Introduction: Opioid dependence is recorded as the most common drug of abuse in Malaysia. Currently, the preferred substitution therapy for most Government treatment centres is methadone used as substitution therapy for opioid dependence. There are, however patients who may benefit from being on the combined buprenorphine-naloxone formulation as substitution therapy instead. We discuss six cases of opioid dependence of varied backgrounds that were treated with buprenorphinenaloxone therapy and their outcomes. Discussion: All of the reported patients improved after the induction of buprenorphine- naloxone. Two of the cases highlighted the transfer of patients on methadone to buprenorphine-naloxone due to the adverse effect and interactions of methadone with other medications. During the transfer there were no major adverse reactions noted, and patients were safely able to continue with the maintenance therapy of buprenorphine- naloxone. Conclusion: Buprenorphine-naloxone is a safe and effective drug substitution therapy for opioid dependence. It has fewer interactions with other medications, and has similar efficacy to methadone. Being a partial agonist, it has a less sedating effect making patients more functional.
Buprenorphine, Naloxone Drug Combination

The alkaloid securinine was assessed against spore germination of some plant pathogenic and saprophytic fungi (Alternaria alternata, Alternaria brassicae, Alternaria brassicicola, Curvularia lunata, Curvularia maculans, Curvularia pallenscens, Colletotrichum musae, Colletotrichum sp., Erysiphe pisi, Helminthosporium echinoclova, Helminthosporium spiciferum, Heterosporium sp.). Spore germinations of all the tested fungi were inhibited. Alternaria brassicicola, C. lunata, C. pallenscens and H. spiciferum were highly sensitive as complete inhibition of spore germination was observed at very low concentrations (200 ppm).
Alternaria ; Azepines ; Brassica ; Colletotrichum ; Fungi ; Germination ; Helminthosporium ; Heterocyclic Compounds, Bridged-Ring ; Lactones ; Musa ; Phyllanthus ; Piperidines ; Plants ; Spores

This study of the clinical use of nalbuphine as a component of a balanced anesthesia technique was undertaken with the purpose of exploring the feasibility and safety of this drug as well as to establish possible guidelines for its use.
Human ; Child ; ANESTHESIA ; ANESTHESIA AND ANALGESIA ; NALBUPHINE ; HETEROCYCLIC COMPOUNDS ; ALKALOIDS ; OPIATE ALKALOIDS ; MORPHINANS ; HETEROCYCLIC COMPOUNDS WITH 4 OR MORE RINGS ; MORPHINANS ; HETEROCYCLIC COMPOUNDS, BRIDGED-RING ; MORPHINANS ; POLYCYCLIC COMPOUNDS ; POLYCYCLIC HYDROCARBONS, AROMATIC ; PHENANTHRENES

OBJECTIVETo examine the therapeutic effect of combined use of obidoxime and atropine with artificial ventilation on respiratory muscle paralysis caused by omethoate poisoning in rats.

METHODSRats were exposed to 2 times the dose of LD50 omethoate and treated with atropine (10 mg/kg) to counteract cholinergic symptoms. When the rats' respiratory frequency became slower and breathed with difficulty, the trachea intubation and artificial ventilation was carried out. The rats in group A were continuously treated with atropine. The dose of obidoxime for Group B, C and D were 8, 15, 20 mg/kg respectively, given at the same time as artificial ventilation and 1, 2, 3 hours later. The doses of atropine was reduced to 1/3 - 2/3 of the first dose so as to maintain the rats atropinized. If the rat survival was beyond 60 minutes after withdrawal of artificial ventilation, the combined treatment was considered successful. The function of isolated phrenic diaphragm of the rats was observed with MS-302 physiological and pharmacological analysis instrument.

RESULTSNone of the rats in Group A was successful after withdrawal from artificial ventilation and the function of phrenic diaphragm appeared poor; whereas > 80% of the rats in B, C, D Group were successful after withdrawal from artificial ventilation in 3 h and the function of phrenic diaphragm remained well. The survival rate in B, C and D groups were higher after withdrawal from artificial ventilation than that in Group A(P < 0.01). The function of phrenic diaphragm in Group B, C and D were gradually decreased after ACh was added into the container.

CONCLUSIONSCombined use of suitable dose of obidoxime and atropine with artificial ventilation for respiratory muscle paralysis caused by omethoate poisoning could promote the recovery of diaphragm function and reduce the death rate in poisoned rats.

Animals ; Atropine ; administration & dosage ; Dimethoate ; analogs & derivatives ; poisoning ; Drug Therapy, Combination ; Obidoxime Chloride ; administration & dosage ; Rats ; Respiration, Artificial ; Respiratory Paralysis ; drug therapy

AIMTo study the chemical constituents of the stems and leaves of Aconitum coreanum (Lèvl.) Rapaics.

METHODSThe constituents of Aconitum coreanum were isolated by using various kinds of modern chromatographic methods. The new alkaloid was identified on the basis of spectral analysis.

RESULTSTwo compounds were isolated and identified as: 13-dehydro-1beta-acetyl-2alpha,6beta-dihydroxyhetisine (I) and Guanfu base G (II).

CONCLUSIONCompound I is a new alkaloid.

Aconitum ; chemistry ; Diterpenes ; Heterocyclic Compounds, Bridged-Ring ; chemistry ; isolation & purification ; Molecular Conformation ; Molecular Structure ; Plant Leaves ; chemistry ; Plant Stems ; chemistry ; Plants, Medicinal ; chemistry

OBJECTIVETo evaluate the efficacy and safety of tiotropium in treatment of severe persistent asthma.

METHODSReports of randomized controlled trials (RCTs) describing tiotropium for treatment of severe persistent asthma published from January 1946 to February 2015 were searched in Cochrane Library, ClinicalTrials.gov, PubMed, Ovid Medline, CNKI, and CSJD. The data of the included RCTs were extracted and the data quality was evaluated. Meta-analyses were performed with Revman 5.3 software.

RESULTSFive RCTs including 1433 patients were analyzed. Meta-analysis of the data showed that compared with the placebo group, tiotropium treatment significantly improved the patients' peak forced expiratory volume in one second (FEV1) [weighted mean difference (WMD): 0.13 L, 95% confidence interval (CI): 0.10-0.16 L, P<0.00001], trough FEV1 (WMD: 0.09 L, 95%CI: 0.06-0.12 L, P<0.00001), peak forced vital capacity (FVC) (WMD: 0.10 L, 95%CI: 0.06-0.14 L, P<0.00001), trough FVC (WMD: 0.12 L, 95%CI: 0.08-0.17 L, P<0.00001), morning peak expiratory flow (PEF) (WMD: 9.21 L/min, 95%CI: 4.2-14.23 L/min, P=0.0003), evening PEF (WMD: 22.06 L/min, 95%CI 13.05-31.08 L/min, P<0.00001). The scores of asthma control questionnaire (ACQ) (WMD: 0.01, 95% CI: -0.07-0.09, P=0.86) or asthma quality of life questionnaire (AQLQ)(WMD: 0.06, 95% CI:-0.18-0.06, P=0.33) were not affected by tiotropium. No significant difference with adverse events between tiotropium group and placebo group were reported in these included studies (P>0.05).

CONCLUSIONSTiotropium for severe persistent asthma treatment can improve FEV1, FVC, and PEF but may not improve the quality of life of the patients. Tiotropium is well tolerated and can be an add-on therapy for severe persistent asthma.

Asthma ; Bronchodilator Agents ; Humans ; Quality of Life ; Tiotropium Bromide

OBJECTIVETo establish RP-HPLC method for determination of atropine sulphate, diphenhydramine hydrochloride, capsaicin and dihydrocapsaicin in pain-relieving plaster for arthritis.

METHODThe sample were separated on an Alltima C18 Column (4.6 mm x 250 mm, 5 microm) with the moblie phase of CH3 CN-0.1% H3 PO4. Flow rate was 1 mL x min(-1). The detective wavelength was set at 210 and 280 nm. Column temperature was 30 degrees C.

RESULTThe calibration curve for atropine sulphate, diphenhydramine hydrochloride, capsaicin and dihydrocapsaicin revealed linearity in the range of 2.01-50.25, 15.08-377.00, 5.02-125.50, 5.03-125.75 mg x L(-1), respectively. The recoveries of atropine sulphate, diphenhydramine hydrochloride, capsaicin and dihydrocapsaicin were 99.00% with RSD of 0.95%, 99.89% with RSD of 1.2%, 100.1% with RSD of 1.5% and 99.51%, with RSD of 1.4%, respectively.

CONCLUSIONThe method is simple, rapid and accurate, which is suitable for the quality control of pain-relieving plaster for arthritis.

Arthritis ; drug therapy ; Atropine ; analysis ; therapeutic use ; Capsaicin ; analogs & derivatives ; analysis ; therapeutic use ; Chromatography, High Pressure Liquid ; methods ; Diphenhydramine ; analysis ; therapeutic use ; Drugs, Chinese Herbal ; analysis ; therapeutic use ; Humans ; Pain ; drug therapy

Effect of pivmecillinam hydrochloride was evaluated on 20 patients with cystitis and 13 patients with urethritis seen in urologic department of Kyungpook National University Hospital during past 4 months periods from April 1982 through August 1982. Pivmecillinam was given orally at a dose of 600mg (3 tablets) tid for 4 days (total 12 tablets) and following results were obtained. 1. In cystitis, effective result was observed in 19 out of 20 patients, giving therapeutic rate of 95%, and pivmecillinam was effective against all G (-) bacilli infections including E. coli except pseudomonas infection in 1. 2. In urethritis, effective result was noticed in 9 out of 13 patients, giving therapeutic rate of 70%, and pivmecillinam was effective against staphylococcus infection in 6 out of 7 patients, serratia infection in 1 out of 2 and G (-), bacilli infection in 1. However, it was ineffective against staphylococcus, serratia, enterococcus and unknown organism in 1 case, respectively. 3. As to the side effect, only diarrhea was observed in one of total 33 patients.
Amdinocillin Pivoxil* ; Anti-Bacterial Agents ; Cystitis ; Diarrhea ; Enterococcus ; Gyeongsangbuk-do ; Humans ; Pseudomonas Infections ; Serratia ; Serratia Infections ; Staphylococcus ; Urethritis ; Urinary Tract Infections* ; Urinary Tract*

Effect of pivmecillinam hydrochloride was evaluated on 20 patients with cystitis and 13 patients with urethritis seen in urologic department of Kyungpook National University Hospital during past 4 months periods from April 1982 through August 1982. Pivmecillinam was given orally at a dose of 600mg (3 tablets) tid for 4 days (total 12 tablets) and following results were obtained. 1. In cystitis, effective result was observed in 19 out of 20 patients, giving therapeutic rate of 95%, and pivmecillinam was effective against all G (-) bacilli infections including E. coli except pseudomonas infection in 1. 2. In urethritis, effective result was noticed in 9 out of 13 patients, giving therapeutic rate of 70%, and pivmecillinam was effective against staphylococcus infection in 6 out of 7 patients, serratia infection in 1 out of 2 and G (-), bacilli infection in 1. However, it was ineffective against staphylococcus, serratia, enterococcus and unknown organism in 1 case, respectively. 3. As to the side effect, only diarrhea was observed in one of total 33 patients.
Amdinocillin Pivoxil* ; Anti-Bacterial Agents ; Cystitis ; Diarrhea ; Enterococcus ; Gyeongsangbuk-do ; Humans ; Pseudomonas Infections ; Serratia ; Serratia Infections ; Staphylococcus ; Urethritis ; Urinary Tract Infections* ; Urinary Tract*

AIMTo establish a high-performance capillary electrophoresis (HPCE) chiral separation method for d-securinine and l-securinine, and use this method to investigate the stereoselective metabolism process of d- and l-securinine in Wistar rats.

METHODSThe electrophoretic condition and parameters were investigated and the optimized conditions were as following: the electrophoretic medium was 40 mmol.L-1 Tris-H3PO4 buffer (pH adjusted to 6.0 with H3PO4) containing 32 mmol.L-1 HP-beta-CD as chiral selector. Determination was carried out with a UV detector at 254 nm. The separations were performed at 16 degrees C with a positive voltage of 15 kV. Samples were injected into the capillary by pressure for 6 s. The biological samples (urine, bile, plasma and feces) of rats were alkalized and extracted with ethyl acetate.

RESULTSThe experimental results showed that the concentration of HP-beta-CD, the concentration of the running buffer and the pH value of the buffer were the main important factors which effected the resolution. d-Securinine and l-securinine were separated at baseline level under the determination conditions. The determination was not interfered by endogenous components and metabolites. After i.p. administration, the rats excreted more d-securinine than l-securinine through bile, urine and feces. The metabolism process in rats was stereoselective.

CONCLUSIONThis method is simple, reliable and suitable for studying the stereoselective metabolism of securinine in rats.

Alkaloids ; chemistry ; isolation & purification ; metabolism ; urine ; Animals ; Azepines ; chemistry ; isolation & purification ; metabolism ; urine ; Bile ; metabolism ; Electrophoresis, Capillary ; methods ; Euphorbiaceae ; chemistry ; Heterocyclic Compounds, 4 or More Rings ; chemistry ; isolation & purification ; metabolism ; urine ; Heterocyclic Compounds, Bridged-Ring ; Lactones ; chemistry ; isolation & purification ; metabolism ; urine ; Male ; Molecular Structure ; Piperidines ; chemistry ; isolation & purification ; metabolism ; urine ; Plants, Medicinal ; chemistry ; Rats ; Rats, Wistar ; Stereoisomerism