Short- and Long-Term Recovery after Moderate/Severe AKI in Patients with and without COVID-19.

Background: Severe AKI is strongly associated with poor outcomes in coronavirus disease 2019 (COVID-19), but data on renal recovery are lacking. Methods: We retrospectively analyzed these associations in 3299 hospitalized patients (1338 with COVID-19 and 1961 with acute respiratory illness but who tested negative for COVID-19). Uni- and multivariable analyses were used to study mortality and recovery after Kidney Disease Improving Global Outcomes Stages 2 and 3 AKI (AKI-2/3), and Machine Learning was used to predict AKI and recovery using admission data. Long-term renal function and other outcomes were studied in a subgroup of AKI-2/3 survivors. Results: Among the 172 COVID-19-negative patients with AKI-2/3, 74% had partial and 44% complete renal recovery, whereas 12% died. Among 255 COVID-19 positive patients with AKI-2/3, lower recovery and higher mortality were noted (51% partial renal recovery, 25% complete renal recovery, 24% died). On multivariable analysis, intensive care unit admission and acute respiratory distress syndrome were associated with nonrecovery, and recovery was significantly associated with survival in COVID-19-positive patients. With Machine Learning, we were able to predict recovery from COVID-19-associated AKI-2/3 with an average precision of 0.62, and the strongest predictors of recovery were initial arterial partial pressure of oxygen and carbon dioxide, serum creatinine, potassium, lymphocyte count, and creatine phosphokinase. At 12-month follow-up, among 52 survivors with AKI-2/3, 26% COVID-19-positive and 24% COVID-19-negative patients had incident or progressive CKD. Conclusions: Recovery from COVID-19-associated moderate/severe AKI can be predicted using admission data and is associated with severity of respiratory disease and in-hospital death. The risk of CKD might be similar between COVID-19-positive and -negative patients.

Community pharmacists' perception and exposure to drug promotion in Pakistan: a cross-sectional study.

OBJECTIVE: Drug promotion is a factor that promotes the irrational use of drugs and sometimes negatively influences the prescribing/dispensing pattern. So there was a need to assess the views about accepting gifts and attitudes/influence towards drug promotion among community pharmacists in Punjab, Pakistan. SETTING: Adopting a preused questionnaire, we conducted a cross-sectional multiple-site survey study. We distributed questionnaires to pharmacists in the community pharmacies to investigate the exposure, scepticism and acceptance to drug promotion as well as their perception about the appropriateness of gifts and to check if they had been taught about dealing with medical representatives. Data were analysed in simple percentages, and the χ2 test was used to evaluate association with demographics. All the analysis was done using SPSS V.23.0. RESULTS: A total 86.9% (463/533) pharmacists completed the survey. One out of four pharmacists reported being taught about the ethics of drug promotion (26.8%) and about how to interpret drug promotional material (25.0%) and were significantly associated with higher age (age 31%-35 years, 81.9%; p<0.05). More than two-thirds of the respondents found it appropriate to accept stationery (73.4%) and textbooks (70.6%) as gifts, and only 17.5% felt it was appropriate to accept direct money. Less than half of the pharmacists (47.3%) perceived drug companies were useful for gaining knowledge about new drugs. Majority (76.2%) thought these drug promotions play a role in the irrational prescribing of antibiotics and 18.6% dispensed antibiotics due to these promotions. CONCLUSION: The majority of pharmacists participating in this study felt it was appropriate to receive small value gifts from pharmaceutical companies. Only a small proportion of the respondents was given ethical training and education about drug promotion. Improving the syllabus and updating the pharmacist's knowledge after graduation, as part of continued pharmacy education, will eventually improve the healthcare professionals' capability to act for the patients' welfare.

Perceptions of healthcare professionals and patients on the role of the pharmacist in TB management in Pakistan: A qualitative study.

Background: Globally, tuberculosis (TB) is the second major cause of death from infectious diseases, particularly in developing countries. A multidisciplinary approach to the management of TB may help to curb the disease burden. Objective: The objective of this study was to outline the perceptions of healthcare professionals and patients regarding the potential role of pharmacists in TB management in Pakistan. Method: This was a large-scale qualitative study conducted at the Chest Disease Unit (CDU) of the Bahawal Victoria Hospital (BVH), Punjab, Pakistan. Data were collected through semi-structured interviews with physicians, pharmacists, and patients recruited using a mix of convenient and snowball sampling. The sample size was decided through standard saturation point criteria. All interviews were audio recorded and transcribed verbatim. The data were analyzed to draw conclusions using a thematic analysis approach. Results: Analysis of the data yielded 19 categories and seven themes. Physicians considered pharmacists qualified healthcare professionals, whereas patients considered them merely dispensers. Inventory management and dispensing of medicines were considered as major responsibilities of pharmacists. Physicians were extremely overburdened and wanted to delegate certain duties to pharmacists, subject to their prior extensive trainings. However, most of the physicians were unaware of the legal scope of pharmacy practice in Pakistan. With regard to the potential duties of pharmacists, physicians, pharmacists, and patients (patients-upon explaining the potential roles during the interview) endorsed monitoring, counseling, medicine brand selection, dose adjustment, inventory management, dispensing, and polypharmacy assessment as their potential roles. In view of all stakeholders, the rationale for integrating pharmacists in TB management included overburdened physicians, sub-standard patient care, medication safety issues, and patient dissatisfaction. The healthcare professionals highlighted that the major barriers to integrating pharmacists within the TB management system were limited interest of regulatory authorities and policy makers, followed by inadequate training and experience-driven questionable competency of pharmacists. Conclusion: The study participants acknowledged the potential role of pharmacists in TB management. However, it was emphasized that healthcare policy makers should devise strategies to overcome the underlying barriers before assigning medicine-related clinical roles to pharmacists.

Antioxidant Enzyme Activity and Lipid Peroxidation in Aporrectodea caliginosa Earthworms Exposed to Silver Nanoparticles and Silver Nitrate in Spiked Soil.

Silver nanoparticles (AgNPs) from industrial use, discharged via the land application of sewage sludge, are interacting with soil biota, including earthworms. In affected organisms, excessive production of reactive oxygen species can result in lipid peroxidation, shifting the balance between oxidants and antioxidants to cause oxidative stress. We determined selected lower-tier biomarkers such as antioxidant responses and lipid peroxidation in Aporrectodea caliginosa earthworms exposed to soils spiked with AgNPs or silver nitrate (AgNO3 ). Aporrectodea caliginosa were exposed to AgNPs at 0 (control), 0.3, 3, 30, and 300 mg/kg or Ag+ (as AgNO3 ) at 0, 0.03, 0.3, 3, and 10 mg/kg in soil for 4 wk. At 1, 2, 3, and 4 wk, the activity of the antioxidant enzymes superoxide dismutase, catalase, glutathione peroxidase, glutathione S-transferase, as well as lipid peroxidation (malondialdehyde content), increased as a function of concentration, with a much larger response for Ag+ than AgNPs. Given the likelihood of ever-increasing AgNP concentrations in soil, where AgNPs can transform to ionic Ag (Ag+ ), our findings of antioxidant response to oxidative stress in a common indicator organism even at an environmentally realistic exposure concentration of 0.03 mg/kg demonstrate that AgNPs may affect soil fertility and, thus, agricultural production. Evaluating selected lower-tier biomarkers offers a meaningful assessment of AgNPs and Ag+ effects on terrestrial earthworms. Environ Toxicol Chem 2020;39:1257-1266. © 2020 SETAC.

Cadmium Concentrations in New Zealand Wheat: Effect of Cultivar Type, Soil Properties, and Crop Management.

Wheat ( L.) grain is a contributing source of dietary Cd in New Zealand, but despite this, there is a dearth of information on Cd concentrations in wheat and the factors that affect uptake. We measured Cd concentrations in 12 wheat cultivars grown in field sites across New Zealand and also assessed the soil, plant, and crop factors that have been reported to affect Cd uptake. We found there was a wide range in grain Cd concentrations (0.004 to 0.205 mg kg fresh weight [FW]). The overall mean concentration (0.066 mg kg FW) was below the maximum limit (ML) of 0.1 mg kg FW. Only 7% of grain samples across seven sites exceeded the ML. There were significant ( < 0.05) differences (2.5-fold) in Cd concentrations in wheat grain between cultivars. No strong significant relationships were found between soil properties and Cd concentrations in grain. Further, management factors affecting grain Cd concentrations were inconsistent. Given the lack of relationships between soils and management practices, the most effective way of limiting Cd uptake in wheat grain at sites where Cd exceeds MLs may be the use of low-Cd-accumulating cultivars. Further studies are required to explore specifically the influence of irrigation and effects of type and rate of fertilizer on Cd uptake in wheat, as well as to better understand the mechanisms of Cd uptake in wheat.

Nerve conduction velocity as a non-destructive biomarker in the earthworm Aporrectodea caliginosa exposed to insecticides.

Earthworms are important and useful soil organisms, but in agricultural soils, they are potentially exposed to a wide variety of pesticides. Insecticides represent the highest threat to earthworms and many are neurotoxic. There is a need for a reliable, relevant, simple biomarker to assess the sub-lethal effects of neurotoxic insecticides on earthworms under laboratory or field conditions. The Aporrectodea caliginosa earthworms were exposed to 0 (control), 0.5×, 1× (normal field application rate), and 5× concentrations of a carbamate (Pirimor®) and an organophosphate (Lorsban®) insecticides. The nerve conduction velocity (NCV) of the medial giant fibers of A. caliginosa earthworm was recorded on days 0, 1, 2, 3, 4, and 7 to quantify sub-lethal neurotoxic effects. Acetylcholinesterase (AChE) enzyme activity of A. caliginosa homogenates was measured at the conclusion of the experiment. Pirimor® but not Lorsban® induced a significant decrease in NCV on days 3, 4, and 7 at 1× and 5× doses. A significant dose-dependent decrease was observed on AChE activity to Pirimor® at the doses used but not Lorsban®. A clear relationship is observed between AChE activity and NCV in the case of Pirimor®. This study showed that NCV is a sensitive biomarker that correlates well with classical biomarker measurements such as AChE enzyme activity. This technique could be used to study the impact of insecticides on earthworms and also their recovery.

An epidemic model with a multistage vaccine.

Many diseases, such as the seasonal flu, tetanus, and smallpox, can be vaccinated against with a single dose of a vaccine. However, some diseases require multiple doses of a vaccine for immunity. For example, Hepatitis B requires three doses of a vaccine, with the second occurring about 1 month after the first and the third occurring about 5 months after the second, for immunity. Diseases requiring a multistage vaccine such as Hepatitis B can have extra complications with its vaccination program, as some who start the doses may forget to complete the program or could become infected before completing the program. This article concerns the setup and analysis of a model for disease spread with a multistage vaccine available to investigate how effective such a vaccine would be at establishing herd immunity for the disease as well as establishing the short-term and long-term effects of such a vaccine.