Nevin Manimala

Brain Behav. 2021 Mar 5:e02038. doi: 10.1002/brb3.2038. Online ahead of print.

ABSTRACT

BACKGROUND: This study aims to identify the determinants of cognitive dysfunction and compare the effect of CPZ and LTC on cognition in WWE.

METHODS: An observational study involving 87 consenting adult WWE aged between 16 and 40 years on LTC or CZP monotherapy. At enrollment, an interviewer-based questionnaire was used to obtain demographic and clinical information from participants. The diagnosis of epilepsy was mainly clinical and supported by electroencephalographic (EEG) features and classified based on recommendation by the 2017 International League Against Epilepsy (ILAE). Zung Self-Reporting Depression Scale (ZSRDS) was used to assess the mood of participants. The Community Screening Interview for Dementia (CSID) was used to assess various cognition domains. The National Hospital Seizure Severity Scale (NHS-3) was used to assess disease severity.

RESULTS: There were statistical differences between the CZP and LTC groups in all domains of cognition assessed except for orientation. The total CSID scores of the LTC group were 59.2 (4.9) as opposed to CZP group, 57.2 (5.0); p: .005. Those with focal onset seizures had lower median total CSID score (58; IQR: 54-62) when compared to those with generalized onset seizures (62; IQR: 58-62), p: .012. There was a significant correlation between ZSRD score and NHS-3 score; rho: 0.30, p: .007. Bivariate analysis shows statistically significant correlation between total CSID score and ZSRDS (rho: -0.65), BMI (rho: 0.22), and NHSS-3 score (rho: -0.36), respectively. However, the effect of AED on CSID scores was lost after multivariate quantile regression with only ZSRDS retaining significance.

CONCLUSION: Depression, seizure severity, type and structural etiology were associated with cognitive impairment among WWE. However, on regression model, only depression was statistically significant. The presence of more risks for cognitive impairment in the CZP group limits possible conclusion of LTC superiority.

PMID:33666367 | DOI:10.1002/brb3.2038

Pediatr Pulmonol. 2021 Mar 5. doi: 10.1002/ppul.25359. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess if intrauterine growth retardation (IUGR) was associated with reduced lung function at 16 to 19 years WORKING HYPOTHESIS: Very prematurely born young people who had IUGR would have reduced lung function post-puberty.

STUDY DESIGN: Prospective follow-up study.

PATIENT-SUBJECT SELECTION: One hundred and fifty-nine 16-19 year olds born prior to 29 weeks of gestation; 37 had IUGR.

METHODOLOGY: Lung function tests were performed: spirometry was used to assess forced expiratory volume in one second (FEV₁ ), forced expiratory flow at 75%, 50% and 25% of expired vital capacity (FEF₇₅ , FEF₅₀ and FEF₂₅ ), peak expiratory flow (PEF) and forced vital capacity (FVC). Functional residual capacity (FRC_pleth ) total lung capacity (TLC_pleth ) and residual volume (RV_pleth ) were measured. Alveolar function was assessed by diffusion capacity within the lungs of carbon monoxide (D_L CO). Impulse oscillometry was used to assess respiratory resistance and lung clearance index to assess ventilation homogeneity. Exercise capacity was assessed using a shuttle sprint test.

RESULTS: After adjustment for BMI, the mean FEV₁ /FVC, FEF₇₅ , FEF_25-75 , FRC_pleth and RV_pleth were poorer in those who had had IUGR, with differences between 0.56 and 0.75 z-scores. After further adjustment for BPD and postnatal corticosteroid use, only the difference in RV_pleth z-scores remained statistically significant, adjusted difference (95% CI): 0.66 (0.18,1.13). Exercise capacity was lower in those with IUGR and this was more pronounced in males (p=0.04).

CONCLUSIONS: At 16 to 19 years of age, those who had IUGR had poorer lung function and exercise capacity compared with those with adequate intrauterine growth. This article is protected by copyright. All rights reserved.

PMID:33666356 | DOI:10.1002/ppul.25359

BJOG. 2021 Mar 5. doi: 10.1111/1471-0528.16674. Online ahead of print.

ABSTRACT

As Georgieva et al point out in this issue of BJOG, the relationship between fetal blood pH and intrapartum brain injury is poor. In contrast, fetal cardiovascular decompensation (CVD) leads via dropping fetal systemic arterial blood pressure (ABP) to a precipitous fall in cerebral perfusion pressure (CPP), resulting in cerebral ischaemia and injury.

PMID:33666319 | DOI:10.1111/1471-0528.16674

Dig Endosc. 2021 Mar 5. doi: 10.1111/den.13965. Online ahead of print.

ABSTRACT

OBJECTIVES: A single-use duodenoscope (SUD) has been recently developed to overcome issues with ERCP-related cross-infections. The aim was to evaluate SUD safety and performance in a prospective multi-centre study.

METHODS: All consecutive patients undergoing ERCP in six French centres were prospectively enrolled. All procedures were performed with the SUD; in case of ERCP failure, operators switched to a reusable duodenoscope. Study outcomes were the successful completion of the procedure with SUD, safety and operators’ satisfaction based on a VAS 0-10 and on 22 qualitative items. The study protocol was approved by French authorities and registered (ID-RCB: 2020-A00346-33). External companies collected the database and performed statistical analysis.

RESULTS: Sixty patients (34 females, median age 65.5-year-old) were enrolled. Main indications were bile duct stones (41.7%) and malignant biliary obstruction (26.7%). Most ERCP were considered ASGE grade 2 (58.3%) or 3 (35.0%). Fifty-seven (95.0%) procedures were completed using the SUD. Failures were unrelated to SUD (1 duodenal stricture, 1 ampullary infiltration, and 1 tight biliary stricture) and could not be completed with reusable duodenoscopes. Median operators’ satisfaction was 9 (7-9). Qualitative assessments were considered clinically satisfactory in a median of 100% of items and comparable to a reusable duodenoscope in 97.9% of items. Three patients (5%) reported an AE. None was SUD-related.

CONCLUSIONS: The use of a SUD allows ERCP to be performed with an optimal successful rate. Our data show that SUD could be used for several ERCP indications and levels of complexity.

PMID:33666280 | DOI:10.1111/den.13965

J Med Virol. 2021 Mar 5. doi: 10.1002/jmv.26918. Online ahead of print.

ABSTRACT

Here we analyze hospitalized and ICU COVID-19 patient outcomes from the international VIRUS registry (https://clinicaltrials.gov/ct2/show/NCT04323787). We find that COVID-19 patients administered unfractionated heparin but not enoxaparin have a higher mortality-rate (390 of 1,012 = 39%) compared to patients administered enoxaparin but not unfractionated heparin (270 of 1,939 = 14%), presenting a risk ratio of 2.79 (95% C.I.: [2.42, 3.16]; p-value: 4.45e-52). This difference persists even after balancing on a number of covariates including demographics, comorbidities, admission diagnoses, and method of oxygenation, with an increased mortality rate on discharge from the hospital of 37% (268 of 733) for unfractionated heparin vs. 22% (154 of 711) for enoxaparin, presenting a risk ratio of 1.69 (95% C.I.: [1.42, 2.00]; p-value: 1.5e-8). In these balanced cohorts, a number of complications occurred at an elevated rate for patients administered unfractionated heparin compared to patients administered enoxaparin, including acute kidney injury, acute cardiac injury, septic shock, and anemia. Furthermore, a higher percentage of Black/African American COVID patients (414 of 1,294 [32%]) were noted to receive unfractionated heparin compared to White/Caucasian COVID patients (671 of 2,644 [25%]), risk ratio 1.26 (95%CI [1.14, 1.40], p-value: 7.5e-5). After balancing upon available clinical covariates, this difference in anticoagulant use remained statistically significant (311 of 1,047 [30%] for Black/African American vs. 263 of 1,047 [25%] for White/Caucasian, p-value: 0.02, risk ratio 1.18, 95%CI [1.03, 1.36]). While retrospective studies cannot suggest any causality, these findings motivate the need for follow-up prospective research into the observed racial disparity in anticoagulant use and outcomes for severe COVID-19 patients. This article is protected by copyright. All rights reserved.

PMID:33666246 | DOI:10.1002/jmv.26918

Clin Pharmacol Ther. 2021 Mar 5. doi: 10.1002/cpt.2224. Online ahead of print.

ABSTRACT

Cell and gene therapies have shown enormous promise across a range of diseases in recent years. Numerous adoptive cell therapy modalities as well as systemic and direct-to-target tissue gene transfer administrations are currently in clinical development. The clinical trial design, development, reporting, and analysis of novel cell and gene therapies can differ significantly from established practices for small molecule drugs and biologics. Here we discuss important quantitative considerations and key competencies for drug developers in preclinical requirements, trial design, and lifecycle planning for gene therapies. We argue that the unique development path of gene therapies requires practicing quantitative drug developers-statisticians, pharmacometricians, pharmacokineticists, epidemiologists, and medical and translational science leads-to exercise active collaboration and cross-functional learning across development stages.

PMID:33666225 | DOI:10.1002/cpt.2224

Phys Chem Chem Phys. 2021 Mar 5. doi: 10.1039/d0cp05013j. Online ahead of print.

ABSTRACT

Water + elastin-like polypeptides (ELPs) exhibit a transition temperature below which the chains transform from collapsed to expanded states, reminiscent of the cold denaturation of proteins. This conformational change coincides with liquid-liquid phase separation. A statistical-thermodynamics theory is used to model the fluid-phase behavior of ELPs in aqueous solution and to extrapolate the behavior at ambient conditions over a range of pressures. At low pressures, closed-loop liquid-liquid equilibrium phase behavior is found, which is consistent with that of other hydrogen-bonding solvent + polymer mixtures. At pressures evocative of deep-sea conditions, liquid-liquid immiscibility bounded by two lower critical solution temperatures (LCSTs) is predicted. As pressure is increased further, the system exhibits two separate regions of closed-loop of liquid-liquid equilibrium (LLE). The observation of bimodal LCSTs and two re-entrant LLE regions herald a new type of binary global phase diagram: Type XII. At high-ELP concentrations the predicted phase diagram resembles a protein pressure denaturation diagram; possible “molten-globule”-like states are observed at low concentration.

PMID:33666204 | DOI:10.1039/d0cp05013j

Indian J Pharmacol. 2020 Nov-Dec;52(6):482-487. doi: 10.4103/ijp.IJP_244_19.

ABSTRACT

CONTEXT: The acquisition of antibiotic without a prescription by the general population is a typical practice found in community pharmacies across India, which is a notable contributor of antimicrobial resistance. According to the present regulation in India, sale of certain antimicrobials included in schedule H1 without prescription is unlawful. In this contest, a program was organized by the Drug Control Administration, Government of Andhra Pradesh, to educate pharmacists regarding schedule H1.

AIMS: The aim of our study is to assess the impact of the program on the rate of antibiotics dispensed at community pharmacies.

SETTINGS AND DESIGN: A cross-sectional study was designed to investigate the nonprescription sale of antibiotics, from September to December 2018 through 200 community pharmacies located in and around Guntur city located in the state of Andhra Pradesh in India.

SUBJECTS AND METHODS: A simulated client methodology was used in this study. A total of 3 female actors including an author of this present study are prior trained to present a standardized simulation of clinical conditions (sore throat, urinary tract infection, cold, and fever) to the pharmacist at the community pharmacies.

STATISTICAL ANALYSIS USED: Microsoft excel sheet was used for data analysis.

RESULTS: The simulated patients successfully obtained antibiotic from 78% pharmacies with the highest rate of urinary tract infection when compared to other conditions. Pharmacists who objected to dispense antibiotics (22%) are found in developed locations in the city and appeared well qualified.

CONCLUSIONS: The present study revealed that the antibiotics are continued to be sold without prescription even after the education program on schedule H1. The deregulation of the act is definitely the problem to be addressed by the government.

PMID:33666189 | DOI:10.4103/ijp.IJP_244_19

Indian J Pharmacol. 2020 Nov-Dec;52(6):476-481. doi: 10.4103/ijp.IJP_174_20.

ABSTRACT

INTRODUCTION: Vernal conjunctivitis comprises 0.5% of allergic eye diseases. The study is intended to collate the effectiveness of drugs by observing the reduction in signs and symptoms.

OBJECTIVES: The objective of the study is to evaluate the effectiveness and safety of olopatadine 0.1% ophthalmic drops with bepotastine besilate 1.5% ophthalmic drops in patients with vernal keratoconjunctivitis (VKC).

MATERIALS AND METHODS: A randomized, open-label, comparative study conducted in Sarojini Devi Eye Hospital, Telangana. The study included 50 patients diagnosed with VKC, of which Group A and Group B were given olopatadine 0.1% ophthalmic drops and bepotastine besilate 1.5% ophthalmic drops, respectively, twice a day for 8 weeks. The reduction in signs and symptoms in both groups was compared. The observations and results were tabulated accordingly, and data were analyzed using the SPSS. The unpaired t-test is used as the test of significance in between two groups. P value is statistically significant when it is less than 0.05.

RESULTS: Overall, 50 cases were included in the study, 72% of total patients were in the age group of 5-10 years, and 28% were in the age group of 11-15 years. There were 39 males and 11 females. After 8 weeks of follow-up, the mean reduction in the scoring of symptoms and signs provided better and quicker relief of watering, ocular discomfort, and conjunctival hyperemia with bepotastine 1.5% eye drops. Olopatadine 0.1% eye drops provided faster improvement in papillary hypertrophy. Both drugs were equally effective in reducing itching. Laboratory findings of absolute eosinophil count had no statistical significance in between the two groups.

CONCLUSIONS: In this study, based on the evaluation of therapeutic performance, bepotastine eye drops proved quicker relief of symptoms and signs compared to olopatadine eye drops but was not statistically significant which would prove beneficial for the patients.

PMID:33666188 | DOI:10.4103/ijp.IJP_174_20

Elife. 2021 Mar 5;10:e64206. doi: 10.7554/eLife.64206. Online ahead of print.

ABSTRACT

Establishing how many people have been infected by SARS-CoV-2 remains an urgent priority for controlling the COVID-19 pandemic. Serological tests that identify past infection can be used to estimate cumulative incidence, but the relative accuracy and robustness of various sampling strategies has been unclear. We developed a flexible framework that integrates uncertainty from test characteristics, sample size, and heterogeneity in seroprevalence across subpopulations to compare estimates from sampling schemes. Using the same framework and making the assumption that seropositivity indicates immune protection, we propagated estimates and uncertainty through dynamical models to assess uncertainty in the epidemiological parameters needed to evaluate public health interventions, and found that sampling schemes informed by demographics and contact networks outperform uniform sampling. The framework can be adapted to optimize serosurvey design given test characteristics and capacity, population demography, sampling strategy, and modeling approach, and can be tailored to support decision-making around introducing or removing interventions.

PMID:33666169 | DOI:10.7554/eLife.64206