The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many

Harrison's Principles of Internal Medicine

The biochemistry and medical significance of the flavonoids.

I first read Davidson 30 years ago: at that time it was already in its 5th edition. A brief comparison shows that it then contained about 440,000 words in 1,100 pages: the current edition has compressed 625,000 words into 800 pages. I think I bought it as a student because it was cheap: but also because it seemed to be comprehensive and straightforward, and I have used it as a basis for my medical knowledge ever since. So I miss some of the old pictures of the acute skin rashes such as scarlet fever: in fact infectious disease has been transferred to the back and genetic factors take the first chapters. But careful linguistic comparison will still uncover the old phrases which some of us know by heart-there are minor changes such as 'alarming reactions to intravenous iron are uncommon, but have occasionally been noted', which becomes 'alarming systemic anaphyllactic reactions can occur'. Sir Stanley Davidson made 'no attempt to describe every rare disease or syndrome, but devoted most of the space available to those disorders most commonly encountered in practice'. I have grown up with successive editions, and have gradually come to appreciate the problems of the authors in the compression of knowledge. Having got to know many of them personally as real people rather than as names I can still recommend the book. It is the essential starting point for the study of internal medicine and for many doctors will remain their base reference work. The present editors have kept up-to-date and been prepared to prune the dead wood. There are many competitors in the market, and the publishers must take care with layout and illustration, although Davidson is still the best value for money. I will continue to recommend it to my clinical students: they will need to read it and know it to pass final MB. Postgraduates will need to remember the facts, but also to be able to place them in a broader perspective. The older consultant will still happily read it, and to get to know the authors themselves is really to complete your medical education. Dr John Macleod and his team have successfully kept alive the primary objective 'to provide a rational and easily comprehensible basis for the practice of medicine'. The book is economical in price and compact in size, but still contains the essential truths for the practice of good medicine.

Davidson's Principles and Practice of Medicine

This book succeeds Review of Medical Pharmacology , by Meyers, Jawetz, and Goldfien. Edited by B. G. Katzung, some of the important areas covered include drug receptors and pharmacodynamics, pharmacokinetics of absorption and biotransformation of drugs, autonomic pharmacology of cholinergic and adrenergic receptor stimulants and antagonists, antihypertensive agents, cardiac glycosides and other agents used in the treatment of congestive heart failure, therapeutic drugs for cardiac arrhythmias, diuretics, pharmacology of the CNS drugs such as anticonvulsants and anesthetics, antidepressants, narcotic analgesics, nonsteroidal anti-inflammatory agents, endocrine pharmacology, antimicrobial and antimycobacterial drugs, antiprotozoal and antihelmintic drugs, cancer chemotherapy, and drugs and the immune system. Written by several prominent researchers and scientists, each chapter begins with a section on the basic pharmacology, chemistry, pharmacokinetics, and pharmacodynamics of the agents under discussion. This is followed by a section on clinical pharmacology, which deals with relevant information regarding the clinical use of drugs on the various

Basic and Clinical Pharmacology

Diabetic autonomic neuropathy

In this study, some depsidones and diaryl ether derivatives isolated from Corynespora cassicola, a fungi endophyte of Gongronema latifolium, were assessed for their anti-inflammatory potentials. The isolated metabolites corynesidone A (1), corynesidone C (2), corynesidone D (3) and corynether A (4) were screened for their effects on tumour necrosis factor-α (TNF-α), inducible nitric oxide (iNO), and reactive oxygen species (ROS) and reactive nitrogen species (RNS) production by stimulated RAW264.7 macrophages. Concentration of 1, 2, 3 and 4 up to 100 μM did not remarkably affect the viability of treated macrophages. The compounds were found to cause a concentration-dependent decrease in lipopolysaccharide-induced TNF-α and iNO in RAW264.7 cells. Pre-treatment with 100 μM of 1, 2, 3 and 4 suppressed iNO by as much as 96.28%, 95.71%, 78.14% and 73.28%; with IC50 of 8.16, 9.49, 15.29 and 26.52 μM, respectively. Similarly, pre-treatment with 100 μM of 1, 2, 3 and 4 caused an inhibition of 99.17%, 99.5...

Inhibition of inflammatory mediators and reactive oxygen and nitrogen species by some depsidones and diaryl ether derivatives isolated from Corynespora cassiicola, an endophytic fungus of Gongronema latifolium leaves

This study was carried out to investigate the effect of concurrent oral administration of aqueous leaf extract of Azadirachta indica (Meliaceae) on the pharmacokinetic properties of chloroquine sulphate in experimental rabbits. The results indicated that concurrent administration of both agents resulted in a significant decrease in serum concentration, slower absorption and elimination as well as longer half-life of chloroquine sulphate. The highest relative decrease of 78.0% was recorded 4 hours after concurrent administration, while the smallest decrease (64.6%) occurred 24 hours after concurrent administration. Significant reductions were also noted in some pharmacokinetic parameters of chloroquine and included the area under the curve (71.9%), maximum serum concentration (69.8%), absorption rate constant (37.3%), elimination rate constant (53.9%), clearance rate (76.5%) and volume of distribution (47.2%). However, there was a pronounced increase in the half-life of the drug (125.7%).

Interaction between chloroquine sulphate and aqueous extract of Azadirachta indica A. Juss (Meliaceae) in rabbits.

Phyllanthus niruri L. (Euphorbiaceae) is acclaimed world-wide for its versatile ethnomedicinal uses. It features in recipes used by some herbalists to manage different diseases, including claims of efficacy against many life-threatening infections, such as HIV/AIDS and hepatitis. In order to understand the mechanisms and the involvement of the immune system in mediating these activities, the effects of the aqueous extract of P. niruri on the activation of murine lymphocytes and macrophages were investigated. The study showed that the extract of P. niruri is a potent murine lymphocytes mitogen, inducing significant (p < 0.01) increases in the expression of surface activation maker (CD69) and proliferation of B and T lymphocytes. The production of interferon-gamma (IFN- gamma) and interleukine-4 (IL-4) by P. niruri extract-stimulated naive splenocytes cultures was also significantly (p < 0.05) increased in a concentration-dependent manner. Various indices of activation and functions murine bone marrow-derived macrophages were significantly (p < 0.05) enhanced by pre-treatment with the extract, including phagocytosis, lysosomal enzymes activity, and TNF-alpha release. Phyllanthus niruri extract was also shown to modulate nitric oxide release by macrophages. These activities suggest that stimulation of the immune system by the extracts of P. niruri could be partly responsible for the ethnomedicinal applications in the management of infectious diseases.

Peter A. Akah

Papers

Inhibition of inflammatory mediators and reactive oxygen and nitrogen species by some depsidones and diaryl ether derivatives isolated from Corynespora cassiicola, an endophytic fungus of Gongronema latifolium leaves

Interaction between chloroquine sulphate and aqueous extract of Azadirachta indica A. Juss (Meliaceae) in rabbits.

The Effects of Phyllanthus niruri Aqueous Extract on the Activation of Murine Lymphocytes and Bone Marrow-Derived Macrophages

Anticonvulsant activity of root and stem extracts of Calliandra portoricensis.

Studies on the gastrointestinal properties of Ficus exasperata