Association of Anti-Rotavirus IgA Seroconversion with Growth, Environmental Enteric Dysfunction and Enteropathogens in Rural Pakistani Infants.

BACKGROUND: The underperformance of oral vaccines in children of low- and middle-income countries is partly attributable to underlying environmental enteric dysfunction (EED). METHODOLOGY: We conducted a longitudinal, community-based study to evaluate the association of oral rotavirus vaccine (Rotarix®) seroconversion with growth anthropometrics, EED biomarkers and intestinal enteropathogens in Pakistani infants. Children were enrolled between three to six months of their age based on their nutritional status. We measured serum anti-rotavirus immunoglobulin A (IgA) at enrollment and nine months of age with EED biomarkers and intestinal enteropathogens. RESULTS: A total of 391 infants received two doses of rotavirus (RV) vaccine. 331/391 provided paired blood samples. Of these 331 children, 45% seroconverted at 9 months of age, 35% did not seroconvert and 20% were seropositive at baseline. Non-seroconverted children were more likely to be stunted, wasted and underweight at enrollment. In univariate analysis, insulin-like growth factor (IGF) concentration at 6 months were higher in seroconverters, median (25th, 75th percentile): 26.3 (16.5, 43.5) ng/ml vs. 22.5 (13.6, 36.3) ng/ml for non-seroconverters, p-value = 0.024. At nine months, fecal myeloperoxidase (MPO) concentrations were significantly lower in seroconverters, 3050(1250, 7587) ng/ml vs. 4623.3 (2189, 11650) ng/ml in non-seroconverted children, p-value = 0.017. In multivariable logistic regression analysis, alpha-1 acid glycoprotein (AGP) and IGF-1 concentrations were positively associated with seroconversion at six months. The presence of sapovirus and rotavirus in fecal samples at the time of rotavirus administration, was associated with non-seroconversion and seroconversion, respectively. CONCLUSION: We detected high baseline RV seropositivity and impaired RV vaccine immunogenicity in this high-risk group of children. Healthy growth, serum IGF-1 and AGP, and fecal shedding of rotavirus were positively associated with RV IgA seroconversion following immunization, whereas the presence of sapovirus was more common in non-seroconverters. TRIAL REGISTRATION: Clinical Trials ID: NCT03588013.

Identification and evaluation of potentially inappropriate medications (PIMs) in hospitalized geriatric patients using Beers criteria.

BACKGROUND: The aim of the study was to identify and evaluate potentially inappropriate medication (PIM) in geriatric patients using Beers criteria and also to identify adverse drug events (ADEs) due to PIMs and various drug-drug interactions. METHODS: The medications in the prescriptions of patients above 60 years of age, their dosage regimen respective of their diagnosis were analyzed. Each medication was then checked with Beers list tables, and any medication if mentioned in the Beers list, was noted along with its strength of recommendation and quality of evidence. Any adverse drug event (ADE) due to PIM was identified. Causality of the events was assessed by Naranjo's Scale. The number of drug-drug interactions per prescription and the severity of each interaction were also analyzed. The collected data from 200 subjects were subjected to statistical treatments using Statistical Package for Social Sciences (SPSS) software version 16.0 for WINDOWS. RESULTS: Based on the Beers criteria 2012, 106 out of 200 (53%) prescriptions had at least one PIM prescribed. A sum of 1690 medications was prescribed as a whole for the entire study subjects. Among which, 134 PIMs were identified. Most commonly prescribed PIMs were benzodiazepines (39, 19.5%), followed by sliding scale use of insulin (31, 15.5%), and prazosin at a rate of 11.5% (23). A total of 10 ADEs were identified during the study. The average number of drug interactions observed among total samples was found to be 3.0±6.0 with 0±5.0 serious interactions, 2±4.0 significant interactions requiring close monitoring, and 0±6.0 minor interactions. CONCLUSIONS: The study shows high prevalence of prescribing PIMs in hospitalized elderly patients; PIM also caused incidence of ADEs; and serious drug-drug interactions were scarce among the patients.

A meta-analysis on the clinical effectiveness of transversus abdominis plane block.

STUDY OBJECTIVE: To study the efficacy of the transversus abdominal plane (TAP) block. DESIGN: Meta-analysis. SETTING: District general hospital. PATIENTS: 86 patients in the TAP block group and 88 in the non-TAP block group. MEASUREMENTS: Statistical analyses were performed using Microsoft Excel 2007 for Windows XP. Hedges g statistic was used for the calculation of standardized mean differences (SMD). Binary data (nausea) were summarized as risk ratios (RR). MAIN RESULTS: Patients with TAP block required less morphine after 24 hours than those who did not have the block (random effects model: SMD -4.81, 95% CI [-7.45, -2.17], z = -3.57, P < 0.001). There was less time to first request of morphine in the non-TAP block group (random effects model: SMD 4.80, 95% CI [2.16, 7.43], z = 3.57, P < 0.001). Patients in the TAP block group had less pain up to 24 hours postoperatively. No statistical differences were found with respect to nausea. CONCLUSIONS: TAP block reduces the need for postoperative opioid use, it increases the time first request for further analgesia, it provides more effective pain relief, and it reduces opioid-associated side effects.

Elective open versus laparoscopic sigmoid colectomy for diverticular disease: a meta-analysis with the Sigma trial.

BACKGROUND: A meta-analysis of published literature comparing open versus laparoscopic elective sigmoid resections for diverticular disease was conducted. METHODS: Electronic databases were searched for data from January 1991 to March 2009. A systematic review was performed to obtain a summative outcome. RESULTS: Twenty-two comparative studies involving 10,898 patients were analyzed; 1538 patients were in the laparoscopic group and 9360 were in the open group. The operative time for laparoscopic sigmoid resection (LSR) is longer than open resections (OSR) [random-effects model: SMD = 1.94, 95% CI = (1.14, 2.74), z = 4.74, p < 0.001]. However, patients who undergo LSR have earlier return to passage of feces [random-effects model: SMD = -1.01, 95% CI (-1.80, -0.22), z = -2.50, p = 0.013] and shorter hospital stay [random-effects model: SMD = -7.65, 95% CI (-10.96, -4.32), z = -4.52, p < 0.001]. Overall morbidity was higher in the OSR group [random-effects model: RR = 0.56, 95% CI (0.40, 0.80), z = -3.24, p < 0.001] and no difference in mortality rates was observed (p = 0.81). CONCLUSIONS: Laparoscopic sigmoid resection takes longer to perform than open procedures; however, it is safe and has lower overall morbidity, earlier return of bowel function, and shorter hospital stays. This approach should be considered for elective cases but more randomized controlled trials are required to strengthen the evidence.