Sole Agent Research Articles

Comparative evaluation of efficacy of topical and intra-sulcular application of Co-enzyme Q10 in the non-surgical treatment of periodontal diseases.

Periodontitis is a ubiquitous and irreversible inflammatory condition that affects the supporting structures of teeth, which could lead to tooth loss as well as contribute to systemic inflammation. During the inflammatory phase, there is a release of superoxide ions and reactive oxygen species, which causes an increase in the oxidative stress. To combat this stress, the use of certain antioxidants has been proposed, which will help in maintaining the harmonious equilibrium. The aim of the present systematic review is to investigate the efficacy of topical and intrasulcular application of coenzyme Q10 in nonsurgical treatment of periodontal disease. We conducted a systematic review on the clinical studies which compared the use of coenzyme Q10 as an adjunct to nonsurgical periodontal therapy. The studies mentioned in this review were in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and met our inclusion criteria - only randomized control trials in humans and literature published between 2000 and 2020 were included. Therapies with coenzyme Q10 as an adjunct to scaling and root planing (SRP) proved to show superior improvement by reduction in the clinical parameters (plaque index, gingival index, bleeding on probing, and clinical attachment loss) when compared to SRP alone. Adjunctive therapy with coenzyme Q10 provides longer-lasting therapeutic effects and better results when compared with SRP alone. The possibility to use the gel as a sole agent to support standard treatment procedures in periodontitis is also suggested.

Electroconvulsive therapy in treatment resistant depression: What is new?

Despite major advances in the treatment of mood disorders, major depression, a common mental disorder, remains a serious public health problem. Electroconvulsive therapy (ECT) regardless of the anesthetic agent used, is the most effective form of treatment in major depression and the gold standard therapy in treatment resistant depression. Ketamine is one of the anesthetic drugs approved by the Αmerican Psychiatric Association Task Force Report for use in ECT. However, it has been used infrequently as an anesthetic in ECT. The initial reports suggested that ketamine has antidepressant properties resulting in rapid antidepressant response when administered in subanesthetic dose (0.5 mg/kg) in slow intravenous injection in patients suffering from depression. In recent trials has been reported that ketamine as the only anesthetic or as an adjunctive to another anesthetic agent may enhance the antidepressant effect of ECT either by increasing efficacy or by producing a rapid antidepressant response. ECT with ketamine may also cause less cognitive side effects. The most notable limitations of these studies are the small number of patients enrolled and several methodological differences (patients characteristics, electrode placements, titration method, anesthetic agent used with ketamine). The results of the clinical trials have been summarized in six meta-analysis and suggest that ketamine when used as a sole anesthetic agent or as an adjunctive anesthetic in ECT may accelerates the antidepressant response but does not augment ECT efficacy. It also does not improve the cognitive profile of the treatment. Larger, double-blind randomized controlled trial are needed for a definite conclusion.

Toldbodens nye dronning - den danske kolonialismes im/materielle aftryk

Through the analysis of both the direct, the derived and the non-existing imprints of Danish colonialism, the article examines the collective memory of the Danish involvement in the transatlantic slave trade. In 2017, 100 years have passed since Denmark sold its three Caribbean islands to the United States. Since then the collective memory of the Danish-West Indian past has evolved into a patriotic narrative where the Danish territorial loss is framed as a consequence of the noble abolition of the slave trade and thus turned into a moral victory. In this narrative the emphasis is placed on Danes as being the sole active agents of history. 
 A potentially new imprint, represented in the article by the proposed memorial statue Queen Mary, presents an alternative version of the past by highlighting the Black resistance and power. In this inversion of the colonial hierarchies of power and representation it is made clear how the cityscape of Copenhagen and the Danish historiography are constantly reproducing the patriotic narrative. Hence, the colonial past is present in Danish society today but in a way that coincides with the Danish culture and thus goes unnoticed.

Propofol/Fentanyl/Rocuronium or Sevoflurane Inhalational Induction for Intubation?

IntroductionAnesthesia induction and airway instrumentation are critical parts of anesthesia administration. Intravenous induction is time convenient but necessitates immediate commencement of ventilation. Inhalational sevoflurane induction takes longer but preserves spontaneous respiration. The primary aim of this study is to evaluate the intubation quality features achieved by sevoflurane as the sole induction agent compared with the standard intravenous induction, involving the use of muscle relaxants.MethodsSixty patients were randomly allocated into two groups: the Inhalational Vital Capacity Induction With Sevoflurane (IVCIS) group (n = 30) in which patients were intubated after sevoflurane inhalational anesthesia with the vital capacity technique and the Standard Intravenous Induction With Propofol, Fentanyl, and Rocuronium (SIPFR) group (n = 30) after propofol 1.5 mg/kg, fentanyl 2 μg/kg, and rocuronium 0.5 mg/kg administration intravenously. Group IVCIS patients were intubated when bispectral index (BIS) < 60 and end-expiratory sevoflurane ≥ 2 minimum alveolar concentration for > eight minutes. Scoring systems were used to evaluate induction and intubation conditions. The Statistical Package for the Social Sciences (SPSS) software version 25.0 (IBM Corp., Armonk, NY) was used for data analysis.ResultsIntubating and induction conditions were of equal quality in both groups. Sevoflurane induction duration was markedly prolonged. Heart rate was higher in IVCIS group patients throughout the induction, especially during laryngoscopy. Less blood pressure fluctuations were recorded in IVCIS group patients.ConclusionsInhalational vital capacity induction with sevoflurane provided acceptable intubating conditions and exhibited a safe hemodynamic profile, albeit the duration was more than 12 minutes.

Autologous Stem Cell Transplantation in AL-Amyloidosis Following Yttrium-90 Labelled Anti-CD66 Monoclonal Antibody As Sole Conditioning Is Associated with Low Toxicity and Demonstrable Disease Responses

▪Delayed diagnosis and lack of effective therapies results in the death of approximately 30% of patients with AL-amyloidosis (AL-A) within the first year of diagnosis. Autologous stem cell transplantation (ASCT) remains an important treatment option, resulting in improved organ function and survival in responders, however its utility is restricted due to the substantial toxicity of conventional ASCT conditioning in the vulnerable AL-A population. We report here the use of a monoclonal anti-CD66 monoclonal antibody (Besilesomab)radiolabelled with yttrium-90 (90Y-anti-CD66) as the sole conditioning agent prior to ASCT in a phase I study in AL-A patients. The study had full ethical and regulatory approvals (EudraCT 2015-002231-18; ISRCTN 13400668) and comprised 3 ascending radiation activity levels, 30, 40 and 45 MBq per kg body weight, each with 3 patients. Patients entered the study after fulfilling entry requirements and with informed consent. Prior to receiving 90Y-anti-CD66, organ dosimetry and biodistribution were determined using anti-CD66 labelled with indium-111 (111In-anti-CD66) with sequential gamma camera imaging. Estimated absorbed radiation to critical organs was determined from an established dosimetry model, organ radiation dose expressed in Gray (Gy). Radiation dose limits of 45Gy for the bone marrow, 15Gy for the liver were used as safety measures.Table 1 summarises patient characteristics, the majority of whom had received multiple lines of treatment including three who had previously undergone ASCT using high dose melphalan (HDM) conditioning. The primary end-point was treatment related toxicity as determined using CTCAE v4.0. Haematological toxicities (cytopenia) were excluded as adverse events (AEs) unless considered life-threatening. Secondary end-points were: clonal disease response determined by changes in serum free light chain assay (FLCa) and malignant plasma cell percentage in bone marrow (BM) as determined by multi-colour flow cytometry; cardiac toxicity using NT-proBNP measurements; overall survival and time to disease progression; biodistribution and dosimetry using SPECT-CT imaging; neutrophil and platelet engraftment (European Blood and Marrow Transplant criteria).Results: Ten patients were studied with 111In-anti-CD66, of whom 9 proceeded to 90Y-anti-CD66 conditioning with infused activity determined by study cohort and body weight; one patient failed dosimetry with excessive hepatic uptake and 2 received reduced activity to keep the BM dose within the 45Gy limit. In total 47 AEs were recorded the majority (41) grades 1-2 with no Serious Adverse Events (SAEs); 3 AEs recorded as grade 4; no transplant related deaths and all patients engrafted with median neutrophil recovery by D+13, platelets by D+11. Importantly no patients experienced mucositis or therapy related diarrhoea maintaining oral nutrition. All patients became profoundly cytopenic consistent with bone marrow suppression due to the targeted radiation. Only two patients experienced a fever post-transplant, neither life-threatening. Table 2 summarises the estimated absorbed radiation dose to critical organs and disease responses. Of the 9 patients treated with 90Y-anti-CD66 and ASCT, 2 had complete responses (CR) and 5 had partial responses (PR); 1 stable disease and 1 progressive disease determined by FLCa. Six of 8 evaluable patients showed a reduction in percentage of malignant plasma cells in the BM. The study collected data to D+100 post-transplant but 4 patients showed continuing reduction in clonal FLCa beyond D+100 with one achieving a near CR 9 months post-transplant. No dose limiting toxicity was seen. No cardiac AEs were recorded. All patients are alive with median follow-up of 32.8 months (15.3 - 58.4).Summary: We have demonstrated that 90Y-anti-CD66 therapy can be used safely as sole conditioning agent prior to ASCT in pre-treated AL patients, associated with low toxicity and promising disease response rates, including patients who previously had undergone ASCT using HDM. BM radiation doses of up to 45Gy were achieved using this targeted approach with acceptably low doses delivered to other critical organs. Further trials are required to determine the full potential of this agent in the context of stem cell transplantation for AL amyloidosis and other haematological diseases. This research was funded by the charity Blood Cancer UK. [Display omitted] DisclosuresOrchard: GSK: Current holder of individual stocks in a privately-held company; Pfizer: Speakers Bureau. Cook: BMS: Current Employment, Honoraria; Celegene: Honoraria, Other: Travel support, Research Funding; Jansen: Honoraria; Takeda: Honoraria, Other: Travel support. Jackson: amgen: Consultancy, Honoraria, Speakers Bureau; takeda: Consultancy, Honoraria, Research Funding, Speakers Bureau; celgene BMS: Consultancy, Honoraria, Research Funding, Speakers Bureau; GSK: Consultancy, Honoraria, Speakers Bureau; J and J: Consultancy, Honoraria, Speakers Bureau; oncopeptides: Consultancy; Sanofi: Honoraria, Speakers Bureau.

JSP191 As a Single-Agent Conditioning Regimen Results in Successful Engraftment, Donor Myeloid Chimerism, and Production of Donor Derived Naïve Lymphocytes in Patients with Severe Combined Immunodeficiency (SCID)

JSP191 As a Single-Agent Conditioning Regimen Results in Successful Engraftment, Donor Myeloid Chimerism, and Production of Donor Derived Naïve Lymphocytes in Patients with Severe Combined Immunodeficiency (SCID)

Treatment of Portal, Mesenteric, and Splenic Vein Thrombosis with Rivaroxaban: A Pilot, Prospective Cohort Study

Introduction: Anticoagulation plays a crucial role in the treatment of splanchnic vein thrombosis (SVT), including thrombosis of the portal (PVT), mesenteric (MVT) and splenic (SpVT) veins. Rivaroxaban is a potential alternative to heparins and vitamin K antagonists (VKA) in these patients, but data to support its use are scant. Several recent guidelines highlighted the limited evidence available for the use of the direct oral anticoagulants in these patients. In addition, despite anticoagulation, SVT patients carry high risk of recurrent venous thromboembolic events.The aim of this study was to evaluate the safety and efficacy of rivaroxaban for the acute-phase treatment of SVT (first 3 months of treatment).Methods: RIVASVT-100 (NCT02627053) was a prospective cohort study of adult patients with a first episode of symptomatic, objectively diagnosed PVT, MVT or SpVT. Exclusion criteria were known liver cirrhosis, Budd-Chiari syndrome, previous or ongoing variceal bleeding, portal cavernoma, thrombocytopenia, severe renal failure, life expectancy <3 months, concomitant interfering medications, treatment with therapeutic dose of heparins for >7 days, ongoing VKA treatment.Patients received rivaroxaban 15 mg twice daily for 3 weeks, followed by 20 mg once daily for a total of 3 months. Afterwards, the decision to continue any available anticoagulant drug was left to the discretion of the attending physicians. Follow-up was performed at 3 weeks, 2 months, 3 months and 6 months.Primary outcome was the occurrence of ISTH-defined major bleeding events during the 3 months of active treatment and up to 2 days after the end of study treatment. Secondary outcomes included death, clinically relevant non-major bleeding (CRNMB), recurrent SVT or symptomatic venous thromboembolism in other sites. We here report the results of the 3-month follow-up.Results: Between June 2015 and March 2021, 103 patients were enrolled from 18 participating centres. After excluding 3 patients who did not meet the criteria for eligibility, 100 patients were included in the analysis. Mean (SD) age was 54.4 (± 15.5) years; 64% were males. Overall, 74% of patients had PVT, 61% MVT and 48% SpVT; 53% of SVT occurred in multiple sites. The most common risk factors were abdominal inflammation/infection (26%), followed by solid cancer (9%), overt myeloproliferative neoplasms (9%) and oestrogen hormonal therapy (9%), while 43% of cases were unprovoked. The JAK2 V617F mutation was detected in 13 out of 50 tested patients (26%).Rivaroxaban was the sole anticoagulant agent used in 21% of patients, whereas the remaining received a combination of anticoagulants, which included low molecular weight heparin, unfractionated heparin or fondaparinux for a median of 5.0 days before transitioning to rivaroxaban.Three patients were lost to follow-up but known to be alive at the end of the study. At 3-month follow-up, 1 (1.0%) patient died due to a non-SVT related cause. Two patients (2.06%; 95% CI, 0.57-7.21) had major bleeding events (both gastrointestinal), while 3 patients (3.09%) had CRNMB. There were 2 recurrent SVT (2.06%) during rivaroxaban treatment, one of these occurred in a patient with metastatic solid cancer. The 6-month follow-up for the last enrolled patient is ongoing.Conclusions: Rivaroxaban appears to be safe and effective for the acute-phase treatment of SVT in non-cirrhotic patients. DisclosuresBeyer-Westendorf: Bayer: Other: Personal fees; Daiichi Sankyo: Other: Personal fees; Pfizer: Other: Personal fees; Portola-Alexion: Other: Personal fees. Carrier: BMS: Honoraria, Research Funding; Leo Pharma: Honoraria, Research Funding; Bayer: Honoraria; Pfizer: Honoraria, Research Funding; Servier: Honoraria; Sanofi: Honoraria. Bertoletti: BMS: Honoraria, Other: Personal Fees; Pfizer: Honoraria, Other: Personal fees; Aspen: Other: Personal Fees; Bayer: Other: Personal Fees; Leo Pharma: Other: Personal Fee. Di Nisio: Bayer, Daiichi Sankyo, BMS-Pfizer, Leo Pharma, and Sanofi: Other: Personal fees. Ageno: Bayer: Research Funding; Bayer, Portola, Janssen, Aspen, Norgine, Sanofi.: Other: Advisory Board. OffLabel Disclosure:The use of rivaroxaban in splanchnic vein thrombosis is off label in most countries.

Modeling and experimental analysis of battery charge controllers for comparing three off-grid photovoltaic power plants

The study of battery charge algorithm as a sole power storage agent in off-grid systems is essential. The battery charge algorithm has various methods, and the battery in these methods relies on the quantity of charges. Hence, a charge controller is used to safeguard and regulate battery charge and discharge for off-grid photovoltaic (PV) systems. This study presents the 11.4 kWp power plant analysis comprising three 3.8 kWp each of off-grid, hybrid and grid-assisted systems with battery capacities of 900 Ah, 1235 Ah and 910 Ah, respectively, where all the systems were reconfigured to function as off-grids. The battery charge controller charges the lead-acid battery using a three-stage charging strategy, including constant current, constant voltage and float charge stage. A DT80 data logger was installed to simultaneously record the electrical parameters of the systems, while Kipp & Zonen CMP 11 pyranometer was selected to measure solar radiation data. Experimentation with three electric bar heaters, each with fan and humidifier, were used as loads to draw constant power of 1.2 kW from batteries of each system on charging and discharging on an overcast and clear sky days for a week. The useful study is performed in the following ways, MPPT tracking performance, battery charging and discharging performance and charge controller efficiency. The performance results reveal that the MPPT can track the PV module maximum point at solar irradiance from 07h15 to around 12h00 maximum power tracking efficiency. An irradiance of illumination fluctuates from 5 W/m2 to 850 W/m2 while the electrical energy consumed by the loads in off-grid, hybrid and grid-assisted systems are 456.12, 568.87 and 80.00 Wh, respectively. It is estimated that individual owners could charge electric appliances from residential and commercial buildings of solar arrays of clean, renewable solar energy.

APROTININ USE IN CARDIAC SURGERY IN A TERTIARY CENTRE IN IRELAND: CASE NUMBERS, INDICATIONS & COMPARISON TO TRANEXAMIC ACID

Introduction Aprotinin is a serine protease inhibitor which is used in cardiac surgery as an anti-fibrinolytic agent to minimise patient bleeding. It was withdrawn from the European market in 2008 due to potential increased mortality when compared to tranexamic acid. Aprotinin was subsequently re-introduced in 2012 with narrow licencing indications, specifically isolated coronary artery bypass graft surgery in high risk patients. Minimisation of intra-operative blood loss plays an important role in patient outcomes, especially in decreasing the need for transfusion which carries its own mortality risks(3,. Tranexamic acid is utilised in the majority of cardiac surgery cases throughout Europe. We looked to quantify and determine indications for aprotinin usage in an Irish tertiary cardiac centre and compare findings to tranexamic acid. Methods Retrospective study of aprotinin usage in cardiac surgery in an Irish tertiary centre over a 3 year period to determine number of cases and indications. Data collection involved operative notes, patient records, pharmacy dispensing accounts. Aprotinin dosage intra-operatively was per the full or half Hammersmith protocol. A cohort which had undergone comparable cardiac surgery procedures with tranexamic acid as the anti-fibrinolytic agent were also studied. Results From 2018-2021, 21 cardiac surgeries were carried out using aprotinin as the sole anti-fibrinolytic agent to minimise patient bleeding in a high risk cohort. For the same time period, to provide scale, 737 cardiac surgeries were carried out using tranexamic acid. Each of the cases which utilised aprotinin represents an emergent, life-threatening operation. The emergency cases comprised: repair of Stanford type A aortic dissection (8, 38%); aortic valve replacement (7, 33.3%); mitral valve replacement (3, 14.3%); tricuspid valve replacement (1, 4.8%); mediastinal revision for cardiac tamponade (1, 4.8%). Valve replacements were complicated by: acute infective endocarditis, aortic root abscess, haematoma, failure of pre-existing prosthetic valves. 1 case utilised aprotinin as per the licenced indication: isolated CABG in patient with high bleeding risk. An ST-elevated myocardial infarction necessitated the emergency CABG procedure in this case. Discussion In summation, 95% of aprotinin usage for cardiac surgery in an Irish tertiary centre falls outside the remit of the licenced indication. Given similar findings in a number of European institutes(5), is it time to re-assess the existing guidelines on aprotinin use, with view to expansion of the licenced indications?

Unchanged gait biomechanics following an 8-week home-based exercise program targeting excessive anterior pelvic tilt in patients with symptomatic hip dysplasia

We report Aspergillus delacroxii (formerly Aspergillus nidulans var. echinulatus) causing recurrent prosthetic valve endocarditis. The fungus was the sole agent detected during replacement of a mechanical aortic valve conduit due to abscess formation. Despite extensive surgery and anti-fungal treatment, the patient had a cerebral hemorrhage 4 months post-surgery prompting a diagnosis of recurrent prosthetic valve endocarditis and fungemia.

Peramalan Pelayanan Service Mobil (After-Sale) Menggunakan Backpropagation Neural Network (BPNN)

The automotive industry in Indonesia, primarily cars, is getting more and more varied. Along with increasing the number of vehicles, Brand Holder Sole Agents (ATPM) compete to provide after-sale services (mobile service). However, the company has difficulty knowing the rate of growth in the number of mobile services handled, thus causing losses that impact sources of income. Therefore, we need a standard method in determining the forecasting of the number of car services in the following year. This study implements the Backpropagation Neural Network (BPNN) method in forecasting car service services (after-sale) and Mean Square Error (MSE) for the process of testing the accuracy of the forecasting results formed. The data used in this study is car service data (after-sale) for the last five years. The results show that the best architecture for forecasting after-sales services using BPNN is the 5-10-5-1 architectural model with a learning rate of 0.2 and the learning function of trainlm and MSE of 0.00045581. This proves that the BPNN method can predict mobile service (after-sale) services with good forecasting accuracy values.

Outcomes of dexmedetomidine sedation for drug-induced sleep ciné magnetic resonance imaging studies in pediatric obstructive sleep apnea patients.

Dexmedetomidine is utilized as a sedative agent for drug-induced sleep cine magnetic resonance imaging studies due to its ability to mimic natural sleep and lack of respiratory depressant effects. The outcomes of dexmedetomidine sedation such as respiratory complications and unplanned admissions in obstructive sleep apnea patients undergoing these studies are currently unknown. To describe the outcomes of dexmedetomidine sedation for outpatient drug-induced sleep magnetic resonance imaging in pediatric patients with obstructive sleep apnea. This is a retrospective chart review conducted in pediatric patients with obstructive sleep apnea undergoing outpatient drug-induced sleep ciné magnetic resonance imaging studies with dexmedetomidine sedation. Demographics, comorbidities, polysomnography study results, vital signs, respiratory complications, airway interventions, successful completion of the scan, and unplanned hospital admissions were measured. We analyzed 337 patients aged 2-18years (median age of 11years). The imaging was completed with dexmedetomidine as the sole sedative agent in 61% (N=207) patients. Ketamine was administered as additional sedative agent in 36% (N=122) of the patients. There was no difference in sedation-related adverse events and respiratory complications with regard to the severity of sleep apnea with the exception of mild desaturation episodes (SpO2 85%-90%). Patients who received additional sedative agents had significantly longer recovery room stay (71.5 [44] vs 55 [39] minutes; 95% CI of difference [9 to 23min], p<0.001) and total periprocedural stay (164.5 [52] vs 138 [64] minutes; 95% CI of difference [17 to 35min], p<.001). Dexmedetomidine alone or along with ketamine provided acceptable sedation in majority of the patients with obstructive sleep apnea undergoing outpatient diagnostic sleep magnetic resonance imaging studies without significant respiratory adverse events regardless of the severity of sleep apnea. Sedation failure and unplanned admissions are rare, and routine planned admission may not be required for this patient population.

Two Coexisting Forms of Simple Molecules for Directing Sesqui-Unit-Cell Zeolite Nanosheets

Feasible strategies are desirable for preparing zeolitic nanosheets with opener porosities and more accessible active sites. Highly delaminated FER nanosheets (ECNU-17) with unit-cell scale thickness were hydrothermally synthesized using a simple, small, and low-cost imidazole molecule as the sole organic structure-directing agent (OSDA). The single OSDA directed the formation of the FER framework, while the π–π stacked OSDAs terminated the growth perpendicular to the zeolite sheets. The ECNU-17 nanosheet is only 2.9 nm in thickness, corresponding to one and a half FER unit cells along a-axis. With open hierarchical porosity and an enhanced external surface area of 253 m2 g–1, ECNU-17 is endowed with improved mass transport and a significantly increased number of active acid sites accessible to bulky organic molecules. The ultrathin sheets of ECNU-17 aluminosilicate display excellent activity and selectivity for the protection reaction of benzaldehyde with pentaerythritol as well as the cracking of 1,3,5-triisopropylbenzene.

Porcine Parvovirus 2 Is Predominantly Associated With Macrophages in Porcine Respiratory Disease Complex.

Porcine respiratory disease complex (PRDC) is a significant source of morbidity and mortality, manifested by pneumonia of multiple etiologies, where a variety of pathogens and environment and management practices play a role in the disease. Porcine reproductive and respiratory syndrome virus (PRRSV), influenza A virus (IAV), and porcine circovirus 2 (PCV2) are well-established pathogens in PRDC. Porcine parvovirus 2 (PPV2) has been identified in both healthy and clinically diseased pigs at a high prevalence worldwide. Despite widespread circulation, the significance of PPV2 infection in PRDC and its association with other co-infections are unclear. Here, PPV2 was detected in the lung tissue in 39 of 100 (39%) PRDC-affected pigs by quantitative polymerase chain reaction (qPCR). Using in situ hybridization (ISH) in conjunction with tissue microarrays (TMA), PPV2 infection was localized in alveolar macrophages and other cells in the lungs with interstitial pneumonia in 28 of 99 (28.2%) samples. Viral load tended to correlate with the number of macrophages in the lungs. Assessment of the frequency, viral titers, and tissue distributions showed no association between infection of PPV2 and other major viral respiratory pathogens. In one-third of the PPV2-positive samples by qPCR, no other known viruses were identified by metagenomic sequencing. The genome sequences of PPV2 were 99.7% identical to the reference genomes. Although intensive intranuclear and intracytoplasmic signals of PPV2 were mainly detected in alveolar macrophages by ISH, no obvious virus replication was noted in in vitro cell culture. Together, these results suggest that PPV2 is associated, but may not be the sole causative agent, with PRDC, warranting the control and prevention of this underdiagnosed virus.

Intrathecal Pethidine as a Sole Anesthetic Agent in Cesarian Section: Case Report for Clinical Education

Pethidine was the first synthetic opioid to be used to provide analgesia in humans and was shown also to have local anesthetic activity comparable with that of cocaine. The neonatal Apgar score after birth is an important factors of mortality of the newborn. In this regard, the type of drug used for the cesarean section is very important in the Apgar score of the cesarean section. Pethidine is an intermediate lipid-soluble opioid with both a postoperative analgesic mechanism and a sensory block which is known as the only opioid which can be used alone in the cesarean section under spinal anesthesia. We used pethidine as an alternative to bupivacaine in patients going under cesarean section.

Synergy between Phage Sb-1 and Oxacillin against Methicillin-Resistant Staphylococcus aureus.

Methicillin-resistant Staphylococcus aureus (MRSA) is a notorious pathogen responsible for not only a number of difficult-to-treat hospital-acquired infections, but also for infections that are community- or livestock-acquired. The increasing lack of efficient antibiotics has renewed the interest in lytic bacteriophages (briefly phages) as additional antimicrobials against multi-drug resistant bacteria, including MRSA. The aim of this study was to test the hypothesis that a combination of the well-known and strictly lytic S. aureus phage Sb-1 and oxacillin, which as sole agent is ineffective against MRSA, exerts a significantly stronger bacterial reduction than either antimicrobial alone. Eighteen different MRSA isolates and, for comparison, five MSSA and four reference strains were included in this study. The bacteria were challenged with a combination of varying dosages of the phage and the antibiotic in liquid medium using five different antibiotic levels and four different viral titers (i.e., multiplicity of infections (MOIs) ranging from 10−5 to 10). The dynamics of the cell density changes were determined via time-kill assays over 16 h. Positive interactions between both antimicrobials in the form of facilitation, additive effects, or synergism were observed for most S. aureus isolates. These enhanced antibacterial effects were robust with phage MOIs of 10−1 and 10 irrespective of the antibiotic concentrations, ranging from 5 to 100 µg/mL. Neutral effects between both antimicrobials were seen only with few isolates. Importantly, antagonism was a rare exception. As a conclusion, phage Sb-1 and oxacillin constitute a robust heterologous antimicrobial pair which extends the efficacy of a phage-only approach for controlling MRSA.

Biogenic Synthesis and Catalytic Efficacy of Silver Nanoparticles Based on Peel Extracts of Citrus macroptera Fruit.

Biogenically synthesized silver nanoparticles (AgNP) increase the fascination over chemical ones due to their facile and green synthetic process. This study reports the development of an eco-friendly and cost-effective synthesis of AgNPs using an aqueous extract of Citrus macroptera fruit peel, an agricultural waste, as a sole agent with both reducing and capping abilities. The formation of AgNPs was verified by the surface plasmon resonance peak at 426 nm in the UV–vis spectrum, X-ray diffraction pattern, and transmission electron micrography images. The AgNPs obtained under the optimized conditions consist of face-centered cubic crystals and spherical morphology with an average size of 11 nm. The AgNPs are coated with phytochemicals in the C. macroptera fruit peel extract and are stably dispersible due to their negatively charged nature. The AgNPs effectively catalyzed the reduction of 4-nitrophenol to 4-aminophenol and the degradation of methyl orange and methylene blue in the presence of sodium borohydride. This method employing a fruit peel extract is facile, efficient, eco-friendly, and cost-effective and has potential for industrial green fabrication of AgNPs.

Low-density lipoprotein cholesterol levels are associated with poor clinical outcomes in COVID-19

Background and aimsSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the sole causative agent of coronavirus infectious disease-19 (COVID-19). Methods and resultsWe performed a retrospective single-center study of consecutively admitted patients between March 1st and May 15th, 2020, with a definitive diagnosis of SARS-CoV-2 infection. The primary end-point was to evaluate the association of lipid markers with 30-days all-cause mortality in COVID-19.A total of 654 patients were enrolled, with an estimated 30-day mortality of 22.8% (149 patients). Non-survivors had lower total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-c) levels during the entire course of the disease. Both showed a significant inverse correlation with inflammatory markers and a positive correlation with lymphocyte count. In a multivariate analysis, LDL-c ≤ 69 mg/dl (hazard ratio [HR] 1.94; 95% confidence interval [CI] 1.14–3.31), C-reactive protein >88 mg/dl (HR 2.44; 95% CI, 1.41–4.23) and lymphopenia <1000 (HR 2.68; 95% CI, 1.91–3.78) at admission were independently associated with 30-day mortality. This association was maintained 7 days after admission. Survivors presented with complete normalization of their lipid profiles on short-term follow-up. ConclusionHypolipidemia in SARS-CoV-2 infection may be secondary to an immune-inflammatory response, with complete recovery in survivors. Low LDL-c serum levels are independently associated with higher 30-day mortality in COVID-19 patients.

Efficacy of Low-Dose Suxamethonium in Reducing Induction Dose of Propofol for Laryngeal Mask Airway Insertion in Nigerian Adults

Background: Propofol is commonly used as a sole induction agent during laryngeal mask airway (LMA) insertion, and additional doses are often required with systemic consequences. Objective: Our study evaluated the effect of 0.1 mg/kg suxamethonium on the dose of induction of propofol when used during insertion of LMA. Methodology: Eighty patients aged between 18 and 60 years were included in this prospective study. Patients undergoing elective procedures under general anaesthesia with LMA and spontaneous ventilation were randomized into two groups. Patients in both groups were induced with an initial dose of 2.5 mg/kg of propofol; the control group (group P) and the second group (group S) received 5 ml of normal saline and 0.1 mg/kg of suxamethonium made up to 5 ml, respectively. The need for additional doses of propofol following insertion of LMA was then assessed based on insertion conditions (ease of insertion, severity of airway response in terms of coughing, gagging, laryngospasm, and patient movement). The total dose of propofol required before successful insertion was recorded, as well as the incidence and duration of apnea post-induction. The pulse rate (PR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were assessed at 0, 1, 3 and 5 min after insertion of LMA for each group. Results: The total dose of propofol required for successful LMA insertion was significantly lower in group S (2.82 ± 0.39 mg/kg) compared to group P (3.13 ± 0.49 mg/kg), P = 0.002. Haemodynamic parameters (SBP, DBP, MAP, PR, and SpO2) were well-controlled post-LMA insertion and were comparable between the two groups. Furthermore, no incidence of hypotension or bradycardia requiring intervention was observed at different time intervals, throughout the study period, in both groups. Conclusion: The dose of propofol is lesser when low-dose suxamethonium (0.1 mg/kg) precedes its use for induction during LMA insertion, and there is a reduction in the duration of apnea; however, it causes a higher apnea incidence. Vital signs were similar in the two study groups.

Evaluation of mycological profile of onychomycosis in a tertiary care centre in Bareilly

Onychomycosis is a chronic fungal infection of nails which is not associated with significant morbidity and mortality but it can have negative impact on patient's emotional, social and occupational functioning. The affected nail can also serve as a chronic reservoir and can communicate the fungal infection to family members this makes onychomycosis an important public health problem. Treatment regimen and duration depends on the etiological agent. So, for the timely initiation of appropriate and effective treatment knowledge of etiological agents causing onychomycosis is required. This study was conducted to improve the knowledge of demographic and mycological profile of onychomycosis in Bareilly region. 74 nail specimens of suspected onychomycosis were evaluated clinically, KOH examination and fungal culture was done. Onychomycosis was present in 59.46% by culture and /or KOH examination. Fingernails and toenails were infected in 24.32% and 41.89% respectively and remaining 6.75% had both. Principal causative agents were dermatophytes (43.47%) with Trichophyton mentagrophytes being the most common (19.56%). In 15 (32.60%) cases, candida species and in 11 (23.91%) cases non-dermatophyte moulds have been isolated as the sole causative agent. This study demonstrated dermatophytes as the main agents causing onychomycosis in our region, as well as proves the importance of performing direct examination and culture in diagnosis of onychomycosis.