In Patients with Treatment-Resistant Depression, How Effective is Ketamine for Rapid Improvement of Depression and its Symptoms?

For decades clinicians and scientists have been searching for an alternative to rapidly treat patients with TRD. This dilemma may be partly resolved for some patients. A new use for an old drug, ketamine, promises to be effective for treatment of TRD. This new role for ketamine will be explored with particular emphasis on whether it is effective, and if so, how durable its benefits are

Urodynamic Study in Children

A b s t r a c t:Urodynamic study (UDS) is a serial of clinical tests, like uroflowmetry, filling cystometry, pressure-flow studies and assessment of urethral closure pressure. These tests include urethral pressure profilometry and also measurement of the leak-point pressure of lower urinary system. UDS is one of the essential clinical studies in children complaining of voiding dysfunction, neurogenic bladder, urine incontinence, enuresis and another lower urinary tract symptom. The aim of proper bladder management in these patients is to maintain the lower urinary tract to have good capacity, low pressure, preventing infection and incontinence. Long term goal is preventing any undue damage to the upper urinary tracts and intact kidneys function. This review article of pediatric urodynamic study provides a classified diagnostic approach to bladder dysfunctions in children

Is D-penicillamine Safe in Management of Little Children with Kidney Cystine Stones? A Case Series

Nephrolithiasis is quite common in children. It sometimes has a genetic basis and can lead to serious complications like urinary obstruction, multiple surgical interventions, or even renal insufficiency if left treated. Cystinic stones and cystinuria account for approximately 8% of the cases of nephrolithiasis in children. We studied seven pediatric patients, 1 to 3 years old (mean age: 20.5 months), with cystinic urinary stones receiving D-penicillamine plus other drugs to dissolve the stone. All of them tolerated the treatment very well and did not show any serious complication. All of our cases were managed with D-penicillamine that was initiated at a low dose and then increased progressively. We used low dose D-penicillamine, maximim15 mg/kg/day, which was beneficial without any specific side effects. D-penicillamine can be used safely in little children. Gradual induction and close observation with CBC, urine analysis, BUN, creatinine, and liver function tests may be required. D-penicillamine can prevent new stone formation and resolve the present cystinic calculi. Low dose D-penicillamine may be sufficient in treating cystinic calculi in children. We suggest more evaluations on the advantage of low dose D-penicillamine in cystinuria.Keywords: D-Penicillamine; Cystinuria; Nephrolithiasis; Complications 

Is Paromomycin an Effective and Safe Treatment against Cutaneous Leishmaniasis? A Meta-Analysis of 14 Randomized Controlled Trials

Millions of people worldwide are suffering from cutaneous leishmaniasis that is caused by parasites of the genus Leishmania. Although pentavalent antimony compounds are the treatment of choice, their use is limited by high cost, poor compliance, and systemic toxicity. Paromomycin was developed to overcome such limitations. However, there is no consensus on its efficacy. This meta-analysis assessed the efficacy and safety of paromomycin compared with placebo and pentavalent antimony compounds. Fourteen randomized controlled trials, including 1,221 patients, met our selection criteria. Topical paromomycin appeared to have therapeutic activity against the old world and new world cutaneous leishmaniasis, with increased local reactions, when combined with methylbenzethonium chloride. Topical paromomycin was not significantly different from intralesional pentavalent antimony compounds in treating the old world form, whereas it was inferior to parenteral pentavalent antimony compounds in treating the new world form. However, a similar efficacy was found between parenteral paromomycin and pentavalent antimony compounds in treating the new world form. Fewer systemic side effects were observed with topical and parenteral paromomycin than pentavalent antimony compounds. These results suggest that topical paromomycin with methylbenzethonium chloride could be a therapeutic alternative to pentavalent antimony compounds for selected cases of the old world cutaneous leishmaniasis

The Role of Eosinophils in Bullous Pemphigoid: A Developing Model of Eosinophil Pathogenicity in Mucocutaneous Disease

Bullous pemphigoid (BP) is an autoimmune blistering disease which carries a significant mortality and morbidity. While historically BP has been characterized as an IgG driven disease mediated by anti-BP180 and BP230 IgG autoantibodies, developments in recent years have further elucidated the role of eosinophils and IgE autoantibodies. In fact, eosinophil infiltration and eosinophilic spongiosis are prominent features in BP. Several observations support a pathogenic role of eosinophils in BP: IL-5, eotaxin, and eosinophil-colony stimulating factor are present in blister fluid; eosinophils line the dermo-epidermal junction (DEJ) in the presence of BP serum, metalloprotease-9 is released by eosinophils at the site of blisters; eosinophil degranulation proteins are found on the affected basement membrane zone as well as in serum corresponding with clinical disease; eosinophil extracellular DNA traps directed against the basement membrane zone are present, IL-5 activated eosinophils cause separation of the DEJ in the presence of BP serum; and eosinophils are the necessary cell required to drive anti-BP180 IgE mediated skin blistering. Still, it is likely that eosinophils contribute to the pathogenesis of BP in numerous other ways that have yet to be explored based on the known biology of eosinophils. We herein will review the role of eosinophils in BP and provide a framework for understanding eosinophil pathogenic mechanisms in mucocutaneous disease

Seepage in stochastic and spatially correlated permeability fields with an application to soil liners

Research was undertaken to study seepage in stochastic and spatially correlated permeability fields. Permeability is considered as a random variable. Assuming second-order stationarity and ergodicity, spatially correlated permeability fields were generated using geostatistical methods for two hypothetical flow fields. Second-order stationarity implies the intrinsic hypothesis, hence the spatial correlation can be characterized by variogram functions. Turning bands (kriging) method and conditional simulation techniques were used to generate spatially correlated (dependent) random fields. For comparison, spatially uncorrelated (independent) random fields were generated assuming stationarity. A numerical model was developed and used with the Monte Carlo technique to simulate seepage in the generated random fields. Simulations results are presented as a series of probability distributions for effective permeability. These pdf\u27s are used to discuss and analyze the results and to identify the influence of spatial correlation and layering. Results indicate that the spatial variation and correlation of permeability fields are important factors in flow systems. This study shows that the geometric average of permeability of heterogeneous field is a proper estimate of effective permeability only when correlation is neglected. The effective permeability for a correlated random field has larger mean and larger variance as compared to that of an uncorrelated random field. It is shown that the mean and variance of effective permeability are direct functions of the sill and range of the variogram, respectively. Results indicates that seepage quantity through a flow system, such as soil liner is an inverse function of layering. Finally, the model is used to simulate an experimental soil liner and the simulated results are compared with measured value. Furthermore, the effect of high conductivity zones (defects) on the results are evaluated, and reliability and failure risk are defined in terms of simulated results. It is shown that the presence of defects causes high seepage quantities, hence failure of the system

In Patients with Treatment-Resistant Depression, How Effective is Ketamine for Rapid Improvement of Depression and its Symptoms?

For decades clinicians and scientists have been searching for an alternative to rapidly treat patients with TRD. This dilemma may be partly resolved for some patients. A new use for an old drug, ketamine, promises to be effective for treatment of TRD. This new role for ketamine will be explored with particular emphasis on whether it is effective, and if so, how durable its benefits are