Pegfilgrastim: More Cost Effective and Equally Efficacious Option as Compared to Filgrastim in Autologous Stem Cell Transplant.

Use of growth factor after high-dose chemotherapy (HDC) and autologous peripheral blood stem cell (PBSC) support is current standard in reducing days of neutropenia. This retrospective study aims to compare the efficacy of two standard growth factors, pegfilgrastim (PEG) and filgrastim (FIL) after HDC. We collected data on 195 consecutive adult patients who received an autotransplant (myeloma, lymphoma and others) between January 2004 and December 2014 at two tertiary care centres. The primary end point was the duration of neutropenia in terms of days to reach an ANC > 0.5 × 109/L. Filgrastim was given to 110 patients and PEG was given to 85 patients. Time to engraftment, defined as the time to reach an ANC of 0.5 × 109/L on 2 consecutive days after the day of auto-SCT, was 12.6 days with FIL compared with 12.1 days with PEG group (p = 0.126). When comparing the total days of severe neutropenia (WBC < 0.1 × 109/L), there were 5.5 days of severe neutropenia with FIL compared with 5.8 days with PEG group (p = 0.7). The duration of febrile neutropenia was an average of 5.3 days with FIL and 4.6 days with PEG (p = 0.029). The total number of antibiotic days was shorter for the patients who received PEG, being 11.08 days with PEG and 12.1 days with FIL (p = 0.184).The average cost savings per person in terms of number of days of hospitalization and number of days of total parental nutrition was 582 Rs (p = 0.512) and 6003 Rs (p = 0.018) respectively in favour of PEG arm. PEG is similar to FIL in hematological reconstitution, however it is more cost effective alternative after HDC and PBSC.

Efficacy assessment of a combined anticholinergic and oxime treatment against topical sarin-induced miosis and visual impairment in rats.

BACKGROUND AND PURPOSE: Eye exposure to the organophosphorus (OP) irreversible cholinesterase inhibitor sarin results in long-term miosis and impaired visual function. We have previously shown that tropicamide is better at ameliorating this insult than topical atropine or cyclopentolate. However, to minimize side effects associated with repeated tropicamide applications and high treatment doses, we evaluated the effects of oximes (ChE re-activators) alone and combined with tropicamide at ameliorating OP-induced ocular impairments. EXPERIMENTAL APPROACH: Rats were topically exposed to sarin, followed by topical treatment with various oximes alone or in combination with tropicamide. Pupil width and light reflex were measured by an infrared-based digital photograph system, while visual performance was assessed by employing the cueing version of the Morris water maze (MWM). KEY RESULTS: Oxime treatment following sarin ocular exposure induced a slow persistent pupil widening with efficacy in the order of HLö-7 > HI-6 > obidoxime = TMB-4 = MMB-4. In the light reflex test, the ability of the iris to contract following oxime treatment was mostly impaired at 1 h and was back to normal at 4 h following sarin exposure. All oxime treatments ameliorated the sarin-induced visual impairment as tested in the visual task (MWM). The combined topical treatment of tropicamide with an oxime induced a rapid improvement in pupil widening, light reflex and visual performance, and enabled a reduction in tropicamide dose. CONCLUSIONS AND IMPLICATIONS: The use of tropicamide combined with an oxime should be considered as the topical treatment of choice against the toxic effects of ocular OP exposure.

"We must challenge the unthinkable".

PIP: This article contains a transcript of US Senator Albert Gore's keynote speech at delivered at a meeting of the Global Legislators Organization for a Balances Environment (GLOBE). The GLOBE meeting took place on July 1, 1991 in Tokyo, Japan. Gore, the president of GLOBE, begins by noting that the world is currently at a historic junction. The world is beginning to think of itself as a global civilization. Most countries have embraced democracy and the free market. Unfortunately, the world also faces an unprecedented crisis -- the destruction of the earth. Gore likens humanity's predicament to that of a frog placed in lukewarm water that is slowly brought to a boil. The gradual process makes the frog oblivious to the fact that the water has reached the boiling point. As Gore points out, the earth's environment is near the boiling point, but humanity remains idle. Gore argues that people are operating under the false assumption that the earth is too big for humans to affect it. But 3 developments have made the destruction of the environment too likely a reality: 1) Population increase -- while it took 20,000 years for the world population to reach 2 billion, world population has grown to 5.4 billion in just the last 45 years. 2) Ecological degradation -- the industrial and technological revolution have change humanity's capacity to affect the environment. And 3) modern civilization's attitude toward nature -- the scientific revolution has made humans think of themselves as separate from nature, entitled to exploit it at will. While some countries have made some efforts to address the problem, full commitment does not exist. Gore chastises the lack of leadership demonstrated by the US. Finally, Gore urges members of GLOBE to work for change and not to lose hope.^ieng