Short-Term Adverse Drug Reactions to Antiretroviral Therapy in Children with HIV: A Cohort Study.

OBJECTIVES: To carry out an active surveillance for adverse drug reactions (ADRs) in children with HIV infection newly initiated on antiretroviral therapy (ART), determine risk factors for their occurrence, and assess their influence on adherence to ART. METHODS: All children newly initiated on ART from 1st March 2014 to 30th June 2019 at a tertiary care children's hospital in New Delhi, were actively monitored for ADRs to ART for a period of 6 mo after ART initiation. The frequency, spectrum, and severity of ADRs, their influence on adherence, and risk factors for their occurrence were analyzed. RESULTS: Among the 174 enrolled children, ADRs were observed in 78 (44.8%) children during the first 6 mo after ART initiation. Total numbers of episodes of ADR observed were 108 (0.62 episodes of ADR/child). Sixty percent of events were of grade 1 severity, 19.4% events were of grade 2 and 3 each, while 1 (0.9%) event was of grade 4 severity. Adherence to ART was adversely affected in 21.8% of ADRs. Gastrointestinal symptoms (49.1%) were most frequent among all the events observed. Zidovudine, lopinavir/ritonavir, efavirenz and nevirapine based regimes were significantly associated with hematological, gastrointestinal, neurological, and dermatological ADRs, respectively. Children with immunological suppression were at a higher risk of developing ADRs as compared to those without it [RR 1.9 (95% CI (1.1-3.2)]. CONCLUSIONS: ADRs to ART are very frequent; most of them are mild and self-limiting. However, they can adversely impact adherence to ART. Anticipatory guidance, ongoing monitoring, and provision of symptomatic treatment will help tide over most ADRs and reduce their adverse impact upon ART adherence.

Molecular characterization of recombinant arginase of Leishmania donovani.

Arginase catalyzes the first committed step in the biosynthesis of polyamines that enable cell growth and hence potential drug target for the treatment of leishmaniasis. The arginase from Leishmania donovani (LdARG) was cloned, overexpressed and characterized. Analysis of the deduced amino acid sequence of LdARG with homologous enzyme from other trypanosomatids arginases identified a non-conserved 12 residues long segment VWGLIERTFLSA from position 161-172. This counter segment in L. mexicana arginase exhibits a different conformation compared with human arginase I. The pH and temperature optima of LdARG were 9.0 and 37 °C, respectively. Biochemical studies revealed that the KM for the substrate L-arginine was 24.76 ±â€¯0.06 mM. Molecular modeling of LdARG studies revealed that the glutamic acid residue at position 288 plays a role in substrate binding. The importance of this glutamic acid residue was validated by constructing a mutant variant of LdARG (E288Q-LdARG) by replacing glutamic acid with glutamine through site-directed mutagenesis. The KM value of mutant variant for L-arginine was found to be 107 ±â€¯0.18 mM. The increase in KM value of E288Q-LdARG as compared to LdARG suggested that substrate binding was significantly affected which could be exploited further. Studies on biochemical and structural characterization of recombinant LdARG will help in evaluating this enzyme as a potential drug target for visceral leishmaniasis.

Correlation between Second to Fourth Digit Ratio and Anthropometric Variables Indicative of Cardiovascular Disease

Second to fourth digit ratio (2D:4D) is a sexually dimorphic biometric marker. Regarding indirect evidence, there have been several studies that link the waist-tohip ratio (WHR) with the 2D:4D ratio. If the 2D:4D ratio is associated with testosterone and estrogen levels, it may be correlated with a risk of myocardial infarction (MI). The aim of the present study is to find out the correlation between anthropometric risk factors for cardiovascular disease and the 2D:4D ratio in 250 young females of the state of Haryana in Northern India. The present study was conducted on 250 females of the Haryana population aged between 17 and 35 years old. A series of 8 anthropometric measurements was obtained from the participants: height, weight, 2D:4D ratio, body mass index (BMI), waist circumference (WC), hip circumference (HC), neck circumference (NC), and WHR. The data was collected, tabulated and subjected to statistical computation using SPSS Statistics for Windows, Version 13.0 (SPSS Inc., Chicago, IL, USA). Strong positive associations between the NC and the WHR confirm that both measures are indicative of body fat. Also, a positive correlation between the 2D:4D ratio and the WHR suggests that low androgen levels in women are associated with a greater risk of obesity.Moreover, this result, as well as the positive correlation between 2D:4D ratios and NC, suggest that the digit ratio is indicative for being overweight in women and suggest a predisposition toward cardiovascular disease ­ however, these correlations of body measurements with digit ratios are not significant.

Arg-265: a critical residue of L.donovani cytosolic SHMT in maintaining the binding of THF and catalysis.

Serine hydroxymethyltransferase belongs to the class of pyridoxal-5-phosphate enzymes along with aspartate aminotransferase. To explore the function of residue(s) involved in binding of the carboxylate group of Tetrahydrofolic acid (THF) to L. donovani cytosolic serine hydroxymethyltransferase (LdcSHMT), the gene was cloned in pET-28(a) vector, overexpressed and purified to homogeneity. With the help of docking results of THF to the active site of protein, the key residues involved in interaction were identified. In an attempt to unravel the function of Arg265 residue involved in binding of the carboxylate group of THF, Arg-265 was mutated to Ala by site-directed mutagenesis. The Arg265Ala-LdcSHMT showed increased Km value (threefold) and decreased kcat/Km value (threefold) for H4-folate as compared with wild type enzyme. The wild and mutant enzymes exhibited similar Km and kcat/Km values for L-allo-threonine. Unlike the wild type enzyme, mutant failed to form characteristic quinonoid intermediate and was unable to carry out the exchange of α-proton from glycine in the presence of Tetrahydrofolate. These results suggested that Arg265 residue is required for the binding of Tetrahydrofolate and may be the base that abstracts α-proton from glycine, leading to formation of quinonoid intermediate in cytosolic SHMT of L. donovani.

Topographical mapping of the posterior interosseous nerve in surgical approaches to the proximal third of the radius

The posterior interosseus nerve, the deep branch of the radial nerve, is vulnerable to injury during internal fixation of radial head fractures. It arises from the radial nerve in front of the lateral epicondyle of the humerus. The aims of this study are to find the distance of the posterior interosseus nerve from the lateral epicondyle of the humerus at its entry point into the supinator muscle and its exit point from the supinator muscle; to evaluate the correlation between these distances with the length of the forearm and epicondylar width; and also to find a safe zone for approaching the proximal part of the radius, in order to minimize the chances of injury to the posterior interosseus nerve. 23 upper limbs obtained from formalin-fixed cadavers were dissected for their posterior interosseus nerve. All distances were measured with the help of sliding calipers and a measuring tape. Statistical analyses were performed using ‘SYSTAT 12 Pearson coefficient analysis’. The mean distance of the posterior interosseous nerve from the lateral epicondyle of the humerus to the posterior interosseus nerve, at its entry point into the supinator muscle and its exit point from supinator muscle, were found to be 4 cm and 8 cm, respectively. A statistically significant correlation between the length of the forearm and the exit of the posterior interosseous nerve from the supinator muscle was found (p-value=0.003). The present study concludes that the safe zone for the posterior interosseous nerve is 3.1 cm distal to the lateral epicondyle of the humerus. These data should be of help to orthopedic surgeons in minimizing the risk of injury to the posterior interosseus nerve while approaching the proximal part of the radius (AU)

No disponible