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Introducción: En Colombia, la información sobre la frecuencia de presentación de la enfermedad por CO-VID-19 y sus desenlaces en personas con esclerosis múltiple (EM) es prácticamente inexistente. El objetivo de este estudio es describir la frecuencia, las características y los factores relacionados con la infección por COVID-19 en una muestra de pacientes con EM en Colombia. Materiales y métodos: Análisis descriptivo y retrospectivo de pacientes diagnosticados con criterios de esclerosis múltiple que acudieron a nuestro centro entre junio y octubre del año 2021. Los pacientes proporcionaron información sobre la infección por SARS-CoV-2 y su vacunación. Se analizaron los factores relacionados con la infección por COVID-19 mediante modelos de regresión logística binomial uni y multivariable. Resultados: Se analizaron 240 pacientes, de los cuales el 71 % eran mujeres, con una edad promedio de 34 años. La mayoría estaban en tratamiento con terapias modificadoras de la enfermedad y más del 80 % estaban vacunados. Sesenta y nueve pacientes declararon haber tenido COVID-19. En los modelos multivariables, la edad (OR 0,96; IC 95 % 0,93-0,99) fue el único factor asociado con una menor probabilidad de infección por COVID-19. Discusión: La infección por COVID-19 en pacientes con EM en Colombia parece ser independiente de las variables clínicas y de tratamiento y parece estar asociada con la menor edad. Conclusiones: Se requieren más estudios para evaluar el comportamiento del COVID-19 en pacientes con EM en el contexto colombiano.
Introduction: The information about the frequency of COVID-19 and its outcomes in people with Multiple Sclerosis (MS) in Colombia is practically non-existent. We aimed to describe the frequency characteristics and factors associated with of COVID-19 in a sample of patients with MS. Materials and methods: Descriptive and retrospective analysis of patients diagnosed with Multiple Sclerosis criteria who attended our center between June and October 2021. Patients provided information about SARS-CoV-2 infection and their vaccination. COVID-19 determinants were analyzed using uni-and multivariable binomial logistic regression models. Results: 240 patients were analyzed, of whom 71% were women, with a mean age of 34 years. The majority of patients were on disease-modifying therapies and over 80 % were vaccinated. 69 patients reported having had COVID-19. In multivariable models, age (OR 0.96; 95 % CI 0.93-0.99) was the only factor associated with a lower odds of COVID-19 infection. Discussion: COVID-19 infection in patients with MS in Colombia appears to be independent of clinical and treatment variables, and it appears to be associated with younger age. Conclusions: More studies are needed to assess the behavior of COVID-19 in MS patients from Colombia.
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Objective:To analyze the clinical characteristics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine breakthrough infections in children, and to provide reference basis for the SARS-CoV-2 vaccination in children.Methods:A total of 97 children aged 3 to 14 years and diagnosed with coronavirus disease 2019 (COVID-19) admitted to Xi′an People′s Hospital (Xi′an Fourth Hospital) from December 27, 2021 to February 7, 2022 were included. According to the COVID-19 vaccination status, the enrolled children were divided into unvaccinated group, partially vaccinated group and fully vaccinated group, and the clinical data of the children in the three groups were collected and compared. Chi-square test, two independent sample t-test and Kruskal-Wallis H test were used for statistical analysis. Results:Totally 97 children including 49 males and 48 females were enrolled, with 87(89.7%) children of mild type, 10(10.3%) children of common type, and no severe or critical case. The proportions of unvaccinated, partially vaccinated and fully vaccinated preschool-aged children (3 to 6 years old) were 56.5%(13/23), 30.8%(12/39) and 17.1%(6/35), respectively, while those of school-aged children (7 to 14 years old) were 43.5%(10/23), 69.2%(27/39) and 82.9%(29/35), respectively. The vaccination proportion in preschool-aged children was significantly lower than that in school-age children ( χ2=9.94, P=0.007). The proportion of the children with fever in fully vaccinated group was 17.1%(6/35), which was lower than that in unvaccinated group (43.5%, 10/23), and the difference was statistically significant ( χ2=4.82, P=0.028). The cycle threshold (Ct) values of the open reading frame ( ORF)1 ab gene in the unvaccinated, partially vaccinated and fully vaccinated groups were 33.77(26.87, 36.58), 35.23 (33.45, 38.57) and 37.12 (34.91, 39.39), respectively, and there was a statistically significant difference among the groups ( H=7.76, P=0.021). The Ct values of the nucleocapsid protein ( N) gene in the three groups were 32.26(25.85, 36.18), 35.12(33.18, 37.96) and 37.26(34.27, 39.24), respectively, and the difference among the groups was statistically significant ( H=7.84, P=0.020). The Ct values of ORF1 ab gene and N gene in fully vaccinated group were higher than those in unvaccinated group, and the differences were statistically significant ( Z=-2.69, P=0.007 and Z=-2.39, P=0.017, respectively). The duration of viral shedding in fully vaccinated children was (9.9±4.1) d, which was shorter than that in unvaccinated children ((12.8±3.7) d), and the difference was statistically significant ( t=2.72, P=0.009). Conclusions:The majority of children with breakthrough infections with SARS-CoV-2 are mild. Vaccination may effectively shorten the duration of viral shedding. And fully vaccination is associated with mild clinical symptoms and lower serum viral load compared to unvaccinated children.
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Objective:To investigate the influencing factors of breakthrough cancer pain (BTcP) in patients with advanced pancreatic cancer.Methods:According to the inclusion and exclusion criteria, patients with advanced pancreatic cancer who were diagnosed and followed up by outpatient service in the 909th Hospital of the Joint Logistic Support Force from January 2019 to December 2020 were prospectively selected as the study subjects. According to whether breakthrough cancer pain occurred, all patients were divided into observation group (breakthrough cancer pain) and control group (no breakthrough cancer pain). The relevant clinical data of the included patients including age, gender, presence or absence of vomit, constipation, sleep disruption, frequency of basic pain every week, with or without regular medication, heavy physical labor, with or without vascular invasion, bone metastasis, abdominal metastasis and lung metastasis, as well as whether surgery, radiotherapy or chemotherapy were collected and the data of evaluation indicators during follow-up were recorded. Digital pain score (NRS) and visual analog score (VAS) were used as pain evaluation score. Univariate and logistic regression were used to analyze the related influencing factors of breakthrough cancer pain. Receiver operating characteristic curve (ROC) was drawn, and area under curve (AUC), sensitivity and specificity were calculated to analyze the predictive value for breakthrough cancer pain.Results:A total of 173 patients were included in the study, with 49 cases in the observation group and 124 cases in the control group. Univariate analysis showed that aged ≥50 years old, constipation, sleep disruption, frequency of basic pain ≥3 times, irregular medication, heavy physical labor, bone metastasis, lung metastasis, radiochemotherapy, high NRS score and high VAS score were the influencing factors for breakthrough cancer pain (all P value <0.05). Multivariate analysis showed that irregular medication ( OR=1.879, 95% CI 2.473-4.757, P=0.002), basal pain ≥3 times ( OR=2.067, 95% CI 1.364-6.825, P=0.004), bone metastasis ( OR=2.756, 95% CI 1.153-5.846, P<0.001), NRS score ( OR=3.787, 95% CI 2.647-5.958, P<0.001), VAS score ( OR=2.684, 95% CI 1.545-7.878, P<0.001), were the risk factors for breakthrough cancer pain. The AUC of NRS score for predicting the occurrence of breakthrough cancer pain was 0.665 (95% CI0.573-0.757, P=0.001), and the cut-off value was 2.5 score with a sensitivity of 61.2% and a specificity of 77.1%. The AUC for predicting breakthrough cancer pain by VAS score was 0.608 (95% CI0.515-0.701, P=0.028), and the cut-off value was 2.5 score with a sensitivity of 67.9% and a specificity of 63.7%. The AUC of NRS+ VAS score for predicting breakthrough cancer pain was 0.692 (95% CI0.604-0.780), and the cut-off value was 4.5 score with a sensitivity of 81.6% and a specificity of 79.8%. Conclusions:Patients with advanced pancreatic cancer have a high incidence of breakthrough cancer pain, which was related to a variety of factors. NRS combined with VAS score can effectively predict the occurrence of breakthrough cancer pain.
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【Objective】 To analyze the dynamics of specific SARS-CoV-2 IgG antibodies in blood donors in Fuzhou area after receiving booster doses of inactivated COVID-19 vaccine and breakthrough infections, and to provide evidence for the timing of the collection of specific immune plasma or convalescent plasma and the subsequent vaccine doses. 【Methods】 A total of 109 volunteers who received the first booster dose of inactivated COVID-19 vaccine and 102 volunteers who experienced breakthrough infections were recruited at Fujian Blood Center from October to November 2021. Blood samples were collected at eight time points: 14 (11, 20) days before the booster dose (Time0), 14 (10, 23) days after the booster dose (Time1), 53 (45.5, 61) days after the booster dose (Time2), 88 (78, 101.5) days after the booster dose (Time3), 124 (112.5, 138.5) days after the booster dose (Time4), 158 (146, 174) days after the booster dose (Time5), 194 (179.5, 214) days after the booster dose (Time6) and within one month after the breakthrough infection (Time7). Serum SARS-CoV-2 IgG antibodies were detected using a chemiluminescence immunoassay. The dynamics of antibody levels were analyzed and the effects of age, gender, weight, BMI, blood type and smoking on antibody levels were also analyzed. 【Results】 The positive rate of SARS-CoV-2 IgG antibodies was 53.2% (58/109) at Time0, 100% (109/109) at Time1, and 95.4% (104/109) at Time6. The antibody levels were significantly higher at Time1 and Time6 than at Time0 (P0.05). The IgG antibody level at Time7 was 2.07 times than that at Time1 (P0.05). The IgG antibody level in breakthrough infection group was significantly higher than that in non-breakthrough infection group (P<0.001). 【Conclusion】 Booster doses of inactivated COVID-19 vaccine and breakthrough infections can stimulate stronger immune responses in the body. It is recommended to collect specific immune plasma or convalescent plasma within one month after breakthrough infections or booster doses of COVID-19 vaccine for special purposes. The timing of subsequent vaccine doses should be based on the dynamics of antibody levels. It is necessary to continuously monitor antibody levels to provide evidence for subsequent vaccine doses.
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Pain is one of the most frightening and unbearable symptoms in cancer patients, approximately 80% of patients with advanced cancer have pain, and a systematic review shows that the prevalence of breakthrough cancer pain (BTcP) was 59.2%. Breakthrough pain often has a significant negative effect on quality of life of patients, which is related to a direct effect (suffering) and an indirect effect (interference with activities of daily living). Clinical management of BTcP is still not satisfactory despite the availability of various effective pain relief agents. The purpose of this review is to summarize the current situation of the management of BTcP at home and abroad, and to discuss the factors that hinder the management of BTcP.
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Background: The COVID-19 pandemic has led to dramatic loss of human life worldwide and presents an unprecedented challenge to public health, food systems, and the world of work. The availability of a safe and effective vaccine for COVID-19 is well recognized as an additional tool to contribute to the control of the pandemic. Although vaccines proved efficacious in preventing infection, yet some cases of post-vaccination breakthrough infections (BTIs) have been reported, raising concerns about the efficacy and safety of COVID vaccines. Aim and Objectives: This study was aimed to investigate the occurrence of BTIs among the vaccinated healthcare workers (HCWs), to analyze the severity of their disease and to know the trends in drug therapy. Materials and Methods: This was a retrospective cross-sectional study. Data were obtained by a predesigned questionnaire and was distributed through Google platform. Details of time, severity of BTIs and the trends in drug therapy among the vaccinated healthcare workers (HCWs) was evaluated and statistically analyzed. Results: A total of 616 HCWs participated in the study, out of which 553 were vaccinated and 63 of them were unvaccinated. About 15%, that is, 85/553 of the vaccinated HCWs developed BTI. Case rate was lesser (12.9%) in fully vaccinated HCWs as compared to partially vaccinated HCWs (19.5%). Most BTI cases (94%) suffered mild to moderate severity of symptoms and were managed in home isolation with medicines (mainly paracetamol, azithromycin, and doxycycline). Only five out of 85 BTI cases developed severe disease and needed hospitalization. Conclusion: BTIs after COVID-19 vaccination are uncommon and typically present with mild symptoms. Thus, vaccination along with hand sanitization, wearing of masks, and maintaining social distancing has provided hope in combating the pandemic.
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Background: The incidence of breakthrough infection with the emergence of new variants of concern of SARS?CoV?2 is posing a threat, and it is pertinent to understand the role of vaccines in protecting the elderly and people with comorbidities. Objective: The present study was undertaken to understand the natural history of SARS?CoV?2 infection in a closed cohort of the elderly population in an old?age home who have received two doses of COVID?19 vaccination. The study has also undertaken genomic sequencing to identify SARS?CoV?2 variants of concern from an academic perspective. Materials and Methods: A prospective observational study was conducted from March to August 2021 among residents of 11 old?age homes in Kerala who were vaccinated with 2 doses of the COVID?19 vaccine, from 2 weeks following vaccination. Samples with a threshold cycle value of <25 were subjected to targeted sequencing of the spike protein receptor?binding domain coding region. Results: Among the 479 vaccinated individuals, 86 (17.95%) turned positive during the follow?up period. The mean duration of symptoms was 3–5 days, and no hospitalization was required. A phylogenetic analysis of the nucleotide sequences from the samples indicated B.1.617.2 lineage representing the Delta strain. Conclusion: The evidence supports maximizing the vaccine coverage among vulnerable groups to prevent hospitalization and death rate on the verge of the emergence of new variants of SARS?CoV?2.
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Background : India launched COVID-19 mass Vaccination campaign after regulatory approval of Covishield & Covaxin vaccines. However, inspite of Vaccination, cases of COVID-19 infection are being reported. Hence, this study is aimed to assess the COVID-19 infection and/or re-infection rate, including breakthrough infections, following vaccination among Health Care Workers at a Tertiary Care Dedicated COVID Hospital. This questionnaire-based survey was initiated following Institutional Ethics Committee approval. We also looked at reasons for Vaccine hesitancy and occurrence of adverse reactions following vaccination, their management and duration amongst the Healthcare Workers. Results : Of 564 Healthcare Workers (HCWs) who consented to participate, only 503 filled in the questionnaire completely. Majority of the HCWs received Covishield vaccine (78.56%). The infection rate postvaccination was 8.28% (with a median of 22 days and IQR of 8-43 days). This infection rate was significantly higher in those who were not vaccinated as compared to the Vaccinated HCWs (OR = 0.10, 95 CI% = 0.05�22, p <0.0001). Breakthrough infection rate was 2.42. Although 58.39% of the participants suffered adverse reactions after vaccination, like myalgia, Fever, Headache, these were mild in nature lasting for an average of 3-4 days. The vaccine hesitancy rate at our hospital HCWs was 6.36%, the main issue being the concerns regarding safety and effectiveness of the vaccines against the COVID-19 infection. Discussion/Conclusion : The infection and Breakthrough infection rates in our study were low and severity of COVID infection post vaccination was mild, not requiring hospitalisation
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COVID‑19 infections despite complete vaccination are called breakthrough infections. Breakthrough infections may decrease the vaccination confidence among people. This study was conducted soon after the Covishield vaccine was approved for use in J and K to find out the incidence of breakthrough infections among the recipients of the Covishield vaccine at SKIMS and to find out the associated factors. List of beneficiaries (between February 14, and May 15, 2021) was obtained from the records. Information was gathered telephonically. Incidence of breakthrough infections 6‑month postvaccination was determined. Among 919 participants, the incidence of breakthrough infections was 2.7% (25 cases). The medical profession was associated with a higher frequency of breakthrough infections. Most infections were mild to moderate (96%). One (4%) person required hospitalization. Thus, COVID‑19 infections can occur despite complete vaccination. Increased exposure places an individual at higher risk of breakthrough infections. Therefore, where exposure is high, COVID‑appropriate behavior should be followed despite being vaccinated.
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Background and Aim : While India’s vaccination drive against COVID-19 continues to progress, the number of Breakthrough Infections are also revealing an uptick due to Community spread of COVID-19. There is a dearth of data quantifying the extent of breakthrough infections, defined as infections following two doses of vaccine. We aimed to understand the occurrence of Breakthrough Infections among the public in the City of Thrissur, Kerala, India, during the recent surge of COVID-19 in Kerala. Methods : Patients visiting the Internal Medicine Outpatient Department (OPD) in a private hospital in the City of Thrissur in Kerala, India were selected for the study. Subjects above the age of 18 years presenting to the OPD between August 01, 2021 and September 30, 2021 were surveyed through a short interview on the COVID-19 infection history, symptoms, severity and vaccination status.Results : Of the 56 participants who tested positive for COVID-19, 38 had received both doses of vaccine and all had received their first dose of vaccine. 4 patients had no symptoms, 37 patients reported mild symptoms and nine patients reported moderate to severe symptoms. Conclusion : Our study demonstrates the occurrence and describes the epidemiology of COVID-19 breakthrough infections in a City from the Indian State of Kerala in a real-world setting. We conclude the occurrence of Symptomatic Breakthrough Infections of COVID-19 in patients who had received two doses of the vaccine were mild in the majority of the patients (87%). Further research is required to understand the mechanisms behind these Breakthrough infections.
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Since the initiation of vaccine rollout, breakthrough COVID-19 infections have been reported. While conventional therapy is the accepted mode of treatment, there has been little recognition of the role played by the alternative therapies like homeopathy. The purposes of this study were to identify the clinico-symptomatic profile of the vaccine breakthrough covid-19 infections and to assess the response of individualized homoeopathic treatment in these breakthrough cases. A retrospective data analysis of patients treated with homoeopathic medicines who confirmed the breakthrough infection criteria: positive infection ≥14 days after completion of both the recommended doses of an authorized COVID-19 vaccine was conducted. IBM SPSS Statistics 21.0 was used for data analysis with a p-value below 0.05 defined as significant. WHO Clinical Progression Scale and Outcome in Relation to Impact on Daily Living score were used as outcome measures. In total 73 cases were reported to be vaccine breakthrough infections. The median recovery time reported in the data set was 9 ± 2 days. While 5 patients dropped out, 68 (93.15%) patients responded positively to homeopathic treatment, and 55 (75.34%) recovered completely with normalized serological markers/ nasal swabs/ HRCT Chest. About 29 (39.72%) of these presented with mild clinical manifestations, 26 (35.61%) moderate, 17 (23.28%) severe and 1 (1.36%) was critical. 10 homeopathic remedies were prescribed to these 73 patients. Majority of the patients attained an ORIDL score of 4. Maximum patients reported a WHO clinical Progression score of 3. Statistical analysis showed a significant response to homeopathic treatment in the study group. Vaccine breakthrough cases occur in a fraction of vaccinated people. Despite the limited number of study subjects, homoeopathy showed some promising results in the present setup. The response rate was highest in the moderate and severe cases which suggest the importance of consideration of alternative medicine in the current pandemic. Further exploratory research studies and comparative clinical trials may be encouraged.
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Humans , Homeopathic Anamnesis , Homeopathic Therapeutics , COVID-19/therapyABSTRACT
Resumen: Objetivo: Evaluar la efectividad de las vacunas contra SARS-CoV-2 para evitar muerte e intubación en pacientes hospitalizados con Covid-19. Material y métodos: Se presentó un análisis de 3 565 hospitalizaciones por SARS-CoV-2 de personas mayores de 20 años de edad, reportadas con fines de salud pública por 10 hospitales de especialidad. Se comparó a los egresados por mejoría (2 094) con los fallecidos (1 471) en modelos mixtos de regresión logística ajustados por edad, sexo, número de comorbilidades y el hospital como variable aleatoria. Resultados: Un esquema completo de vacunación, con cinco tipos de vacunas disponibles, tuvo un efecto protector para muerte o intubación (RM: 0.67, IC95%: 0.54,0.83, 33% de protección); y para muerte (RM: 0.80, IC95%: 0.64,0.99, 20% de protección) estos datos se compararon con los que no habían sido vacunados. Todas las vacunas aplicadas mostraron un efecto protector con un RM<0.8, con intervalos de confianza variables. Conclusiones: El antecedente de vacunación reduce los riesgos de ser intubado y morir, aun en pacientes previamente vacunados y hospitalizados con Covid-19 grave.
Abstract: Objective: To evaluate the effectiveness of SARS-CoV-2 vaccines to avoid death and intubation in hospitalized patients with Covid-19. Materials and methods: We present an analysis of 3 565 hospitalizations for SARS-CoV-2 in people over 20 years of age, reported for public health purposes by 10 specialty hospitals, comparing those discharged for improvement (2 094) with those who died (1 471) in mixed models of logistic regression adjusted for age, sex, number of comorbidities and the reporting hospital as a random variable. Results: A complete vaccination schedule, with five types of vaccine available, had a protective effect for death or intubation (OR: 0.67, CI95%: 0.54,0.83, 33% protection) and for death (OR: 0.80, CI95%: 0.64,0.99, 20% protection) compared to those who had not been vaccinated. All the applied vaccines in the Mexican program showed a protective effect with an OR<0.8, with variable confidence intervals. Conclusions: Even in patients previously vaccinated and hospitalized with severe Covid-19, a history of vaccination reduces the risks of being intubated and dying.
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Introduction: Vaccination against Covid-19 has become the promising strategy in controlling rise in Covid cases. Covishield and Covaxin were the two vaccines initially available in India which have been administered to all those >18years of age. These vaccines exhibit a spectrum of side effects, which may affect vaccination rates. The study was conducted to estimate the frequency of side effects of Covid vaccines in India and their relationship with co-morbidities and prior Covid-19 infection. Methodology: A cross sectional questionnaire-based online survey was conducted for duration of one month among 1800 participants who had received at least one dose of Covid vaccine at KIMS Hospital, Hubballi, Karnataka, selected using systematic random sampling and information about vaccination, comorbidities and covid infection after vaccination was collected. Results: The most common side effects were fever, headache and generalised body ache. The prevalence of infection after complete vaccination with Covishield (4.45%) was higher than Covaxin (1.08%) and difference was statistically significant. The prevalence of side effects and Covid-19 infection after vaccination did not vary with co-morbidities. Conclusion: The side effects reported were not serious and the prevalence was similar in both the vaccines. The prevalence of infection still remains high after vaccination; hence Covid Appropriate Behaviour should be continued.
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Coronavirus disease 2019 (COVID-19) has become a global pandemic disease. SARS-CoV-2 variants have aroused great concern and are expected to continue spreading. Although many countries have promoted roll-out vaccination, the immune barrier has not yet been fully established, indicating that populations remain susceptible to infection. In this review, we summarize the literature on variants of concern and focus on the changes in their transmissibility, pathogenicity, and resistance to the immunity constructed by current vaccines. Furthermore, we analyzed relationships between variants and breakthrough infections, as well as the paradigm of new variants in countries with high vaccination rates. Terminating transmission, continuing to strengthen variant surveillance, and combining nonpharmaceutical intervention measures and vaccines are necessary to control these variants.
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Humans , COVID-19/prevention & control , COVID-19 Vaccines , Pandemics/prevention & control , SARS-CoV-2ABSTRACT
Resumo Este trabalho teve como objetivo avaliar as remoções de carbono orgânico dissolvido presente em águas filtradas de estação de tratamento de água com tratamento complementar por pré-oxidação com ozônio e adsorção em carvão ativado granular. Para o estudo de adsorção foi utilizado o método de ensaio rápido em coluna de escala reduzida, com carvão ativado produzido de cascas de coco. Realizou-se a comparação entre as curvas de ruptura para os ensaios com e sem aplicação de ozônio. Os resultados mostraram reduções nas concentrações de carbono orgânico dissolvido no início dos ensaios e após a passagem da água com e sem pré-ozonização pelas colunas ensaio rápido em coluna de escala reduzida seguida de incrementos progressivos das concentrações à medida que se aumentou o volume de leitos tratados. Na fase final dos ensaios, os aumentos de volume de leitos tratados não causaram mudanças significativas nas concentrações efluentes de carbono orgânico dissolvido. O mesmo comportamento foi observado com relação à absorção em radiação ultravioleta a 254 nm. O uso de ozônio previamente à adsorção em carvão ativado granular, usando o método ensaio rápido em coluna de escala reduzida, resultou em maiores reduções na absorbância da luz ultravioleta em 254 nm do que nas concentrações de carbono orgânico dissolvido. As absorbâncias específicas à radiação ultravioleta das amostras ozonizadas foram menores do que as que não receberam ozônio.
Abstract The objective of this study was to evaluate the removal of dissolved organic carbon in filtered water followed by pre-oxidation with ozone and adsorption on granular activated carbon. The rapid small-scale column test was used for the adsorption essays with activated carbon produced from coconut shells. A comparison was made between the breakthrough curves for tests performed with and without pre-oxidation with ozone. The results showed reductions in dissolved organic carbon concentrations after initial passage of water with and without ozone through the rapid small-scale column test column, followed by progressive increases in concentrations along with the number of the bed volumes. In the final phase of the tests, increases in bed volumes did not cause significative changes in effluent dissolved organic carbon concentrations. The same behavior was also observed with respect to ultra-violet absorbance at 254 nm. The use of ozone prior to adsorption on GAC, using the ERCER method, caused greater reductions on UV254 absorbance than in concentrations of dissolved organic carbon. The specific ultraviolet absorbance values of samples that received ozone were lower than those that were not ozonized.
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Objectives: To determine the optimum range of phenytoin (PHT) and valproate (VAP) levels and find out the critical drug levels below which chances of breakthrough seizures increase in North Indian population. Methodology: A cross-sectional, case-controlled, record-based study was conducted in a quaternary care hospital from September 2018–2019. The case group comprised epilepsy patients on monotherapy with PHT/VAP presenting with breakthrough seizures after at least 6 months of seizure control. Noncompliant, overdose, toxicity, no or partial response, any other psychiatric or neurological disorder, adverse effects, and patients taking two or more antiepileptic drugs were excluded. Results: Data of 100 patients in each group were analyzed. Significantly lower mean levels in cases were observed in PHT (5.74 ± 3.68 mg/L vs. 13.75 ± 4.27 mg/L control) and VAP (24.13 ± 27.39 mg/L vs. 76.37 ± 17.71 mg/L control). A negative correlation of drug levels was observed with age and weight in both the groups. The level/dose ratio in controls (0.05 ± 0.03; 0.09 ± 0.06) was significantly (P < 0.0001) higher than cases (0.02 ± 0.01; 0.02 ± 0.03) in PHT and VAP, respectively. Conclusions: This study identifies the critical levels and level/dose ratio at which the risk of breakthrough seizures increases. A wide level/dose ratio was found in controls, more so in the VAP group. A prospective study with larger group size along with genetic studies should be done to evaluate further.
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BACKGROUND: The most current application of compound porcine cerebroside and gangiioside injection (CPCGI) focuses on the clinical therapeutic efficacy in some craniocerebral injuries and neonatal hypoxic ischemic encephalopathy, but the molecular mechanism of CPCGI involved in the recovery of nerve function is rarely reported. OBJECTIVE: To study the protective effect and mechanism of CPCGI in a neonatal mouse model of intrauterine hypoxia-induced brain injury. METHODS: Fifteen Kunming mice were randomly divided into control group, hypoxia group and treatment group. At the 14th day after pregnancy, mice in hypoxia group and treatment group were put into a 10% oxygen incubator to make the model of intrauterine hypoxia. After delivery, neonatal mice were intraperitoneally injected with CPCGI and PBS respectively, and mouse development in each group was observed after treatment. Mice in the control group were not hypoxic and treated. The expression of glial fibrillary acidic protein, Neurocan, SynDIGI and collagen IV were observed by immunofluorescence staining and western blot assay. A step-down test was used to test animal memory function. The study protocol was approved by the Animal Ethic Committee of Luohe Medical College in China. RESULTS AND CONCLUSION: Compared with the control group, the expressions of glial fibrillary acidic protein and Neurocan in the hypoxia group were significantly increased, while the expressions of SynDIGI and collagen IV were significantly decreased. The expression of SynDIGI and collagen IV in the treatment group was significantly increased than that in the hypoxia group, while the expression of glial fibrillary acidic protein and Neuroncan was significantly decreased than that in the hypoxia group. The learning and memory ability of mice in the hypoxia group was significantly decreased compared with the control group, but was significantly improved after CPCGI treatment. These results suggest that CPCGI can alleviate brain injury and improve learning and memory ability after hypoxic ischemic encephalopathy. The detailed mechanism might be related to inhibiting activation of astrocytes, down-regulating Neuroncan expression, up-regulating collagen IV expression, promoting synaptic reconstruction and reducing cerebrovascular injury.
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Fentanyl buccal tablets place the tablet at the buccal site (above a rear molar, between the upper cheek and gum) and wait until it dissolves, but some patients may not be able to retain it due to defects of the maxillary molars. The aim of this study was to evaluate the effectiveness and safety of fentanyl buccal tablets when they were used outside the buccal site. Seven patients were treated with fentanyl buccal tablets outside the buccal site. For each of 5 episodes in which effective dose was identified, were investigated to average pain intensity assessed on a 0 to 10 numerical rating scale at 30 min postadministration and reduction in pain intensity of more than 33%. Pain intensity significantly decreased at 30 min postadministration in 5 patients with effective doses identified (p<0.001). In 92.0% of episodes treated, there was a reduction in pain intensity of more than 33%. Adverse events were somnolence and nausea with mild. However, these effects did not result in discontinuation of medication. Our findings suggested that fentanyl buccal tablets can be used effectively and safely even when patients used outside the buccal site.
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Resumen: El cáncer es la principal causa de muerte a nivel mundial, en México constituye la tercera causa de muerte con el 12% de todas las defunciones, llegando a 222 muertes diarias. Según datos del Foro de Líderes contra el Cáncer 2017, se estima que para 2025 la incidencia en México aumente un 50% pasando de 147,000 a 220,000 casos nuevos al año. Datos arrojados en 52 artículos revisados mostraron que el dolor oncológico ha alcanzando cifras de 33% en pacientes curados, 59% en pacientes con tratamiento oncológico y 64% en pacientes con metástasis. Más de un tercio de los pacientes con dolor en esta revisión clasificaron su dolor de moderado a severo. El óptimo manejo del dolor agudo o crónico en el paciente oncológico requiere un abordaje integral basado en evidencia, tomar en cuenta el tratamiento previo con opioides, abordar los cuadros de dolor irruptivo y hacer una autoevaluación constante de estrategia y resultados.
Abstract: Cancer is the leading cause of death worldwide, in Mexico it is the third cause of death with 12% of all deaths, reaching 222 deaths per day. According to data from the 2017 Forum of Leaders against Cancer, it is estimated that by 2025 the incidence in Mexico will increase by 50%, going from 147,000 to 220,000 new cases per year. Data from 52 reviewed articles showed that oncological pain reached Figures of 33% in cured patients, 59% in patients with oncological treatment and 64% in patients with metastasis. More than a third of patients with pain in this review classified their pain as moderate to severe. The optimal management of acute or chronic pain in the oncological patient requires a comprehensive approach based on evidence, taking into account the previous treatment with opioids, addressing breakthrough pain charts and making a constant self-assessment of strategy and results.
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Background: The prevalence of breakthrough seizures in persons with epilepsyis very high in developing countries. Consequently, patients and physicians should be aware of the possible factors that may cause breakthrough seizures.Objective: The aim of our study is to determine the possible factors that may be a precipitating cause for breakthrough seizures in patients with epilepsy.Methods: This cross-sectional study included 100 persons with epilepsywith idiopathic epilepsy receiving antiepileptic drugs (AEDs). They were divided into two groups. Group 1 included 50 persons with epilepsywith a history of recent breakthrough seizures. Group 2 included 50 persons with epilepsywho had not experienced any recent breakthrough seizures. Patients were subjected to a thorough questionnaire addressing precipitating factors. All participants were subjected to an electroencephalogram (EEG) and medication adherence assessment.Results: There was no significant differences between group 1 and group 2 regarding age, sex, ageOriginal Research Article of onset of epilepsy, occupation and marital status (P value range 0.5 –0.2). The patients in group 1 were found to have longer durations of epilepsy, lower adherence to AEDs (P= 0.001), moremissed doses of AEDs (P= 0.0001), more side effects of AEDs (P = 0.0005), more sleep deprivation, lower level of AEDs (P= 0.0006), more frequently on AED polytherapy (P = 0.0002), and more flickering lights(P= 0.04) than the participants in group 2. In terms of the EEG, group 1 showed a higher percentage of abnormal EEGs and more frequent focal epileptiform discharges (P = 0.003). Also, pathological findings in MRI brain were associated with higher breakthrough seizures (P = 0.005). No significant difference was found in both group1 and group 2 regarding emotional stress (P = 0.55), substitution of brand AEDs by generic one (P = 0.83), concurrent illness (P = 1), or the use of non AEDs (P = 0.79). Conclusion: The precipitating factors of breakthrough seizures are multifactorial and it is very important to educate patients about these precipitating factors to achieve better control of epilepsy