Morphological and Skeletal Abnormalities Induced by Rolapitant: An Antiemetic Agent.

Introduction Rolapitant hydrochloride is a highly selective, long-acting antagonist of the neurokinin-1 (NK1RA) receptor with a high level of central nervous system (CNS) penetrance. Clinically, it is given to cancer patients with high and moderate emetogenic chemotherapy to prevent chemotherapy-induced nausea and vomiting (CINV). The facts produced in this research support the interpretation of teratogenic effects like anatomical malformations and abnormal skeletal changes affected by high doses of rolapitant in developed chick embryos, which can be extrapolated to humans due to gaps in the literature regarding the teratogenic potential of rolapitant. As rolapitant is metabolized by the liver and excreted through the kidney by leaving a deep impact on the various systems of the body and due to its high plasma concentration with a half-life of more than 180 hours, the study was conducted to acquire some additional information about its adverse effects over the various body systems. Chick is one of the best animals for embryological laboratory research. For various reasons, it is preferred to research embryology in chicks or domestic hens (Gallus domesticus). Chick eggs are large, readily available all year, easy to incubate, and regulate artificially. Aim This study aimed to determine the morphological and skeletal abnormalities due to the effect of rolapitant, an antiemetic agent, in developing White Leghorn (G. domesticus) chicken eggs. Materials and methods The experiment used 300 fertilized White Leghorn chicken eggs. The eggs were categorized into five experimental groups (A, B, C, D, and E, each with 30 eggs) and five control groups (a, b, c, d, and e, each with 30 eggs). Rolapitant was administered into the five experimental groups of eggs on incubation day five at various concentrations of 0.00039, 0.0005, 0.00075, 0.001, and 0.00125 mg, respectively, while the control groups received the same volume (0.039, 0.05, 0.075, 0.1, and 0.125 ml, respectively) of normal saline. Results At all doses, the mean weight and crown-rump (CR) length of chick embryos were significantly greater in the control group than in the experimental group. The experimental group died at a higher rate than the control group. Additionally, it was found that the mortality due to the rolapitant dosages increases with dose. All groups except group A showed skeletal anomalies such as poor ossification, bent, and displacement, and morphological abnormalities such as yolk sac retraction, hematoma, and scanty feathers were found in experimental groups C, D, and E. This was shown to be more prevalent in the experimental groups and was exacerbated by subsequent rolapitant dosages. Conclusion Rolapitant is toxic when taken in large doses and for an extended period. As a result, rolapitant should be taken only when a valid diagnosis has been established and only at the recommended dose, not at a larger dose or for an extended period of time.

Patterns of RT-PCR Test Conversion and Implications on Time of Discharge in a District Hospital and a COVID-19 Care Centre in Pali, Rajasthan, India.

Introduction Although coronavirus disease 2019 (COVID-19) first appeared in 2019, the symptoms are similar to common viral illnesses, and if undiagnosed or there is a delay in treatment, it may prove fatal because of the virus's propensity to attack the respiratory and cardiovascular system. The antigenic conversion status of reverse transcription-polymerase chain reaction (RT-PCR) was an important criterion for discharge among the COVID-19 patients of the two hospitals in the study. Aim The aim of the study was to assess the time taken to antigenic conversion from positive to negative in RT-PCR test for COVID-19 done on patients admitted to the two hospitals where the study took place. Materials and methods A prospective cross-sectional study with repeated sampling for antigenic conversion by RT-PCR was done on 117 patients of different age groups admitted to Bangur Hospital and Agarsen Bhavan in Pali, Rajasthan, India, from April 27 to June 30, 2020. Pharyngeal and nasal swabs were analyzed by real-time RT-PCR for COVID-19 infection. The patients' first positive sample was taken as "zero sample". If the repeat sample taken on the fifth day was positive, sampling was repeated after 48 hours on consecutive days 7, 9, 11, 13, and 15 of admission till the RT-PCR test returned negative. Results Among the 117 patients, 92 (78.63%) were treated as mild, 10 (8.54%) were moderately severe, and 15 (12.82%) were very severe requiring ICU care. The median rate of conversion of RT-PCR test (positive to negative) from the day of admission was quite variable as five patients converted to negative by RT-PCR test on day seven of admission, one on day eight of admission, 26 on day nine, 30 on day 10, five on day 11, 13 on day 12, 10 on day 13, 11 on day 14, five on day 15, six on day 16, three on day 17, and one on day 18 of admission. Conclusion The study proved that follow-up of patients, prompt and comprehensive treatment, and repeated sampling ensures fast recovery with implications on time to discharge of such patients in a pandemic. The study justified and heralds the message that the inherent immunity of an individual corresponds to the time taken to conversion from positive to negative in the RT-PCR test.

Sero-prevalence of HBV and associated risk factors among HIV positive individuals attending ART clinic at Mekelle hospital, Tigray, Northern Ethiopia.

BACKGROUND: Because of the shared mean of transmission, hepatitis B virus (HBV) is one of an important cause of co-morbidity and mortality in peoples living with HIV/AIDS. Hence, the aim of this study was to determine the sero-prevalence of HBV infection and associated risk factors in HIV/AIDS positive individuals attending ART clinic at Mekelle hospital, Mekelle, Northern Ethiopia. METHODS: A cross sectional study was conducted from August to October 2014 in HIV/AIDS positive adult individuals. Socio-demographic data and other explanatory variables were collected from 508 study participants using pre-tested and structured questionnaire-based interviews. Serum hepatitis B surface antigen (HBsAg) was detected using commercially available rapid test and third generation enzyme-linked immunosorbent assay (ELISA). Bivariate and multivariate analysis, using SPSS V.20.0, were performed to assess the variables associated with HBV infection and P value less than 0.05 was considered as statistically significant. RESULTS: A total of 508 study participants, 305 females and 203 males were included in this study with the mean (+SD) age of 37.8 + 9.6. The sero-prevalence of HBsAg was 5.9 %. Male gender (AOR = 2.6, 95 % CI 1.2-5.7), multiple sexual partners (AOR = 4.2, 95 % CI 1.3-13.1) and CD4 count <200 cells/µl (AOR = 3.5, 95 % CI 1.1-11.2) were significantly associated with HBsAg positivity. CONCLUSION: The prevalence of HBsAg was similar to the general population. However, HIV/AIDS positive individuals with reduced CD4 count, <200 cells/µl, showed a significant association with HBsAg seropositivity. Therefore, we recommended, all HIV/AIDS positive individuals should be screened for HBsAg during their follow for better treatment outcome and minimize risks of HBV transmission.

Sero-prevalence and associated risk factors for hepatitis C virus infection among voluntary counseling testing and anti retroviral treatment clinic attendants in Adwa hospital, northern Ethiopia.

BACKGROUND: Hepatitis C virus (HCV) is a major health concern where about 3% of the world's population is infected globally. In Ethiopia the prevalence ranges from 0.9 to 1.3% in the general populations. Human immune deficiency virus (HIV) patients due to their weak immune response are heavily affected by the virus. There is no data on magnitude and associated risk factors for HCV infection among voluntary counseling, testing center and anti retroviral treatment clinic Attendants in the study area. Therefore, the aim of this study was to determine the sero-prevalence and associated risk factors for HCV infection among voluntary counseling testing and anti retroviral treatment clinic attendants Adwa general hospital. METHODS: Cross sectional study was carried out among 302 participants (151 HIV-negative from VCT and 151 HIV-positive from ART follow up) clinics of Adwa hospital from September to December, 2014. About 5 ml of venous blood samples were collected from study participants for anti HCV antibody tests. Univariate analyses were used to identify associated variables with anti HCV positivity. Variables having p < 0.05 were considered as statistically significant association. RESULTS: Out of the total 302 participants, 52.6% of them were females and 47.4% males. The mean age of the participants was 34.1 year (SD ± 10.5). The overall sero-prevalence of HCV in this study was 4.3%. The prevalence HCV (6.6%) was higher among the ART clinic attendants than the VCT (2%) clinic attendants. History of hospitalization (p = 0.001), tooth extraction (p = 0.018) and blood transfusion (p = 0.041) showed statistically significant association with anti-HCV antibody. CONCLUSION: HCV sero-prevalence in this study was high. The prevalence was three fold higher among HIV positive patients than their counter parts. Thus, screening of HCV should be done among HIV patients for close monitoring and better management in HIV patients.

A pneumococcal brain abscess: a case report.

A brain abscess which is caused by Streptococcus pneumoniae is a rare entity. Here, we have described a gentle man who presented with the signs and symptoms of a mass lesion which was localized to the temporal lobe. The clinical examination and computerized tomography revealed the diagnosis of a temporal abscess. The loculated mass was tapped and it was sent for histopathology, which confirmed the presence of an organizing abscess. A laboratory investigation of the pus revealed Streptococcus pneumoniae. The treatment included total excision and the administration of prolonged antibiotics, which led to a good outcome in the patient.