Trial Sequential Analysis and Meta-Analysis of Olanzapine in Pediatric Patients for Chemotherapy-Induced Nausea and Vomiting (CINV).

Background and Objective: Olanzapine (OLZ) containing regimens are approved in adults for chemotherapy-induced nausea and vomiting (CINV) receiving highly emetogenic chemotherapy (HEC) or moderately emetogenic chemotherapy (MEC), and the same has not been approved in the pediatric population. In order to generate data regarding the efficacy and safety of OLZ as an adjunct to the standard of care (SoC) for CINV in pediatric patients receiving HEC/MEC, the review authors performed this systematic review and meta-analysis. Methods: A systematic literature search was performed through the databases Cochrane Library, Pub Med, and clinicaltrials.gov, from inception to September 2023, using keywords: "chemotherapy" and "olanzapine," "nausea" and "vomiting." Randomized clinical trials published in English that analyzed the efficacy and safety of olanzapine as an adjunct to SoC were included. The essential outcomes included in this study were the proportion of patients with no emesis in the acute and delayed phase, patients with no nausea in the acute and delayed phase, the proportion of patients requiring rescue medication, and the proportion of patients with reduced CNS arousal. Results: In the OLZ group, a greater number of patients had no emesis both in the acute and delayed phase (RR = 1.22; 95% CI = 1.09-1.37; P = .0004); and (RR = 1.23; 95% CI = 0.92-1.63; P = .16) respectively. Similarly, a higher number of patients showed no nausea both in the acute and delayed phase (RR = 1.08; 95% CI = 0.78-1.48; P = .66) and (RR = 1.12; 95% CI = 0.79-1.61; P = .52) respectively. The use of rescue medication was significantly less in the OLZ group (RR = 0.62; 95% CI = 0.42-0.91; P = .01). More patients experienced reduced CNS arousal in the OLZ group (RR = 2.97; 95% CI = 2.02-4.38; P < .0001). Conclusions: Olanzapine as an adjunct to the SoC may be effective in acute emesis, which may also reduce the use of rescue medication. Reduced CNS alertness was the significant adverse effect observed. For other endpoints, more studies are required to substantiate its role in CINV.

Tenecteplase versus Alteplase in Acute Ischemic Stroke: A Systematic Review and Meta-analysis.

Background: A number of clinical trials have compared tenecteplase (TNK) and alteplase for the management of acute ischemic stroke (AIS) and the results are inconsistent. Purpose: Present systematic review and meta-analysis is undertaken to analyse the efficacy and safety of TNK in AIS compared to alteplase. Summary: A thorough literature search was performed through the databases Embase, Cochrane Library, PubMed, and clinicaltrials.gov, for a period from inception to September 2022, with the keywords i.e., "tenecteplase" and "alteplase" and "acute ischemic stroke." Clinical trials published in English that compared the efficacy and safety of TNK to alteplase in AIS were included. The major outcomes of this meta-analysis were proportion of patients free from disability and functional independence at 90 days, early neurological improvement at 24 hours, all-cause mortality at 90 days, patients with intra cranial hemorrhage (ICH), and patients with severe disability at 90 days. A total of nine studies with 3,573 patients were included in the analysis. The proportion of patients with freedom from disability was comparable in both groups (relative risk [RR] = 1.04, 95 per cent CI = 0.92-1.17; p = .53). Similarly, proportion of patients with functional independence was comparable (RR = 1.12, 95 per cent CI = 0.96-1.31; p = .14). TNK group had a higher rate of early neurological recovery (RR = 1.56, 95 per cent CI = 0.96-2.54; p = .07). All-cause mortality at 90 days was comparable in both groups (RR = 0.97; 95 per cent CI = 0.72-1.29; p = .82). The proportion of patients with ICH was higher in TNK group (RR = 1.14, 95 per cent CI = 0.77-1.68; p = .52). The proportion of patients with severe disability was less in TNK group (RR =0.84, 95 per cent CI = 0.53-1.32; p = .44). Key Message: TNK was similar to alteplase in terms of efficacy and safety. The patients in TNK group showed early neurological improvement but were simultaneously at higher risk of ICH. The TNK can be an alternative to alteplase if the benefits outweigh the risks.

Post COVID sequelae among COVID-19 survivors: insights from the Indian National Clinical Registry for COVID-19.

INTRODUCTION: The effects of COVID-19 infection persist beyond the active phase. Comprehensive description and analysis of the post COVID sequelae in various population groups are critical to minimise the long-term morbidity and mortality associated with COVID-19. This analysis was conducted with an objective to estimate the frequency of post COVID sequelae and subsequently, design a framework for holistic management of post COVID morbidities. METHODS: Follow-up data collected as part of a registry-based observational study in 31 hospitals across India since September 2020-October 2022 were used for analysis. All consenting hospitalised patients with COVID-19 are telephonically followed up for up to 1 year post-discharge, using a prestructured form focused on symptom reporting. RESULTS: Dyspnoea, fatigue and mental health issues were reported among 18.6%, 10.5% and 9.3% of the 8042 participants at first follow-up of 30-60 days post-discharge, respectively, which reduced to 11.9%, 6.6% and 9%, respectively, at 1-year follow-up in 2192 participants. Patients who died within 90 days post-discharge were significantly older (adjusted OR (aOR): 1.02, 95% CI: 1.01, 1.03), with at least one comorbidity (aOR: 1.76, 95% CI: 1.31, 2.35), and a higher proportion had required intensive care unit admission during the initial hospitalisation due to COVID-19 (aOR: 1.49, 95% CI: 1.08, 2.06) and were discharged at WHO ordinal scale 6-7 (aOR: 49.13 95% CI: 25.43, 94.92). Anti-SARS-CoV-2 vaccination (at least one dose) was protective against such post-discharge mortality (aOR: 0.19, 95% CI: 0.01, 0.03). CONCLUSION: Hospitalised patients with COVID-19 experience a variety of long-term sequelae after discharge from hospitals which persists although in reduced proportions until 12 months post-discharge. Developing a holistic management framework with engagement of care outreach workers as well as teleconsultation is a way forward in effective management of post COVID morbidities as well as reducing mortality.

Analysis of Research Publications on Pharmacogenomics of Sulphonylurea - A Scientometric Study.

This study analysed pharmacogenomics studies on sulfonylurea research publications using the Pubmed and Scopus databases. In the end, 65 publications from the years 2015 to 2021 were noticed. The objective of this study was to analyse these studies using scientometric tools, such as frequency counts, percentages, relative growth rates, doubling times, and collectively. A maximum of 19 (29.23%) research publications were contributed during the 2020 research period. The relative growth rate tends to decrease from 2015 to 2020 and the doubling time tends to increase and decrease after 2020. Up to 2 (3.08%) research publications were contributed by Ewan R. Pearson and Chen each. The top authors have an average degree of collaboration of 0.90 and 41 (63.83%) of their research publications are articles. The United States is the major contributor with 19 (29.23%) pharmacogenomics research publications on sulfonylureas. Although the United States is the most prolific country in sulfonylurea pharmacogenomics research, there are few Indian institutions that are not listed among the most prolific institutions.

Glycopyrrolate-induced polyuria: An unexpected side effect.

Polyuria is urine output exceeding 3 L/d in adults, primarily due to solute and water diuresis. In a hospital setting, mannitol and diuretics commonly lead to polyuria. We have found an interesting association of polyuria with glycopyrrolate; to the best of our knowledge, no case is reported in the literature. Here, we are describing a case of Guillain-Barre Syndrome, which developed polyuria during the hospital stay, which was secondary to glycopyrrolate.

Steroid and sphingomonas.

Sphingomonas paucimobilis is a Gram-negative bacteria identified as a rare infectious agent, more commonly seen among immune-compromised hosts. Infections include bacteremia, septicemia leading to septic shock, bone and soft-tissue infections such as septic arthritis, osteomyelitis, infection of shunts, and implantable devices. Although the organism has been reported to have low pathogenicity, infections in the immune compromised can be devastating leading to even death.

Résumé Sphingomonas paucimobilis est une bactérie Gram-négative identifiée comme un agent infectieux rare, plus fréquemment observé chez les hôtes immunodéprimés. Les infections comprenaient la bactériémie, la septicémie entraînant un choc septique, les infections des os et des tissus mous telles que l'arthrite septique, l'ostéomyélite, l'infection des shunts et des dispositifs implantables. Bien que l'organisme ait été signalé comme ayant une faible pathogénicité, les infections chez les personnes immunodéprimées peuvent être dévastatrices et même entraîner la mort. Mots clés: Sphingomonas, stéroïdes, antibiotiques.

Hospital mortality among COVID-19 patients - Experience of a multi-disciplinary tertiary care teaching hospital of Chhattisgarh in Central India.

Introduction: The mortality from coronavirus disease 2019 (COVID-19) infection and the severity of it vary among populations. There is a dearth of research on epidemiology and clinical outcomes in central Indian populations with COVID-19. Our aim was to provide an analysis of all hospitalized mortality among patients with COVID-19 infection in a tertiary care hospital of Chhattisgarh in central India. This analysis helped us to know the severity predictors for mortality and in future will help the authorities to formulate a plan to decrease the mortality in the epidemic or uncertain ongoing pandemic. Methodology: This was a retrospective observational study using the hospital-based record of multi-disciplinary teaching hospital in Chhattisgarh, India. All COVID-19 reverse-transcriptase polymerase chain reaction-positive patients who were declared dead or died during the course of treatment from April 1, 2020 to March 31, 2021 were included in the study. In-hospital mortality was the primary outcome of interest. In secondary analysis, age and gender distribution, co-morbidity, length of stay, and the cause of death were also investigated. Results: A total of 7495 patients with a confirmed diagnosis of COVID-19 were enrolled in the study, of whom 762 (10.16%) died in the hospital with COVID-19 as the primary cause of death. The majority of the patients were more than 60 years of age (45.7%). A total of 416 (54.4%) of the deceased patients were having co-morbidity with diabetes (13.4%), hypertension (16.4%), or both (24.4%). The majority of the patients who succumbed had a hospital stay of less than a week (≤7) (68.5%). More than half of the patients (58.3%) who expired had referred and reported to the hospital in the second or third week of illness. The respiratory system involvement was the dominant contributor of death with pneumonia (78.8%) being the most common cause, followed by acute respiratory distress syndrome (62.2%). 13.6% of expired patients had multiple system involvement, and 11.2% had sepsis as well. Conclusion: Mortality in COVID-19 patients was associated with advanced age, co-morbidities such as diabetes and hypertension, and delay in hospitalization. These are high-risk groups and should be vaccinated against COVID-19 on priority.