Related Adverse Effects Research Articles

Integrative Assessment of Sediment Quality in the São Francisco River (Mina Gerais, Brazil)

The São Francisco River (one of the most important South American rivers) has many contamination sources, but just a few environmental assessments have been conducted. A weight-of-evidence approach identified the pollution sources (industrial activities, mineral processing, fisheries, and tourism) in the river and the city of Três Marias based on two different lines of evidence: the structure of the benthic community (biological monitoring working party score system, abundance of taxa, number of individuals, Margalef species richness, Pielou evenness, and Shannon–Wiener diversity) and the physicochemical determination of sediments (%fines, TOC, nitrate, ammonium, ammonia, ammoniacal nitrogen, metalloids, and SEM/AVSs). The results show that the wastewater treatment plant was the most important source of pollution. A factory was also detected as a source of contamination, with related adverse effects having been measured downstream. Other sources of contamination and stress were detected in the studied area. The macro-benthic identification study identified three different sentinel species (Tanytarsus sp., Crytochironomus sp., and Polypedilum sp.) for future monitoring assessments of the sediment quality in riverine areas. Thus, an improvement in the management of river effluents and more measures focused on cutting contaminant emissions from the waste treatment plant are recommended.

Effect of pre-administration of esketamine intraoperatively on postpartum depression after cesarean section: A randomized, double-blinded controlled trial.

To evaluate the effect of pre-administration of esketamine intraoperatively on the occurrence of postpartum depression after cesarean section under combined spinal-epidural anesthesia. A total of 120 women aged 24 to 36 years undergoing cesarean section by spinal-epidural anesthesia with American Society of Anesthesiologists physical status II were enrolled. According to the intraoperative use of esketamine, all participants were randomly divided into 2 groups: test group (group E) and control group (group C). Esketamine was administered intravenously at a dose of 0.2 mg/kg after the infant was delivered in group E and equal volume of normal saline was given in group C. The incidence of postpartum depression was recorded at 1 week and 6 weeks after the operation. The occurrence of adverse reactions such as postpartum bleeding, nausea and vomiting, drowsiness, and nightmares were also recorded at 48 hours after surgery. Compared with group C, the incidence of postpartum depression was significantly lower at 1 week and 6 weeks after surgery in group E (P < .01). There was no significant difference of the adverse effects at 48 hours after the operation between the 2 groups. Intravenous infusion of 0.2 mg/kg esketamine in women during cesarean section can significantly reduce the incidence of postpartum depression at 1 week and 6 weeks after surgery without increasing related adverse effects.

SAFETY MONITORING OF COVID-19 VACCINE: IN A TERTIARY CARE HOSPITAL IN HARYANA

Objective: The present study aimed to ensure the safety and related potential adverse effects following ChAdOx1 nCoV-19 vaccination (AZD1222) in a scenario when numerous vaccines have been approved on an emergency basis by the WHO and other regulatory agencies to prevent the widespread of COVID-19 infection and to decrease the associated mortality and morbidity. Methods: This study was an open, non-comparative, non-interventional, observational study conducted on healthcare workers of BPS Govt. medical college for women and elderly people who received the first dose of COVID-19 vaccinationChAdOx1 nCoV-19 vaccine (AZD1222) by conducting their interviews and recording the data Results: Between January and March 2021, a total of 1907 participants were enrolled in this study. Out of 1907 recipients, 70 recipients reports adverse drug events following vaccination. Myalgia (0.629%), headache (1.31%), fever (≥ 37.5 °C, 0.839%) and fever with chills (≥ 37.5 °C, 1.048) were the most common adverse events after the first dose of vaccination of ChAdOx1 nCoV-19 vaccine (AZD1222. Throat irritation (0.209 %) and Generalised itching (0.262) were the least common adverse events. Conclusion: ChAdOx1 nCoV-19 (Astrazeneca) has an acceptable safety profile as observed in this study. To our knowledge, very few studies are done that review the safety of COVID-19 vaccines. Further safety data from a larger sample size and of longer duration are warranted to establish safety

A phase 2 study of ibrutinib as neoadjuvant therapy in patients with localized prostate cancer.

387 Background: Treatment of localized prostate cancer (PCa) with surgery or radiotherapy remains suboptimal with failure rates of 35-40%. Bruton’s Tyrosine Kinase (BTK) is seen elevated in PCa tissues compared to normal prostate tissue. Malignant B-cell density has been correlated with higher risk of aggressive PCa and mitigating that through the BTK has been proposed in mouse models. Ibrutinib is a potent BTK inhibitor which targets B-cell signaling pathways, has an established safety profile, and has been shown to inhibit in vivo prostate tumor growth pre-clinically. Therefore, we hypothesized that ibrutinib will augment anti-tumor immune responses through inhibiting tumor-intrinsic growth via blocking BTK B-cell signaling pathways, while also inducing favorable T-cell profiles in localized PCa. Methods: We performed a neoadjuvant clinical trial (NCT02643667) studying ibrutinib in PCa. Eligible patients had localized PCa with no prior treatment, and deemed suitable for undergoing a radical prostatectomy. Patients received 840mg/day oral ibrutinib for 28 days followed by a radical prostatectomy 7-12 days later. Patients were assessed 4 weeks after surgery. The primary objectives are to assess safety of ibrutinib and characterize B and T cell infiltration. Correlative pre- and post- treatment tissue and blood samples were collected; BTK and PD-L1 expression in tumor and immune-infiltrating immune cells will be examined, and BCR and TCR clonality and diversity will be evaluated. Results: 22 patients were registered and underwent treatment to date. 4 patients had early termination of ibrutinib treatment with 3 due to adverse effects and 1 due to discovery of surgically unresectable disease. A total of 21 of 22 patients received radical prostatectomies. There were no intra-operative complications attributed to ibrutinib. The treatment was generally well tolerated with 7.1% grade 3 treatment related adverse effects. 2% experienced a grade 4 treatment adverse effects of hepatic dysfunction. The most common grade 1-2 adverse effects were diarrhea (8.2%), fatigue (7.1%), and anemia (6.1%). The median follow-up time was 23.9 months. Median overall survival and median failure free survival have not been reached and the two-year milestone is 100%. Sample collection is complete and immune correlative analyses are ongoing. Safety/tolerability, clinical outcomes, and preliminary correlative data will be reported. Conclusions: This is the first clinical trial of ibrutinib in PCa, and lays the foundation for larger future studies. Clinical trial information: NCT02643667 .

Enzalutamide-Induced Acute Maculopapular Rash in Treatment of Metastatic Prostate Cancer: First Case Report from a Tertiary Cancer Care Center of North India.

Enzalutamide is a new potent inhibitor of the signaling pathway for the androgen receptor with a half-life of 5.8 days. It has been on the market for the treatment of metastatic castration-resistant prostate cancer since November 2013.We report a case of acute generalized exanthematous maculopapular rash induced by enzalutamide. In summary, newer androgen receptor blockers have a propensity to cause skin related adverse effects. Most common among these are apalutamide. Enzalumatamide, per se, is a safe drug and has not been associated frequently in causing maculopapular rash. Few cases has been reported. In all these cases, the drug was discontinued and 2nd line therapy was instituted. In this report, Enzalutamide was withheld for 10 days and anti-histaminics was instituted. After a full recovery, Enzalutamide was reinstituted in treatment.A 62-year-old male patient with no significant medical history, was diagnosed in March 2020 with metastatic prostatic adenocarcinoma. Baseline PSA was 456 ng/ml. PSMA PET scan showed evidence of multiple bony metastasis. He was started on Degarelix subcutaneous injection with oral abiraterone initially. PSA level showed initial decreasing trend till September 2021 followed by sudden increase. Intramuscular Injection leuprolide was started and initial responses were good followed by later rise of PSA from January. Tab Xtandi (Enzalutamide) was added to the regimen from 31.1.22. Three days after starting enzalutamide treatment, the patient experienced an acute skin reaction. It is about of the plaques covered with widespread millimetric non-follicular papules. Enzalutamide was stopped after appearance of rashes to avoid further serious adverse effects. Anti-histaminics were started. Complete resolution of skin lesions occurred within 10 days. Tab Enzalutamide was reinstituted on 11th day after stoppage and on complete resolution of skin resolutions. According to the CTCAE 5.0 criteria, these skin rash was graded as grade 2. In view of evidence in literature and clinical improvement after stoppage, the acute drug reaction was attributed to enzalutamide.Uro oncologist can be confronted with adverse skin drug reactions attributable to new therapeutic molecules. The slow resolution of symptoms seems be due to the long half-life of enzalutamide. It should not be withdrawn from therapy owing to these effects. Rather, it should be with stopped for 10-14 days. Basic treatment with anti-histaminics or topical steroids may be enough to warranty the resolution of symptoms, and the drug (Enzalutamide) can be continued thereafter.

Rituximab as Initial Therapy in Adult Patients With Minimal Change Disease

Rituximab as Initial Therapy in Adult Patients With Minimal Change Disease

Opioid sparing effects of intravenous and oral acetaminophen in hip fracture patients: A population-based study

Study objectiveAcetaminophen (APAP) and intravenous acetaminophen (IVAPAP) has been proposed as a part of many opioid-sparing multimodal analgesic pathways. The aim of this analysis was to compare the effectiveness of IVAPAP with oral APAP on opioid utilization and opioid-related adverse effects. DesignRetrospective study of population-based database. PatientsThe Premier Healthcare database was queried patients undergoing surgery for a primary diagnosis of hip fracture from 2011 to 2019 yielding 245,976 patients. Primary exposure was use of IVAPAP or oral APAP on the day of surgery. InterventionsNone. MeasurementsThe primary outcome of interest was opioid utilization over the hospital stay, secondary outcomes included opioid-related adverse effects, length, and costs of hospital stay. Mixed effect models measured the association of IVPAP and APAP and outcomes. Main resultsIn the study population 30.67% (75,445) received at least 1 dose of IVAPAP on the day of surgery. Upon adjusting for relevant covariates, patients who received IVPAP on the day of surgery had slightly higher opioid use standardized by length of hospital stay (2.8% CI: 2%, 3.6%; p < .001), higher hospital cost (2.7% CI: 2.1%, 3.4%), and higher odds of naloxone use (1.18, CI: 1.1, 1.27; p < .001) when compared with patients who received oral APAP. ConclusionsIn this population, IVAPAP use on the day of surgery failed to reduce opioid use or associated opioid related adverse effects when compared with oral APAP. IVAPAP was associated with increased overall costs, opioid requirements, and naloxone use. These results do not support the use of IV over oral APAP routinely for hip fracture surgery patients.

A Study on Dispensing Pattern of OTC (Over the Counter) Medication among Community Pharmacist in Kalaburagi City

Purpose: Over the counter drugs (OTC) are sold without the prescription of a registered medical practitioner. There are reports that OTC drug market in India is on the rise. This is attributed to the rising cost of healthcare, difficulty in accessing healthcare, and an alarming tendency to self-manage symptoms. The outcome of this is OTC related adverse effects, abuse and hospitalizations.&#x0D; Subjects and Methods: The primary objective was to assess the knowledge of drug dispensing pattern of community pharmacists. The secondary objective was to assess the knowledge regarding drug related problems of over the counter medication. The tertiary objective was to find out whether the pharmacists involving in counselling activities. A community based, observational study was conducted among community pharmacist in Kalaburagi city, to find out knowledge on dispensing pattern of OTC medication. All the community pharmacist participated in the study were provided with a data collection form including self -structured questionnaires. One week after pre-test all the community pharmacist were educated regarding OTC drugs by means of providing information leaflets about OTC drugs. Post-test has been taken after 15 days of education by means of same questionnaires. Data were entered into Excel and analyzed using SPSS software. Pre and post intervention data were compared using student’s t-test.&#x0D; Results: Among 110 pharmacist, males 98 (89.1%) were more compared to females 12(10.9%). The mean knowledge scores on drug dispensing pattern of community pharmacist in pre-test were 57.0% and post test is 87.6%.&#x0D; Conclusions: Among 110 pharmacist, males 98 (89.1%) were more compared to females 12(10.9%). The mean knowledge scores on drug dispensing pattern of community pharmacist in pre-test were 57.0% and post test is 87.6%.

Xanthine Oxidase Inhibitory Activity of Ethanolic Extract of Ficus Carica Fruit

Hyperuricemia is a purine metabolism disorder characterised by an excess of uric acid in the blood and considered as a risk factor for gout, coronary heart disease, hypertension, diabetes, and a variety of other illnesses. Xanthine oxidase inhibitors have key role in management of hyperuricemia and related disorders but multiple adverse effects associated with these agents have minimized their chronic use. Ficus carica fruit has been widely used around world as a therapeutic agent for several disorders. In traditional medicine it has been used to treat gouty arthritis but the effect has not been scientifically established so far. Objective: This study was conducted to assess the in vitro xanthine oxidase inhibition of Ficus carica fruit extract. Method: The ethanolic extract of Ficus carica fruit was evaluated in vitro at five different doses for its xanthine oxidase inhibition. Xanthine oxidase inhibitory activity was measured spectrophotometrically and inhibitory concentration IC 50 was calculated. The dose dependant inhibition of Ficus carica fruit was compared with inhibition of standard drug allopurinol. Results: Ficus carica fruit extract was found to possess xanthine oxidase inhibition with IC50 27.5 µg/ml in comparison to the allopurinol with IC50 11.0 µg/ml.Thus the agent can be used as alternative to standard drug allopurinol for treatment of hyperuricemia and related disorders. Conclusion: The study showed that Ficus carica fruit has potential to inhibit the xanthine oxidase so can be used as natural source to treat gout and many other xanthine oxidase related medical disorders. Keywords: Ficus carica Extract (FCE), Xanthine Oxidase (XO), Xanthine Oxidase Inhibition (XOI), Hyperuricemeia (HU).

EFFICACY AND SAFETY OF VEDOLIZUMAB AND TUMOR NECROSIS FACTOR INHIBITORS IN THE TREATMENT OF STEROID-REFRACTORY MICROSCOPIC COLITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract BACKGROUND Tumor necrosis factor (TNF-α) inhibitors and the α4β7 integrin antagonist, vedolizumab have been investigated as a treatment option for patients with steroid-refractory microscopic colitis (MC) with controversial findings. AIMS To perform a systematic review and meta-analysis to evaluate the benefit of vedolizumab and TNF-α inhibitors in patients with steroid-refractory MC. METHODS Retrospective cohort studies and case series involving adult patients with steroid-refractory MC who either received vedolizumab, adalimumab, or infliximab were eligible for inclusion. Outcomes of interest included the rate of clinical remission at induction, clinical response, maintenance of remission, histologic remission, and overall medication related adverse effects. Pooled proportional meta-analyses were used to calculate the overall rates of the primary and secondary endpoints. Heterogeneity was assessed using the I2 statistic. Publication bias was assessed via visual inspection of the funnel plots and using Egger’s regression. All statistical analysis was performed in R using the metafor and meta packages. RESULTS A total of 14 retrospective case series/studies involving 164 patients were included. Pooled analysis showed a clinical remission rate of 63.5% (95% CI [0.483; 0.776], I2=43% P=0.08), 57.8% (95% CI [0.3895; 0.7571], I2=0%, P=0.7541), and 39.3% (95% CI [0.0814; 0.7492, I2=66%, P=0.02) for vedolizumab, infliximab, and adalimumab, respectively. The maintenance of remission rate was 60.5% (95% CI [0.2772; 0.8953], I2=67%, P=0.03), 45.3% (95% CI [0.1479; 0.7747], I2=0%, P=0.36) and 32.5% (95% CI [0.000; 0.8508], I2=53%, P=0.14) in patients who received vedolizumab, infliximab, and adalimumab, respectively. Rate of biologic-related adverse events warranting discontinuation of therapy was 12.2%, 32.9%, and 23.0% for the vedolizumab, infliximab, and adalimumab groups, respectively. CONCLUSION Vedolizumab and anti-TNF-α agents demonstrated a clinical benefit in the treatment of steroid-refractory MC and with a tolerable safety profile. Given the nature of included studies, superiority of either therapy could not be elucidated. Future randomized controlled trials are needed to standardize study protocols, compare vedolizumab with TNF-α inhibitors, and further examine data on patients’ quality of life. Forest plot showing the pooled clinical remission rate at induction in patients with steroid-refractory microscopic colitis receiving (A) vedolizumab or TNF inhibitors (B) Data summary of the meta-analyses of the studies investigating secondary endpoints in patients with refractory MC receiving either (A) vedolizumab or (B) TNF inhibitors ABBREVIATIONS MR, maintenance remission; CR, clinical response; HR, histologic remission; OAE, overall adverse effects.

Application of Repetitive Transcranial Magnetic Stimulation in Neuropathic Pain: A Narrative Review.

Neuropathic pain, affecting 6.9-10% of the general population, has a negative impact on patients' quality of life and potentially leads to functional impairment and disability. Repetitive transcranial magnetic stimulation (rTMS)-a safe, indirect and non-invasive technique-has been increasingly applied for treating neuropathic pain. The mechanism underlying rTMS is not yet well understood, and the analgesic effects of rTMS have been inconsistent with respect to different settings/parameters, causing insufficient evidence to determine its efficacy in patients with neuropathic pain. This narrative review aimed to provide an up-to-date overview of rTMS for treating neuropathic pain as well as to summarize the treatment protocols and related adverse effects from existing clinical trials. Current evidence supports the use of 10 Hz HF-rTMS of the primary motor cortex to reduce neuropathic pain, especially in patients with spinal cord injury, diabetic neuropathy and post-herpetic neuralgia. However, the lack of standardized protocols impedes the universal use of rTMS for neuropathic pain. rTMS was hypothesized to achieve analgesic effects by upregulating the pain threshold, inhibiting pain impulse, modulating the brain cortex, altering imbalanced functional connectivity, regulating neurotrophin and increasing endogenous opioid and anti-inflammatory cytokines. Further studies are warranted to explore the differences in the parameters/settings of rTMS for treating neuropathic pain due to different disease types.

Configuring Therapeutic Aspects of Immune Checkpoints in Lung Cancer.

Immune checkpoints are unique components of the body's defense mechanism that safeguard the body from immune responses that are potent enough to harm healthy body cells. When proteins present on the surface of T cells recognize and bind to the proteins present on other tumor cells, immune checkpoints are triggered. These proteins are called immunological checkpoints. The T cells receive an on/off signal when the checkpoints interact with companion proteins. This might avert the host's immune system from eliminating cancer cells. The standard care plan for the treatment of non-small cell lung cancer (NSCLC) has been revolutionized with the use of drugs targeting immune checkpoints, in particular programmed cell death protein 1. These drugs are now extended for their potential to manage SCLC. However, it is acknowledged that these drugs have specific immune related adverse effects. Herein, we discuss the use of immune checkpoint inhibitors in patients with NSCLC and SCLC, their outcomes, and future perspectives.

Perception of Climate Change Impacts on Livelihoods in Central Mali

The main objective of this research is to analyze the perceptions of local communities on climate change and its impacts on livelihoods in Central Mali. A survey data collected using multistage random sampling methods have been used for that purpose. From the result, the multinomial logit analysis, shows that households in Central Mali are well aware of climate change, its different manifestations (change in temperature, in precipitation duration and amount, in wind etc.) and the related adverse effects on their livelihoods. However, they face considerable challenges in adapting to those changes in climate. Lack of funds and credit facilities, lack of access to timely weather information, lack of technologies (physical infrastructure, technical material and equipment), lack of knowledge regarding adaptation technics (required human skills, e.g., applying specific planning and management approaches and methods), lack of appropriate seeds have been identified as the major critical barriers to climate change adaptation in the region. These constraints probably explain why individuals often resort to poor but more affordable adaptation strategies which are conflict sensitive and likely to disrupt social cohesion between local communities. In this context, implementing policies aiming at improving the effectiveness of extension services in supporting households to better adapt to climate change could be of great importance.

Impact of hematopoietic stem cell transplantation in glycogen storage disease type Ib: A single-subject research design using 13C-glucose breath test

BackgroundGlycogen storage disease type Ib (GSD Ib) is an autosomal recessively inherited deficiency of the glucose-6-phosphate translocase (G6PT). Clinical features include a combination of a metabolic phenotype (fasting hypoglycemia, lactic acidosis, hepatomegaly) and a hematologic phenotype with neutropenia and neutrophil dysfunction. Dietary treatment involves provision of starches such as uncooked cornstarch (UCCS) and Glycosade® to provide prolonged enteral supply of glucose. Granulocyte colony-stimulating factor (G-CSF) is the treatment of choice for neutropenia. Because long-term stimulation of hematopoiesis with G-CSF causes serious complications such as splenomegaly, hypersplenism, and osteopenia; hematopoietic stem cell transplantation (HSCT) has been considered in some patients with GSD Ib to correct neutropenia and avoid G-CSF related adverse effects. Whether HSCT also has an effect on the metabolic phenotype and utilization of carbohydrate sources has not been determined. ObjectiveOur objective was to measure the utilization of starch in a patient with GSD Ib before and after HSCT using the minimally invasive 13C-glucose breath test (13C-GBT). DesignA case of GSD Ib (18y; female) underwent 13C-GBT four times: UCCS (pre-HSCT), UCCS (3, 5 months post-HSCT) and Glycosade® (6 months post-HSCT) with a dose of 80 g administered via nasogastric tube after a 4 h fast according to our patient's fasting tolerance. Breath samples were collected at baseline and every 30 min for 240 min. Rate of CO2 production was measured at 120 min using indirect calorimetry. Finger-prick blood glucose was measured using a glucometer hourly to test hypoglycemia (glucose <4 mmol/L). Biochemical and clinical data were obtained from the medical records as a post-hoc chart review. ResultsUCCS utilization was significantly higher in GSD Ib pre-HSCT, which reduced and stabilized 5 months post-HSCT. UCCS and Glycosade® utilizations were low and not different at 5 and 6 months post-HSCT. Blood glucose concentrations were not significantly different at any time point. ConclusionsFindings show that HSCT stabilized UCCS utilization, as reflected by lower and stable glucose oxidation. The results also illustrate the application of 13C-GBT to examine glucose metabolism in response to various carbohydrate sources after other treatment modalities like HSCT in GSD Ib.

Opioid-based Anaesthesia versus Opioid Free Anaesthesia in Laparoscopic Cholecystectomies: A Randomised Clinical Study

Introduction: Intravenous opioids have been frequently used to provide analgesia and supplemental sedation during general anaesthesia or monitored anaesthesia care. Opioid Free Anaesthesia (OFA) is a multimodal approach which combines different drugs likes lignocaine, dexamethasone, paracetamol and dexmedetomidine with different techniquessuch as hypnosis, sedation, analgesia and sympatholysis. Thus, reducing and avoiding opioids perioperatively will lead to decrease in opioid related adverse effects with better postoperative outcomes. Aim: To compare OFA and Opioid-based Anaesthesia (OBA) in terms of haemodynamic stability, speed and quality of recovery, postoperative pain score and analgesic requirement. Material and Methods: The present study was a randomised study conducted over a period from June 2021 to September 2022, in which 90 patients of American Society of Anaesthesiologists (ASA) Grade I,II, 20-60 years of age undergoing elective Laparoscopic Cholecystectomy (LC) were divided into OBA fentanyl and OFA-lignocaine and dexmedetomidine. A standard general anaesthesia protocol of the institute was followed. OBA group received fentanyl (2 μg/kg) over 10 minutes before induction of anaesthesia and OFA group received lignocaine (2 mg/kg) and dexmedetomidine (0.5 μg/kg) both intravenously over 10 minutes before induction of anaesthesia. In OFA group analgesia was maintained by infusion of lignocaine 2 mg/kg/hr and dexmedetomidine 0.5 μg/kg/hr whereas in OBA group fentanyl 0.5 μg/kg was given whenever required till the gallbladder was resected. Postoperative intraperitoneal instillation of gallbaldder fossa was done with 20 mL 0.5% bupivacaine. Intraoperative mean Heart Rate (HR) and Mean Arterial Pressure (MAP) were recorded. Postoperative speed and quality of recovery, pain score, analgesic requirements and incidence of Postoperative Nausea and Vomiting (PONV) were noted. Paracetamol 15 mg/kg was given intravenously whenever Numerical Rating Scale (NRS) score was ≥6. Comparison of means between the two groups was done using unpaired t-test, association between two non parametric variables was done using Pearson Chi-square (χ2 test) test. Results: The mean age, sex, weight, ASA and duration of surgery were comparable in both the groups. The mean HR and mean MAP were significantly lower in OFA group compared to the OBA group at all the time points (p-value=0.001). Although postoperative speed of recovery was slower in OFA group, the overall quality of recovery was better (p-value=0.001). The postoperative pain score, analgesic requirement and incidence of nausea and vomiting were all significantly less in OFA group as compared to OBA group with p-values of 0.02, 0.001 and 0.02, respectively. Conclusion: OFA is new anaesthetic approach that provides better perioperative haemodynamic stability, postoperative pain control with less PONV and thus can be used safely and successfully

Androgenic-anabolic steroid abuse trend and management: A prospective, cross-sectional, questionnaire-based survey.

Androgenic-anabolic steroid (AAS) abuse is a global health concern, studies revealing an increasing trend of abuse and deleterious effects on reproductive health. Unfortunately, there is no consensus about management pathways due to the lack of specific guidelines. A prospective study, multicentre, online survey, composed of 30 questions, was conducted to investigate the current trend of AAS abuse and the management followed by practitioners from different specialities dealing with this condition. A total of 151 respondents were included. The majority were general urologists (68.21%), andrologists (22.51%), and endocrinologists (9.28%). An increasing trend of AAS abuse was noticed by 90.73%of participants mostly in young age populations. Most of AAS abusers were presented with infertility (64.24%) and erectile dysfunction (59.60%), and their investigations showed abnormal semen analysis (77.48%), abnormal hormones (follicle-stimulating hormone, luteinizing hormone, testosterone, and estradiol) (94.70%), and reduction in testicular size (50.33%). Most of respondents expected: the need of long duration for spontaneous recovery (6-12 months), relapse of AAS abuse in one-third of patients, less knowledge about the adverse effects (39.74%), and risk of drug dependence (54.30%). Immediate treatment was the most offered plan of management (44.37%) followed by a waiting spontaneous recovery (32.45%), while the remaining would refer the patients to an either endocrinologist or andrologist. The treating physicians did not follow specific guidelines and most of participants (44.44%) reverted to their personal experience in the management. Our study revealed an increasing trend of AAS abuse, deleterious effects of AAS use on reproductive health, and lack of consensuses among the treating physicians regarding the management of related adverse effects. Our study could be considered a call to the scientific bodies to have more studies, establish guidelines for management, and to have better awareness of this serious public health concern.

Oral acute, sub-acute toxicity and phytochemical profile of Brassica carinata A. Braun microgreens ethanolic extract in Wistar rats

Ethnopharmacological relevanceCurrently, there is a remarkable increase in the consumption of microgreens, (young edible vegetables or herbs), as potential nutraceuticals for the management of diseases. Brassica carinata A. Braun is one of the traditional leafy vegetables cultivated in various parts of Sub- Saharan Africa. The plant is revered for its efficacy in the treatment of wounds and gastrointestinal disorders among other medicinal benefits. It is therefore crucial to characterize Brassica carinata microgreens for their phytoconstituents and ascertain their safety for use. Aim of the studyThe study evaluated the oral acute and subacute toxicity of Brassica carinata microgreens ethanol extract (BMEE) in Wistar rats and identification of its chemical composition and profile. Materials and methodsFor acute toxicity (14 days), rats were grouped into four and received a single oral dose, the control group received distilled water, while others received 500 mg/kg, 1000 mg/kg, and 2000 mg/kg of BMEE. For the subacute toxicity (28 days), rats in four groups received daily doses of 250 mg/kg, 500 mg/kg or 1000 mg/kg and distilled water. Daily clinical observations like lethargy and mortality were conducted. Hematological, biochemical, and histopathological evaluations were performed at the end of each experiment. Phytochemical profile was determined using a UV-VIS spectrophotometer and Gas Chromatography coupled to Mass Spectrometry (GC-MS) analysis determined the potential bioactive components in the microgreens extract. ResultsIn both acute and sub-acute toxicity studies, no mortalities, indications of abnormality, or any treatment related adverse effects were observed at doses of 2000 mg/kg, 1000 mg/kg, 500 mg/kg, and 250 mg/kg. The LD50 of BMEE was above 2000 mg/kg. No significant (p > 0.05) changes in the hematological and biochemical parameters of the treated groups compared to the control groups in both studies. Histopathological examination of the liver, kidney, lungs, and heart revealed a normal architecture of the tissues in all the treated animals. Phytochemical analyses revealed the presence of flavonoids (most abundant), phenols and alkaloids. Phytol, linoleic acid, and 9,12,15-octadecatrienoic acid, among other compounds, were identified by GC-MS analysis. ConclusionThe results showed that B. carinata microgreens ethanol extract is nontoxic and found to have several compounds with reported pharmacological significance suggesting safety for use.

Extracellular polymeric substances from soil-grown bacteria delay evaporative drying

When soils dry, water flow and nutrient diffusion cease as the hydraulic microenvironments vital for soil life become fragmented. To delay soil drying locally and related adverse effects, bacteria and plants modify their surroundings by releasing extracellular polymeric substances (EPS). As a result, the physical properties of hotspots like biological soil crusts or the rhizosphere differ from those of the surrounding bulk soil. Specifically, the presence of EPS delays evaporative soil drying. Despite the evidence of reduced evaporation from EPS-amended soils, the mechanisms controlling soil water content dynamics remain elusive. Thus, our study aimed to elucidate the potential of bacteria to modify their local environment when exposed to oscillations in soil water content induced by evaporative drying. We incubated sand microcosms with two contrasting strains of Bacillus subtilis for one week in a flow cabinet. At the end of the incubation period, local water loss was quantified and spatially resolved using time-series neutron radiography. Strain NCIB 3610, a complex biofilm producer steadily modified soil evaporation dynamics during the incubation period resulting in a substantial delay in soil drying due to hydraulic decoupling of the evaporation front from the soil surface. Evaporation dynamics remained largely unaltered in the microcosms inoculated with the domesticated strain 168 trp+ compared to the control treatment. The mechanism of hydraulic decoupling induced by NCIB 3610 was verified by estimates of diffusive fluxes and the position of the evaporation plane in the microcosm. Additionally, the role of polymeric substances in hydraulic decoupling was confirmed by an evaporation experiment using xanthan as an EPS analogue.

Pain management in total knee arthroplasty. A comprehensive review

Total knee arthroplasty (TKA) is one of the most common surgeries performed to relieve joint pain in patients with end-stage osteoarthritis or rheumatic arthritis of the knee. However, TKA is followed by moderate to severe postoperative pain that affects postoperative rehabilitation, patient satisfaction, and overall outcomes. Historically, opioids have been widely used for the perioperative pain management of TKA. However, opioids are associated with undesirable adverse effects, such as nausea, respiratory depression, and urine retention, which limit their application in daily clinical practice. This review aimed to discuss the current postoperative pain management regimens for TKA. Our review of literature demonstrated that multimodal analgesia is considered the optimal regimen for perioperative pain management of TKA and improves clinical outcomes and patient satisfaction, through a combination of several types of medications, including preemptive analgesia, especially local infiltration analgesia and peripheral nerve blockade. Multimodal analgesia provides superior pain relief, promotes knee recovery, and reduces opioid consumption and related adverse effects in patients undergoing TKA.

1940. COVID-19 Vaccines and Related Adverse Effects among Health Sciences and Non-Health Sciences Students from Two Large Public Universities in Thailand

Abstract Background Existing data on vaccine regimens received by university students and related adverse effects are limited. Methods An online survey study was conducted among students from 12 Health Sciences faculties (HS), including Faculty of Medicine and from 16 non-Health Sciences faculties (NHS) of two large urban Thai universities from October 2021 to January 2022. Types, doses and adverse effects (AEs) of COVID-19 vaccines received by HS and NHS were assessed. Results There were 1,439 participating students who had received two doses of COVID-19 vaccines. Of these 1,439 students, 522 (36%) were HS (208 were medical students), 393 (27%) were from faculties of Sciences, and 524 (37%) were from faculties of Social Sciences. The types of the first dose vaccine received were inactivated (49%), viral vector (46%) and mRNA (5%), while the types of the second dose vaccine received were viral vector (53%), inactivated (40%) and mRNA (7%). For the first dose vaccines, the most common AE of inactivated, viral vector and mRNA vaccines were muscle pain (47%, 82%, 58%, respectively). For the second dose vaccines, the most common AE were cough (47%) for inactivated vaccines and muscle pain (49% for viral vector and 56% for mRNA vaccines). Viral vector vaccines were more likely to cause fever, muscle pain, diarrhea, headache and rashes while inactivated vaccines were more likely to cause cough. The mRNA vaccines caused injection site pain more than inactivated vaccines. Tables 1 and 2 demonstrate the type and onset of AEs by types of the vaccines. Overall, the majority of AEs occurred at 24-48 hours after vaccination (57-68%), were more severe with the first dose compared to the second dose (59%) and resolved spontaneously or with symptomatic treatment without the need for hospitalization (98%). The AEs experienced by HS and NHS were different according to the types of vaccine they received. Table 1Adverse effects of the first dose of COVID-19 vaccine, stratified by type, of those who had received two doses of the vaccinesTable 2Adverse effects of the second dose of COVID-19 vaccine, stratified by type, of those who had received two doses of the vaccines. Conclusion The AEs experienced by the students were different according to the type and number of doses of COVID-19 vaccines. The AEs were mostly non-severe and occurred less for the second dose compared to the first dose. The study findings could serve as information provided to university students for decision making regarding COVID-19 vaccination. Disclosures All Authors: No reported disclosures.