Dolutegravir in Pregnancy as Compared with Current HIV Regimens in the United States.

BACKGROUND: Data on the effectiveness and safety of dolutegravir-based antiretroviral therapy (ART) for human immunodeficiency virus type 1 (HIV-1) infection in pregnancy as compared with other ART regimens commonly used in the United States and Europe, particularly when initiated before conception, are limited. METHODS: We conducted a study involving pregnancies in persons with HIV-1 infection in the Pediatric HIV/AIDS Cohort Study whose initial ART in pregnancy included dolutegravir, atazanavir-ritonavir, darunavir-ritonavir, oral rilpivirine, raltegravir, or elvitegravir-cobicistat. Viral suppression at delivery and the risks of infants being born preterm, having low birth weight, and being small for gestational age were compared between each non-dolutegravir-based ART regimen and dolutegravir-based ART. Supplementary analyses that included participants in the Swiss Mother and Child HIV Cohort Study were conducted to improve the precision of our results. RESULTS: Of the pregnancies in the study, 120 were in participants who received dolutegravir, 464 in those who received atazanavir-ritonavir, 185 in those who received darunavir-ritonavir, 243 in those who received rilpivirine, 86 in those who received raltegravir, and 159 in those who received elvitegravir-cobicistat. The median age at conception was 29 years; 51% of the pregnancies were in participants who started ART before conception. Viral suppression was present at delivery in 96.7% of the pregnancies in participants who received dolutegravir; corresponding percentages were 84.0% for atazanavir-ritonavir, 89.2% for raltegravir, and 89.8% for elvitegravir-cobicistat (adjusted risk differences vs. dolutegravir, -13.0 percentage points [95% confidence interval {CI}, -17.0 to -6.1], -17.0 percentage points [95% CI, -27.0 to -2.4], and -7.0 percentage points [95% CI, -13.3 to -0.0], respectively). The observed risks of preterm birth were 13.6 to 17.6%. Adjusted risks of infants being born preterm, having low birth weight, or being small for gestational age did not differ substantially between non-dolutegravir-based ART and dolutegravir. Results of supplementary analyses were similar. CONCLUSIONS: Atazanavir-ritonavir and raltegravir were associated with less frequent viral suppression at delivery than dolutegravir. No clear differences in adverse birth outcomes were observed with dolutegravir-based ART as compared with non-dolutegravir-based ART, although samples were small. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and others.).

Dolutegravir and pregnancy outcomes in women on antiretroviral therapy in Brazil: a retrospective national cohort study.

BACKGROUND: Dolutegravir has been widely available in Brazil since 2017. Following the signal that infants born to women with dolutegravir exposure at conception in Botswana had a higher risk of neural tube defects (NTDs), public health leaders initiated a national investigation to evaluate periconception dolutegravir exposure among all pregnant Brazilian women with HIV and its potential association with risk of NTDs, stillbirth, or miscarriage before 22 weeks (also called spontaneous abortion). METHODS: In this retrospective, observational, national, cohort study, we identified all women with pregnancies and possible dolutegravir exposure within 8 weeks of estimated date of conception between Jan 1, 2017, and May 31, 2018, and approximately 3:1 matched pregnant women exposed to efavirenz between Jan 1, 2015, and May 31, 2018, using the Brazilian antiretroviral therapy database. We did detailed chart reviews for identified women. The primary outcomes were NTD and a composite measure of NTD, stillbirth, or miscarriage. NTD incidences were calculated with 95% CI. The composite outcome was examined with logistic regression using propensity score matching weights to balance confounders. FINDINGS: Of 1427 included women, 382 were exposed to dolutegravir within 8 weeks of estimated date of conception. During pregnancy, 183 (48%) of 382 dolutegravir-exposed and 465 (44%) of 1045 efavirenz-exposed women received folic acid supplementation. There were 1452 birth outcomes. There were no NTDs in either dolutegravir-exposed (0, 95% CI 0-0·0010) or efavirenz-exposed groups (0, 95% CI 0-0·0036). There were 23 (6%) stillbirths or miscarriages in 384 dolutegravir-exposed fetuses and 28 (3%) in the 1068 efavirenz-exposed fetuses (p=0·0037). Logistic regression models did not consistently indicate an association between dolutegravir exposure and risk of stillbirths or miscarriages. After study closure, two confirmed NTD outcomes in fetuses with periconception dolutegravir exposure were reported to public health officials. An updated estimate of NTD incidence incorporating these cases and the estimated number of additional dolutegravir-exposed pregnancies between Jan 1, 2015 and Feb 28, 2019, is 0·0018 (95% CI 0·0005-0·0067). INTERPRETATION: Neither dolutegravir nor efavirenz exposure was associated with NTDs in our national cohort; incidence of NTDs is probably well under 1% in dolutegravir-exposed HIV-positive women but still slightly above HIV-uninfected women (0·06%) in Brazil. FUNDING: The Brazilian Ministry of Health and the United States' National Institutes of Health.

Bees prefer foods containing neonicotinoid pesticides.

The impact of neonicotinoid insecticides on insect pollinators is highly controversial. Sublethal concentrations alter the behaviour of social bees and reduce survival of entire colonies. However, critics argue that the reported negative effects only arise from neonicotinoid concentrations that are greater than those found in the nectar and pollen of pesticide-treated plants. Furthermore, it has been suggested that bees could choose to forage on other available flowers and hence avoid or dilute exposure. Here, using a two-choice feeding assay, we show that the honeybee, Apis mellifera, and the buff-tailed bumblebee, Bombus terrestris, do not avoid nectar-relevant concentrations of three of the most commonly used neonicotinoids, imidacloprid (IMD), thiamethoxam (TMX), and clothianidin (CLO), in food. Moreover, bees of both species prefer to eat more of sucrose solutions laced with IMD or TMX than sucrose alone. Stimulation with IMD, TMX and CLO neither elicited spiking responses from gustatory neurons in the bees' mouthparts, nor inhibited the responses of sucrose-sensitive neurons. Our data indicate that bees cannot taste neonicotinoids and are not repelled by them. Instead, bees preferred solutions containing IMD or TMX, even though the consumption of these pesticides caused them to eat less food overall. This work shows that bees cannot control their exposure to neonicotinoids in food and implies that treating flowering crops with IMD and TMX presents a sizeable hazard to foraging bees.

[Study on standard of safe application of thiamethoxam on GAP of Lonicera japonica].

The paper is aimed to establish a method of residue analysis for thiamethoxam and to study its degradation dynamic and final residue and its standard of safe application of thiamethoxam on Lonicera japonica. Samples extracted with methanol by ultrasonication were purified with dichloromethane by liquid-liquid extraction and SPE column and analysed by HPLC-UV. The results showed that average rate was 84.91%-94.44% and RSD 1.74%-4.96% with addition of thiamethoxam in respectively diverse concentration, which meets inspection requirement of pesticide residue. Two kinds of dosages of thiamethoxam were treated- varying from recommended dosage (90 g x hm(-2)) to high dosage (135 g x hm(-2)), Results of two years test showed that thiamethoxam was degraded more than 90% seven days after application and the half - life period of thiamethoxam was 1.54-1.66 d. The digestion rate of thiamethoxam was fast in the L. japonica. The recommended MRL of thiamethoxam in the L. japonica is 0.1 mg x kg(-1), the dosage of 25% thiamethoxam WDG from 90-135 g x hm(-2) is sprayed less than three times a year on L. japonica and 14 days is proposed for the safety interval of the last pesticide application's and harvest's date.

Comparison of the dissipation behaviour of three neonicotinoid insecticides in tea.

The dissipation behaviour of three neonicotinoids - thiamethoxam, imidacloprid and acetamiprid - was compared in tea shoots, in Chinese green and black tea, and after tea infusion in hot water. The simple and rapid analytical procedures for the quantification of these three residues in these matrices were developed using HPLC with ultraviolet (UV) detection. Degradation rates in tea shoots of neonicotinoids applied in either recommended or double dosages followed first-order kinetics, with half-lives of 1.62 or 1.58 days for thiamethoxam, of 2.45 or 2.67 days for imidacloprid, and of 3.24 or 3.85 days for acetamiprid, respectively. Through harvest and processing the residue retentions for thiamethoxam, imidacloprid and acetamiprid were 85.0%, 84.1% and 70.6% of the initial dosages in green tea, and 77.1%, 52.4% and 57.4% in black tea. These three residues all showed high transfer rates through green or black tea brewing of 80.5% or 81.6% for thiamethoxam, of 63.1% or 62.2% for imidacloprid, and of 78.3% or 80.6% for acetamiprid. Waiting periods between the last application and harvest of at least 12, 17 and 20 days were suggested for thiamethoxam, imidacloprid and acetamiprid, respectively, after application at their recommend dosages to ensure levels below a maximum residue limit (MRL) of 0.05 mg kg(-1).

Fostamatinib, a Syk inhibitor prodrug for the treatment of inflammatory diseases.

Rigel Pharmaceuticals Inc is developing fostamatinib, a prodrug of the spleen tyrosine kinase (Syk) inhibitor R-406, for the potential treatment of autoimmune diseases such as rheumatoid arthritis (RA), idiopathic thrombocytopenic purpura (ITP) and B-cell lymphomas. Syk is a key mediator of Fc and B-cell receptor signaling in inflammatory cells, such as B-cells, mast cells, macrophages and neutrophils. Preclinical studies of R-406 or fostamatinib demonstrated a significant reduction in major inflammatory mediators such as TNFalpha, IL-1, IL-6 and IL-18, leading to reduced inflammation and bone degradation in models of RA. In a phase II clinical trial, fostamatinib treatment effectively improved American College of Rheumatology response rates in patients with RA. Preclinical studies and phase II trials also suggested the potential of using fostamatinib for the treatment of ITP and B-cell lymphomas, by increasing platelet counts and inducing response rates, respectively. Fostamatinib is orally bioavailable and was well tolerated in phase I and II trials, with the most common side effect being gastrointestinal symptoms. At the time of publication, phase II trials for fostamatinib were ongoing in patients with RA, ITP and B-cell lymphomas. The Syk inhibitor appears to be a promising therapeutic for immunological diseases, but further data are required to establish the efficacy and long-term safety of the drug in humans.

The safety of thiamethoxam to pollinating bumble bees (Bombus terrestris L.) when applied to tomato plants through drip irrigation.

Thiamethoxam, mainly sold under the trademark of Actara, is a neonicotinoid widely used in covered vegetables for the control of aphids and whiteflies. In these crops, and particularly in covered tomatoes, bumble-bees are used for cross-pollination as an alternative to labour intensive manual techniques. In this study, made on tomatoes grown in separated greenhouse plots in Murcia, Southern Spain, thiamethoxam was applied through drip irrigation at a rate of 200 g ai/ha, and as a split application of the same rate, to evaluate the effects on pollinating bumble bees compared to a foliar application of a toxic standard. The results showed that the toxic foliar standard had a clear effect on the pollination of tomato flowers, declining to zero pollination two weeks after application, whereas both the single and split drip irrigation applications of Actara had no effect on pollination when compared to the control plots. The count of dead adults and larvae did not show any differences between the treatments, whereas the measurement of sugar water consumption was shown to correlate well with pollination. The consumption of sugar water declined in the toxic standard plots by 69% with respect to the control, whilst the decline in lower dose drip irrigation application was only 3%. In regard to hive weight, and number of adults and brood after destructive sampling; there were no statistical differences between the treatments but a negative effect of the foliar treatment was observed. Based on these results we can conclude that a split application of Actara applied in drip irrigation to the soil/substrate has no effect on the bumble-bees used in tomatoes for pollination.

Anti-inflammatory activity of BF389, a Di-T-butylphenol, in animal models of arthritis.

Biofor 389 (BF389), dihydro-4-[[3,5-bis(1,1-dimethyl)-4-hydroxyphenyl] methylene]-2-methyl-2H-1,2-oxazin-3(4H)-one, was tested for anti-inflammatory activity in various animal models of arthritis. Initial evaluation in the lipoidalamine (LA) arthritis model in rats (5-day dosing protocol) resulted in an oral ED50 of 4.9 mg/kg for inhibition of paw swelling. No effects on splenomegaly were observed, suggesting that the compound was efficacious as a result of anti-inflammatory rather than immunomodulatory effects. BF389 was efficacious in interleukin 1 (IL-1)-enhanced type II collagen arthritis in rats (oral ED50 less than 1.0 mg/kg) as assessed by paw volume measurement and histologic evaluation of joints. Mice with IL-1-enhanced type II collagen arthritis given 30 mg/kg of BF 389 had significantly lower histological scores for joint damage than did untreated controls. Normal rats given single oral doses of BF389 had significant suppression of arachidonate-stimulated whole blood prostaglandin E2 and thromboxane B2 production 2 hr postdosing (ED50 = 0.1 mg/kg). Leukotriene B4 production in these animals was not decreased. After it became apparent that the compound was a potent inhibitor of prostaglandin production in vivo, a study was done to compare the efficacy and toxicity of BF389 with several currently marketed nonsteroidal anti-inflammatory drugs, piroxicam, naproxen and diclofenac. Lipoidalamine-injected rats were given daily oral doses of BF389 or the comparators for 21 days. Quantitation of effects on arthritis on day 21 resulted in ED50 values of 0.9 mg/kg (BF389), 3.9 mg/kg (naproxen), 4.9 mg/kg (diclofenac) and 0.6 mg/kg (piroxicam).(ABSTRACT TRUNCATED AT 250 WORDS)

No cytogenetic effects of quinolone treatment in humans.

Cytogenetic effects of ciprofloxacin (500 to 2,000 mg daily) and ofloxacin (200 mg daily) were studied in lymphocytes from 31 patients treated for 1 to 10 weeks. Blood samples for cytogenetic analysis were taken before the start of treatment from all patients, after 1 week from 25 patients, and after 2, 4, 6, and 10 weeks from six patients. No chromosome-damaging effect could be demonstrated in any treatment group. The mean aberration yields for each cytogenetic parameter studied and the total number of aberrations were all normal at each sampling occasion.

Drug-induced photo-onycholysis. Three subtypes identified in a study of 15 cases.

We have studied 15 patients with photo-onycholysis induced by tetracyclines, psoralens, or fluoroquinolones. Three distinct clinical subtypes of onycholysis were seen. Type I showed a half-moon-shaped separation that was concave distally. Type II had a circular notch opened distally and shaped as if the distal nail plate had acted as a convex lens. In type III the changes were located in the central part of the nail bed with no connection to the margins. Ultraviolet (UV) irradiation of normal fingernails with various wavelengths showed that 3% to 20% of the irradiation could penetrate the nail. The different patterns of photodamage might be caused by the nail acting as a lens. Less protection by lack of melanin and absence of sebum and stratum granulosum may favor penetration of UV irradiation and explain why the skin was not always affected.

The efficacy and safety of ciprofloxacin and ofloxacin in chronic Pseudomonas aeruginosa infection in cystic fibrosis.

The clinical efficacy and safety of ciprofloxacin and ofloxacin were compared in a prospective, randomized double blind, placebo combined cross-over study in 26 adult cystic fibrosis patients with chronic broncho-pulmonary Pseudomonas aeruginosa infection. Active treatment consisted of ciprofloxacin 750 mg orally twice daily or ofloxacin 400 mg orally twice daily; both treatments were given for 14 days, with three months between treatment periods; 21 patients completed both treatment periods. Treatment with both ciprofloxacin and ofloxacin was associated with a good clinical response as judged by clinical score, lung function tests and inflammatory parameters; no difference between ciprofloxacin and ofloxacin was found. Adverse reactions were seen in nine of 24 patients who received ciprofloxacin and in six of 23 who received ofloxacin. The majority were dyspeptic reactions or photosensitivity. No serious adverse reactions occurred. Three cases of treatment failure were found, one of which was associated with development of resistant P. aeruginosa during ofloxacin treatment. The mean MIC of both drugs increased during treatment but returned to pretreatment values within three months. Ciprofloxacin and ofloxacin seem to be valuable agents for intermittent treatment of chronic P. aeruginosa lung infection in adult cystic fibrosis patients.

Ofloxacin versus trimethoprim-sulphamethoxazole in acute cystitis.

The clinical and bacteriological efficacy and adverse reactions of ofloxacin vs trimethoprim-sulphamethoxazole were investigated in a double-blind, randomised study in 250 female patients (125 in each group) with acute, uncomplicated lower urinary tract infections. The dosages of ofloxacin and trimethoprim-sulphamethoxazole were 100mg and 160mg + 800mg twice daily, respectively. The duration of therapy was 3 days. 81% of the patients had significant bacteriuria. Escherichia coli was isolated in 76% and Staphylococcus saprophyticus in 11% of the infections. The bacteriological elimination, clinical cure and improvement rates of the evaluable patients on ofloxacin treatment were 92 and 95%, respectively. The corresponding figures on trimethoprim-sulphamethoxazole therapy were 88 and 90%. Adverse reactions were clinically unimportant, and none of the patients had to stop treatment. Mild and transient side effects, mainly from the gastrointestinal tract, central nervous system and skin, were reported by 19 and 22% of the patients in the ofloxacin and trimethoprim-sulphamethoxazole groups, respectively. None of the differences in clinical and bacteriological efficacy and side effects of ofloxacin vs trimethoprim-sulphamethoxazole were statistically significant. Ofloxacin appears to be an appropriate antibiotic for short term therapy of acute, uncomplicated, lower urinary tract infections, comparing favourably with trimethoprim-sulphamethoxazole treatment in this study.

Clinical experience with ofloxacin in upper and lower urinary tract infections. A comparison with co-trimoxazole and nitrofurantoin.

The efficacy and tolerance of ofloxacin were compared with those of co-trimoxazole in upper urinary tract infections (UTIs) and nitrofurantoin in lower UTIs in a prospective, controlled, randomised, observer-blind study. Ofloxacin proved to be an effective and well-tolerated substance. The clinical cure rate was more pronounced than that of both comparative drugs and ofloxacin was also superior to co-trimoxazole and nitrofurantoin in terms of bacterial elimination. A second, controlled study showed that single doses of ofloxacin 100mg were clinically and bacteriologically as effective as a 3-day course of ofloxacin 100mg twice daily in women with uncomplicated lower UTIs.

Ofloxacin treatment in the management of chronic osteitis.

In an open prospective study, the efficacy and tolerability of ofloxacin in the treatment of chronic post-traumatic osteitis was examined in 83 patients. 103 different pathogens were isolated. More than 75% were Gram-positive bacteria with Staphylococcus aureus occurring in 61% of cases. After ofloxacin treatment bacteriological elimination was more than 90% for both Gram-positive and Gram-negative species, leading to a clinical cure in 85% of patients. Reinfection occurred in 5% of patients. These values were obtained from follow-up examinations which were carried out at least 6 months after the end of therapy. The tolerability of ofloxacin was excellent and no drug-related allergic reactions or side effects were observed. In conjunction with adequate surgical treatment, ofloxacin proved to be a useful antibacterial agent in the therapy of chronic bone infection.

An open randomised comparison of ofloxacin and doxycycline in lower respiratory tract infections.

The efficacy and tolerance of ofloxacin and doxycycline were compared in patients with lower respiratory tract infections. Doses used were 200 or 400mg twice daily for ofloxacin and 100mg twice daily for doxycycline. Of 230 patients treated, 219 could be assessed for effectiveness. 88 patients were treated for exacerbations of chronic bronchitis and 131 for pneumonia. Clinical cure was achieved in 18 of 52 patients with bronchitis treated with ofloxacin. Improvement occurred in 29 and failure in 5. In the doxycycline-treated bronchitis group 11 of 36 patients were cured, 22 improved and 1 failure occurred. Of 62 patients with pneumonia who were administered ofloxacin, 34 were cured, 26 improved and treatment failed in 2. In the doxycycline-treated group of patients with pneumonia 39 of 69 were cured, 23 improved and 7 failed to respond. Two patients experienced adverse effects during ofloxacin treatment and 7 while receiving doxycycline.

Open randomised comparison of ofloxacin and norfloxacin in the treatment of complicated urinary tract infections.

The efficacies of ofloxacin and norfloxacin in the treatment of chronic complicated urinary tract infections were compared. 30 adult outpatients suffering from underlying urinary tract disease, with pyuria of 10 or more WBC/hpf and bacteriuria of 10(4) or more viable organisms per millilitre, were randomly assigned to receive ofloxacin 200mg once daily or norfloxacin 400mg twice daily for 10 days. After treatment pyuria was cleared in 9 cases and decreased or unchanged in 6 cases in the ofloxacin group. The corresponding numbers were 10 and 5 in the norfloxacin group. Bacteriuria was eliminated in 12 patients, unchanged in 1 and replaced in 2 in the ofloxacin group. In the norfloxacin group bacteriuria was eliminated in 8 cases, unchanged in 1, decreased in 1 and replaced in 5. The overall effectiveness rate was 14 of 15 in the ofloxacin group and 12 of 15 in the norfloxacin group. Ofloxacin 200mg once daily was as effective as norfloxacin 400mg twice daily in this open study.

The use of quinolones in respiratory tract infections.

In a prospective (and continuing) trial, a total of 271 patients with acute purulent exacerbations of chronic respiratory disease (bacteriologically confirmed) were treated with various new oral quinolones including enoxacin (26), pefloxacin (50), ciprofloxacin (80) and ofloxacin (115). Various therapeutic schedules were employed, with differing drug dosages, frequencies of administration and durations of treatment. All patients were investigated microbiologically during and immediately after treatment and after 7 days of follow-up. The best clinical results were noted after ofloxacin 800 mg once daily for 7 days, which showed excellent gastrointestinal absorption and rapid penetration through to the sputum. Some of the treatment failures with enoxacin and pefloxacin could be ascribed to the development of resistance during treatment, rises in minimal inhibitory concentrations (MICs) being noted with Streptococcus pneumoniae and Pseudomonas aeruginosa.

Clinical efficacy of ofloxacin in lower respiratory tract infections. A multicentre study.

A multicentre clinical trial was carried out to determine the activity and tolerability of ofloxacin in the treatment of lower respiratory tract infections. 667 patients were randomly allocated to 1 of 3 different twice daily dosage regimens: 400 mg (245 patients), 600 mg (211) or 800 mg (211). The mean duration of treatment was 8.77 +/- 2.62 days. Satisfactory overall clinical results (i.e. cured or improved) were obtained in 612 of 667 patients (91.8%). Eradication of pathogens was achieved for 279 of 354 isolated strains (78.8%). Side effects were observed in 31 patients and consisted of gastrointestinal disturbance (22), skin rash (1), neurological disturbance (3) and others (5). No significant alteration of haematological parameters was reported.

Photoonycholysis induced by the fluoroquinolones pefloxacine and ofloxacine. Report on 2 cases.

Pefloxacine and ofloxacine are 2 new synthetic fluoroquinolones which should be added to the list of drugs inducing photoonycholysis. Two cases are reported.