First Oral Treatment Specific for Postpartum Depression.

Postpartum depression is one of the most common perinatal mood disorders. The U.S. Food and Drug Administration approved the first oral medication developed specifically for the treatment of postpartum depression in August 2023. Zuranolone, marketed under the brand name Zurzuvae (Sage Therapeutics, Inc. and Biogen), is thought to work similarly to other positive allosteric modulators of gamma-aminobutyric acid A receptors such as benzodiazepines. It can be used alone or as an adjunct to other oral antidepressant medication. Its 2-week regimen of once-daily oral administration provides women with postpartum depression the opportunity to maintain their daily routines in an outpatient setting. This article provides an overview of zuranolone, including indications, mechanism of action, potential adverse reactions, and implications for nursing practice.

Topical N-phosphonacetyl-l-aspartate is a dual action candidate for treating non-melanoma skin cancer.

Each year, 3.3 million Americans are diagnosed with non-melanoma skin cancers (NMSC) and an additional 40 million individuals undergo treatment of precancerous actinic keratosis lesions. The most effective treatments of NMSC (surgical excision and Mohs surgery) are invasive, expensive and require specialised training. More readily accessible topical therapies currently are 5-fluorouracil (a chemotherapeutic agent) and imiquimod (an immune modulator), but these can have significant side effects which limit their efficacy. Therefore, more effective and accessible treatments are needed for non-melanoma cancers and precancers. Our previous work demonstrated that the small molecule N-phosphonacetyl-L-aspartate (PALA) both inhibits pyrimidine nucleotide synthesis and activates pattern recognition receptor nucleotide-binding oligomerization domain 2. We propose that topical application of PALA would be an effective NMSC therapy, by combining the chemotherapeutic and immune modulatory features of 5-fluorouracil and imiquimod. Daily topical application of PALA to mouse skin was well tolerated and resulted in less irritation, fewer histopathological changes, and less inflammation than caused by either 5-fluorouracil or imiquimod. In an ultraviolet light-induced NMSC mouse model, topical PALA treatment substantially reduced the numbers, areas and grades of tumours, compared to vehicle controls. This anti-neoplastic activity was associated with increased expression of the antimicrobial peptide cathelicidin and increased recruitment of CD8+ T cells and F4/80+ macrophages to the tumours, demonstrating both immunomodulatory and anti-proliferative effects. These findings indicate that topical PALA is an excellent candidate as an effective alternative to current standard-of-care NMSC therapies.

Semaglutide Is a New Once-Daily Oral Medication to Treat Type 2 Diabetes.

Semaglutide is an oral glucagon-like peptide receptor agonist approved in 2019 by the U.S. Food and Drug Administration. It is marketed under the brand name Rybelsus and was approved to be used in conjunction with lifestyle modifications to treat individuals with type 2 diabetes. It is the first in its drug class to be administered in a once-daily oral form. Through its actions on glucose control and body weight, this once-daily oral medication could contribute to better glycemic control and healthier lives for many women with type 2 diabetes.

Cefiderocol for Infections Caused by Multidrug-Resistant Gram-Negative Bacteria.

In 2019, the U.S. Food and Drug Administration approved cefiderocol, a new treatment option for individuals with complicated urinary tract infections. Cefiderocol is a cephalosporin antibiotic indicated for use in adults 18 years or older who have minimal treatment options due to resistance for complicated urinary tract infections caused by Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, and Enterobacter cloacae complex. The recommended dose of cefiderocol is 2 g intravenously every 8 hours infused over 3 hours. The dose is adjusted for individuals with creatinine clearance of less than 60 ml/min or greater than 120 ml/min. Gastrointestinal symptoms such as diarrhea and constipation are the most common adverse events reported by individuals taking cefiderocol.

Lasmiditan Is a New Option for Acute Migraine Treatment.

Lasmiditan is a new oral medication for treatment of acute migraine. It was approved by the U.S. Food and Drug Administration in October 2019 and is marketed under the brand name Reyvow (Eli Lilly and Company, Indianapolis, IN). It is the first of its kind in a new drug class called ditans. Lasmiditan has been studied as monotherapy for acute migraine treatment and as an abortive therapy for adults taking chronic migraine preventive medication. Lasmiditan may be an option for individuals who have had no relief with triptans or other acute migraine treatment agents or who are unable to use other migraine treatments because of contraindications.

Measles-What's Old Is New Again.

Measles (rubeola) was once nearly eradicated in the United States. Unfortunately, it has reappeared, with more than three times the number of confirmed cases in 2019 than in 2018. The virus, which produces a distinct rash that appears within days of exposure, can spread quickly and can produce severe complications. There is no cure; treatment is supportive care. Measles was once a minimal concern in the United States due to high vaccination rates. The Centers for Disease Control and Prevention reports that, because of the increase in individuals traveling to countries with high rates of measles and the fact that fewer U.S. children are being immunized against measles, the incidence of measles will likely continue to rise in the United States. It is vital that nurses and other health care providers educate individuals about the importance of the prevention and treatment of measles.

New Osteoporosis Treatment Means New Bone Formation.

The U.S. Food and Drug Administration approved romosozumab as a new osteoporosis drug in April 2019. Marketed under the brand name Evenity (Amgen, Thousand Oaks, CA), it is a sclerostin inhibitor that promotes new bone formation. It is the first in its drug class to work by increasing bone formation and also preventing bone resorption. It has been approved for use in postmenopausal women at greater risk for bone fracture. Romosozumab is administered once monthly in injection form for 12 consecutive months.

An in silico evaluation of non-synonymous single nucleotide polymorphisms of mastitis resistance genes in cattle.

Recognition of deleterious non-synonymous single nucleotide polymorphism (SNPs) aids in the assessment of genetic basis of diseases and prediction of clinical phenotypes. In this study, data obtained from whole exome sequencing of Vechur cow using Illumina HiSeq 2500 platform is compared with that of crossbred cattle of Kerala. Sequence analysis of selected 18 mastitis resistant genes, evaluated the consequence of non-synonymous SNPs in these genes from both Vechur and crossbred cattle of Kerala, using sequence and structure-based computational tools such as SIFT, PROVEAN and I-MUTANT 2.0. Compared to Vechur cattle, incidence of missense deleterious mutation to effect protein functioning were relatively higher in crossbred cattle. These results on the type of genetic variants and its impact on normal functioning of a protein will assist to predict and enhance the disease resistance in cattle breeds.

A New Year-Long Combination Hormonal Contraceptive.

The U.S. Food and Drug Administration approved a new combination hormonal contraceptive in August 2018. Sold under the brand name Annovera, it is a combination of segesterone acetate and ethinyl estradiol, and it is the first multiuse vaginal contraceptive system that prevents ovulation for up to 13 menstrual cycles in a year. Although there are several combination hormonal contraceptives on the market, this is the first single system that can be repeatedly used for an entire year and does not require placement by a health care provider. This innovation gives women control over when to stop using the contraceptive, should they so desire. Annovera is stored at room temperature when not in use, allowing women living in uncontrolled-temperature climates to use one contraceptive method for an entire year.

Gastrointestinal Disturbances in the Elderly.

Gastrointestinal (GI) age-related changes create alterations in the body's ability to digest, absorb, and excrete nutrients, medications, and alcohol and disrupts GI immunity responses. All older adults exhibit some degree of swallowing difficulty, also known as senescent swallowing. The effects of chronic disease and sustained use of alcohol, tobacco, and medications often exacerbate age-related GI dysfunction. Older adults often have nonspecific complaints, warranting a thorough health history and physical examination, including prescription and over-the-counter medications. Colorectal cancer screening tests should be discussed with all older adults because of the high incidence of colorectal cancer in this patient population.

Popular species of edible mushrooms as a good source of zinc to be released to artificial digestive juices.

Because fruiting bodies of edible mushrooms accumulate elements very effectively, in this study for the first time we aimed at determining the degree of the release of zinc(II) ions to artificial digestive juices imitating the human gastrointestinal tract from freeze-dried popular edible mushroom fruiting bodies, such as Agaricus bisporus, Boletus badius and Cantharellus cibarius. For the analysis, anodic stripping voltammetry method was used. The amount of zinc released to artificial saliva within 1 minute ranged from 0.03 to 1.14 mg/100 g d.w. In gastric juice, the amounts were higher and ranged from 0.75 to 2.07 mg/100 g d.w. depending on the incubation time. After incubation of the freeze-dried edible mushroom fruiting bodies for 1 minute in artificial saliva, 15 in artificial gastric juice and then 150 minutes in artificial intestinal juice, it was found that the concentration of the released zinc in artificial intestinal juice was the highest and amounted to 6.44 mg/100 g d.w. The total average amount of zinc released from Boletus badius was the highest and this was estimated at 4.13 mg/100 g d.w. For the remaining two investigated species of A. bisporus and C. cibarius, the total amounts of zinc released into artificial digestive juices were only slightly lower and were estimated at 2.23 and 3.29 mg/100 g d.w. on average, respectively. It was demonstrated for the first time that mushrooms release zinc to artificial digestive juices imitating conditions in the human digestive tract and are a good source of this element.

SCIENTIFIC PAPER PRESENTATION DURING CONCURRENT INTEREST SESSION. Community Health Nursing (Speciality). Iron-deficiency anemia.

Iron deficiency anaemia is the most common form of malnutrition in the world. The global prevalence of anaemia mainly in South East Asia is 65.5 percent, in India 56 percent among adolescent girls. A study conducted to assess the effectiveness of structured teaching programme on knowledge and attitude of adolescent girls in prevention of iron and folic acid deficiency anaemia at a selected corporation school. It adopted one group pre-test post-test design with 60 samples selected by employing stratified random sampling technique. The study revealed that during pre-test 90 percent of them had inadequate knowledge and 65 percent of them had unfavourable attitude towards iron and folic acid deficiency anaemia. After the structured teaching programme the knowledge and attitude was improved (73% had adequate knowledge and 79% had most favourable attitude). Overall the structured teaching programme was found effective in improving the knowledge and attitude of adolescent girls in prevention of iron and folic acid deficiency anaemia.

Increased mortality in African Americans with idiopathic pulmonary arterial hypertension.

BACKGROUND: Idiopathic pulmonary arterial hypertension (IPAH) is a progressive disorder that usually culminates in right ventricular failure and death without treatment. OBJECTIVE: To assess mortality trends by race and gender for idiopathic pulmonary arterial hypertension in the United States from 1994-1998. METHODS: The U.S. National Center for Health Statistics data for the years 1994-1998 was reviewed for deaths in which the underlying cause was primary pulmonary hypertension (ICD-9 code 416.0), now known as IPAH. The age, gender, race and state of residence of the deceased were abstracted from the Centers for Disease Control Wonder System (http://wonder.cdc.gov). Average annual age-adjusted region-, race- and gender-specific rates were then calculated. RESULTS: African-American women demonstrated the highest mortality rates for IPAH across all age groups compared to other racial and gender groups. No geographical differences in mortality rates were noted. An increase in mortality rates with advancing age was observed in all racial and gender groups, with the highest mortality rates for IPAH noted in the elderly. DISCUSSION: African Americans with IPAH exhibit a substantially increased mortality compared with Caucasians, particularly African-American women.

Aerosolized amikacin for treatment of pulmonary Mycobacterium avium infections: an observational case series.

BACKGROUND: Current systemic therapy for nontuberculous mycobacterial pulmonary infection is limited by poor clinical response rates, drug toxicities and side effects. The addition of aerosolized amikacin to standard oral therapy for nontuberculous mycobacterial pulmonary infection may improve treatment efficacy without producing systemic toxicity. This study was undertaken to assess the safety, tolerability and preliminary clinical benefits of the addition of aerosolized amikacin to a standard macrolide-based oral treatment regimen. CASE PRESENTATIONS: Six HIV-negative patients with Mycobacterium avium intracellulare pulmonary infections who had failed standard therapy were administered aerosolized amikacin at 15 mg/kg daily in addition to standard multi-drug macrolide-based oral therapy. Patients were monitored clinically and serial sputum cultures were obtained to assess response to therapy. Symptomatic improvement with radiographic stabilization and eradication of mycobacterium from sputum were considered markers of success. Of the six patients treated with daily aerosolized amikacin, five responded to therapy. All of the responders achieved symptomatic improvement and four were sputum culture negative after 6 months of therapy. Two patients became re-infected with Mycobacterium avium intracellulare after 7 and 21 months of treatment. One of the responders who was initially diagnosed with Mycobacterium avium intracellulare became sputum culture positive for Mycobacterium chelonae resistant to amikacin after being on intermittent therapy for 4 years. One patient had progressive respiratory failure and died despite additional therapy. There was no evidence of nephrotoxicity or ototoxicity associated with therapy. CONCLUSION: Aerosolized delivery of amikacin is a promising adjunct to standard therapy for pulmonary nontuberculous mycobacterial infections. Larger prospective trials are needed to define its optimal role in therapy of this disease.

Thoracic lymphatic disorders.

Thoracic complications of lymphatic disorders can culminate in respiratory failure and death and should be considered in any patient with a lymphatic disease and clinical or radiographic evidence of chest disease. Congenital lymphatic disorders are being increasingly recognized in the adult population. The spectrum of thoracic manifestations of lymphatic disorders ranges from incidental radiographic findings to diffuse lymphatic disease with respiratory failure. This article serves to review some recent advances that allow improved diagnosis and management of thoracic lymphatic disorders. Herein, we describe their anatomical and physiologic effects, the time course of their progression, and the therapies that are currently available. The management of malignant (cancerous) lymphatic disorders of the thorax is beyond the scope of this paper.

Lactic acid permeabilizes gram-negative bacteria by disrupting the outer membrane.

The effect of lactic acid on the outer membrane permeability of Escherichia coli O157:H7, Pseudomonas aeruginosa, and Salmonella enterica serovar Typhimurium was studied utilizing a fluorescent-probe uptake assay and sensitization to bacteriolysis. For control purposes, similar assays were performed with EDTA (a permeabilizer acting by chelation) and with hydrochloric acid, the latter at pH values corresponding to those yielded by lactic acid, and also in the presence of KCN. Already 5 mM (pH 4.0) lactic acid caused prominent permeabilization in each species, the effect in the fluorescence assay being stronger than that of EDTA or HCl. Similar results were obtained in the presence of KCN, except for P. aeruginosa, for which an increase in the effect of HCl was observed in the presence of KCN. The permeabilization by lactic and hydrochloric acid was partly abolished by MgCl(2). Lactic acid sensitized E. coli and serovar Typhimurium to the lytic action of sodium dodecyl sulfate (SDS) more efficiently than did HCl, whereas both acids sensitized P. aeruginosa to SDS and to Triton X-100. P. aeruginosa was effectively sensitized to lysozyme by lactic acid and by HCl. Considerable proportions of lipopolysaccharide were liberated from serovar Typhimurium by these acids; analysis of liberated material by electrophoresis and by fatty acid analysis showed that lactic acid was more active than EDTA or HCl in liberating lipopolysaccharide from the outer membrane. Thus, lactic acid, in addition to its antimicrobial property due to the lowering of the pH, also functions as a permeabilizer of the gram-negative bacterial outer membrane and may act as a potentiator of the effects of other antimicrobial substances.

Effects of packaging and storage conditions on volatile compounds in gas-packed poultry meat.

Volatile compounds released by raw chicken legs packed in modified atmosphere packages were determined in order to develop a spoilage indicator for monitoring the shelf-life of raw chicken. Internal spoilage indicators would react with compounds released during chemical, enzymatic and/or microbial spoilage reactions. The effects of four packaging factors (headspace volume, oxygen transmission rate of the package, residual oxygen and carbon dioxide concentration) and three storage factors (temperature, illumination and storage time) on the amounts of volatile compounds in the headspace of gas packages containing two chicken legs were studied. Statistical experimental design was applied and a linear screening design comprising 18 experiments (fractional factorial) was utilized. Volatile compounds in package headspace were determined by gas chromatography--mass spectrometry using the dynamic headspace technique. The results were compared with the results of sensory evaluation and microbial determinations. The head-space of stored packages was dominated by the following compounds: butene, ethanol, acetone, pentane, dimethylsulphide, carbon disulphide and dimethyl disulphide. In modelling, some interaction terms and squared terms were needed in addition to linear terms. The main factors affecting the amounts of ethanol, dimethyl sulphide, carbon disulphide and dimethyl disulphide were storage time and temperature. Other factors had only minor importance, carbon dioxide concentration and headspace volume being the most significant package parameters. The same four factors also had the greatest effects on the odour of chicken legs.

Purity of recycled fibre-based materials.

In order to study the purity of recycled fibre-based materials, products containing recycled fibre as well as recycled pulp were examined with regard to their chemical impurities, toxicity and microbiological quality. The study was carried out to clarify both qualitatively and quantitatively the variations in microbiological quality. The levels of several classes of chemical substances were analysed and semi-volatile and volatile substances identified. The toxicity and mutagenicity of virgin fibre and recycled fibre materials were screened using the Photobacter toxicity test and the Ames Salmonella mutagenicity test. Preliminary chemical characterization of the mutagens was carried out. Identification of the compounds found in the mutagenic fractions was performed by gas chromatography/mass spectrometry (GC/MS). The concentration of various substances analysed was found to be low, although the variety of substances present appeared to be very broad. Preliminary chemical characterization revealed that some samples contained compounds known to have mutagenic or other toxic activity. Also, the recycled fibre pulps contained large amounts of various microbes, the microbial load consisting mainly of aerobic spore-forming bacteria. The paper-making process was found to clearly have reduced the total microbial counts.

Heterocyclic aromatic amines in human urine following a fried meat meal.

In a search for suitable biomarkers for human dietary exposure to heterocyclic aromatic amines (HAAs), we have investigated the concentrations of three common fried food mutagens in food and urine after consumption of a fried meat meal. In this connection we developed a method for the determination of HAAs and have investigated the common fried red meat HAAs 2-amino-1-methyl-6-phenylimidazo[4,5-beta]pyridine (PhIP), 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline (MeIQx) and 2-amino-3,4,8-trimethylimidazo[4,5-f]quinoxaline (DiMeIQx). Eight volunteers participated in the study, each consuming a meal of fried minced beef patties (295 g), boiled potatoes, and a green salad. Urine was collected for two 12-hr periods prior to and following the meal. HAAs were determined in cooked meat and in untreated and acid hydrolysed urine by a series of liquid/liquid extractions, followed by Blue cotton adsorption and finally by a novel derivatized technique for gas chromatography-mass spectrometry (GC-MS). The primary amino groups were derivatized by acylation with heptafluorobutyric acid anhydride, and the resulting amide methylated using diazomethane. Phenolic hydroxyl groups were also methylated by this procedure, making it possible to detect hydroxylated HAAs, possible metabolites or constituents of the fried meat. 4'-Hydroxy-PhIP ¿2-amino-1-methyl-6-(4-hydroxyphenyl)imidazo[4,5-beta]pyridine¿ (4'-OH-PhIP) was indeed found in meat as well as in urine. The contents of PhIP, MeIQx and DiMeIQx in meat were 4.0 +/- 2.6, 3.5 +/- 0.9 and 0.3 +/- 0.1 ng g-1 (mean +/- SD, n = 4), from which the mean amounts ingested were calculated to be 1180, 1030 and 90 ng, respectively. Total amounts of HAAs in the 0-24-hr post-meal untreated urine (and percent of ingested dose) were 6-23 ng PhIP (0.5-2%) and 10-63 ng MeIQx (1-6%). In hydrolysed urine, the levels of HAAs were higher, totalling 24-100 ng PhIP (2-8.5%) and 133-329 ng of MeIQx (13-32%). DiMeIQx was below detection limit in all urine samples. Judged from our study, there were rather large inter-individual variations in the amounts of excreted HAAs, possibly caused by variations in the activities of enzymes taking part in HAA metabolism.

Effect of commercial marinades on the mutagenic activity, sensory quality and amount of heterocyclic amines in chicken grilled under different conditions.

The effect of processing conditions on the mutagenic activity and sensory quality of everyday food was studied by investigating grilled chicken samples seasoned with four different marinades and grilled at temperatures of about 110, 170 and 220 degrees C. The amounts of the heterocyclic amines 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline, 2-amino-3,4,8-trimethylimidazo[4,5-f]quinoxaline and 2-amino-1-methyl-6-phenylimidazo[4,5,-b]pyridine were determined only in samples grilled at 220 degrees C, using a gas chromatography-mass spectrometry technique with negative-ion chemical ionization. Sensory quality was determined using the extended ranking test method and the mutagenic activity using the Ames Salmonella assay. At 220 degrees C one of the marinades decreased the mutagenic activity in the chicken samples compared with the unseasoned control or samples treated with the other marinades. Great variations, without any clear correlation with mutagenicity, were observed in the amounts of heterocyclic amines between chicken samples treated with the same or different marinades. At the grilling temperatures of 170 degrees C and 110 degrees C the mutagenic activities of the chicken samples were lower or they were non-mutagenic. There was no correlation between mutagenic activity and sensory quality of the products. The samples with high mutagenic activity were ranked to be as good as the samples with lower or no mutagenicity. The results show that it is possible to prepare grilled products with reduced mutagenicity without compromising their sensory quality. It was also evident that marinades can have a reducing effect on the mutagenicity of grilled chicken. Variation observed in the amounts of heterocyclic amines between equivalent products makes it difficult to estimate their concentration in everyday foods.