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Your clinic primarily serves migrant farm workers who spend several months a year in California and Oregon harvesting a variety of fruit and vegetable crops. Mrs. Hernandez has brought her 20month-old son Miguel to your clinic. She and her husband both work, and Miguel is cared for during the day by a teenage baby-sitter. The chief complaint is that Miguel is often cranky, cries during meals, and indicates that eating is painful, particularly for sweet, hot, or cold foods. Mrs. Hernandez is aware that some of Miguel's front teeth are discolored and parts of his teeth seem to be missing, but she does not understand why. Mrs. Hernandez is not very concerned about Miguel's condition because the affected teeth will be replaced in a few years by permanent teeth. An oral exam reveals grossly decayed baby teeth and two gum abscesses in areas where caries has reached the pulp chamber. The pattern of carious teeth is compatible with rampant infant and early childhood caries. Upon questioning, Mrs. Hernandez reveals that she still puts Miguel to bed with a bottle of milk or Kool-Aid because he seems to fall asleep sooner and cries less. She is in her sixth month of pregnancy with her second child, and she regularly attends prenatal classes at your clinic, but her husband rarely attends these sessions.
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The Journal of Bangladesh College of Physicians and Surgeons is a peer reviewed Journal. It is published three times a year January, May and September ; . It accepts original articles, review articles, and case reports. Complimentary copies of the journal are sent to libraries of all medical and other relevant academic institutions in the country and selected institutions abroad. While every effort is always made by the Editorial Board and the members of the Journal Committee to avoid inaccurate or misleading information appearing in the Journal of Bangladesh College of Physicians and Surgeons, information within the individual article are the responsibility of its author s ; . The Journal of Bangladesh College of Physicians and Surgeons, its Editorial Board and Journal Committee accept no liability whatsoever for the consequences of any such inaccurate and misleading information, opinion or statement.
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11. PICHICHERO, M. E.: Group A streptococcal tonsillopharyngitis: cost-efective diagnosis and treatment. Ann. Emerg. Med. 25, 1995, p. 390-403. 12. BLINT, O.: Antibiotic treatment of both acute upper respiratory tract and bronchi infections in Slovak ; . Liek. Bull. 7, 1998, p. 1-4. 13. KRISTFEK, P.: Guidelines for Rational Pharmacotherapy Acute respiratory infections in Slovak ; . Progr. Hepato-Pharmacol. 7, 2002, p. 33-36. 14. WAWRUCH, M. BOZEKOV, L. HUDEC, R. KRISKA, M.: Antibiotics in out-patients practice in Slovakia in 1999 2001 in Slovak ; . Ces. a Slov. Farm. 52, 2003, p. 166-170. 15. WAWRUCH, M. BOZEKOV, L. KRISKA, M.: Analysis of antibiotics consumption in out-patients practice in Slovak Republic in 2000 in Slovak ; . Acta Chemother. 11, 2002, p. 80-86. 16. JARCUSKA, P. HUGECOV, D. SCHRTER, I. JAKAB, A. JARCUSKOV, M. ADAMKOVICOV, E.: Utilization of cefadroxil in acute tonsillitis treatment in children in Slovak ; . Acta Chemother. 9, 2000, p. 39-43. 17. CURTIN, C.D. CASEY, J.R. MURRAY, P.C. CLEARY, C.T. HOEGER, W.J. MARSOCCI, S.M. MURPHY, M.L. FRANCIS, A.B. PICHICHERO, M.E.: Efficacy of cephalexin two vs. three times daily vs. cefadroxil once daily for streptococcal tonsillopharyngitis. Clin. Pediatr. 42, 2003, p. 519-526. 18. MOSNROV, R.: Position of macrolides in respiratory tract infection treatment in Slovak ; . Zdrav. Noviny 43, 2002, p. 6-7. 19. COHEN, R.: Defining the optimum treatment regimen for azitromycin in acute tonsillopharyngitis. Pediatr. Infect. Dis. J. 23, 2004, p. 129-134. 10. KRCMRY, V. HJKOV, M.: Short-term therapeutic procedures in respiratory tract infections in Slovak ; . Med. Monitor 1, 2000, p. 32-34.
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Aslamkhan A, Han YH, Walden R, Sweet DH, and Pritchard JB 2003 ; Stoichiometry of organic anion dicarboxylate exchange in membrane vesicles from rat renal cortex and hOAT1expressing cells. J Physiol 285: F775F783. Bacheller CD and Bernstein JM 1997 ; Urinary tract infections. Med Clin North 81: 719 730. Bockman DE, Ganapathy V, Oblak TG, and Leibach FH 1997 ; Localization of peptide transporter in nuclei and lysosomes of the pancreas. Int J Pancreatol 22: 221225. Bretschneider B, Brandsch M, and Neubert R 1999 ; Intestinal transport of beta-lactam antibiotics: analysis of the affinity at the H peptide symporter PEPT1 ; , the uptake into Caco-2 cell monolayers and the transepithelial flux. Pharm Res NY ; 16: 55 61. Brown GR 1993 ; Cephalosporin-probenecid drug interactions. Clin Pharmacokinet 24: 289 300. Chen X, Zhong D, Huang B, and Cui J 2003 ; Determination of cefaclor in human plasma by a sensitive and specific liquid chromatographic-tandem mass spectrometric method. J Chromatogr B Analyt Technol Biomed Life Sci 784: 1724. Daniel H and Kottra G 2004 ; The proton oligopeptide cotransporter family SLC15 in physiology and pharmacology. Pflueg Arch Eur J Physiol 447: 610 618. Engel K, Zhou M, and Wang J 2004 ; Identification and characterization of a novel monoamine transporter in the human brain. J Biol Chem 279: 5004250049. Garcia-Carbonell MC, Granero L, Torres-Molina F, Aristorena JC, Chesa-Jimenez J, Pla-Delfina JM, and Peris-Ribera JE 1993 ; Nonlinear pharmacokinetics of cefadr0xil in the rat. Drug Metab Dispos 21: 215217. Garrigues TM, Martin U, Peris-Ribera JE, and Prescott LF 1991 ; Dose-dependent absorption and elimination of cefadroxill in man. Eur J Clin Pharmacol 41: 179 183. Han HK, Rhie JK, Oh DM, Saito G, Hsu CP, Stewart BH, and Amidon GL 1999 ; CHO hPEPT1 cells overexpressing the human peptide transporter hPEPT1 ; as an alternative in vitro model for peptidomimetic drugs. J Pharm Sci 88: 347350. Hill G, Cihlar T, Oo C, Ho ES, Prior K, Wiltshire H, Barrett J, Liu B, and Ward P 2002 ; The anti-influenza drug oseltamivir exhibits low potential to induce pharmacokinetic drug interactions via renal secretion-correlation of in vivo and in vitro studies. Drug Metab Dispos 30: 1319. Hosoyamada M, Sekine T, Kanai Y, and Endou H 1999 ; Molecular cloning and functional expression of a multispecific organic anion transporter from human kidney. J Physiol 276: F122F128. Jariyawat S, Sekine T, Takeda M, Apiwattanakul N, Kanai Y, Sophasan S, and Endou H 1999 ; The interaction and transport of -lactam antibiotics with the cloned rat renal organic anion transporter 1. J Pharmacol Exp Ther 290: 672 677. Karoda M, Kusuhara H, Endou H, and Sugiyama Y 2005 ; Rapid elimination of cefaclor from the cerebrospinal fluid is mediated by a benzylpenicillin-sensitive mechanism distinct from organic anion transporter 3. J Pharmacol Exp Ther 314: 855 861. Liang R, Fei YJ, Prasad PD, Ramamoorthy S, Han H, Yang-Feng TL, Hediger MA, Ganapathy V, and Leibach FH 1995 ; Human intestinal H peptide cotransporter. Cloning, functional expression, and chromosomal localization. J Biol Chem 270: 6456 6463. Liu W, Liang R, Ramamoorthy S, Fei YJ, Ganapathy ME, Hediger MA, Ganapathy V, and Leibach FH 1995 ; Molecular cloning of PEPT 2, a new member of the H peptide cotransporter family, from human kidney. Biochim Biophys Acta 1235: 461 466. Luckner P and Brandsch M 2005 ; Interaction of 31 beta-lactam antibiotics with the H ; peptide symporter PEPT2: analysis of affinity constants and comparison with PEPT1. Eur J Pharm Biopharm 59: 1724. Meyers BR 2000 ; Cefaclor revisited. Clin Ther 22: 154 166. Motohashi H, Sakurai Y, Saito H, Masuda S, Urakami Y, Goto M, Fukatsu A, Ogawa O, and Inui K 2002 ; Gene expression levels and immunolocalization of organic ion transporters in the human kidney. J Soc Nephrol 13: 866 874. Ocheltree SM, Shen H, Hu Y, Xiang J, Keep RF, and Smith DE 2004 ; Mechanisms of cefadroxl uptake in the choroid plexus: studies in wild-type and PEPT2 knockout mice. J Pharmacol Exp Ther 308: 462 467. Sakurai Y, Motohashi H, Ueo H, Masuda S, Saito H, Okuda M, Mori N, Matsuura M, Doi T and cefpodoxime.
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Acceptable Blood and Body Fluid Specimen Identification. 9 Specimen Rejection Criteria. 9 General Guidelines for Submitting Cytology Specimens. 9 Acceptance Rejection of Cytology Specimens. 9 Order of Blood Draw. 10 Vacutainer Tube Instruction . 10 Blood Processing and Packaging For Courier Pickup . 10 Semen Collection . 11 Stool-Culture Collection. 11 Stool-Occult Blood Collection . 12 Stool-Ova and Parasite Collection. 12 Urine-General Collection Guidelines . 13 General Collection Instructions For a 24 Hour Urine Specimen . 13 Urine-24 Hour Collection For Creatinine Clearance. 13 Urine-24 Hour Collection for Catecholamines VMA . 14 Urine-24 Hour Collection for F.S.H. Follicle Stimulating Hormone ; . 14 Urine-24 Hour Collection for 5HIAA-Serotonin. 14 STAT Tests Available . 15.
Alanyl peptides we observed that only di- and tripeptides but not peptides with more than three amino acid residues interact with the substrate-binding site of the transporter. The stereospecificity of interaction was determined by peptides containing either L or D isomers of alanine in different positions Fig. 6A ; . Incorporation of D-alanine into the N-terminal position maintained an inhibitory potency of the peptide, whereas peptides with D-alanine in the C-terminal position or in both positions failed to inhibit cefadroxil uptake. Of the various , 3-lactam antibiotics tested, only the cephalosporins carrying a free a-amino group loracarbef, cefaclor, and cephalexin ; reduced cefadroxil influx Fig. 6B ; . This is consistent with previous observations in kidney BBMV 7, 8, 10 ; . From a variety of other compounds suggested to serve as substrates for the peptide transporters in epithelial cells, we chose to investigate whether angiotensin-converting enzyme ACE ; inhibitors and aminopeptidase inhibitors such as arphamenin A and bestatin inhibited cefadroxil transport mediated by rPepT2. Whereas 5 mM bestatin or arphamenin A significantly reduced cefadroxil uptake by 55% 4% and 62% + 7% data not shown ; , no inhibition was seen with any of the ACE inhibitors tested captopril and enalapril ; Fig. 6B ; . In summary, it appears that only di- and tripeptides, aminocephalosporins, and selected aminopeptidase inhibitors interact with the substrate-binding site of the transporter. In contrast to the intestinal peptide H + symporter PepTi 17 ; , ACE inhibitors and 3-lactam antibiotics without an a-amino group appear not to be transported by the renal carrier protein. On the basis of functional criteria, including the driving force, kinetics of transport, and substrate specificity and affinity, rPepT2 shows some similarities with PepTI but also distinctly different features, including a different pH dependence under identical experimental conditions, including the substrate ; , a 40 times higher substrate affinity, and a different substrate specificity. The observed differences in structure and function of the intestinal peptide transporter PepTI and the renal clone rPepT2 are summarized in Table 1. Tissue-specific expression of the mRNA corresponding to rPepT2 was examined by Northern blot analysis Fig. 7 ; . In the rabbit, a mRNA species of 4.8 kb from kidney cortex hybridized with the 1.24-kb RNA probe. Signals of similar or identical size were obtained also in rabbit brain, lung, liver, and heart at both low and high stringencies Fig. 7 ; . Although peptide transporters with functions like those of rPepT2 have not been described yet in any other tissue but kidney and intestine, Northern analysis suggests that similar transporters may be expressed in other tissues, where they could contribute to the removal of short-chain peptides and peptide-derived drugs circulating in the blood. The cDNA insert of our clone was completely sequenced on both strands. It is 4265 bp long, and the deduced amino acid sequence Fig. 8 ; from the open reading frame of the nucleotide sequence indicated that the gene product is a protein of 729 amino acids. Hydropathy analysis, performed as described previously 14, 15 ; , predicted 12 membrane-spanning domains with a large extracellular loop between transmembrane domains 9 and 10. Besides five putative extracellular Nglycosylation sites, four intracellular consensus regions containing protein kinase C motifs have been identified. In comparisons with other members of the POT family of protondependent oligopeptide transporters 18 ; or the major facilitator superfamily 19 ; by using the BLAST program, the predicted rPepT2 amino acid sequence shows a high identity 47% ; and similarity 67% ; only with the intestinal peptide transporter PepTl recently cloned from the rabbit small intestine 17, 20 ; . However, the significant identity is predominantly found in the membrane-spanning domains, whereas the large extracellular loop, which contains 210 amino acid residues, shows only a 21% sequence match. Comparisons with and cetirizine.
LASS-FLORL ET AL. TABLE 2. PCR results in patients with probable aspergillosis and undergoing antifungal therapy.
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REFERENCES BERTLER, O., CARLSSON, A. & ROSENGREN, E. 1958 ; . A method for the fluorimetric determination of adrenaline and noradrenaline in tissues. Acta phy8iol. 8cand. 44, 273-292. BLAKELEY, A. G. H. & BROWN, G. L. 1963 ; . Uptake of noradrenaline hy the isolated perfused spleen. J. Physiol. 169, 98-99P. BRAY, G. A. 1960 ; . Analyt. Biochem. 1, 279-285. BROW-N, G. L., DAVIES, B. N. & FERRY, C. B. 1961 ; . The effect of neuronal rest on the output of sympathetic transmitter from the spleen. J. Physi, ol. 159, 365-380. BROWN, G. L. & J. S. 1957 ; . The output of sympathetic transmitter from the spleen of the cat. J. Physiol. 138, 81-102. FALCK, B. 1962 ; . Observations on the possibilities of the cellular localisation of monoamines by a fluorescence method. Acta physiol and. 56, Suppl. 197, 1-24. GILLESPIE, J. S. & KIRPEKAR, S. M. 1965a ; . The inactivation of infused noradrenaline by the cat spleen. J. Physiol. 176, 205-227. GILLESPIE, J. S. & KIRPEKAR, S. M. 1965b ; . Uptake and release of 3H noradrenaline by the splenic nerves. J. Physiol. 178, 44-45P. GILLESPIE, J. S. & KIRPEKAR, S. M. 1966 ; . The histological localization of noradrenaline in the cat spleen. J. Physiol. 187, 69-79. GREEN, H. & ERICKSON, R. W. 1960 ; . Effect of trans-2-phenylcyclopropylamine upon the norepinephrine concentration and mono-amine oxidase activity of rat brain. J. Pharmac. exp. Ther. 129, 237-242. HAEFELY, W., HURLIMANN, A. & THOENEN, H. 19605 ; . Relation between the rate of stimulation and the quantity of noradrenaline liberated from sympathetic nerve endings in the isolated perfused spleen of the cat. J. Physiol. 181, 48-58. HERTTING, G. & AXELROD, J. 1961 ; . Fate of tritiated noradrenaline at the sympathetic nerve endings. ature, Lond. 192, 172. N IVERSEN, L. L. 1963 ; . The uptake of noradrenaline by the isolated perfused rat heart. Br. J. Pharmac. Chemother. 21, 523-537. KOPIN, I. J. & BRIDGERS, W. 1963 ; . Differences in D and L norepinephrine 3H. Life Sci. Oxford 2, 356-362. MAICKEL, R. P., BEAVEN, M. A. & BRODIE, B. B. 1963 ; . Implications of uptake and storage of norepinephrine by sympathetic nerve endings. Life Sci. Oxford 2, 953-958. MONTANARI, R., COSTA, E., BEAVEN, M. A. & BRODIE, B. B. 1963 ; . Turnover rates of norepinephrine in hearts of intact rats and guinea pigs using tritiated norepinephrine. Life Sci., Oxford 3, 282-240. ROSELL, S., AXELROD, J. & KOPIN, . J. 1964 ; . Release of tritiated epinephrine following I sympathetic nerve stimulation. Nature, Lond. 201, 301. ROSELL, S., KOPIN, I. J. & AxELROD, J. 1963 ; . Fate of 3H noradrenaline in skeletal muscle before and following sympathetic stimulation. Am. J. Physiol. 205, 317-321. SPECTOR, S., MELmoN, K. & SJOERDSMA, A. 1962 ; . Evidence for rapid tumover of norepinephrine in rat heart and brain. Proc. Soc. exp. Biol. Med. 111, 79-81. UDENFRIEND, S. & ZALTZMAN-NIRENBERG, P. 1963 ; . Norepinephrine and 3, 4 dihydroxyphenylethylamine turnover in guinea pig brain in vivo. Science, N.Y. 142, 394-396. VON EULER, U. S. & of LISsHAJKO, F. 1964 ; . Uptake L and D-isomers of catecholamines in adrenergic nerve granules. Adta physiol. scand. 60, 217-222.
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