Synthesis and anticancer activity evaluation of Novel 6 mercaptopurine derivatives.

A series of five (6- mercaptopurine derivatives) have been synthesized as disulfide, Schiff base, Oxadiazole and amide products and the activity as anticancer was evaluated against three types of cancer lines. The pilot studies indicated that compound 1, 2, 3, 4 and 5 were the active compounds, but only compound (1) reviewed in detail .The reaction progress and products purity were checked by thin layer chromatography. The target chemical structures of compounds and intermediates were proved by their physicochemical properties as melting points, infrared spectroscopy, and elemental microanalysis (CHNS) and proton nuclear magnetic resonance (H1NMR)  Keywords: cancer, 6 -mercaptopurine, disulfide, penicillamin

Synthesis of nitrocoumarin derivative and separation of its isomers

Coumarins antgonise the effects of vitamine K During the formation of clotting factors II, VII, IX and X in the liver, vitamine K is converted into a biologically inactive metabolite which then reduced back to the active vitamine by the enzyme epoxide reductase. Coumarins which are structurally similar to vitamine K, are believed to act as competitive inhibitors of this enzyme and thus limit the availability of the active form of the vitamine to form clotting factors. Coumarins, e.g. (warfarin) is indicated in deep–vein thrombosis and in pulmonary embolism …etc. The aim of this study is to synthesize and isolate a nitrocoumarin derivative with a possible high intrinsic activity. The nitrocoumarin derivative was synthesized by the reaction of 7–hydroxy, 4–methylcoumarin with mixture of concentrated sulfuric acid and concentrated nitric acid at 0°C. The identity of the prepared compound had been confirmed using UV–Vissibile spectroscopy, I.R spectroscopy, elementary analysis, (sodium fusion test) and HPLC

Intensive community care services for children and young people in psychiatric crisis: an expert opinion.

BACKGROUND: Children and young people's (CYP) mental health is worsening, and an increasing number are seeking psychiatric and mental health care. Whilst many CYPs with low-to-medium levels of psychiatric distress can be treated in outpatient services, CYPs in crisis often require inpatient hospital treatment. Although necessary in many cases, inpatient care can be distressing for CYPs and their families. Amongst other things, inpatient stays often isolate CYPs from their support networks and disrupt their education. In response to such limitations, and in order to effectively support CYPs with complex mental health needs, intensive community-based treatment models, which are known in this paper as intensive community care services (ICCS), have been developed. Although ICCS have been developed in a number of settings, there is, at present, little to no consensus of what ICCS entails. METHODS: A group of child and adolescent mental health clinicians, researchers and academics convened in London in January 2023. They met to discuss and agree upon the minimum requirements of ICCS. The discussion was semi-structured and used the Dartmouth Assertive Community Treatment Fidelity Scale as a framework. Following the meeting, the agreed features of ICCS, as described in this paper, were written up. RESULTS: ICCS was defined as a service which provides treatment primarily outside of hospital in community settings such as the school or home. Alongside this, ICCS should provide at least some out-of-hours support, and a minimum of 90% of CYPs should be supported at least twice per week. The maximum caseload should be approximately 5 clients per full time equivalent (FTE), and the minimum number of staff for an ICCS team should be 4 FTE. The group also confirmed the importance of supporting CYPs engagement with their communities and the need to remain flexible in treatment provision. Finally, the importance of robust evaluation utilising tools including the Children's Global Assessment Scale were agreed. CONCLUSIONS: This paper presents the agreed minimum requirements of intensive community-based psychiatric care. Using the parameters laid out herein, clinicians, academics, and related colleagues working in ICCS should seek to further develop the evidence base for this treatment model

Dental management considerations for the patient with an acquired coagulopathy. Part 1: Coagulopathies from systemic disease

Current teaching suggests that many patients are at risk for prolonged bleeding during and following invasive dental procedures, due to an acquired coagulopathy from systemic disease and/or from medications. However, treatment standards for these patients often are the result of long-standing dogma with little or no scientific basis. The medical history is critical for the identification of patients potentially at risk for prolonged bleeding from dental treatment. Some time-honoured laboratory tests have little or no use in community dental practice. Loss of functioning hepatic, renal, or bone marrow tissue predisposes to acquired coagulopathies through different mechanisms, but the relationship to oral haemostasis is poorly understood. Given the lack of established, science-based standards, proper dental management requires an understanding of certain principles of pathophysiology for these medical conditions and a few standard laboratory tests. Making changes in anticoagulant drug regimens are often unwarranted and/or expensive, and can put patients at far greater risk for morbidity and mortality than the unlikely outcome of postoperative bleeding. It should be recognised that prolonged bleeding is a rare event following invasive dental procedures, and therefore the vast majority of patients with suspected acquired coagulopathies are best managed in the community practice setting

Adverse effects of extra-articular corticosteroid injections: a systematic review

<p>Abstract</p> <p>Background</p> <p>To estimate the occurrence and type of adverse effects after application of an extra-articular (soft tissue) corticosteroid injection.</p> <p>Methods</p> <p>A systematic review of the literature was made based on a PubMed and Embase search covering the period 1956 to January 2010. Case reports were included, as were prospective and retrospective studies that reported adverse events of corticosteroid injection. All clinical trials which used extra-articular corticosteroid injections were examined. We divided the reported adverse events into major (defined as those needing intervention or not disappearing) and minor ones (transient, not requiring intervention).</p> <p>Results</p> <p>The search yielded 87 relevant studies:44 case reports, 37 prospective studies and 6 retrospective studies. The major adverse events included osteomyelitis and protothecosis; one fatal necrotizing fasciitis; cellulitis and ecchymosis; tendon ruptures; atrophy of the plantar fat was described after injecting a neuroma; and local skin effects appeared as atrophy, hypopigmentation or as skin defect. The minor adverse events effects ranged from skin rash to flushing and disturbed menstrual pattern. Increased pain or steroid flare after injection was reported in 19 studies. After extra-articular injection, the incidence of major adverse events ranged from 0-5.8% and that of minor adverse events from 0-81%. It was not feasible to pool the risk for adverse effects due to heterogeneity of study populations and difference in interventions and variance in reporting.</p> <p>Conclusion</p> <p>In this literature review it was difficult to accurately quantify the incidence of adverse effects after extra-articular corticosteroid injection. The reported adverse events were relatively mild, although one fatal reaction was reported.</p

Evaluation of Analgesic Activity of Newly Synthesized Phthalyl- tyrosyl-glycin Sodium

Alteration in the backbone structure of the endogenously released opioid peptides Leu5/Met5 enkephalins may result in compounds having comparable profile of pharmacological activity but with different physicochemical properties and side effects. Phthalyl amino acid and phthalyl esters are among the derivatives that have been synthesized and evaluated for their antibacterial and antifungal activities.This study was conducted to evaluate the possible analgesic activity of phthalyl-tyrosyl-glycin sodium that has been recently synthesized by our team.The study was carried out on 24 albino mice using hot plate method. The animals were allocated in to three groups; the first group received saline and represent a control group; the second group received morphine HCl as a standard drug; and the third group received phthalyl-tyrosyl-glycin sodium. The onset with which the animal lift his forearm and the number of jumps per 25 seconds were recorded for each group.    The results of this study showed that phthalyl-tyrosyl-glycin sodium resulted in significant improvement (P0.05) was observed in analgesia score but with significant delay in induced hyperalgesia.The results obtained in this study provide experimental evidences for the effectiveness of the prepared compound as analgesic with comparable effect to that of morphine. Key words: Phthalyl-tyrosyl-glycin sodium, phthalyl group, analgesi

Phytochemical Investigation for the Main Active Constituents in Arctium lappa L. Cultivated in Iraq

Burdock ( Arctium lappa), is among the most popular plants in traditional medicine and it is associated with several biological effects. Literature survey revealed the presence of phenylpropanoid compounds .The most widespread are hydroxycinnamic acids ( mainly caffeic acid and chlorogenic acid) and lignans (mainly arctiin and arctigenin). This work will confirm the presence of these compounds in Arctium lappa, cultivated in Iraq, in both root and leaf samples.  The dried plant samples were extracted by soxhlet with 80% methanol then separated the main constituents by thin layer chromatography (TLC) and high performance liquid  chromatography (HPLC). Identification of the isolated compounds was carried out by UV, IR, and compared with reference standards using TLC, HPLC and  HPTLC. Keywords: Actium  lappa, hydroxycinnamic acid,  Lignan, Phytochemical

ScvO 2 changes after red-blood-cell transfusion for anaemia in cardiothoracic and vascular ICU patients: an observational study

International audienceBackground and Objectives: Haemoglobin threshold for transfusion has been significantly decreased, but haemoglobin plasma concentration may not be sufficient to assess the need of red‐blood‐cell (RBC) transfusion. Central venous oxygen saturation (ScvO2) is a clue of metabolic matching between O2 transport and consumption, which could help to assess when transfusion is appropriate once anaemia has been diagnosed in ICU patients.Materials and Methods: Adult patients admitted consecutively to a cardiothoracic and vascular ICU were included in a prospective, observational and single‐centre study over a 6‐month period (September 2014 to February 2015), provided they were transfused with RBC. Patients with active bleeding or in unstable condition were excluded. Haemoglobin and ScvO2 were collected through a central venous catheter before and after transfusion. In order to identify a ScvO2 threshold, analysis of ScvO2 changes after transfusion was performed.Results: Fifty‐three patients received 100 RBC transfusions. Haemoglobin at the time of transfusion was 7·2 g/dl [6·8–7·7], while ScvO2 was 66·9% [60–73]. A 5% increase in ScvO2 after transfusion has the best specificity and positive predictive values, with a ScvO2 threshold of 65%. After transfusion (RBC units, 2 [1‐2]), ScvO2 increased only in patients with ScvO2 ≤65%, from 58% [53–62] to 69% [64–73] (P < 0·001).Conclusion: In anaemic patients, RBC transfusion induced a significant increase in ScvO2, provided it was low before transfusion. A 65% cut‐off value of ScvO2 before transfusion showed good specificity and good positive predictive value for a 5% increase after transfusion