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Teaching Effectiveness of the Individual Faculty Members Speakers Gene L. Colice, MD, FCCP Effective in Presenting the Material 1 2 3 Avoided Commercial Bias or Influence 1 2 3.

RESULTS Metabolism of f Q-PHIPA 3-10 in Rat Hearts Fifteen, 30 and 60 min after intravenous injection of 20 30 MBq non-carrier-added I31I-PHIPA 3-10 BSA, the animals showed heart uptake values that slowly decreased from 4.6% to 3.9%ID g. RP-8 HPLC of the heart extracts showed small variations in the radioactivity distributed between esterified and free radioactive fatty acids. As an example, the UV- and gamma-HPLC readouts of a 60-min heart extract are shown in Figure 2. Free 131I-PHIPA 3-10 eluting at 60 min was identified by spiking with cold PHIPA 3-10. A metabolite could also be detected eluting somewhat earlier. Table 1 summarizes the results evaluated from the gamma-HPLC chromatograms. The labeled free fatty acids decreased with time from 14.8% at 15 min to 10.3% at 60 min after injection, whereas the relative amount of free metabolite increased from 60.1% to 85.4%. In addition, the heart extracts were hydrolyzed and analyzed by HPLC. Figure 3 shows the RP-18 gamma-HPLC of a hydrolyzed heart extract, which was obtained 15 min after the injection of 131I-PHIPA 3-10. The UV trace demonstrates the retention behavior of the two potential metabolites PHIPA 1-10 and DH-PHIPA 3-10 Fig. 1 ; . Accordingly, the more lipophilic gamma-HPLC peak was identified to be PHIPA 3-10, and the less lipophilic component was assigned to PHIPA 1-10. The relative amount of the metabolite as compared to the parent compound increased with time from 42.5% at 15 min to 51.0% at 60 min after injection. The data are summarized in Table 1. To obtain additional proof of the identity of PHIPA 1-10, mass spectrometric analysis was performed with the HPLCpurified hydrolyzed heart extract from an animal that received unlabeled PHIPA 3-10 in addition to 13II-PHIPA 3-10 BSA Convenient for performing the study as a routine method of detecting deficiency. Thiamine Triphosphate As early as 1938, Minz 8 ; first suggested a relationship between thiamine and nervous excitation when he observed that thiamine was released into the bathing medium when the pneumogastric nerve, taken from an ox, was stimulated. Cooper and Pincus 9 ; reviewed the evidence that there was a possibility that thiamine has a neurophysiological function that is distinct from its activity as a coenzyme. They reported that thiamine appears to be uniformly distributed throughout the nervous system and appears to be highly localized in membrane structures. More recently, the distribution of thiamine was studied in rats 10 ; . After intracerebroventricular injection of labeled thiamine the distribution of its radioactive esters was found to be as follows: thiamine, 812%; TMP, 1214%; TPP, 7274%; and thiamine triphosphate TTP ; , 23%. Cooper and Pincus 9 ; had reported that they, and other investigators, had confirmed that nerve stimulation in experimental animal systems resulted in decline of the level of TPP and TTP in the preparation. The released compounds were in the form of TMP and free thiamine. This phenomenon made it difficult to interpret the function of the vitamin in nerve conduction. Bettendorff et al. 11 ; discussed the physiological significance of TTP in the main electric organ of Electrophous electricus that is particularly rich in TTP, representing 87% of the total thiamine content of this tissue. The real substrate of TTP phosphatase, they said, is probably a 1 : complex of Mg2 and TTP. Incubation of rat brain homogenates with thiamine and TPP leads to synthesis of TTP 12 ; and further study suggested that TTP is an activator of chloride channels having a large unit conductance 13 ; . In mammalian tissues TTP concentrations are regulated by a specific thiamine triphosphatase 14 ; . The role of TTP is, however, incompletely known at the present time. Thiamine Transporter The SLC gene family of solute carriers is a family of three transporter proteins with significant structural similarity, transporting substrates with different structure and ionic charge. SLC19A1 mediates the transport of reduced folate and its analogs and SLC19A2 mediates the transport of thiamine. SLC19A3 is also capable of transporting thiamine 15, 16 ; . Thiamine Deficiency Disease The classical syndrome caused primarily by thiamine deficiency in humans is beriberi, in which the benefit of thiamine in prevention and treatment is uncontested 17, 18 ; . In older texts it has been divided into categories known as `wet', `dry', `childhood', `infantile' and WernickeKorsakoff syndrome. More modern knowledge recognizes that the symptoms and signs may or may not be associated with edema and vary.

Acitretin trade name soriatane ; is a second generation retinoid and actimmune.

HA Standard Drugs General Drugs ZINC 13.3 TOPICAL LOCAL ANAESTHETICS AND ANTIPRURITICS CALAMINE CALAMINE + SULPHUR CROTAMITON LIGNOCAINE TOPICAL ; MEPYRAMINE 13.4 TOPICAL CORTICOSTEROIDS BETAMETHASONE DIPROPIONATE TOPICAL ; ALCLOMETASONE DIPROPIONATE BETAMETHASONE VALERATE TOPICAL ; BETNESALIC OR EQUIV ; CROTAMITON + HYDROCORTISONE DAKTACORT OR EQUIV ; DIPROGENTA OR EQUIV ; DIPROSALIC OR EQUIV ; FLUOCINOLONE ACETONIDE FLUOCINOLONE ACETONIDE + NEOMYCIN HYDROCORTISONE TOPICAL ; HYDROCORTISONE + CLIOQUINOL HYDROCORTISONE + NEOMYCIN KENACOMB OR EQUIV ; SYNALAR + VIOFORM OR EQUIV ; TRIAMCINOLONE ACETONIDE TOPICAL ; TRIDERM OR EQUIV ; 13.5 PREPARATIONS FOR ECZEMA AND PSORIASIS COAL TAR SALICYLIC ACID SALICYLIC ACID + COAL TAR + SULPHUR SALICYLIC ACID + SULPHUR SALICYLIC ACID IN ALCOHOL ACITRETIN CALCIPOTRIOL DITHRANOL + SALICYLIC ACID METHOXSALEN METHOXSALEN TOPICAL ; PINETARSOL OR EQUIV ; POLYTAR OR EQUIV ; 13.6 ACNE AND ROSACEA ACNE AID OR EQUIV ; TOPICAL ; BENZOYL PEROXIDE SULPHUR BETAMETHASONE IN PROPYLENE GLYCOL TOPICAL ; CLOBETASOL PROPIONATE CLOBETASONE BUTYRATE DIFLUCORTOLONE FLUTICASONE PROPIONATE TOPICAL ; HALOMETHASONE LOCASALEN OR EQUIV ; METHYLPREDNISOLONE TOPICAL ; MOMETASONE + SALICYLIC ACID MOMETASONE TOPICAL ; NERISONE C OR EQUIV ; TRAVOCORT OR EQUIV ; Special Drugs. Acitretin Oral retinoids were introduced for the treatment of psoriasis over the past two decades. Etretinate was the first retinoid available for psoriasis, but because of its long half-life, it could not be prescribed for women of childbearing potential due to the risk of long term teratogenicity. Acitretin, the active metabolite of etretinate, has a shorter half-life. Once it was approved, etretinate was withdrawn from the market. Acitretin is also associated with teratogenicity, but because of its shorter half-life, it can be given to women as long as they are not planning a pregnancy for three years after discontinuing its use. In the presence of alcohol, however, acitretin is converted back to etretinate, so caution must be used in women of childbearing potential to make sure they do not consume alcohol when taking acitretin.30 Both acitretin and etretinate are associated with numerous mucocutaneous side effects. At doses of 1 mg kg daily, many patients develop hair loss. Cheilitis, characterised by fissuring and cracking of the lips, is common as are several other cutaneous side effects. A sticky sensation to the skin, desquamation of the palms and soles, thinning of the nail plates, and development of pyogenic granulomas in paronychial areas can occur. Elevation of cholesterol levels, and especially triglycerides, is common even at lower doses of etretinate or acitretin. Triglycerides can become so elevated that pancreatitis can occur. Muscle aches and pains are also common. Elevation of liver function tests occurs in a small proportion of patients and must be monitored. Acitretin is prescribed in doses of 1050 mg daily. At doses of 1025 mg in combination with UVB or PUVA phototherapy, acitretin is highly effective in clearing the condition in most patients with minimal side effects.31 Higher doses are associated with more adverse reactions but limited improvement in psoriasis. With chronic use, acitretin can be associated with the development of calcification of ligaments and tendons. Although these developments are usually asymptomatic, pain near ligaments and tendons in patients on acitretin warrants radiological examination to determine if the drug should be discontinued. Retinoids can benefit psoriatic arthritis in some patients.32 Ciclosporin Ciclosporin, the most effective oral therapy for psoriasis, was fortuitously discovered to help psoriasis when it was administered to transplant patients with the disease. The side effects of ciclosporin are numerous and include hypertension, nephrotoxicity, hypomagnesaemia, hyperkalaemia, hyperuricaemia, elevation of liver function tests, development of paraesthesias, and hypertrichosis. In transplant patients, this immunosuppressive drug is associated and adalimumab.

Herv Gurin, a director since November 2006, has 30 years of pharmaceutical management expertise. Since 2005, he has been a director of Xytis Pharmaceuticals. From 1999 to 2004, he was a director of Sanofi Synthelabo. From 1999 to 2001, he was the Vice Chairman and Chief Operating Officer of Sanofi Synthelabo. Prior to the merger of Sanofi and Synthelabo in 1999, Mr. Gurin had been the Chairman and Chief Executive Officer of Synthelabo since 1989. Mr. Gurin had also previously held positions as Regional President UK, Northern Europe, Middle East, Asia, Pacific & Africa for Rhne Poulenc and May and Baker. He was also Financial Vice President for Europe and Regional President for Canada, Latin America, Asia & Pacific for Revlon Healthcare. Mr. Gurin, who is French, is a graduate from HEC and holds an MBA from Harvard Business School. He also received the chevalier de la Lgion d'Honneur, the leading French civil and military order. Permanent management and consultancy functions for Swiss and foreign interest groups: none and adefovir.
Advantages over chemotherapeutic agents. They preserve the patients' immune function, augment the patients' anti-tumour inflammatory response and are less toxic than chemotherapeutic agents.27 Isotretinoin, etretinate and acitretin have been used to treat MF. It has not been documented that they are potent enough to be given as monotherapy, although an overall response rate as high as 60% had been reported.25 Combination with PUVA gives similar results as PUVA alone but the number of sessions and UVA dose needed to induce remission appeared lower. Combination with interferon- IFN- ; gave variable results and some revealed similar response rate as IFN- monotherapy while sustained remission was reported in some trials. Targretin Bexarotene ; , a novel RXR-selective retinoid analog, has shown promising results both topically and orally in the treatment of early and advanced stage of CTCL.32 IFN- has a direct anti-proliferative and immunomodulatory effects. Low dose is given at 3 to daily to 3 times per week systemically or intralesionally. The optimal dose is believed to be 3MU three times weekly. Newer long acting weekly-dosing IFN is also available now. The objective response rate is 50-60% and CR rate is about 10-20%, which are comparable to single-agent chemotherapy. Its combination with PUVA has given superior results, with the CR rates increasing to 90-100%.14, 33.

The low-risk patient profile delineated in the first Princeton Consensus Conference1 was confirmed by the second Princeton Consensus Panel.2 The majority of patients fall into the low-risk category, for whom sexual activity does not pose a significant cardiac risk. Those patients who are assessed at low risk and have ED, can be treated safely with PDE5 inhibitors.2 Criteria for categorization of a patient as low-risk are listed here.2 Cardiac risk is generally low for patients with fewer than 3 major risk factors for CVD excluding male gender ; and whose HTN if present ; is well controlled; whose angina if present ; is mild and stable; whose coronary revascularization if needed ; is adequate; and whose mitral valvular disease, left ventricular dysfunction LVD ; , and congestive heart failure CHF ; if present ; are mild.2 Likewise, a currently asymptomatic patient with a history of MI more than 6 to 8 weeks previously is at low risk provided that there is no ongoing ischemia and the post-MI stress test is negative. For selected patients with a satisfactory postMI stress test, the period of sexual abstinence may be reduced to 3 to weeks.2 and aggrenox. 9. Van der Kerhof PC, de Rooij MJ. Multiple squamous cell carcinomas in a psoriatic patient following high-dose photochemotherapy and cyclosporin treatment: response to long-term acitretin maintenance. Br J Dermatolog 136: 275-8, 1997. Spuls PI, Hadi S, River L et al. Retrospective analysis of the treatment of psoriasis of the palms and soles. J Dermatolog Treat 14: Suppl 2: 21-5, 2003. Maini RN, Breedveld FC, Kalden JR et al. Therapeutic efficacy of multiple intravenous infusions of anti-tumor necrosis factor alpha monoclonal antibody combined with low-dose weekly methotrexate in rheumatoid arthritis. Arthritis Rheum 41: 1552-63, 1998 and acitretin.

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