Double Dose Research Articles

A spectrometric analysis of variedly purified cinnabar in a siddha drug- linga chendhooram.

A siddha drug, linga chendhooram was prepared from cinnabar (lingam) and Citrullus colocynthis L. The transition of heavy metals concentration throughout theprocess were analysed to comprehend the significance ofdrug preparatory methods. In addition to that the main constituent cinnabar was purified from two different methods to comparatively analyse the significance of purification methods. Atomic absorption spectrometric studies were employed to obtain the concentration of class I heavy metals (lead, arsenic, cadmium and mercury) in all five samples- raw cinnabar (R), cinnabar purified (P1 and P2) from purification method 1 and 2, linga chendhooram (D1 and D2) prepared from P1 and P2. Based on the permissible limits given by The Ayurvedic Pharmacopoeia of India, except cadmium the concentrations of all other three heavy metals were found to be above the limit in P1, P2, D1 and D2. According to the oral Permitted Daily Exposure values for elemental impurities given in ICH Q3D(R1) Guidelines, D1 was within the permissible limits for both single and double oral doses whereas D2 showed a slight increase in the concentration of lead in a single oral dose itself. The drug preparatory method showed a reduction of the heavy metals concentration and comparative analysis of the purification methods revealed a substantial reduction of heavy metals concentration in the end drug D1 when compared with D2 showing that the methods of purification and drug preparation in siddha system plays a vital role in reducing the concentrations of heavy metals accordingly.

Effect of long-term proton pump inhibitors on phosphocalcium metabolism and bone mineral density.

Aim: Although Proton pump inhibitors (PPIs) are well-tolerated, their long-term use may be associated with decreased bone mass. Methods: This is a case-control study including patients treated with PPIs (>1year) and control subjects who have not received PPIs treatment. Results: A total of 90 patients and 90 matched controls were included. PPIs use was associated with hypocalcemia and hypomagnesemia. Vitamin D3 deficiency and hyperparathyroidism were associated with PPIs use. Long-term PPIs use was significantly associated with decreased bone density. Risk factors of decreased bone mineral density (BMD) included age >50years, menopause, lack of sun exposure, double PPIs dose, daily intake, post-meal intake and association with a mucoprotective agent. Conclusion: Our results highlight the risk of decreased BMD in patients on long-term PPIs treatment.

Dissipation pattern of tetraniliprole in/on green chilies

Field and lab experiments explored tetraniliprole dissipation in chili plants. A supervised trial in Devarayapuram village, Coimbatore, assessed the CO2 chili variety (December–March 2018–2019). Using the Quick, Easy, Cheap, Effective, Rugged, and Safe (QuEChERS) method and ultra-high-performance liquid chromatography (UHPLC), samples were collected up to 15 d post-application. Initial tetraniliprole deposits on chili fruits, 1-h post-spray, were 0.898 and 1.271 μg g−1 at single and double doses. Over 80% dissipated within 5 d, reaching below detection limits by day 7 and 10 for single and double doses, respectively. Transformation analysis favored first-order kinetics. Tetraniliprole half-life on chili fruit was 1.49 and 1.53 d at recommended and double doses. The safe waiting period was 4.16 and 5.04 d for 60 and 120 g a.i ha−1. This study provides insights into tetraniliprole dynamics in chili plants, crucial for effective pesticide management.

Safety and prescribing recommendations for verapamil in newly diagnosed pediatric type 1 diabetes (T1D): The CLVer experience

ObjectivesTo report the safety and side effects associated with taking verapamil for beta-cell preservation in children with newly-diagnosed T1D. Research Design and MethodsEighty-eight participants aged 8.5 to 17.9 years weighing ≥ 30 kg were randomly assigned to verapamil (N = 47) or placebo (N = 41) within 31 days of T1D diagnosis and followed for 12 months from diagnosis, main CLVer study. Drug dosing was weight-based with incremental increases to full dosage. Side effect monitoring included serial measurements of pulse, blood pressure, liver enzymes, and electrocardiograms (ECGs). At study end, participants were enrolled in an observational extension study (CLVerEx), which is ongoing. No study drug is provided during the extension, but participants may use verapamil if prescribed by their diabetes care team. ResultsOverall rates of adverse events were low and comparable between verapamil and placebo groups. There was no difference in the frequency of liver function abnormalities. Three CLVer participants reduced or discontinued medication due to asymptomatic ECG changes. One CLVerEx participant (18 years old), treated with placebo during CLVer, who had not had a monitoring ECG, experienced complete AV block with a severe hypotensive episode 6 weeks after reaching his maximum verapamil dose following an inadvertent double dose on the day of the event. ConclusionsThe use of verapamil in youth newly-diagnosed with T1D appears generally safe and well tolerated with appropriate monitoring. We strongly recommend monitoring for potential side effects including an ECG at screening and an additional ECG once full dosage is reached.ClinicalTrials.gov number: NCT04233034.

Optimizing phosphorus fertilization for two commonly grown ground covers: creeping jenny and periwinkle

Growing nursery plants in containers usually requires the addition of fertilizer to achieve optimal growth. However, misconceptions among growers often lead them to apply quantities of fertilizers exceeding the recommended dose, resulting in nutrient runoff and increased production costs. Reducing fertilizer application is beneficial to have healthy plants and environment as well as to save on fertilizer costs. In this study, we wanted to determine the minimal level of phosphorus (P) required to grow bedding plants i.e. Lysimachia nummularia ‘creeping jenny’ (moneywort) and Vinca minor ‘Bowles’ (periwinkle) in nursery. The plants were grown within a greenhouse in a mixture of peat moss, vermiculite, and rice hulls (3:1:1 v/v) substrates and subjected to various P treatments. The treatments included single dose of 1, 3, or 6 mg/L of P, double doses of 3 or 6 mg/L of P, or a control that received 6 mg/L of P at each irrigation. The results indicated that single dose of 6 mg/L of P had similar fresh weight compared to control in both taxa. Reducing P application further to a single dose of 1 and 3 mg/L reduced fresh weight and leaf area in both groundcovers however did not reduce their stem length or physiological parameters such as Soil Plant Analysis Development (SPAD) and normalized difference vegetation index (NDVI). Phosphorus concentration in the plant tissue at maturity was lower in all treatments than control for both the taxa. During the study period, control plants received 26 times the dose of P compared to plants receiving 6 mg/L of P once. Therefore, this study outlines the possibility of reducing P fertilizer application while growing these groundcovers in nurseries for sale.

Safety and effectiveness of single- versus double-dose of seasonal influenza vaccine in kidney transplant recipients: a randomized clinical trial

Introduction. Influenza virus poses significant risks to immunocompromised individuals such as those who have received organ transplants and are undergoing immunosuppressive treatment to prevent transplant rejection. Therefore, annual influenza vaccination is recommended for these individuals. This study aimed to comparison of safety and effectiveness of single- versus double-dose of seasonal influenza vaccine in kidney transplant recipients. Materials and methods. This randomized clinical trial involved 50 kidney transplant recipients at Imam Khomeini Hospital. Participants were randomly assigned to two groups: those receiving a single dose (standard dose) and those receiving a double dose of the seasonal flu vaccine. Serum samples were collected before and 4 weeks after vaccination to measure influenza AB-related antibodies. Sixteen patients were excluded from the study. The trial focused on evaluating the vaccine safety and immunogenicity, as well as documenting any local and systemic side effects following vaccination. Results. The results indicated no significant difference in gender, age, and type of immunosuppressive drug used between the single- and double-dose groups (p 0.05). No significant difference in post-vaccination adverse effects, such as injection site pain (p = 0.21) between the two groups. The seroconversion rates (change from IgG 9 IU/µL to IgG 11 IU/µL) for IgG Influenza A were 12.5% (n = 2) in the single-dose group and 26.7% (n = 4) in the double-dose group, and for IgG Influenza B, they were 11.8% (n = 2) and 21.4% (n = 3), respectively. Conclusion. A double dose of the influenza vaccine slightly enhanced the immune response in kidney transplant patients without causing any adverse side effects.

Dissipation, processing factors and dietary risk assessment of the bioinsecticide abamectin in herbal plants belonging to Lamiaceae family from open field to herbal tea infusion

Abamectin, the mixture of avermectin B1a and B1b, is widely used as a bioinsecticide and is an alternative to chemical pest control from insects. To our knowledge, its behaviour is not fully recognized, especially in herbs. Thus, the objective of this study was to investigate the environmental fate of abamectin in herbal plants belonging to the Lamiaceae family, its dissipation in open field studies laboratory processing treatments and dietary risk assessment. Three medicinally and culinary important species of herbs: Melissa officinalis L., Mentha × piperita L. and Salvia L. were treated with single and double dose than recommended on the label during their cultivation (BBCH 11–29). Residues were monitored using the QuEChERS method followed by the LC-MS/MS. The dissipation pattern of the sum of avermectin B1a and B1b and their persistence were observed 14 d after spraying. Abamectin decline was very rapid in plants and followed the first-order kinetics model. The half-life (t1/2) was in the range of 0.96–1.08 d (single dose) and 0.93–1.02 d (double dose). The pre-harvest intervals (decrease to the level of 0.01 mg kg−1) were 7.29–7.92 d at single and 7.99–8.64 d at double dose application. Herbal infusion preparation in previously washed and dried mint, lemon balm and sage leaves was the key processing step in the removal of abamectin residues. The reduction of initial deposits after single dose treatment was noted up to 65% (PF = 0.35–0.67) and up to 79% after double dose application (PF = 0.21–0.72) in herbal tea. Acute risk assessment of children and adults for the highest residues in EFSA PRIMo model at single and double dose expressed as hazard quotients (HQ) were <1, indicating no risk to humans via consumption of the herbal products. The data provide a better understanding of abamectin behaviour in herbal plants and can help assure herbs' safety for consumers.

Lack of detectable sex differences in the mitochondrial function of Caenorhabditis elegans

BackgroundSex differences in mitochondrial function have been reported in multiple tissue and cell types. Additionally, sex-variable responses to stressors including environmental pollutants and drugs that cause mitochondrial toxicity have been observed. The mechanisms that establish these differences are thought to include hormonal modulation, epigenetic regulation, double dosing of X-linked genes, and the maternal inheritance of mtDNA. Understanding the drivers of sex differences in mitochondrial function and being able to model them in vitro is important for identifying toxic compounds with sex-variable effects. Additionally, understanding how sex differences in mitochondrial function compare across species may permit insight into the drivers of these differences, which is important for basic biology research. This study explored whether Caenorhabditis elegans, a model organism commonly used to study stress biology and toxicology, exhibits sex differences in mitochondrial function and toxicant susceptibility. To assess sex differences in mitochondrial function, we utilized four male enriched populations (N2 wild-type male enriched, fog-2(q71), him-5(e1490), and him-8(e1498)). We performed whole worm respirometry and determined whole worm ATP levels and mtDNA copy number. To probe whether sex differences manifest only after stress and inform the growing use of C. elegans as a mitochondrial health and toxicologic model, we also assessed susceptibility to a classic mitochondrial toxicant, rotenone.ResultsWe detected few to no large differences in mitochondrial function between C. elegans sexes. Though we saw no sex differences in vulnerability to rotenone, we did observe sex differences in the uptake of this lipophilic compound, which may be of interest to those utilizing C. elegans as a model organism for toxicologic studies. Additionally, we observed altered non-mitochondrial respiration in two him strains, which may be of interest to other researchers utilizing these strains.ConclusionsBasal mitochondrial parameters in male and hermaphrodite C. elegans are similar, at least at the whole-organism level, as is toxicity associated with a mitochondrial Complex I inhibitor, rotenone. Our data highlights the limitation of using C. elegans as a model to study sex-variable mitochondrial function and toxicological responses.

Residues determination, risk assessment, and dissipation behavior of myclobutanil formulation on apple.

This study aimed to investigate the dissipation pattern, risk assessment, and waiting period of myclobutanil on apple fruit (Malus domestica Borkh.) under temperate conditions in Kashmir, India. The study involved the application of myclobutanil 10 WP at a single recommended dosage (125 g a.i.ha-1) and double dosage (250 g a.i.ha-1) on Red Velox apple trees, 2 months before harvest. GC equipped with an electron capture detector was used to analyze myclobutanil residues in fruit samples. The study revealed that myclobutanil, at both recommended and double recommended doses, dissipated rapidly and became nondetectable after 55 and 60 days, respectively. The waiting period for myclobutanil application was determined to be 12.41 days for the single dose and 25.58 days for the double dose, respectively. These waiting periods were based on the maximum residue limit of 0.6 ppm as prescribed by the Codex Alimentarius Commission, Food Safety and Standards Authority of India, and European Commission. The study concludes that myclobutanil 10 WP is safe for consumers at both recommended and double recommended doses when applied 2 months before harvest. Risk assessment, considering the average daily apple consumption in India and theoretical maximum residue contributions (TMRCs), indicates negligible health hazards even at double the recommended dosage. The calculated TMRC values at Day 0 were significantly below the maximum permissible intake. For average and maximum myclobutanil residues at single and double doses, the TMRC values were found to be 0.0069 and 0.0070 mg day-1 person-1 and 0.0105 and 0.0106 mg day-1 person-1, respectively. These results indicate that myclobutanil, when used according to recommended dosages and waiting periods, poses minimal health risks to consumers. The study emphasizes the importance of prudent fungicide use to minimize fungicide residues on fruits, thereby ensuring their safety for consumption.

The Effect of Combined Exposure of Fusarium Mycotoxins on Lipid Peroxidation, Antioxidant Defense, Fatty Acid Profile, and Histopathology in Laying Hens' Liver.

Fumonisin B1, T-2 toxin, and deoxynivalenol are frequently detected in feed materials. The mycotoxins induce free radical formation and, thereby, lipid peroxidation. The effects of mycotoxin exposure at the EU recommended limit (T-2/HT-2 toxin: 0.25 mg/kg; DON = 3AcDON/15-AScDON: 5 mg/kg; fumonisin B1: 20 mg/kg) and double dose (T-2/HT-2 toxin: 0.5 mg/kg, DON/3-AcDON/15-AcDON: 10 mg, and FB1: 40 mg/kg feed) were investigated during short-term (3 days) per os exposure in the liver of laying hens. On day 1 higher while on day 3 lower MDA concentrations were found in the low-dose group compared to the control. Fatty acid composition also changed: the proportion of monounsaturated fatty acids increased (p < 0.05) and the proportion of polyunsaturated fatty acids decreased by day 3. These alterations resulted in a decrease in the index of unsaturation and average fatty acid chain length. Histopathological alterations suggested that the incidence and severity of liver lesions were higher in the mycotoxin-treated laying hens, and the symptoms correlated with the fatty acid profile of total phospholipids. Overall, the findings revealed that mycotoxin exposure, even at the EU-recommended limits, induced lipid peroxidation in the liver, which led to changes in fatty acid composition, matched with tissue damage.

Proton-Pump Inhibitors in Eosinophilic Esophagitis: A Review Focused on the Role of Pharmacogenetics.

Proton-pump inhibitors (PPIs) are the most administered first-line treatment for eosinophilic esophagitis (EoE). However, only around half of EoE patients respond histologically to a double dosage of PPI. In addition, 70% of responders maintain EoE in remission after tapering the PPI dose. In order to avoid endoscopy with biopsies-the only accurate method of assessing PPI response-efforts have been made to identify PPI responder patients. The clinical or endoscopic features and biomarkers evaluated so far, however, have not proven to be sufficient in predicting PPI response. Although new approaches based on omics technologies have uncovered promising biomarkers, the specialized and complex procedures required are difficult to implement in clinical settings. Alternatively, PPI pharmacogenetics based on identifying variations in CYP2C19 and STAT6 genes have shown promising results in EoE, and could easily be performed in most laboratories. Other genetic variations have also been associated with PPI response and may explain those cases not related to CYP2C19 or STAT6. Here, we provide an overview of PPI treatment in EoE and evidence of how genetic variations in CYP2C19 and other genes could affect PPI effectiveness, and also discuss studies evaluating the role of pharmacogenetics in predicting PPI response in patients with EoE.

Proton pump inhibitors and risk of severe COVID-19 in older people.

Severe acute respiratory syndrome coronavirus 2 is a viral respiratory infection that can cause systemic disorders and lead to death, particularly in older people. Proton pump inhibitors (PPIs) increase the risk of enteric and lung infections. Considering the broad use of PPIs in older people, the potential role of PPIs in COVID-19 could be of dramatic significance. The objective of our study was to evaluate the link between PPIs and severe COVID-19 in older people. We performed a retrospective cohort study, including all patients aged ≥65, hospitalised for a diagnosis of COVID-19. Epidemiological, clinical and biological data were extracted and we performed an Inverse Probability of Treatment Weighing method based on a propensity score. From March 2020 to February 2021, a total of 834 patients were included, with a median age of 83 and 52.8% were male. A total of 410 patients had a PPIs prescription, 358 (87.3%) were long-term PPIs-users and 52 (12.7%) were recent PPIs-users. Among PPIs-users, 163 (39.8%) patients developed severe COVID-19 versus 113 (26.7%) in PPIs-non users (odds ratio (OR) = 1.59 [1.18-2.14]; P < 0.05). Moreover, the double dose PPI-users had a higher risk of developing severe COVID-19 (OR = 3.36 [1.17-9.66]; P < 0.05) than the full dose PPI-users (OR = 2.15 [1.22-3.76]; P < 0.05) and the half dose PPI-users (OR = 1.64 [1.13-2.37]; P < 0.05). Our study reports evidence that the use of PPIs was associated with an increased risk of severe COVID-19 in older people.

The Effects of T-2 Toxin, Deoxynivalenol, and Fumonisin B1 on Oxidative Stress-Related Genes in the Kidneys of Laying Hens.

In the context of nephrotoxic risks associated with environmental contaminants, this study focused on the impact of mycotoxin exposure on the renal health of laying hens, with particular attention to oxidative stress pathways. Sixty laying hens were assigned to three groups-a control group (CON), a low-dose mycotoxin group (LOW), and a high-dose mycotoxin group (HIGH)-and monitored for 72 h. Mycotoxin contamination involved T-2/HT-2 toxin, DON/3-AcDON/15-AcDON, and FB1 at their EU-recommended levels (low mix) and at double doses (high mix). Clinical assessments revealed no signs of toxicity or notable weight changes. Analysis of the glutathione redox system parameters demonstrated that the reduced glutathione content was lower than that in the controls at 48 h and higher at 72 h. Glutathione peroxidase activity increased in response to mycotoxin exposure. In addition, the gene expression patterns of key redox-sensitive pathways, including Keap1-Nrf2-ARE and the AhR pathway, were examined. Notably, gene expression profiles revealed dynamic responses to mycotoxin exposure over time, underscoring the intricate interplay of redox-related mechanisms in the kidney. This study sheds light on the early effects of mycotoxin mixtures on laying hens' kidneys and their potential for oxidative stress.

Phytochemical analysis underlying membrane stabilization and anti-oxidant promising potentials of Acacia nilotica seed extract

This study has aimed to evaluate the Acacia nilotica seed extract as a natural antioxidant and membrane stabilizer, as well as screening phytochemicals contained in the extract that may underline these activities. Antioxidant activity was evaluated using Phospho-molybdenum and DPPH antioxidant assays; membrane stabilization was evaluated using HRBC-MS assay, whereas phytochemicals were detected using qualitative analytical tests. Acacia nilotica hydro-methanolic extract exhibited potent, concentration (4-512 μg/mL)-dependent antioxidant activity indicated by Phospho-molybdenum and DPPH antioxidant assays, with IC50 values of 100.5 and 33.19 μg/mL, respectively. In addition, the extract exerted membrane stabilizing effects in a concentration (4-512 μg/mL)-dependent manner, with an IC50 value of 41.47 μg/mL. Phytochemical analysis of the plant extract clarified the active biological constituent(s) underlying these effects, including tannins, saponins, gums, flavonoids, anthraquinone glycosides, carbohydrates and proteins. These data may suggest Acacia nilotica extract, according to in vitro assays, as a highly potent antioxidant and membrane stabilizer derived from nature and could be applied as an adjunct therapy in disease conditions associated with inflammation and oxidative stress. Keywords: Acacia nilotica; antioxidant; membrane stabilizer; anti-inflammatory.

Evaluating the protective effect of alpha-lipoic acid against gentamicin-induced gonadal toxicity indicated by histopathology.

Gentamicin induces gonadotoxicity in animal models, accompanied by oxidative stress. This study evaluated the histopathological protective effect of alpha-lipoic acid against gentamicin-induced gonadotoxicity. A parallel experimental study included 50 albino Wister rats, which were divided into 5 groups of ten according to the intraperitoneal intervention: group I received gentamicin, group II received gentamicin plus alpha-lipoic (100 mg/kg), group III received gentamicin plus a double dose of alpha-lipoic acid, group III received gentamicin plus oral vitamin E, and group IV received NaCl 0.9% (control). The animals were equally euthanized on days 15 and 16. Tests were dissected, prepared, and stained using a light microscope for histopathological examination. Rats exposed to gentamicin showed degeneration of seminiferous tubules, characterized by a significant decrease in germinal epithelial cells, impaired spermatogenesis, and a lack of spermatozoa in the lumen. An improvement in testes of animals co-treated with alpha-lipoic acid or vitamin E, including restoration of spermatogenesis and epithelial thickness. The histometric analysis also showed that the tubule epithelial thickness decreased when gentamicin was used, but this did not happen when alpha-lipoic acid or vitamin E was added simultaneously. The detrimental effects of gentamicin on testicular architecture are preventable through alpha-lipoic acid or vitamin E co-treatment. Keywords: Alpha-lipoic acid; Gonads; Histometric; Gentamicin; Seminiferous tubule; Spermatogenesis.

Side Effects of COVID-19 Vaccination among the Pregnant Women: A Cross-Sectional Study in a Tertiary Hospital of Bangladesh

Introduction: Pregnancy is a very special time for a woman and her family, although being pregnant is a stressful condition for every woman. The COVID-19 pandemic has made that condition more stressful. Clinical trials prove that COVID-19 vaccines are safe for pregnant women and also for lactating mothers. So WHO has approved vaccines for both above-mentioned groups. Hence, Bangladesh Government has taken the decision to vaccinate every pregnant woman against COVID-19 infection. Objectives: To assess the side effects of COVID-19 vaccination on pregnant women in a tertiary care hospital in Bangladesh Army. Methods: This cross sectional single-centered observational study was conducted in Combined Military Hospital (CMH) Dhaka from August 2021 to November 2021. Total 50 pregnant nullipara and multipara women with double dose vaccination were included. Relevant data were recorded in a preformed data collection sheet and analyzed by SPSS version 20. Results: Mean age of the participants was 19.2±10.8 years. The most commonly observed symptoms were pain in injection site, fatigue, swelling in injection site and myalgia. The most prevalent affected age group were 25-35 years. Among 48 participants, 20(41.6%) had co-morbidites. Two participants were found to have COVID-19 infection (4%) after vaccination. Conclusion: Side effects profile obtained from pregnant women in this study were non-life threatening. A recognized vaccine programme can be a relieving factor for pregnant women from increased stress and anxiety caused by COVID-19. JAFMC Bangladesh. Vol 19, No 1 (June) 2023: 34-37

Effect of protected fatty acid supplementation on ovarian activity, reproductive hormone profiles and reproduction of Barki ewes under semiarid conditions

Abstract. The objective of this experiment was to evaluate the impact of dietary supplementation with rumen-protected fat (calcium soaps of fatty acids, CSFA) and/or hormonal superovulation using equine chorionic gonadotropin (eCG) on ovarian activity, changes in ovarian hormones, and reproductive performance in Barki ewes under semiarid conditions. A total of 39 non-pregnant Barki ewes, with an average body weight of 34.7 ± 0.25 kg and an average age of 3–4 years, were divided into four groups. The first group (9 ewes) served as the control, while the second group (10 ewes) received double doses of PGF2α, administered 9 d apart, and was superovulated with 600 IU (international unit) eCG. The third group (10 ewes) was supplemented with 30 g per head per day of rumen-protected fat. The fourth group (10 ewes) underwent the same superovulation protocol as the second group and was also supplemented with 30 g per head per day of rumen-protected fat. All the ewes were fed a basal diet. Ovarian activity was detected using ultrasonography during the estrus phase in all the groups, after which all the ewes were naturally bred with Barki rams. The results demonstrated significant (P&lt;0.05) increases in estradiol 17-β (E2) and progesterone (P4) levels in the treated groups compared to the control group. Ewes in all the treated groups exhibited large follicles, with an overall mean diameter (≥5 mm) significantly higher than that of ewes in the control group. Although there were no significant differences between the treated and control groups, the ewes treated with CSFA and/or the eCG hormone showed tendencies to improve the reproductive traits of Barki ewes. Overall, the findings of this study demonstrated a positive effect of CSFA alone or in combination with an estrous synchronization protocol on ovarian activity in Barki ewes, as indicated by the number and size of follicles and the presence of large-sized follicles.

Implementation of a high-resolution, high-contrast magnetic resonance imaging protocol with extended delayed phases for peritoneal mesothelioma.

Imaging of peritoneal malignancies using conventional cross-sectional imaging is challenging, but accurate assessment of peritoneal disease burden could guide better selection for definitive surgery. Here we demonstrate feasibility of high-resolution, high-contrast magnetic resonance imaging (MRI) of peritoneal mesothelioma and explore optimal timing for delayed post-contrast imaging. Prospective data from inpatients with malignant peritoneal mesothelioma (MPM), imaged with a novel MRI protocol, were analyzed. The new sequences augmenting the clinical protocol were (I) pre-contrast coronal high-resolution T2-weighted single-shot fast spin echo (COR hr T2w SSH FSE) of abdomen and pelvis; and (II) post-contrast coronal high-resolution three-dimensional (3D) T1-weighted modified Dixon (COR hr T1w mDIXON) of abdomen, acquired at five delay times, up to 20 min after administration of a double dose of contrast agent. Quantitative analysis of contrast enhancement was performed using linear regression applied to normalized signal in lesion regions of interest (ROIs). Qualitative analysis was performed by three blinded radiologists. MRI exams from 14 participants (age: mean ± standard deviation, 60±12 years; 71% male) were analyzed. The rate of lesion contrast enhancement was strongly correlated with tumor grade (cumulative nuclear score) (r=-0.65, P<0.02), with 'early' delayed phase (12 min post-contrast) and 'late' delayed phase (19 min post-contrast) performing better for higher grade and lower grade tumors, respectively, in agreement with qualitative scoring of image contrast. High-resolution, high-contrast MRI with extended post-contrast imaging is a viable modality for imaging peritoneal mesothelioma. Multiple, extended (up to 20 min post-contrast) delayed phases are necessary for optimal imaging of peritoneal mesothelioma, depending on the grade of disease.

Proximal esophageal impedance baseline increases the yield of impedance-pH and is associated with response to PPIs in chronic cough patients.

Chronic cough significantly impairs the quality of life. Although various studies focused on MNBI as assessed in the distal esophagus, scarce data are available on the clinical value of proximal measurements. To investigate the role of proximal MNBI in the workup of patients with chronic cough and its ability to predict PPI response. Demographic, clinical, endoscopy findings, impedance-pH and HRM tracings from consecutive cough patients were evaluated. MNBI was calculated at proximal and distal esophagus. One hundred and sixty four patients were included. In addition to traditional variables, when considering also the PSPW index or MNBI at 3 cm or 15 cm, the proportion of patients with pathological impedance-pH monitoring significantly increased. 70/164 patients were responders, while 94 (57.3%) were non-responder to double PPI dose (p < 0.05). Patients with pathologic MNBI at 3 cm and/or 15 cm as well as those with pathologic PSPW index were characterized by a significantly higher proportion of responders than that observed among patients with normal impedance-pH variables (p < 0.001). The proportion of responders with pathological MNBI at 15 cm was significantly higher than the proportion of responders with pathological MNBI at 3 cm (82.8% vs. 64.3%, p < 0.05). At multivariable model, pathological MNBI at both 3 cm and 15 cm as well as PSPW index were associated with PPI responsiveness. The strongest association with PPI response was observed for MNBI at 15 cm. The assessment of MNBI at proximal esophagus increases the diagnostic yield of impedance-pH monitoring and may represent a useful predictor of PPI responsiveness in the cumbersome clinical setting of suspected reflux-related cough.

Falsa positivización del antígeno de superficie del virus de la Hepatitis B (HBsAg) tras vacunación.

Introduction: The chronic hemodialysis population has a greater exposure and risk to the hepatitis B virus, which is why immunoprophylaxis using the double dose scheme (40mcg) on days 0-30-60-180, with application of this regimen for a second extra time in nonresponders, is common practice in this population. Clinical case: This is a 67-year-old male patient of Afro-Ecuatorian ethnicity who started hemodialysis (HD) in August 2023 for chronic kidney disease (CKD) secondary to diabetic nephropathy. When starting HD, he had negative serology for hepatitis and negativity for HBsAg. For this reason, he received his first vaccination dose on November 29, 2023, and on December 15, he had HBsAg positivity with values of 4.14 S/CO (≥1 positive), with Ac-ANTI-HBSAG levels &lt; 2 IU/L. Management: Given the findings, it was decided to isolate the patient with control of liver function, which is normal, and a new test of HBsAg levels in 15 days, which were subsequently negative. Conclusion: In this case, we want to remember the false politicization of HBsAg after vaccination in hemodialysis patients, a situation associated with the vaccine being composed of live attenuated viruses or recombinant particles of surface proteins.