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Case Reports in Medicine 2015A 27-year-old Caucasian female with a history of depression was admitted to our local hospital with vague events that occurred a day before. This included an episode of...
A 27-year-old Caucasian female with a history of depression was admitted to our local hospital with vague events that occurred a day before. This included an episode of dysarthria, and unsteadiness, followed by feeling generally unwell. Two weeks prior to presentation she was commenced on phenelzine. During clinical assessment she suddenly deteriorated with a dramatic fall in her conscious level. Moreover, she became hyperthermic, tachycardic, and diaphoretic, and developed increased tone in all muscles and ocular clonus. Rectal diazepam was administered but failed to control the symptoms. Consequently, she was transferred to the intensive care unit for intubation and muscle relaxants were commenced. She responded well and recovered next day without complications. Her symptoms and signs were consistent with the serotonin syndrome with phenelzine being the likely cause. To the best of our knowledge, this is the first reported case to associate the condition with phenelzine alone at therapeutic dose.
PubMed: 25861278
DOI: 10.1155/2015/931963 -
Journal of Ethnopharmacology Apr 2015Mahuang decoction, Ephedra combined with Cassia twig, Bitter apricot kernel and Prepared licorice, has been widely used as a multi-herb prescription in traditional...
Effects of herbal drugs in Mahuang decoction and their main components on intestinal transport characteristics of Ephedra alkaloids evaluated by a Caco-2 cell monolayer model.
ETHNOPHARMACOLOGICAL RELEVANCE
Mahuang decoction, Ephedra combined with Cassia twig, Bitter apricot kernel and Prepared licorice, has been widely used as a multi-herb prescription in traditional Chinese medicine (TCM). Many modern pharmacological studies have shown that the compatibility application of these four herbs has promising therapeutic effects on respiratory infection, acute glomerulonephritis and chronic renal failure. However, the underlying principles for governing the formulation of Mahuang decoction remain unknown. In this study, we used a Caco-2 cell monolayer model to explicate the possible compatibility mechanism of Mahuang decoction from the perspective of intestinal absorption.
MATERIAL AND METHODS
Firstly, the apical-to-basolateral and basolarteral-to-apical transport of the main characteristic active alkaloids in Ephedra, l-ephedrine (LEP), d-pseudoephedrine (DPEP) and l-methylephedrine (LMEP), as a single compound, was investigated. Secondly, the influence of main components in Cassia twig, Bitter apricot kernel and Prepared licorice on the transport of LEP, DPEP and LMEP was investigated. Finally, the bidirectional transport of these three alkaloids in single Ephedra extract, in Mahuang decoction and in drug pair extracts, such as Ephedra-Cassia twig, Ephedra-Bitter apricot kernel, Ephedra-Prepared licorice, was assessed.
RESULTS
The investigated LEP, DPEP and LMEP could transport through the Caco-2 cell monolayer at a high level, with the efflux ratio (ER) of 1.41, 1.33 and 1.30, respectively, when the cells were treated with each single compound solution. In the presence of verapamil, the permeability from apical side to basolateral side (PAB) of the three alkaloids increased significantly (P<0.05), and their ERs decreased. The treatment of cells with Mahuang decoction and the drug pair extracts from Ephedra-Cassia twig, Ephedra-Bitter apricot kernel and Ephedra-Prepared licorice appreciably decreased PAB of LEP, DPEP and LMEP with increased ERs, compared to the treatment with single Ephedra extract. When concomitant administration with herbal drugs and their main ingredients (including cinnamaldehyde-cinnamyl alcohol-cinnamic acid group, volatile oil from Cassia twig, liquiritin-glycyrrhizic acid group from Prepared licorice, Cassia twig extract, Bitter apricot kernel extract and Prepared licorice extract), was adopted, PAB of LEP, DPEP and LMEP were reduced significantly and the ERs of the corresponding compounds were promoted appreciably. Only amygdalin (from Bitter apricot kernel) had little influence on the transport of Ephedra alkaloids.
CONCLUSION
The findings indicate that LEP, DPEP and LMEP in Ephedra extract have similar absorption as in the pure solution of each compound. The intestinal absorption of LEP, DPEP and LMEP is through passive diffusion and these compounds may be P-gp substrates. The compatibility application of Cassia twig, Bitter apricot kernel and Prepared licorice, and their main components except amygdalin can suppress the absorption of the three main Ephedra alkaloids across the Caco-2 cell monolayer. On the basis of our results, Cassia twig, Bitter apricot kernel and Prepared licorice in Mahuang decoction decrease the absorption of Ephedra alkaloids, which may alleviate the drastic diaphoretic function and toxicity of Ephedra.
Topics: Alkaloids; Caco-2 Cells; Drug Interactions; Drugs, Chinese Herbal; Ephedra sinica; Humans; Intestinal Absorption
PubMed: 25660335
DOI: 10.1016/j.jep.2015.01.043 -
Chemistry & Biodiversity Dec 2014Elderberries are used in the preparation of pie, jelly, punch, wine, or liqueur, as well as in many herbal remedies and food supplements. Elderberry products may provide...
Elderberries are used in the preparation of pie, jelly, punch, wine, or liqueur, as well as in many herbal remedies and food supplements. Elderberry products may provide diaphoretic, diuretic, antioxidant, and immunostimulant activities that offer protection against cold and flu. Herein, we report for the first time the qualitative and quantitative evaluation of two isomeric triterpenoids isolated from Sambuci fructus. The analysis revealed that ursolic acid and oleanolic acid are present in Sambuci fructus. The average concentration of ursolic acid was ca. three times higher than the concentration of oleanolic acid. The triterpenoids were detected and quantified using chromatographic methods such as TLC and HPLC. Spectroscopic techniques, including HR-MS and 2D-NMR, allowed unequivocal structure determination.
Topics: Chromatography, High Pressure Liquid; Chromatography, Thin Layer; Mass Spectrometry; Oleanolic Acid; Proton Magnetic Resonance Spectroscopy; Sambucus; Triterpenes; Ursolic Acid
PubMed: 25491337
DOI: 10.1002/cbdv.201400118 -
Retinal Cases & Brief Reports 2014To report a case of multiple bilateral branch retinal artery occlusions associated with vancomycin infusion in an African American patient in acute sickle crisis.
PURPOSE
To report a case of multiple bilateral branch retinal artery occlusions associated with vancomycin infusion in an African American patient in acute sickle crisis.
METHODS
Single case report.
RESULTS
A 30-year-old man with complicated sickle cell disease presented with pain, fever, and hypoxia. During infusion of vancomycin, he became diaphoretic, hypotensive, and unresponsive, and exhibited respiratory distress and a disseminated red skin rash consistent with a severe allergic reaction referred to as the red man syndrome. When the patient regained consciousness within an hour, he complained of severe vision loss and demonstrated multiple bilateral branch retinal artery occlusions. Within 4 days, visual acuity recovered to 20/20 in the right eye but remained hand motions in the left eye.
CONCLUSION
Retinal artery occlusion is a rare but potentially devastating complication of sickle cell disease. The potential for complications from vancomycin infusion during acute sickle crisis should be considered, although further study is warranted.
Topics: Acute Disease; Adult; Anemia, Sickle Cell; Anti-Bacterial Agents; Humans; Male; Pigmentation Disorders; Retinal Artery Occlusion; Vancomycin
PubMed: 25372520
DOI: 10.1097/ICB.0000000000000102 -
Zhongguo Zhong Yao Za Zhi = Zhongguo... Apr 2014To optimize the prescription dose of Mahuang decoction in a multi-target manner, in order to provide reference for the quantitative optimization of the prescription dose...
OBJECTIVE
To optimize the prescription dose of Mahuang decoction in a multi-target manner, in order to provide reference for the quantitative optimization of the prescription dose of the traditional Chinese medicine compound.
METHOD
The number of diaphoretic spots in rats, the tracheal antispasmodic rate in guinea pigs and the writhing times by acetic acid in mice were taken as the indexes for evaluating the diaphoretic, antispasmodic and analgesic effects. According to the experimental results of the 16 orthogonal combination prescriptions, a mathematical dose-effect model was built by support vector regression (SVR) and quadratic response surface regression (RSR) respectively. The multi-target optimization was achieved by elitist non-dominated sorting genetic algorithm (NSGA-II) and entropy weight TOPSIS method.
RESULT
The optimal dose of Mahuang decoction after being optimized by SVR modeling contained 17.71 g of Ephedrae Herba, 9.57 g of Cinnamomi Ramulus, 11.75 g of Armeniacae Semen Amarum and 4.39 g of Glycyrrhizae Radix et Rhizoma Praeparata Cum Melle. The optimized result by RSR modeling contained 13.37 g of Ephedrae Herba, 11.61 g of Cinnamomi Ramulus, 11.98 g of Armeniacae Semen Amarum and 5.67 g of Glycyrrhizae Radix et Rhizoma Praeparate Cum Melle. SVR was superior to RSR in both of the forecast capacity and optimization results.
CONCLUSION
SVR-NSGA-II-TOPSIS method could be adopted for the multi-target optimization for the dose of Mahuang decoction and other traditional Chinese medicine compounds. It is proved to be the optimal prescription with the best efficacy, and could provide scientific quantitative basis for determining the dose of traditional Chinese medicine compound prescriptions and developing new traditional Chinese medicines.
Topics: Animals; Cinnamomum; Drug Compounding; Drug Dosage Calculations; Drug Prescriptions; Ephedra; Ephedra sinica; Glycyrrhiza; Guinea Pigs; Mice; Rats
PubMed: 25011267
DOI: No ID Found -
Respiratory Care Oct 2014Noninvasive ventilation (NIV) in severe acute asthma is controversial but may benefit this population by preventing intubation. We report on a 35-year-old male asthma...
Noninvasive ventilation (NIV) in severe acute asthma is controversial but may benefit this population by preventing intubation. We report on a 35-year-old male asthma patient who presented to our emergency department via emergency medical services. The patient was responsive, diaphoretic, and breathing at 35 breaths/min on 100% oxygen with bag-mask assistance, with S(pO2) 88%, heart rate 110-120 beats/min, blood pressure 220/110 mm Hg, and temperature 35.8 °C. NIV at 12/5 cm H2O and FIO2 0.40 was applied, and albuterol at 40 mg/h was initiated. Admission arterial blood gas revealed a pH of 6.95, P(aCO2) 126 mm Hg, and P(aO2) 316 mm Hg. After 90 min of therapy, P(aCO2) was 63 mm Hg. Improvement continued, and NIV was stopped 4 h following presentation. NIV tolerance was supported with low doses of lorazepam. The patient was transferred to the ICU, moved to general care the next morning, and discharged 3 days later. We attribute our success to close monitoring in a critical care setting and the titration of lorazepam.
Topics: Acute Disease; Adult; Anti-Anxiety Agents; Asthma; Blood Gas Analysis; Humans; Lorazepam; Male; Noninvasive Ventilation
PubMed: 24782556
DOI: 10.4187/respcare.02730 -
Clinical Laboratory 2014Herbs have been used for centuries to prevent and control many diseases. The biggest challenge and problem is lack of information about the effect of herbs and its side...
Herbs have been used for centuries to prevent and control many diseases. The biggest challenge and problem is lack of information about the effect of herbs and its side effects. Thyme (thymus vulgaris) is a small shrubby plant with a strong, spicy taste, and odor. Thyme has carminative, diaphoretic, expectorant, sedative, antibacterial and antifungal properties. It also has antispasmodic effects; tea made by infusing the herb in water or thyme juice ready-to-use is traditionally frequently used for infantile colic in our country. A fourteen-day-old male newborn was admitted to the emergency department with severe respiratory distress. There was a history of 50 mL of thyme juice (added table sugar) ingestion given for his infantile colic two hours before admission. He had hypoglycemia, hyperuricemia, and lactic acidosis. Further investigation confirmed fructose 1-6 diphosphatase deficiency in the patient. We thought that lactic acidosis may have been triggered by fructose added to the thyme water to sweeten its taste. However, phenolic compounds of thyme juice may also cause acidosis.
Topics: Fructose-1,6-Diphosphatase Deficiency; Humans; Infant, Newborn; Plant Extracts; Thymus Plant
PubMed: 24600990
DOI: 10.7754/clin.lab.2013.130245 -
Acta Bio-medica : Atenei Parmensis Jan 2014We describe here a paradigmatic case of mushroom poisoning mimicking a stroke. A 64-year old male was referred to the emergency department (ED) for a car accident. He... (Review)
Review
We describe here a paradigmatic case of mushroom poisoning mimicking a stroke. A 64-year old male was referred to the emergency department (ED) for a car accident. He was found diaphoretic, hypotensive, bradycardic, and slightly confused at presentation. No signs of trauma were observed on physical examination. The patient had weakness of the right limbs and bilateral severe myosis. The lab tests were normal, except for leukocytosis, mild hyperglycemia, mild hyperazotemia and moderate hypokalemia. The clinical picture, with the exception of miosis, was thereby suggestive for a stroke, which was also considered the cause of the car accident. The patients' wife, who was brought later to the ED, reported that the husband had suffered a stroke 4 years earlier, with residual right hemiparesis. She also referred that the patient showed signs of diaphoresis and confusion, and the car was intentionally driven into the ditch. Among other details, she referred that the husband ate mushrooms that she had personally collected 2 hours before taking the drive. Two mg of atropine, intravenous rehydration and potassium were hence administered in the suspicion of a cholinergic toxydrome, and complete clinical remission was rapidly obtained. Among the mixture of mushrooms eaten by the patient, a mycologist identified Armillaria Mellea (an edible mushroom) and notably Inocybe Fastigiata, a toxic muscarine-containing mushroom, easily confounded with Armillaria. After observation and oral rehydration, the patient was discharged.
Topics: Accidents; Diagnosis, Differential; Humans; Male; Middle Aged; Miosis; Muscle Weakness; Mushroom Poisoning; Stroke
PubMed: 24458168
DOI: No ID Found -
International Journal of Molecular... Feb 2014Sinodielide A (SA) is a naturally occurring guaianolide, which is isolated from the root of Sinodielsia yunnanensis. This root, commonly found in Yunnan province, is...
Sinodielide A exerts thermosensitizing effects and induces apoptosis and G2/M cell cycle arrest in DU145 human prostate cancer cells via the Ras/Raf/MAPK and PI3K/Akt signaling pathways.
Sinodielide A (SA) is a naturally occurring guaianolide, which is isolated from the root of Sinodielsia yunnanensis. This root, commonly found in Yunnan province, is used in traditional Chinese medicine as an antipyretic, analgesic and diaphoretic agent. A number of studies have reported that agents isolated from a species of Umbelliferae (Apiaceae) have antitumor activities. We previously reported, using combined treatments with this medicinal herb and hyperthermia at various temperatures, an enhanced cytotoxicity in the human prostate cancer androgen‑independent cell lines, PC3 and DU145, and analyzed the related mechanisms. In the present study, we investigated the effects of treatment with SA prior to hyperthermia on the thermosensitivity of DU145 cells, and the mechanisms related to the induction of apoptosis and G(2)/M cell cycle arrest via the activation of extracellular-regulated kinase (ERK)1/2, c-Jun N-terminal kinase (JNK) mitogen-activated protein kinase (MAPK) signaling pathways, as well as the phosphoinositide 3-kinase (PI3K)/Akt signaling pathways. Cells were exposed to hyperthermia alone (40-44˚C) or hyperthermia in combination with SA. Lethal damage to cells treated with mild hyperthermia (40 or 42˚C) for up to 6 h was slight; however, hyperthermia in combination with SA synergistically enhanced thermosensivity. Lethal damage to cells treated with acute hyperthermia (43 or 44˚C) was more severe, but these effects were also enhanced and were more significant by the combined treatment with SA. The kinetics of apoptosis induction and cell cycle distribution were analyzed by flow cytometry. In addition, the levels of ERK1/2, JNK and Akt were determined by western blot analysis. The incidence of apoptotic cells after treatment with SA (20.0 µM) at 37˚C for 4 h, hyperthermia (44˚C) alone for 30 min, and the combination in sequence were examined. The sub-G1 division (%) in the diagram obtained by flow cytometry was applied to that assay. The percentage of apoptotic cells (10.53±5.02%) was higher at 48 h as compared to 0, 12 and 24 h after treatment. The distribution of DU145 cells in the G2/M cell cycle phase was markedly increased after 24 h of heating at 44˚C and after the combined treatment with heating and SA. The phosphorylation of ERK1/2 was reduced following treatment with heating and SA, while the levels of phosphorylated JNK (p-JNK) were markedly increased immediately after heating at 44˚C and when heating was combined with SA. By contrast, the levels of phosphorylated Akt (p-Akt) were immediately increased only after heating at 44˚C. Thus, we concluded that SA exerts its thermosensitizing effects on DU145 cells by inhibiting the activation of the MAPK/ERK1/2 and PI3K/Akt signaling pathways.
Topics: Apiaceae; Apoptosis; Cell Cycle Checkpoints; Cell Division; Cell Line, Tumor; Combined Modality Therapy; G2 Phase; Humans; JNK Mitogen-Activated Protein Kinases; Male; Mitogen-Activated Protein Kinase 1; Mitogen-Activated Protein Kinase 3; Phosphatidylinositol 3-Kinases; Phosphorylation; Plant Extracts; Plant Roots; Prostatic Neoplasms; Proto-Oncogene Proteins c-akt; Proto-Oncogene Proteins c-raf; Proto-Oncogene Proteins p21(ras); Signal Transduction; Temperature
PubMed: 24285252
DOI: 10.3892/ijmm.2013.1568 -
Zhongguo Zhong Xi Yi Jie He Za Zhi... Sep 2013To find out Chinese herbal compounds (CHCs) with high frequency in treating rheumatoid arthritis (RA) patients of cold-dampness obstruction syndrome (CDOS) by... (Review)
Review
OBJECTIVE
To find out Chinese herbal compounds (CHCs) with high frequency in treating rheumatoid arthritis (RA) patients of cold-dampness obstruction syndrome (CDOS) by inductively reviewing literatures concerning clinical application of CHCs, thus improving theoretical and medical practice levels of Chinese medical recipes.
METHODS
The CHCs for treating RA patients of CDOS published in medical journals in recent 30 years were retrieved. The database of CHCs was set up. The herbal functions, meridian tropism, flavors and properties were statistically analyzed.
RESULTS
There were 126 single herbs in CHCs for treating RA patients of CDOS. The top 31 single herbs occupied 70.7% cumulative frequency, being high frequency CHCs for treating RA patients of CDOS. From the function aspect, the anti-rheumatic herbs, asthenia supplementing herbs, diaphoretic, and herbs for activating blood circulation and removing blood stasis were identified as high frequency CHCs. From the meridian tropism aspect, Gan-meridian, Pi-meridian and Shen-meridian, occupied the top 3. As for flavors, acid, bitter, and sweet occupied the top three. As for drug nature, herbs of warm property were used most frequently.
CONCLUSION
The high frequency CHCs obtained from analytical statistics could provide evidence for clinical medication.
Topics: Arthritis, Rheumatoid; Drugs, Chinese Herbal; Humans; Medicine, Chinese Traditional; Phytotherapy
PubMed: 24273988
DOI: No ID Found