' consumption of an isoenergetic-isonitrogenous diet in which whole wheat or white flour provided all the protein and +/- 50% of carbohydrate, and remained at this level for the 27-day dietary period. On changing again to the casein-based diet, the serum cholesterol level rose within nine days to 154 +/- 42 mg/dl. There was no similar diet-related change in serum triglyceride values. None of the known mechanisms whereby diet affects serum cholesterol adequately explains these findings.

To determine whether increasing proportions of cassava could be consumed and satisfactorily digested, eight recovering malnourished children (20-38 mo old) received 25, 50 and 75% of their diet energy as freeze-dried cassava flour during 9-d periods, with intervening casein control diets. Enough casein was added to all cassava diets to bring protein energy to 8% of the total. When compared to the control diet, the 25% diet had no significant effect on consumption time or measures of protein and energy digestion. With the 50% diet, fecal wet and dry weights were moderately higher than with the 25% diet (196 +/- 44 and 24 +/- 4 vs. 121 +/- 36 and 16 +/- 3 g/d, respectively), as were fecal energy (89 +/- 16 vs. 63 +/- 16 kcal/d) and calculated carbohydrate (11 +/- 2 vs. 5 +/- 1 g/d); apparent nitrogen absorption (mostly from casein) was slightly lower (79 +/- 5 vs. 83 +/- 6%) and consumption time slightly higher (5-25, median 10, vs. 4-18, median 6 min/feeding). When energy from cassava was increased to 75%, fecal weights (240 +/- 49 and 31 +/- 5 g/d), energy (124 +/- 27 kcal/d) and carbohydrate (16 +/- 4 g/d) were all higher than when cassava provided 50 or 25% of energy. Consumption required 8-34, median 17 min/feeding and apparent nitrogen absorption was 76 +/- 6% of intake.(ABSTRACT TRUNCATED AT 250 WORDS)

Plasma concentrations of thiopentone were determined at frequent intervals over the first 12 min following injection i.v. in eight patients. Samples of arterial and peripheral venous blood were obtained in all subjects. In six, central venous and in two, internal jugular samples were obtained also. Thiopentone concentrations in arterial and central venous plasma did not differ significantly after 2 min. Differences between arterial and peripheral samples were significant for 2 min although, in some patients, considerable variability persisted for up to 9 min. In both patients from whom jugular venous samples were obtained, the difference between these and the peripheral plasma concentrations was marked. This difference may account for the appearance of acute tolerance. A computer model for this hypothesis is presented.

Between 1966 and 1976, heights and weights were determined yearly on all available children from 163 families who had had at least one child successfully treated for malnutrition between 1961 and 1971 and from eight families who had adopted such a child. Between 1959 and 1976, a total of 72 fathers departed from these families: 12 died, 47 deserted, six were jailed, and seven left to look for work elsewhere. Heights and weights as Z scores and the weight age/height age ratios were analyzed, when available, during four periods around the date of the event: 6 to 18 months before (period 1B), 0 to 6 months before (period 2B), 0 to 6 months after (period 3A), and 6 to 18 months after (period 4A). Mean Z scores for all children measured in the period were already low (-0.26 +/- 0.93 and -0.25 +/- 0.95) during period 1B, were higher during period 2B, (-0.15 and 0.04), lower during period 3A (-0.39 and -0.46), and similar to original levels during period 4A (-0.37 and -0.27). Mean weight age/height age was low (0.93 +/- 0.17) only during period 3A for children 2 to 18 years of age. In paired comparisons for children measured during any two periods there were significant increases in Z height and Z weight from periods 1B to 2B and from periods 1B to 4A in children less than 2 years of age and a significant decrease in the weight age/height age ratio from periods 1B to 3A in those 2 to 18 years of age. Loss of father had little or no further impact on the already poor growth of these children.

The bioavailability and gastrointestinal site of release of enteric coated aspirin tablets ("Rhusal", G.P. Laboratories) were investigated following dosage with single tablets. A delay of one to more than eight hours was observed between dosage and the appearance of salicylate in plasma or saliva. This delay was decreased by pretreatment with metoclopramide. No aspirin or salicylate was detected in gastric aspirates. The mean urinary recovery of salicylate was equivalent to 92% of the administered dose. All these tests were consistent with the designed function of the enteric coating. The time course of concentrations of salicylate in saliva rather than in plasma was confirmed as a useful technique for the evaluation of different formulations of aspirin. The acceleration of gastric emptying by metoclopramide is a useful technique for the evaluation of enteric coated tablets.

The quality of the protein in a complete tube feeding formula intended for use in adults was evaluated in convalescent malnourished children. The casein-soy protein isolate blend was found to be similar to casein by comparative nitrogen balance studies carried out in five children, with protein providing 6.4% of calories. Three- and four-hour postprandial plasma free amino acid determinations at the same level of protein intake did not show the drop of plasma free methionine or of the methionine/total essential amino acid molar fraction characteristically seen when this amino acid is first limiting for protein synthesis. Three additional children were fed the formula, altered only by the addition of water, for periods of up to 3.6 months to test the tolerance to and completeness of the diet. No untoward effects nor signs of specific nutrient deficiency were encountered. Linear growth was appropriate for the stage of recuperation. The failure to achieve a normal (greater than 3.8 g/dl) serum albumin concentration in two of the three children may have been due to their rapid weight gain. Although it is intended for the adult, our results indicate that the formula could meet the nutritional requirements of infants and children.