Open Access Editorial

Prodrugs-Current and Future Drug Development Strategy

Rafik Karaman

International Journal of Medical and Pharmaceutical Case Reports, Page 58-63
DOI: 10.9734/IJMPCR/2014/13183

The focus of traditional prodrug approach was on altering various physiochemical parameters, whereas the current modern computational approach considers designing prodrugs through attaching appropriate linkers with drugs having poor bioavailability which upon exposure to physiological environments release the parent active drugs in a programmable (controlled) manner resulting in an improvement of their bioavailability. With the possibility of designing prodrugs with different linkers, the release rate of the parent active drugs can be controlled.
The future of prodrug technology is exciting and yet challenging. Advances must be made in understanding the chemistry of many organic reactions that can be effectively utilized to enable the development of more types of prodrugs. The understanding of organic reaction mechanisms of certain processes, particularly intramolecular reactions, will be the next major milestone in this field. It is envisioned that the future of prodrug technology holds the ability to create safe and efficacious delivery of a wide range of active small molecules and biotherapeutics. This goal can be achieved using computational chemistry methods such as ab initio, semi-empirical and density functional theory (DFT), and molecular mechanics (MM) to calculate physicochemical and molecular properties of current marketed drugs suffer low bioavailability or/and unpleasant taste or odor.

Open Access Case Study

Resection of Degenerated Leiomyoma by Laparotomy during Second Trimester of Pregnancy with Favorable Outcome: A Case Report and Review of Literature Regarding Leiomyomas during Pregnancy

Theodoros Felekis, Christodoulos Akrivis, Ioannis Korkontzelos, Panagiotis Tsirkas

International Journal of Medical and Pharmaceutical Case Reports, Page 30-36
DOI: 10.9734/IJMPCR/2014/11573

Aims: We present a case of degenerated leiomyoma in pregnancy causing pain that deteriorated with conservative management and was successfully treated with myomectomy.
Presentation of Case: A 37-year-old woman with a known asymptomatic subserosal leiomyoma was admitted to the obstetrics clinic of our hospital at the gestational age of 18+3 weeks due to gradually worsening constant right quadrant lower abdominal pain of acute onset. Clinical examination, laboratory investigation and abdominal ultrasonography led to the conclusion that the pain was due to the degeneration of the leiomyoma. The initial conservative approach was not effective so the subserous leiomyoma was resected by laparotomy. The pregnancy progressed normally until the delivery of a healthy neonate at 37+5 weeks gestational age by cesarean section due to the prior myomectomy. The pathologic examination revealed a nodular 6,5x5x3cm tumor with histological features of leiomyoma with regional hydropic and focal hyaline degeneration.
Discussion: Prevalence of leiomyomas during pregnancy is reported as 0, 3-3, 9% according to epidemiologic studies. They usually remain asymptomatic but they can also cause complications in 10% of all cases. Management of uterine leiomyomas in pregnancy is based on conservative treatment, but there are cases where surgical intervention is necessary.
Conclusion: We present data from relative literature, showing that myomectomy during pregnancy can under circumstances be an inevitable treatment choice to this medical condition, in favour of the best outcome for the ongoing gestation.

Open Access Case Study

A Case of Gastric and Esophageal Perforation Caused by Endoscopic Retrograde Cholangiopancreatography

Savas Yakan, Erdem Sari, Erdem Carti, A. Deniz Ucar, Nazif Erkan, Mehmet Yildirim, Durmus Ali Cetin

International Journal of Medical and Pharmaceutical Case Reports, Page 37-41
DOI: 10.9734/IJMPCR/2014/11875

Aim: Endoscopic retrograde cholangiopancreatography (ERCP) is no longer in use as a diagnostic procedure but rather when a therapeutic intervention is needed or most likely to be needed depending on the pre-ERCP imagings as transabdominal ultrasonography (TAUS), endoscopic ultrasonography (EUS), magnetic resonance cholangiopancreatography (MRCP), because it is an invasive procedure with potential life-threatening complications specially perforation, because most of the diagnosis that ERCP can provide, can be solved by the above mentioned cross sectional imagings. One the most serious complication of this widely used intervention is perforation. We present a case of ERCP-induced perforation of the lesser curvature and esophagus with literature review.
Presentation of Case: A 90 years old female patient admitted to secondary level hospital with chronic abdominal pain, yellow discoloration of skin and sclera. ERCP was planned for differential diagnosis of periampullary tumor. Patient is redirected to Izmir Bozyaka Education and Research Hospital General Surgery Department for iatrogenic perforation during the procedure starting from lesser curvature of the stomach extending to thoracic esophagus. Unconsciousness, hypotension (70/40mmHg), tachycardia (140/min) tachypnea (24/min) were the first presenting symptoms. Body temperature was 38ºC. Generalized tenderness and rigidity were presented during abdominal examination. An emergency operation was planned with these findings. Operation including total gastrectomy, transhiatal esophagectomy and feeding jejunostomy was the definitive surgery performed. At postoperative 14th day the patient lost her life after sudden cardiac arrest.
Discussion and Conclusion: ERCP has some complication risks like every invasive procedure. Early diagnosis and correct management are crucial in the management of the intervention related complications.

Open Access Case Study

Vasospasm after Collagenase Clostridium Histolyticum Infiltration in Dupuytren’s Contracture

R. Sanjuan-Cerveró, N. Franco

International Journal of Medical and Pharmaceutical Case Reports, Page 42-48
DOI: 10.9734/IJMPCR/2014/12446

Treatment with collagenase clostridium histolyticum has been shown to be effective at the short- and mid-term against Dupuytren’s contracture in which cords have formed. As with any new drug, pharmacovigilance studies will allow for reporting new complications with the treatment.
We present a clinical case of vasospasm after collagenase clostridium histolyticum infiltration in a patient with a 60º affectation of the proximal interphalangeal joint forming an ulnar cord of fifth radius in the left hand. Evolution at one year presents the cord in the same contracture as before, and no vascular alteration.
In our opinion, most complications from infiltration with collagenase clostridium histolyticum take place when the treatment is performed and are due to extravasation of the infiltration into healthy tissue. In cases of greater extravasation, vessels may be affected causing transient vasospasms due to the local action of the enzyme, together with a secondary inflammatory reaction to the collagenase action.

Open Access Case Study

External Auditory Canal Fracture after Posterior Dislocation of an Intact Condylar Head

Karabouta Irene, Kalimeras Eleftherios, Georgiou A. Christos

International Journal of Medical and Pharmaceutical Case Reports, Page 49-57
DOI: 10.9734/IJMPCR/2014/12498

Aims: The aim of this article is the kind of applied treatment for fracture of the external auditory canal, following traumatic facial injuries.
Presentation of Case: The case report of the patient described in this article, is evaluated for the posterior dislocation of an intact mandibular condyle after facial injuries she had due to a car accident. The physical and x-ray examination of the External Auditory Canal (EAC) revealed facial fractures, TMJ dysfunctional symptoms with severe disk displacement, as well as fracture of the anterior wall of the EAC. Atraumatical reduction of the fracture was accomplished during the TMJ disc reduction and joint exploration, resulting in a satisfactory outcome with no complications and with improvement of hearing impairment.
Discussion: The anterior osseous wall of the external auditory canal, which represents part of the tympanic portion of the temporal bone, defines the posterior limit of the glenoid fossa, and is situated close to the condyle of the mandible. Due to this intimate anatomical relationship, herniation of the TMJ apparatus into the external auditory canal (EAC) occurs spontaneously or secondary to neoplasia, inflammation, developmental problems and especially trauma. Direct high-energy impact into the chin displaces the condyle posteriorly and the result may be a fracture of the condyle or posterior dislocation of intact condyle without fracture, a dislocation of condyle into middle cranial fossa or temporal fossa, or a fracture on the anterior wall of the EAC.
Conclusion: In summary, a direct blow to the mandible can result in a TMJ apparatus injury. Due to the close relationship between TMJ and EAC, an atypical injury, such as a fracture of the anterior wall of the EAC can occur. An oral & maxillofacial surgeon, when called to examine and diagnose TMJ injury disorders, has the challenging responsibility to take into account the potential concomitant temporal bone fractures or intracranial complications in cooperation with radiologists, ENT doctors and neurosurgeons.