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Pellagra is associated with low levels of vitamin B3 (niacin) and/or tryptophan and often involves other other B vitamins. Since the time Gasper Casal first described the disease in 1972, it was observed that the patients with pellagra were all poor, subsisted mainly on maize, and rarely ate fresh meat. Subsequent occurrences have been in the form of epidemic outbreaks, consequent to either introduction to maize as a major food or increased consumption of other niacin-deficient diets like Jowar (Sorgum vulgare). The virtual disappearance of pellagra as an endemic health problem in recent years can be attributed to a rise in the standard of living of farmers and diversification of the diet globally. The clinical picture is a combination of multisystem alterations typically involving gastrointestinal, skin and central nervous system abnormalities. The cardinal manifestations have been popularly known as the three D's, which are dementia, dermatitis and diarrhea. Psychiatric manifestations are fairly common but are easily overlooked due to their non specific nature. These are commonly seen as irritability, poor concentration, anxiety, fatigue, restlessness, apathy and depression. The occurence of psychosis in pellagra is an uncommon finding, which is usually seen in advanced stages of pellagroid encephalopathy, commonly found in chronic alcoholics. Delusional parasitosis has been also reported in this condition, although the association is still controversial. We report a case of pellagra manifesting with delusional parasitosis in a man whose delusion resolved rapidly after he started niacin-augmentation therapy. This case may provide clues to the biological underpinnings of delusional parasitosis as well as niacin treatment as treatment option in similar cases.
Gen Hosp Psychiatry
PMID:Rapid resolution of delusional parasitosis in pellagra with niacin augmentation therapy. 1906 87

Chronic Obstructive Pulmonary Disease (COPD) exacerbations are potential medical emergencies treated with bronchodilators, glucocorticoids and supplemental oxygen. However, in extreme cases, adequate treatment requires mechanical ventilation via endotracheal intubation to correct the acid-base imbalance created by the disease process. We present a case of a 52-year-old female with COPD exacerbation requiring intubation who failed extubation multiple times while concurrently being treated with lorazepam, for agitation. Based on the evidence for increased carbon dioxide retention associated with benzodiazepine use, we weaned the patient off the lorazepam which in turn allowed the patient to be successfully weaned off the ventilator.
Gen Hosp Psychiatry
PMID:A failed case of weaning from a mechanical ventilator with lorazepam successfully accomplished by ziprasidone. 1970 44

A few brief statements summarizing the foregoing conclusions may make a picture of the structure of the starch grain somewhat clearer. 1. The presence of lines on the negatives indicates a regular arrangement of the planes of atoms. 2. The lines are in close agreement with lines which would be produced by a lattice of the tetragonal system, the elementary cell of which is a square prism with the dimensions 5.94 x 5.94 x 5.05 A.u. 3. The unit of the lattice occupies a space equal to the volume of the starch group, C(6)H(10)O(5). 4. The large number of atoms in the unit makes it highly probable that principal planes and secondary planes of atoms occur for every reflecting position. 5. The effect of the secondary upon the principal planes may readily account for the differences in the density of the lines produced on the negatives. 6. From theoretical considerations, reflections, such as those obtained, would occur if starch grains were built up of concentric layers of units. 7. Two other factors which might affect the density of the lines are thermal agitation and the curvature of the concentric layers. 8. A model of the starch group was constructed to scale based on the accepted sizes of the atoms involved and upon rather meager chemical evidence. The model apparently fulfills the requirements necessary to produce reflections such as were obtained. 9. The model fits the elementary cell loosely enough to suggest a low density and to allow for considerable thermal movement. At the same time, parts of it approach the faces of the cell closely enough to make cohesion seem possible. 10. The model makes clearer the basis for the assumption that reflection from certain positions would be stronger than from others. If the interpretation of the data is correct and if the assumptions made are sound, then the starch grain is built up of units arranged in concentric layers, and the units are groups of atoms, each containing 6 carbon, 10 hydrogen, and 5 oxygen atoms. Such a structure is certainly not an amorphous structure, and on the other hand it is not crystalline in the common sense of the term. Parts of the grain, it is true, act as crystals in that for certain distances the layers of units are in planes, but taken as a whole the layers are curved. As to the validity of the conclusions, those pertaining to the type of lattice and to the size of the unit may be accepted as sound in our present knowledge of x-rays and crystal structure; those, however, pertaining to the nature and the spherical arrangement of the units, while they seem convincing, need the support of further investigation into the various structures deposited by living protoplasm. In conclusion, the assumption that the units form a sort of spherical space lattice, gives a picture of the starch grain which leads us to ponder over the nature of the activity in protoplasm when it is depositing solid substances. Starch, cellulose, and pectic bodies are about the only solid deposits made directly by the living substance of plants, and all three have the same proportional formula, C(6)H(10)O(5). Investigations, as yet incomplete, indicate that cellulose also consists of a regular arrangement of C(6)H(10)O(5) groups, each acting as a unit, but the spacing (6.14 x 6.14 x 5.55) is slightly different from that of starch. Pectin has not been studied. Protoplasm may be thought of as being composed of molecules of many different sizes, polypeptides, or even proteins forming the larger, and amino-acids the smaller, if water and electrolytes are ignored. The smaller molecules, such as those of the amino-acid, leucine, are approximately equal in size to the C(6)H(10)O(5) group of starch. That being the case, what can be the state of affairs at the interface when the starch particles are being deposited? Is it probable that protoplasm is homogeneous to the extent of being able to deposit these particles at 6 A.u. intervals? From quite another view-point a clear picture of the units of structure and their arrangement in cellulose should give a new point of attack on the many problems connected with osmosis. And from still a different view-point, it might lead perhaps, to a solution of problems connected with swelling. Another line of thought is suggested by the uniformity of the groups in the starch grain. Since the C(6)H(10)O(5) group occurs as an individual unit, one is inclined to suspect that it is really the molecule. Generally the starch molecule is considered to be very large, to be composed of several dozens of such groups, and to have a molecular weight of 7,000 or much more. No one figure, however, seems satisfactory to the different authorities. There is already at hand considerable evidence which will be assembled in a later paper favoring the single group, C(6)H(10)O(5), as the molecule. Finally, problems in polarized light may receive more satisfactory explanations through a clearer notion of the molecular structure of the carbohydrates.
J Gen Physiol 1923 Jul 20
PMID:STRUCTURAL UNITS OF STARCH DETERMINED BY X-RAY CRYSTAL STRUCTURE METHOD. 1987 35

1. Small dumps of the luminous cells of Mnemiopsis cannot readily be stimulated mechanically but will luminesce on treatment with saponin solution. Larger groups of luminous cells (such as are connected with two paddle plates) luminesce on mechanical stimulation. This suggests that mechanical stimulation to luminesce occurs chiefly through a nerve mechanism which has been broken up in the small dumps of luminous tissue. 2. The smallest bits of luminous tissue, even cells freed from the animal by agitation, that will pass through filter paper, lose their power to luminesce in daylight and regain it (at least partially) in the dark. 3. Luminescence of the whole animal and of individual cells is suppressed by near ultra-violet light (without visible light). 4. Inhibition in ultra-violet light is not due to stimulation (by the ultra-violet light) of the animal to luminesce, thereby using up the store of photogenic material. 5. Animals stimulated mechanically several times and placed in ultra-violet light show a luminescence along the meridians in the same positions as the luminescence that appears on stimulation. This luminescence in the ultra-violet or "tonic luminescence," is not obtained with light adapted ctenophores and is interpreted to be a fluorescence of the product of oxidation of the photogenic material. 6. Marked fluorescence of the luminous organ of the glowworm (Photuris) and of the luminous slime of Chatopterus may be observed in ultra-violet but no marked fluorescence of the luminous substances of Cypridina is apparent. 7. Evidence is accumulating to show a close relation between fluorescent and chemiluminescent substances in animals, similar to that described for unsaturated silicon compounds and the Grignard reagents.
J Gen Physiol 1925 Jan 20
PMID:STUDIES ON BIOLUMINESCENCE : XVII. FLUORESCENCE AND INHIBITION OF LUMINESCENCE IN CTENOPHORES BY ULTRA-VIOLET LIGHT. 1987 39

1. Muscular activity during decompression causes bubble formation in the blood of intact bullfrogs. The amount of gas liberated depends on the degrees of muscular activity and supersaturation (as influenced by altitude). In decompressed dissected bullfrogs, bubbles appear in veins leading from active but not from inactive muscles. 2. Muscular activity during decompression similarly causes bubble formation in rats. Bubbles appear in veins coming from muscles, and often in the lymphatic system. Quiescent rats do not form bubbles. 3. Violent muscular activity before decompression favors bubble formation in bullfrogs during ensuing decompression, but it is less effective than exercise during decompression. The effect persists in large frogs for about an hour. 4. Pre-oxygenation for 2 to 4 hours before decompression reduces the incidence of bubble formation in decompressed bullfrogs. It thus has the same effect on bubble formation in bullfrogs as it does on the "bends" in man. The effect is presumably due to removal of nitrogen. 5. Possible mechanisms by which muscular activity causes bubble formation are discussed. The effects of mechanical agitation and of metabolic CO(2) are considered to be the dominant factors.
J Gen Physiol 1945 Jan 20
PMID:MUSCULAR ACTIVITY AND BUBBLE FORMATION IN ANIMALS DECOMPRESSED TO SIMULATED ALTITUDES. 1987 15

1. A heavy ingestion of frothy emulsified fat by rats and bullfrogs does not increase susceptibility to bubble formation when the animals are decompressed 2 to 72 hours later. This indicates that gaseous films (bubble nuclei) initially present do not pass across the intestinal wall with the digested fat, and also that high fat content per se in the lymph and blood does not increase susceptibility to bubble formation. 2. Liquid caprylic acid injected into veins of bullfrogs crystallizes when the frogs are cooled. The crystallization causes bubbles to form without muscular activity on subsequent decompression. Cooling normal bullfrogs to 1-2 degrees C. fails, however, to crystallize any substances occurring naturally in the animals that might act in a similar manner. 3. When bullfrogs are cooled (e.g. to -5 degrees to -10 degrees C.) until ice forms in the blood vessels, and are then warmed and decompressed, bubbles form in the absence of exercise. Crystallization of water in the body thus forms nuclei or even small bubbles that persist. If only one foot is frozen, bubbles originate in the frozen foot. In some cases visible bubbles were observed in thawed feet at sea level (i.e. without decompression). When frog's blood is partly frozen in test tubes or in tied off sections of veins, bubbles will appear on decompression in the absence of mechanical agitation. The practical relation of this phenomenon to flight at high altitude should not be overlooked. 4. Fracturing a leg bone (tibia or femur) in a frog induces bubble formation on subsequent decompression. Bubble nuclei, which persist for (1/2) to 1 hour, are probably formed as a result of the intense mechanical disturbance when the bone snaps. Fracturing of bone is considerably more effective than crushing muscles for producing bubbles in frogs.
J Gen Physiol 1945 Jan 20
PMID:ADDITIONAL MECHANISMS FOR THE ORIGIN OF BUBBLES IN ANIMALS DECOMPRESSED TO SIMULATED ALTITUDES. 1987 18

Analytical methods which are accurate to about 1 per cent have been developed for the determination of small amounts (ca. 500 gamma) of bis(beta-chloroethyl)-sulfide (H), ethyl-bis(beta-chloroethyl)amine (EBA), tris(beta-chloroethyl)amine (TBA), beta-chloroethyl-benzylsulfide (benzyl-H), and beta-chloroethyl-ethylsulfide (ethyl-H). The determinations are made by micro titration of the HCl liberated upon complete hydrolysis of the vesicants. A description is given of an apparatus suitable for applying vapors of vesicants to unit areas of skin. A very precise and reproducible micropipetting technique is described for the introduction of the vesicants into the penetration apparatus. By means of this penetration apparatus studies have been made of several factors which may influence the rate at which vesicant vapors penetrate into skin. Model experiments have been performed in which H was allowed to vaporize and the vapor was absorbed on a surface such as that of diethylene glycol or vaseline. It has been found that if the surface of liquid H is increased by spreading the agent on filter paper, the rate of evaporation is markedly increased. Furthermore, if the vapor is agitated by means of a magnetically driven fan, the rate of absorption by diethylene glycol is greatly accelerated. With vaseline as the absorbing surface it has been found that the area of the absorbing surface has an effect on the rate of absorption of H vapor. More H is absorbed by vaseline spread on filter paper to give a rough surface than is absorbed by a smooth film of vaseline. Measurements of the rate of penetration into human skin of H, EBA, TBA, benzyl-H, and ethyl-H vapors have been performed at 21-23 degrees C. and 30-31 degrees C. by means of the penetration apparatus described in this paper. The measurements were carred out on human volunteers under conditions of controlled temperature and humidity. When human skin is exposed to air saturated with H vapor, the H penetrates the skin of the forearm at a rate of about 1.4 gamma per cm.(2) per minute (temperature 21-23 degrees C.; relative humidity 46 per cent). This value was found to hold in experiments in which H vapor was applied for 3 to 30 minute intervals, thus indicating that the permeability of the skin to H vapor is not altered during a 30 minute exposure. Agitation of the H vapor by fanning did not result in any measurable increase in the rate of penetration. Two of the volunteers were Negroes; the permeability of their skin to H vapor did not differ appreciably from that found for the other subjects. When human skin is exposed to air saturated with EBA vapor, the vesicant penetrates at the rate of 2.8 gamma per cm.(2) per minute (temperature 22 degrees C., relative humidity 50 to 52 per cent). The amount of EBA penetrated is linear with exposure time for exposure periods of 5 to 20 minutes. Under similar conditions, it was found that TBA penetrates at a rate of about 0.18 gamma per cm.(2) per minute (temperature 22-23 degrees C.; relative humidity 45 to 48 per cent). This value was found to hold in experiments in which TBA vapor was applied for 30 to 60 minute intervals. The amount of TBA penetrated is linear with exposure time. In the case of benzyl-H, a linear relationship between the amount lost from the penetration cup and exposure time was also observed but the plot did not pass through the origin. It is suggested that this anomaly is due to retention on the skin surface of an appreciable quantity of benzyl-H as a result of rapid physical adsorption or chemical combination with a constituent of the skin. The rate of penetration of benzyl-H may be calculated from the slope of the plot and is found to be 0.35 gamma per cm.(2) per minute (temperature 22 degrees C., relative humidity 55 to 60 per cent). The results with ethyl-H showed great variation among individual subjects and no satisfactory value for the rate of penetration can be given as yet. Measurements were also made of the rate of penetration of H, EBA, and TBA vapors at 30-31 degrees C. (relative humidity 47 to 49 per cent). At this temperature, a linear relationship was observed between the amount penetrated and the time of exposure. H vapor penetrated at a rate of 2.7 gamma per cm.(2) per minute, EBA vapor at 5.1 gamma per cm.(2) per minute, and TBA vapor at 0.29 gamma per cm.(2) per minute. Three of the subjects in the EBA measurements were Negroes. The permeability of their skin to EBA vapor did not differ from that found for the white subjects. Despite this fact, their skin failed to vesicate after an exposure period twice that which caused 50 per cent vesication in the white subjects. Calculation of the precision of the data showed that the average deviation, standard deviation, and standard error were not appreciably different for the data obtained with human subjects as compared with data for control experiments in which human skin was not involved. Consequently, no significant differences in the rate of penetration into the skin of individual subjects can be discerned from the data presented in this communication. The increase in the rate of penetration of H, EBA, and TBA vapors from 21-23 degrees C. to 30-31 degrees C. is approximately proportional to the increase in volatility of each agent. These results indicate that at the same gas concentration in milligrams per liter, H, EBA, and TBA vapors would all penetrate at about the same rate. The data presented above permit a determination of the approximate amount of each vesicant which must penetrate to cause vesication in about 50 per cent of the exposed sites. This amount has been designated by the symbol V(50). The V(50) for H and TBA at 21-23 degrees C. is the same, being about 6gamma; at 30-31 degrees C., the V(50) is 4 to 5 gamma. On the other hand, the V(50) for EBA at 22 degrees C. and 30-31 degrees C. is about 26 to 28 gamma. Thus, per gamma penetrated, H and TBA vapors are about equally effective in producing vesication while EBA vapor is only (1/5) to (1/8) as effective.
J Gen Physiol 1946 Jul 20
PMID:THE PENETRATION OF VESICANT VAPORS INTO HUMAN SKIN. 1987 72

1. The solubility of mustard (H) in water and in molar sodium chloride was found to be 5.8 x 10(-3) molar and 3.2 x 10(-3) molar respectively or 0.92 mg. per ml. and 0.5 mg. per ml. Solubility curves have been drawn and the usefulness of this method in examining the homogeneity of H preparations as well as in establishing their solubility, is discussed. 2. Certain detergents increase the solubility of H in water. The solubility was found to increase with the concentration of detergent. 3. Many detergents were found to affect the interfacial tension between H and water so that with slight agitation liquid H breaks up into minute droplets. This in turn greatly accelerates the rate of solution.
J Gen Physiol 1947 Jul 20
PMID:SOLUBILITY OF MUSTARD GAS [BIS (beta-CHLOROETHYL) SULFIDE] IN WATER, MOLAR SODIUM CHLORIDE, AND IN SOLUTIONS OF DETERGENTS. 1987 10

Bupropion, a dual norepinephrine and dopamine reuptake inhibitor, has been approved by the United States Food and Drug Administration for the treatment of major depressive disorder. The most common treatment-emergent adverse events reported with bupropion were headache, dry mouth, nausea and agitation. The following is a case report intended to draw attention to a rarely reported adverse effect of bupropion. This article describes a female adolescent with depression who developed aphthous ulcers while on high-dose bupropion with positive rechallenge. This is the first case report indicating the incidence of aphthous ulcers associated with bupropion treatment.
Gen Hosp Psychiatry
PMID:Aphthous ulcers associated with bupropion in a female adolescent: a case verified by rechallenge. 2176 40

Synthetic analogs of the cathinone molecule have seen increasing recreational use as substitutes for cocaine, 3,4-methylenedioxymethamphetamine (ecstasy) and methamphetamine. Repeated use of these drugs is associated with a paranoid hallucinatory delirium. A subset of patients using these substances develops a syndrome of extreme agitation and violent behavior that has been reported following the use of other stimulant drugs that also produce rapid changes in brain monoamines. This syndrome, characterized as "excited delirium," presents to the acute care setting with a challenging combination of paranoia, severe agitation and violent behavior. These patients frequently suffer from dehydration, skeletal muscle damage and renal failure that may lead to multiorgan failure and death. Management of these individuals requires careful consideration of the consequences of interventions commonly implemented in medical settings to control dangerous aggressive behavior.
Gen Hosp Psychiatry
PMID:Excited delirium following use of synthetic cathinones (bath salts). 2289 45


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