Announcing the first novel class of rapid-onset antidepressants in clinical practice Olumuyiwa John Fasipe, Peter Ehizokhale Akhideno, Omagbemi Sampson Owhin, Oluwatosin Beatrice Ibiyemi-Fasipe Journal of Medical Sciences 2019 39(5):205-216 This study was designed with the rational aim/purpose of announcing and discussing the new class of rapid-onset antidepressants that will bring forth significant improvement and positive impact to the management of patients with depression disorders in clinical practice. The class of N-methyl-D-aspartate-glutamatergic ionoceptor blockers represent the first separate novel class of rapid-onset antidepressants with a direct action on the excitatory glutamatergic neurotransmission system but no direct action on the serotonergic, noradrenergic, or dopaminergic neurotransmission systems. It consistently fits into the antidepressants' classification nomenclature, and the pharmacological properties also deemed it appropriate to be accepted and announced as the first separate novel class of rapid-onset antidepressants.

A monoclonal enzyme-linked immunoassay for the detection of botulinum neurotoxin type E Der-Jiang Chiao, Jiunn-Jye Wey, Wen-Zhi Lin, Shiao-Shek Tang, Pei-Yi Tsui, Rong-Hwa Shyu, Jyh-Hwa Kau, Chih-Heng Huang, Chuan-Wang Li, Cheng-Cheung Chen, Cheng-Che Liu Journal of Medical Sciences 2019 39(5):217-222 Background and Aim: Botulinum neurotoxin Type E (BoNT/E), one of the most lethal toxin known, is the common contamination in fishery products or fish consumption that causes foodborne botulism. It is necessary to establish a sensitive and specific method for the detection of BoNT/E because of its extremely low lethal dose. Methods: In this study, a practical enzyme-linked immunosorbent assay for BoNT/E detection was developed. The assay is based on the sandwich format using monoclonal antibodies of two distinct specificities. An affinity-purified anti-BoNT/E light chain Mab (1E1) is utilized to adsorb BoNT/E from solution, and the second anti-BoNT/E heavy chain C terminus Mab (5E1) conjugated with peroxidase is then used to form sandwich complexes, and peroxidase allows color development and measurement of optical density at 450 nm. Results: Standard curves were linear over the range of 5–100 ng/ml BoNT/E. The limit of detection was below 10 ng/ml in phosphate-buffered saline buffer. The developed BoNT/E assay also showed no cross-reaction to Type A neurotoxin (BoNT/A) and Type B neurotoxin (BoNT/B). Conclusion: Herein, a sensitive and accurate ELISA for BoNT/E detection was presented. It has the potential to utilize in vivo BoNT/E analysis and contamination monitoring.

Knee joint injection resveratrol amelioration inflammation in collagen antibody induced arthritis Feng-Jen Tseng, Gu-Jiun Lin, Yuan-Wu Chen, Herng-Sheng Lee, Huey-Kang Sytwu, Wei-Tso Chia Journal of Medical Sciences 2019 39(5):223-230 Background: Resveratrol has been considered to possess anti-inflammatory properties. Here, we propose that intra-articular resveratrol injection might ameliorate acute inflammation in a single knee joint in mice with collagen antibody-induced arthritis (CAIA). Methods: The clinical expression of CAIA was analyzed by two investigators. Resveratrol (30 mg/kg in 30 μL dimethyl sulfoxide [DMSO]) was injected into the knee joint of BALB/c mice from days 0 to 9. Footpad thickness was photographed and calculated. On day 10, the joints were examined histopathologically. Serum cytokine levels were measured by enzyme-linked immunosorbent assay. mRNA levels in paws were measured by real-time polymerase chain reaction (PCR). Results: In CAIA, acute inflammation was induced on day 7 and continued until day 10. In the resveratrol-treated mice, the severity of inflammation was obviously reduced. Expression levels of interleukin-1β, cyclooxygenase-2 (COX-2), and inducible nitric oxide synthase were decreased in the treated mice; however, tumor necrosis factor-α (TNF-α) levels did not change significantly after treatment. Conclusion: The anti-inflammatory mechanism of resveratrol is associated with NF-κB inhibition. Further investigations of the clinical applications of resveratrol are required.

Parotid abscess: 15-year experience at a tertiary care referral center in Taiwan Li-Hsiang Cheng, Hsing-Won Wang, Chien-Ming Lin, Cheng-Ping Shih, Yueng-Hsiang Chu, Wei-Chen Hung, Wei-Yun Wang, Chih-Wei Wang, Jih-Chin Lee Journal of Medical Sciences 2019 39(5):231-235 Background: Parotid abscess is an uncommon condition, but it can cause potentially lethal systemic infections. The aim of this study was to analyze cases with parotid abscess during 15-year period and further determine the optimal diagnostic and therapeutic modalities at a tertiary medical center in Taiwan. Patients and Methods: Nineteen patients diagnosed with parotid abscess were retrospectively analyzed from November 2002 to October 2017. Patients' clinical symptoms, etiology, diagnostic methods, bacteriology, and antibiotic and surgical treatment were evaluated. Results: Among 19 patients diagnosed with parotid abscess, 12 were male and 7 were female. Their diagnostic ages ranged from 25 to 88 years (mean 55.5 years). The most common symptoms at initial presentation were painful swelling of the intra-auricular region and fever. Typical etiologies were odontogenic infections or poor oral hygiene. Thirteen out of 18 patients with drainage of abscess showed positive finding of bacterial cultures, and the most common pathogen was Klebsiella pneumoniae in six patients. One patient received intravenous antibiotics alone but eventually died of sepsis. In addition to antibiotic treatment, the other 18 patients underwent a combination of antibiotic treatment and drainage of abscess. Among them, 14 patients received surgical drainage and 4 patients received ultrasound-guided needle aspiration of abscess. After drainage, all had complete resolution of disease without recurrence or sequelae during at least 1 year of follow-up.Conclusions: This study highlights that K. pneumonia is an important pathogen of parotid abscess in consideration of the rapidly increasing cases of diabetes mellitus in Taiwan. In addition to early diagnosis, parotid abscess should be managed with broad-spectrum antibiotics, adequate hydration, and appropriate drainage to prevent unwanted morbidity and mortality.

Association between Cardiovascular Health Metrics and Frailty in a Taiwanese Population Ying-Chuan Wang, Chun-Hsiang Chiu, Chih-Chia Wang, Wei-Liang Chen, Hui-Fang Yang, Tao-Chun Peng Journal of Medical Sciences 2019 39(5):236-242 Introduction: Frailty is known as a reduced response to stressors and an increased vulnerability to adverse health events. Early intervention for individuals with risk factors for frailty will improve their outcomes. Despite the growing amount of evidence indicating that cardiovascular disease is associated with frailty, the evidence for primary prevention is poor. Materials and Methods: The data were drawn from the MJ Health Management Institution and were cross-sectional design. The participants were general population. Cardiovascular health (CVH) metrics included smoking status, body mass index, healthy diet score, physical activity, total cholesterol, blood pressure, and blood glucose. The definition of frailty was modified from the Study of Osteoporotic Fractures Frailty Index. Multiple logistic regression analysis was used to examine the associations among CVH metrics, individual components of frailty, and frailty itself. Results: The mean age of 37,843 participants was 62.15 ± 7.66 years. Overall, 19.2% of the participants were defined as having frailty. When those with 0–2 ideal CVH metrics were used as the reference group, the odds ratios for frailty were 0.68 (95% confidence interval [CI], 0.56–0.82) for those with 3–4 ideal CVH metrics and 0.36 (95% CI, 0.23–0.55) for those with 5–7 ideal CVH metrics after adjustment for potential confounders. Conclusions: Our results suggested a significantly lower risk of frailty among older individuals with more ideal CVH metrics. These findings suggest that attaining ideal CVH metrics has the potential to reduce the burden of frailty.

Carcinoma of base of tongue with disseminated nonregional lymph nodal metastases clinically mimicking lymphoma: The first reported case and review of literature Anirban Halder, Rituparna Biswas, Sujit Shukla, Nisha Rana, Vikas Yadav, Jaspreet Kaur Journal of Medical Sciences 2019 39(5):243-246 Head-and-neck squamous cell carcinomas (SCCs) are malignancy with propensity mostly for the locoregional spread. Most frequent sites of distant metastases include lung, bone, liver, and adrenal. Distant metastases to nonregional lymph nodes without visceral involvement from oropharyngeal cancer are extremely rare. To the authors' knowledge, this is the first case reported where a male presented with SCC of the base of tongue with widespread nodal metastases without any visceral involvement as primary presentation.

Use of bispectral index monitoring to predict the outcome of patients with posterior reversible encephalopathy syndrome: Two case reports Tsai-Shan Wu, Yin-Tzu Liu, Zhi-Fu Wu, Wei-Cheng Tseng, Hou-Chuan Lai Journal of Medical Sciences 2019 39(5):247-250 Posterior reversible encephalopathy syndrome (PRES) is a reversible neurologic disorder characterized by a variety of symptoms such as seizures, headache, vomiting, altered mental status, and visual disturbances. Bispectral index (BIS) monitor is a kind of electroencephalography and is widely used in anesthesia depth surveillance. In intensive care units, BIS has been used to survey sedation and predict prognosis of coma patients. Here, we report two cases diagnosed radiologically with PRES that had persistent consciousness disturbance resulted from severe life-threatening complications. In our patients, they progressed with different BIS values and different outcomes. We advise that BIS should be used in intensive care as an adjunctive monitor when patients' consciousness status could not be predicted.

Unexpected caustic esophageal injury associated with the use of a bowel preparation agent Yi-Ting Chou, Tien-Yu Huang, Chao-Feng Chang Journal of Medical Sciences 2019 39(5):251-253 Bowel preparation is crucial for maintaining the quality of colonoscopic findings. Many bowel preparation agents are available that have a few adverse effects. However, inappropriate use of bowel preparation agents may cause severe complications that need immediate management. Sodium picosulfate with magnesium citrate (SPMC) is a widely used colon-cleansing agent. We present a case wherein inappropriate use of SPMC manifested as extensive esophageal ulceration. The patient did not comply with the drug instructions. Progressive chest tightness and epigastric pain developed after he took the drug. Upper endoscopy revealed caustic esophageal injury of the middle-to-distal esophagus. The patient was treated with a proton-pump inhibitor and sucralfate. There was no chronic complication during the 3-month follow-up period. The patient education regarding the correct use of SPMC should be prioritized by the clinician.

Observation on silver nanoparticle interference on dichlorophenol indophenol precipitation test Pathum Sookaromdee, Viroj Wiwanitkit Journal of Medical Sciences 2019 39(5):254-254