Efficacy of SGLT2 inhibitors for anthracycline-induced cardiotoxicity: a meta-analysis in cancer patients.

Aim: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) lower anthracycline-induced cardiotoxicity. Methods: PubMed and Google Scholar were searched until September 2023 for studies regarding SGLT2i for treating anthracycline-induced cardiotoxicity. Overall mortality and cardiovascular events were considered. Using a random-effects model, data pooled RR and HR at a 95% confidence interval (CI). Results: 3 cohort studies were identified, analyzing 2817 patients. Results display a significant reduction in overall mortality [RR = 0.52 (0.33-0.82); p = 0.005; I2= 32%], HF hospitalization [RR = 0.20 (0.04-1.02); p = 0.05; I2= 0%] and no significant reduction in HF incidence [RR = 0.50 (0.20-1.16); p = 0.11, I2= 0%]. Conclusion: SGLT2i mitigates mortality and hospitalization due to heart failure, improving cancer patient's chances of survival by undergoing anthracycline treatment.

What is this article about? This article explores the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) as a solution for reducing anthracycline-induced cardiotoxicity. Anthracycline is an established subclass of chemotherapeutic drugs which has been known to cause harm to the heart. The study, conducted a systematic search of PubMed and Google Scholar up until September 2023, assessing the effects of SGLT2i on overall mortality and cardiovascular events in cancer patients, regardless of the presence or absence of diabetes mellitus and the effectiveness of SGLT2i as a cardiotoxic therapy in cancer patients.What were the results? The analysis of studies involving 2817 patients showed findings indicating that giving SGLT2i could lower the chances of anthracycline-induced heart problems in cancer patients undergoing treatment. The findings showed a striking decrease in hospitalization due to heart failure and overall mortality whereas the findings for the effect of SGLT2i on incidence of heart failure were insignificant. The encouraging outcomes offer valuable insights that could help enhance the outlook and chances of survival for individuals with cancer.What do the results of the study mean? These findings indicate that SGLT2i notably reduces the risk of death and cardiovascular issues, like being hospitalized due to heart failure, in cancer patients undergoing anthracycline treatment. This has significant implications for how doctors might treat cancer patients in practice. Including SGLT2i in the treatment plan could improve the survival prospects of these patients, offering a promising advancement in handling anthracycline-induced heart issues with side effects that can be managed.

Triple-Negative Sjogren's Syndrome and Recurrent Pneumothorax: An Uncommon Presentation of Autoimmune Disease.

Sjogren's syndrome (SS) is a chronic exocrinopathy caused by lymphocytic infiltration and is associated with numerous manifestations and morbidities. We discuss a case of a 60-year-old female who presented to the Acute Medical Assessment Unit complaining of progressive shortness of breath for one month, not associated with chest pain or lower limb swelling. She also reported joint pain involving both wrists and proximal interphalangeal (PIP) joints, oral dryness, hair loss, and numerous tongue ulcerations. Blood workup revealed triple-negative SS, negative rheumatoid factor, anti-SSA and anti-SSB, a high erythrocyte sedimentation rate (ESR), and antinuclear antibody (ANA) titer of 640. A diagnosis of SS was made. Nevertheless, her CT chest showed massive left-sided pneumothorax; subsequently, a chest tube was urgently inserted. The chest tube was removed two days later with complete resolution on chest X-ray (CXR). However, one week later, she presented with a recurrent pneumothorax that persisted and required surgical intervention that led to complete recovery afterward. Pneumothorax is an extremely rare but potentially unfavorable complication related to SS, with only two cases reported in the literature so far and usually associated with underlying lung pathology.

Nanoparticle-based amplification for sensitive detection of ß-galactosidase activity in fruits.

Development of fast and sensitive assays for enzyme activity detection has received a great deal of attention because of the wide spread applications in measurements of numerous clinical, food and environmental processes. Herein, a novel amplification approach to enhance the sensitivity of colorimetric assays for detection of ß-galactosidase (ß-Gal) activity is proposed. ß-Gal detection is important in biomedical applications and in food industry, where it is associated with the ripening process of fruits. The method is based on the use of multivalent cerium oxide nanoparticles (CeNPs) which catalyze the oxidation of 4-aminophenol (4-AP) produced in the hydrolysis process of the 4-aminophenyl-ß-d-galactopyranoside substrate (4-APG) by ß-Gal, thus enhancing detection sensitivity of ß-Gal in the visible range. The developed assay is highly sensitive and easy to use. Using the optimized procedure, a limit of detection of 0.06 mU/mL was obtained with a linearity range up to 2.0 mU/mL. The feasibility of the method was demonstrated for detection of ß-Gal activity in fruits and the results were compared with the conventional assay, providing over a 30-fold amplification as compared to a commercially available ß-Gal protocol. The advantage of the presented assay is its biocatalytic event amplified by a secondary reaction, which enables much more sensitive detection of the enzymatic product. The sensing platform can be applied broadly to a variety of applications that rely on ß-Gal activity measurements.

Ocular surface: A route for SARS CoV-2 transmission- a case report.

SARS-CoV-2 infections are transmitted through droplets or through direct contact with secretions from an infected person. The transmission of the virus through tears and other body secretions remains controversial. PCR detection of Covid-19 in the samples/swabs taken from nasopharynx, CSF fluid, and tears, clarifies that the virus may be transmitted through the modes other than aerosol droplets or direct contact. In order to control and prevent this infectious disease, cutting-off the route of transmission will be one of the most important steps. SARS-CoV-2 RNA has been detected in tears and conjunctival samples of patients. The ocular tropism of Covid-19 is still uncertain but contentious.

An unusual case of T-cell acute lymphoblastic leukemia in a patient with BCR-ABL positive chronic myeloid leukemia and Gaucher disease.

BACKGROUND: Chronic myelogenous leukemia (CML) is a chronic myeloproliferative disease characterized by a massive overproduction of myeloid cells. It is associated with the Philadelphia chromosome [Ph1, t (9; 22) (q34; q11)] or BCR-ABL fusion gene. CML usually undergoes a triphasic clinical course ending in a blast crisis, an accelerated phase of blasts and promyelocyte production. Ten percent of CML patients reach the blast crisis phase, with 20-30% of leukemias belonging to B-cell lymphoid lineage. However, a transformation of CML into T-cell acute lymphoblastic leukemia (T-ALL) is rare. CASE PRESENTATION: We present a 56-year-old male patient, known case of hypertension and Ph1 CML of eight years with a family history of Gaucher disease who developed T-ALL. The patient presented with lymphadenopathy and severe anemia, needing packed RBC transfusion, neutropenia and thrombocytopenia at the admission. However, the monocytes and basophils percentage were high. The patient underwent a cervical lymph node core biopsy, and the immunohistochemistry stains showed an invasion of neoplastic cells positive for CD3, CD5, BCL2, CD34, TdT and focally positive for C-Kit and negative for CD20, CD56 and pan-CK. These histopathology features were consistent with T-cell acute lymphoblastic leukemia (T-ALL). CONCLUSION: Blast crisis remain a challenge in CML management. It's of great importance to do a full proper workup including lymph nodes biopsies. The aim is to reverse blast crisis and restore the chronic phase.

SARS-CoV-2 infection with pneumonia and stroke.

BACKGROUND: Covid-19 pandemic has been manifested mainly as respiratory and constitutional symptoms. Though, it may demonstrate the involvement of other systems i.e. cardiovascular system (CVS), central nervous system (CNS) or gastrointestinal system (GI). DISCUSSION: Systemic manifestation of Covid-19 requires further research. Recent surveys revealed a few alarming facts about Covid-19, that, when it hits the brain, can cause some serious complications like; psychosis, stroke and dementia. CASE PRESENTATION: Here, the case is about two patients, having PCR confirmed Covid-19 and radiographic evidence of stroke, who eventually died during hospital stay. Data collection was done after informed consent and in retrospective manner.

Management of acute fever in children: Consensus recommendations for community and primary healthcare providers in sub-Saharan Africa.

Fever is one of the most common reasons for unwell children presenting to pharmacists and primary healthcare practitioners. Currently there are no guidelines for assessment and management of fever specifically for community and primary healthcare workers in the sub-Saharan Africa region. This multidisciplinary consensus guide was developed to assist pharmacists and primary healthcare workers in sub-Saharan Africa to risk stratify and manage children who present with fever, decide when to refer, and how to advise parents and caregivers. Fever is defined as body temperature ≥ 37.5 °C and is a normal physiological response to illness that facilitates and accelerates recovery. Although it is often associated with self-limiting illness, it causes significant concern to both parents and attending healthcare workers. Clinical signs may be used by pharmacy staff and primary healthcare workers to determine level of distress and to distinguish between a child with fever who is at high risk of serious illness and who requires specific treatment, hospitalisation or specialist care, and those at low risk who could be managed conservatively at home. In children with warning signs, serious causes of fever that may need to be excluded include infections (including malaria), non-infective inflammatory conditions and malignancy. Simple febrile convulsions are not in themselves harmful, and are not necessarily indicative of serious infection. In the absence of illness requiring specific treatment, relief from distress is the primary indication for prescribing pharmacotherapy, and antipyretics should not be administered with the sole intention of reducing body temperature. Care must be taken not to overdose medications and clear instructions should be given to parents/caregivers on managing the child at home and when to seek further medical care.

Paper-Based Enzyme Biosensor for One-Step Detection of Hypoxanthine in Fresh and Degraded Fish.

Food freshness monitoring, which can reflect the quality of the product at the time of use, remains a great challenge for consumers and the food industry. Herein, we report the development of a cost-effective enzyme-based paper biosensor, which can monitor fish freshness and predict spoilage. The biosensor measures the release of hypoxanthine (HX), an indicator of meat and fish degradation, using the enzymatic conversion of HX by xanthine oxidase (XOD). We demonstrate that the entrapment of XOD and an organic dye, nitro blue tetrazolium chloride (NBT), within a sol-gel biohybrid enables their stabilization on paper and promotes the enzymatic reaction with further retention of the reaction products within the cellulosic network . Linearity in the micromolar concentration range with a detection limit of 3.7 µM for HX is obtained. The biosensor has high selectivity toward HX and is manufactured in few steps from inexpensive widely available materials. The applicability of the biosensor is demonstrated by following fish degradation over time and measuring HX concentrations ranging from 117 (±9) to 198 (±5) µM within 24 h of degradation, at levels that are comparable with those measured by a commercial enzymatic kit for HX detection. As compared to the commercial kit, our biosensors are more cost-effective, do not require addition of exogenous reagents and are portable, having all of the reagents needed for analysis embedded within the sensing platform. This proof-of-concept work demonstrates that the paper-based HX biosensor has potential as a robust reagentless device for real-time monitoring of food freshness and for other applications in which HX plays an important role.

Successful antibiotic stewardship in hospitalised children in a developing nation.

OBJECTIVES: Increasing antimicrobial resistance has become a looming threat to paediatric health and, therefore, health facilities are obliged to practice antimicrobial stewardship. This study was undertaken to review stewardship adherence in the Department of Pediatrics at the Central Hospital, Pretoria, South Africa. METHODS: Antibiotic prescriptions of children admitted to hospital were reviewed for consistency with the national essential medicines list from January 2017 to January 2019. Medical records of children were reviewed to obtain the primary diagnosis, requested laboratory investigations and antibiotic prescription practices. The management was adjudicated as consistent with policy by a score system. RESULTS: This study reveals that management was in agreement with standard guidelines in 69.3% of cases, with a range of 33-77%. From the start of the study in January 2017 to the final date in January 2019 there was a significant increase in the number of patients with respiratory tract infections who were treated correctly, increasing from 41% to 73% at study end. CONCLUSIONS: This study is the first to report the success of antibiotic stewardship in children admitted to a tertiary hospital in South Africa. However, it is critical that antibiotic stewardship be continued and antibiotic prescriptions be aligned with guidelines.

Acute allergic rhinitis.

Allergic rhinitis is a common and troubling condition. Basic management of this condition has been well described. However, acute exacerbations of the chronic condition allergic rhinitis are a seldom discussed or described problem despite the fact that even well-controlled patients frequently have exacerbations. This consideration means that a new approach is necessary to define the management of these patients. There are three important events that illustrate the need for a new therapeutic approach:A person who gets a new diagnosis of allergic rhinitis, but has symptoms for many months or yearsA sufferer of allergic rhinitis who is exposed to an environment that triggers an exacerbationA person who has an exacerbation related to another trigger.Recognition of triggers and management strategies to correctly use 'relief' therapies such as topical nasal decongestants is the key to successful management. In addition, the use of an 'action plan', as for asthma, is useful.

Nanotechnology-based approaches for food sensing and packaging applications.

The rapid advancement of nanotechnology has provided opportunities for the development of new sensing and food packaging solutions, addressing long-standing challenges in the food sector to extend shelf-life, reduce waste, assess safety and improve the quality of food. Nanomaterials can be used to reinforce mechanical strength, enhance gas barrier properties, increase water repellence, and provide antimicrobial and scavenging activity to food packaging. They can be incorporated in chemical and biological sensors enabling the design of rapid and sensitive devices to assess freshness, and detect allergens, toxins or pathogenic contaminants. This review summarizes recent studies on the use of nanomaterials in the development of: (1) (bio)sensing technologies for detection of nutritional and non-nutritional components, antioxidants, adulterants and toxicants, (2) methods to improve the barrier and mechanical properties of food packaging, and (3) active functional packaging. The environmental, health and safety implications of nanomaterials in the food sector, along with an overview of regulation and consumer perception is also provided.

Chemical and Biological Sensors for Food-Quality Monitoring and Smart Packaging.

The growing interest in food quality and safety requires the development of sensitive and reliable methods of analysis as well as technology for freshness preservation and food quality. This review describes the status of chemical and biological sensors for food monitoring and smart packaging. Sensing designs and their analytical features for measuring freshness markers, allergens, pathogens, adulterants and toxicants are discussed with example of applications. Their potential implementation in smart packaging could facilitate food-status monitoring, reduce food waste, extend shelf-life, and improve overall food quality. However, most sensors are still in the development stage and need significant work before implementation in real-world applications. Issues like sensitivity, selectivity, robustness, and safety of the sensing materials due to potential contact or migration in food need to be established. The current development status of these technologies, along with a discussion of the challenges and opportunities for future research, are discussed.

DNA assay based on Nanoceria as Fluorescence Quenchers (NanoCeracQ DNA assay).

Functional nanomaterials with fluorescent or quenching abilities are important for the development of molecular probes for detection and studies of nucleic acids. Here, we describe a new class of molecular nanoprobes, the NanoCeracQ that uses nanoceria particles as a nanoquencher of fluorescent oligonucleotides for rapid and sensitive detection of DNA sequences and hybridization events. We show that nanoceria forms stable and reversible bionanoconjugates with oligonucleotides and can specifically recognize and detect DNA sequences in a single step. In absence of the target DNA, the nanoprobe produced minimal background fluorescence due to the high quenching efficiency of nanoceria. Competitive binding of the target induced a concentration dependent increase in the fluorescence signal due to hybridization and release of the fluorescent tag from the nanoparticle surface. The nanoprobe enabled sensitive detection of the complementary strand with a detection limit of 0.12 nM, using a single step procedure. The results show that biofunctionalized nanoceria can be used as a universal nanoquencher and nanosensing platform for fluorescent DNA detection and studies of nucleic acid interactions. This approach can find broad applications in molecular diagnostics, sensor development, gene expression profiling, imaging and forensic analysis.

Multifunctional Nanotechnology-Enabled Sensors for Rapid Capture and Detection of Pathogens.

Nanomaterial-based sensing approaches that incorporate different types of nanoparticles (NPs) and nanostructures in conjunction with natural or synthetic receptors as molecular recognition elements provide opportunities for the design of sensitive and selective assays for rapid detection of contaminants. This review summarizes recent advancements over the past ten years in the development of nanotechnology-enabled sensors and systems for capture and detection of pathogens. The most common types of nanostructures and NPs, their modification with receptor molecules and integration to produce viable sensing systems with biorecognition, amplification and signal readout are discussed. Examples of all-in-one systems that combine multifunctional properties for capture, separation, inactivation and detection are also provided. Current trends in the development of low-cost instrumentation for rapid assessment of food contamination are discussed as well as challenges for practical implementation and directions for future research.

Forms of Melanoplus bowditchi (Orthoptera: Acrididae) collected from different host plants are indistinguishable genetically and in aedeagal morphology.

The sagebrush grasshopper, Melanoplus bowditchi Scudder (Orthoptera: Acrididae), is a phytophilous species that is widely distributed in the western United States on sagebrush species. The geographical distribution of M. bowditchi is very similar to the range of its host plants and its feeding association varies in relation to sagebrush distribution. Melanoplus bowditchi bowditchi Scudder and M. bowditchi canus Hebard were described based on their feeding association with different sagebrush species, sand sagebrush and silver sagebrush, respectively. Recently, M. bowditchi have been observed feeding on other plant species in western Nebraska. We collected adult M. bowditchi feeding on four plant species, sand sagebrush, Artemisia filifolia, big sagebrush, A. tridentata, fringed sagebrush, A. frigidus, and winterfat, Krascheninnikovia lanata. We compared the specimens collected from the four plant species for their morphological and genetic differences. We observed no consistent differences among the aedeagal parameres or basal rings among the grasshoppers collected from different host plants. Amplified Fragment Length Polymorphism markers were used to test the genetic relationships among the grasshoppers. Analysis of Molecular Variance and distance-based Unweighted Pair Group Method with Arithmetic mean dendrogram failed to reveal significant differences. Although the forms showed behavioral and minor color and size differences, the genetic data suggest all forms under study likely interbreed, which indicates they are a single species instead of four species or subspecies. These results indicate that host plant use may influence melanopline phenotype and suggest the need of further genetic analysis of subspecies recognized based on morphology, distribution, and ecology.

Transient immune impairment after a simulated long-haul flight.

INTRODUCTION: Almost 2 billion people travel aboard commercial airlines every year, with about 20% developing symptoms of the common cold within 1 wk after air travel. We hypothesize that hypobaric hypoxic conditions associated with air travel may contribute to immune impairment. METHODS: We studied the effects of hypobaric hypoxic conditions during a simulated flight at 8000 ft (2438 m) cruising altitude on immune and stress markers in 52 healthy volunteers (mean age 31) before and on days 1, 4, and 7 after the flight. We did a cohort study using a generalized estimating equation to examine the differences in the repeated measures. RESULTS: Our findings show that the hypobaric hypoxic conditions of a 10-h overnight simulation flight are not associated with severe immune impairment or abnormal IgA or cortisol levels, but with transient impairment in some parameters: we observed a transient decrease in lymphocyte proliferative responses combined with an upregulation in CD69 and CD14 cells and a decrease in HLA-DR in the immediate days following the simulated flight that normalized by day 7 in most instances. DISCUSSION: These transient immune changes may contribute to an increased susceptibility to respiratory infections commonly seen after long-haul flights.

Response surface methodology to obtain beta-estradiol biodegradable microspheres for long-term therapy of osteoporosis.

The purpose of this work was to evaluate the main and interaction effects of formulation factors on the drug encapsulation efficiency of beta-estradiol biodegradable microspheres by applying response surface methodology. A secondary purpose was to obtain an optimized formula for long-term therapy of osteoporosis. A three factor, three level Box-Behnken experimental design was used to get 15 experimental runs. The independent variables were drug/polymer ratio (X1), dispersing agent concentration (X2), and deaggregating agent concentration (X3). The dependent variables were percentage encapsulation efficiency (Y1), cumulative percent drug released (Y2), and percentage yield of the microspheres (Y3). The formulations were prepared by emulsion solvent evaporation technique using ethyl acetate as organic solvent. The optimized formulation was maximized for encapsulation efficiency and further characterized for the particle size distribution, scanning electron microscopy (SEM), X-ray diffraction (XRD), and Fourier transform infrared (FT-IR). The mathematical relationship obtained between X1, X2, X3, and Y1 was: Y1 = -129.85 + 29.35X1 + 129.99X2 + 64.82X3 - 3.2X1X2 - 0.29X1X3 - 35.83X2X3 - 2.05X(2)(1) - 13.23X(2)(2) - 5.92X(2)(3) (R2 = 0.99) The equation showed that X1, X2, and X3 affect Y1 positively but interaction between any two of these factors affects Y1 negatively. The most significant interaction was between X2 and X3. The finding indicated that controlled releases beta-estradiol biodegradable microspheres with high encapsulation efficiency and low pulsatile release can be prepared and the quantitative response surface methodology applied helped in understanding the effects and the interaction effects between the three factors applied.

Biodegradable microparticulates of beta-estradiol: preparation and in vitro characterization.

Beta-estradiol has been recommended for the long-term therapy of osteoporosis and its oral formulations are subjected to intensive first pass metabolism. The present investigation was aimed at preparing and characterizing biodegradable microparticles of beta-estradiol with polymers such as PLA, PLGA 85/15, PLGA 75/25, and their mixtures. The microparticles were prepared by solvent evaporation method using methylene chloride as a solvent and polyvinyl alcohol as a surfactant. The drug-polymer ratios were 1:3, 1:5, and 1:7. The prepared microparticles (twelve formulations) were tested for encapsulation efficiency and in vitro drug release in 50% methyl alcohol/phosphate buffer pH 7.4. The results showed that the encapsulation efficiency varied from 81 to 100% and the formulation fabricated from PLGA 85/15 (1:3) showed less burst and consistent long time release. This formulation when further characterized displayed irregular spherical shape with an average particle size of 72 microm. The crystallinity of the drug was reduced when investigated using X-ray diffractometry. No chemical interaction between the drug and the polymer was observed as evidenced by FT-IR analysis. The results indicated that beta-estradiol biodegradable microparticles with PLGA 85/15 (1:3) could be a suitable approach for long term therapy of osteoporosis.

Anchorage control in bioprogressive vs straight-wire treatment.

Orthodontic techniques with different concepts and philosophies have emerged to provide adequate anchorage control. The purpose of this study was to compare the effectiveness of the Bioprogressive and Straight-wire techniques in the control of lower anchorage. Data were obtained from the records of 40 patients presenting Class I and II malocclusions treated with first bicuspid extractions. One group of 20 patients was treated with a utility arch used to set up cortical anchorage in the lower arch and sectional retraction mechanics for space closure. The second group was treated with straight wire with a preadjusted appliance system. Treatment evaluation revealed no significant between-group differences in the amount of skeletal growth relative to cranial base and lower mesial movement of first molars. Mean lower anchorage loss was 3.1 mm in the Bioprogressive patients and four mm in the Straight-wire patients. The apical base change was the most important component to molar correction. Although cortical anchorage did not impede lower molar movement, it was no less effective in controlling molar movement with a partial appliance than was the fully banded Straight-wire appliance.