Field Effectiveness of a Typhoid Conjugate Vaccine: The 2018 Navi Mumbai Pediatric TCV Campaign.

Typbar-TCV®, a typhoid conjugate vaccine (TCV), was prequalified by the World Health Organization in 2017. We evaluated its effectiveness in a mass vaccination program targeting children 9 months to 14 years in Navi Mumbai, India, from September 2018 to July 2020. We compared laboratory-confirmed typhoid cases from six clinical sites with age-matched community controls. Of 38 cases, three (8.6%) received TCV through the campaign, compared with 53 (37%) of 140 controls. The adjusted odds ratio of typhoid fever among vaccinated children was 0.16 (95% CI: 0.05-0.55), equivalent to a vaccine effectiveness of 83.7% (95% CI: 45.0-95.3). Vaccine effectiveness of Typbar-TCV in this large public sector vaccine introduction was similar to prior randomized controlled trials, providing reassurance to policymakers that TCV effectiveness is robust in a large-scale implementation.

The catalytic asymmetric polyene cyclization of homofarnesol to ambrox.

Polyene cyclizations are among the most complex and challenging transformations in biology. In a single reaction step, multiple carbon-carbon bonds, ring systems and stereogenic centres are constituted from simple, acyclic precursors1-3. Simultaneously achieving this kind of precise control over product distribution and stereochemistry poses a formidable task for chemists. In particular, the polyene cyclization of (3E,7E)-homofarnesol to the valuable naturally occurring ambergris odorant (-)-ambrox is recognized as a longstanding challenge in chemical synthesis1,4-7. Here we report a diastereoselective and enantioselective synthesis of (-)-ambrox and the sesquiterpene lactone natural product (+)-sclareolide by a catalytic asymmetric polyene cyclization by using a highly Brønsted-acidic and confined imidodiphosphorimidate catalyst in the presence of fluorinated alcohols. Several experiments, including deuterium-labelling studies, suggest that the reaction predominantly proceeds through a concerted pathway in line with the Stork-Eschenmoser hypothesis8-10. Mechanistic studies show the importance of the enzyme-like microenvironment of the imidodiphosphorimidate catalyst for attaining exceptionally high selectivities, previously thought to be achievable only in enzyme-catalysed polyene cyclizations.

Contrasting gut bacteriomes unveiled between wild Antheraea assamensis Helfer (Lepidoptera: Saturniidae) and domesticated Bombyx mori L. (Lepidoptera: Bombycidae) silkworms.

BACKGROUND: Insect gut microbiomes play a fundamental role in various aspects of insect physiology, including digestion, nutrient metabolism, detoxification, immunity, growth and development. The wild Muga silkworm, Antheraea assamensis Helfer holds significant economic importance, as it produces golden silk. METHODS AND RESULTS: In the current investigation, we deciphered its intricate gut bacteriome through high-throughput 16S rRNA amplicon sequencing. Further, to understand bacterial community dynamics among silkworms raised under outdoor environmental conditions, we compared its gut bacteriomes with those of the domesticated mulberry silkworm, Bombyx mori L. Most abundant bacterial phyla identified in the gut of A. assamensis were Proteobacteria (78.1%), Bacteroidetes (8.0%) and Firmicutes (6.6%), whereas the most-abundant phyla in B. mori were Firmicutes (49-86%) and Actinobacteria (10-36%). Further, Gammaproteobacteria (57.1%), Alphaproteobacteria (10.47%) and Betaproteobacteria (8.28%) were the dominant bacterial classes found in the gut of A. assamensis. The predominant bacterial families in A. assamensis gut were Enterobacteriaceae (27.7%), Comamonadaceae (9.13%), Pseudomonadaceae (9.08%) Flavobacteriaceae (7.59%) Moraxellaceae (7.38%) Alteromonadaceae (6.8%) and Enterococcaceae (4.46%). In B. mori, the most-abundant bacterial families were Peptostreptococcaceae, Enterococcaceae, Lactobacillaceae and Bifidobacteriaceae, though all showed great variability among the samples. The core gut bacteriome of A. assamensis consisted of Pseudomonas, Acinetobacter, Variovorax, Myroides, Alteromonas, Enterobacter, Enterococcus, Sphingomonas, Brevundimonas, Oleispira, Comamonas, Oleibacter Vagococcus, Aminobacter, Marinobacter, Cupriavidus, Aeromonas, and Bacillus. Comparative gut bacteriome analysis revealed a more complex gut bacterial diversity in wild A. assamensis silkworms than in domesticated B. mori silkworms, which contained a relatively simple gut bacteriome as estimated by OTU richness. Predictive functional profiling of the gut bacteriome suggested that gut bacteria in A. assamensis were associated with a wide range of physiological, nutritional, and metabolic functions, including biodegradation of xenobiotics, lipid, amino acid, carbohydrate metabolism, and biosynthesis of secondary metabolites and amino acids. CONCLUSIONS: These results showed great differences in the composition and diversity of gut bacteria between the two silkworm species. Both insect species harbored core bacterial taxa commonly found in insects, but the relative abundance and composition of these taxa varied markedly.

Catalytic asymmetric cationic shifts of aliphatic hydrocarbons.

Asymmetric catalysis is an advanced area of chemical synthesis, but the handling of abundantly available, purely aliphatic hydrocarbons has proven to be challenging. Typically, heteroatoms or aromatic substructures are required in the substrates and reagents to facilitate an efficient interaction with the chiral catalyst. Confined acids have recently been introduced as tools for homogenous asymmetric catalysis, specifically to enable the processing of small unbiased substrates1. However, asymmetric reactions in which both substrate and product are purely aliphatic hydrocarbons have not previously been catalysed by such super strong and confined acids. We describe here an imidodiphosphorimidate-catalysed asymmetric Wagner-Meerwein shift of aliphatic alkenyl cycloalkanes to cycloalkenes with excellent regio- and enantioselectivity. Despite their long history and high relevance for chemical synthesis and biosynthesis, Wagner-Meerwein reactions utilizing purely aliphatic hydrocarbons, such as those originally reported by Wagner and Meerwein, had previously eluded asymmetric catalysis.

[Protein Repeats Show Clade-Specific Volatility in Aves].

Protein repeats are a source of rapid evolutionary and functional novelty. Repeats are crucial in development, neurogenesis, immunity, and disease. Repeat length variability and purity can alter the outcome of a pathway by altering the protein structure and affecting the protein-protein interaction affinity. Such rampant alterations can facilitate species to rapidly adapt to new environments or acquire various morphological/physiological features. With more than 11000 species, the avian clade is one of the most speciose vertebrate clades, with near-ubiquitous distribution globally. Explosive adaptive radiation and functional diversification facilitated the birds to occupy various habitats. High diversity in morphology, physiology, flight pattern, behavior, coloration, and life histories make birds ideal for studying protein repeats' role in evolutionary novelty. Our results demonstrate a similar repeat diversity and proportion of repeats across all the avian orders considered, implying an essential role of repeats in necessary pathways. We detected positively selected sites (PSS) in the polyQ repeat of RUNX2 in the avian clade; and considerable repeat length contraction in the Psittacopasserae. The repeats show a species-wide bias towards a contraction in Galloanseriformes. Interestingly, we detected the length contrast of polyS repeat in PCDH20 between Galli-formes and Anseriformes. We speculate the length variability of serine repeat and its interaction with ß-catenin in the Wnt/ß-catenin signaling pathway could have facilitated fowls to adapt to their respective environmental conditions. We believe our study emphasizes the role of protein repeats in functional/morphological diversification in birds. We also provide an extensive list of genes with considerable repeat length contrast to further explore the role of length volatility in evolutionary novelty and rapid functional diversification.

Impact of Ruxolitinib Cream on Work Productivity and Activity Impairment and Associated Indirect Costs in Patients with Atopic Dermatitis: Pooled Results From Two Phase III Studies.

BACKGROUND: Atopic dermatitis is a chronic inflammatory skin disease that can negatively impact work productivity and daily activities. Ruxolitinib cream, a Janus kinase inhibitor, demonstrated efficacy and safety in patients with atopic dermatitis in two phase III studies (TRuE-AD1 and TRuE-AD2). OBJECTIVE: This post hoc analysis sought to describe the effects of ruxolitinib cream on work productivity and activity impairment from pooled data from the phase III studies, to estimate indirect costs due to atopic dermatitis, and to estimate the incremental cost savings with ruxolitinib cream versus vehicle cream. METHODS: Patients in both studies were ≥ 12 years old with atopic dermatitis for ≥ 2 years, an Investigator's Global Assessment score of 2 or 3, and a 3-20% affected body surface area at baseline. Patients were randomized 2:2:1 to receive ruxolitinib cream (0.75% or 1.5%) or vehicle cream for 8 weeks. Patient self-reported productivity in the efficacy-evaluable population was assessed at weeks 2, 4, and 8 using the Work Productivity and Activity Impairment Questionnaire-Specific Health Problem version 2.0. Statistical significance for the two doses versus vehicle was calculated using an analysis of covariance. Work Productivity and Activity Impairment overall work impairment scores were converted to a model of costs per employed patient due to lost productivity and incremental cost savings from ruxolitinib cream treatment using a human capital approach. RESULTS: Of 1249 patients enrolled (median age, 32 years; female sex, 61.7%), 1208 were included in the efficacy-evaluable population. Patients applying 0.75% or 1.5% ruxolitinib cream had significant changes in overall work impairment (- 17.9% [0.75% strength] and - 15.0% [1.5% strength] vs - 5.7% for vehicle; p < 0.0001 for both) and daily activity impairment (- 20.6% [0.75% strength] and - 21.5% [1.5% strength] vs - 10.6% for vehicle; p < 0.0001 for both). These corresponded to estimated lost productivity costs in 2021 US dollars of $1313 (0.75% strength) and $1242 (1.5% strength) versus $2008 (vehicle) over the 8-week trial period. Compared with a patient receiving vehicle, incremental annual indirect cost savings were estimated to be $5302 with 0.75% ruxolitinib cream and $4228 with 1.5% ruxolitinib cream. CONCLUSIONS: Ruxolitinib cream therapy is associated with improved work productivity and daily activity compared with vehicle and is estimated to reduce the indirect cost burden on the patient. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov identifiers: NCT03745638 (registered 19 November, 2018) and NCT03745651 (registered 19 November, 2018).

Valorization of potato peel waste: Recovery of p-hydroxy benzoic acid (antioxidant) through molecularly imprinted solid-phase extraction.

Solid waste management of the potato peels, generated during the processing of potatoes, can be done sustainably by adding value to the peel waste. Peels contains polyphenols, which serve as a defense mechanism against foreign pathogens in plants and have a variety of pharmacological properties such as antioxidant and anti-carcinogenic properties. However, specific segregation of any one polyphenol from waste can be challenging due to its complex matrix and low concentration of the targeted polyphenol. This work presents a way to combat this challenge through molecularly imprinted solid-phase extraction (MISPE) using customized graphene oxide-based molecularly imprinted composite (GOMIP) as sorbent for the selective recovery of p-hydroxy benzoic acid (P-HA) (antioxidant used in food industries), from potato peels for the effective valorization of peels. Various parameters such as flow rate, vacuum manifold pressure, conditioning solvent, washing solvent, and elution solvent were optimized for effective segregation of targeted P-HA. The imprinting factor of 2.14, obtained using breakthrough curves for GOMIP and control (graphene oxide based non-imprinted composite-GONIP) sorbent under optimized condition, indicated the ability of the sorbent GOMIP to recover P-HA from the extract of potato peels. Reusability and selectivity studies were performed for GOMIP sorbent using the real sample [potato peels extract (PPE)]. 77.44% recovery for P-HA was exhibited by the GOMIP sorbent in the MISPE cartridge as determined using HPLC. MISPE with customized GOMIP sorbent can be a sustainable approach to valorize the potato peel solid waste.

Co-inoculation of native multi-trait plant growth promoting rhizobacteria promotes plant growth and suppresses Alternaria blight disease in castor (Ricinus communis L.).

Background: Castor (Ricinus communis L.) is cultivated for seed oil and to feed (leaves) Eri silkworm, Samia ricini (Donovan) Hutt. Alternaria blight affects castor cultivation resulting substantial yield loss (∼30%). Uses of synthetic fertilizers and agrochemicals for disease management have serious concerns as the castor leaves are fed to eri silkworms for rearing. Application of plant growth promoting rhizobacteria for disease suppression and to enhance plant growth will be a healthier choice in castor cultivation. The aim of this study was to assess the efficacy of Alternaria blight disease suppression by native rhizobacteria isolated from wasteland castor and their ability on plant growth promotion. Methodology: We isolated 50 bacterial antagonists from castor rhizosphere using the dilution plate method and evaluated their antagonistic activity against the castor blight pathogen, Alternaria ricini. Based on antimicrobial bioassay and plant growth promotion (PGP) traits (phosphate solubilization, ACC deaminase activities, production of IAA, GA3, HCN, NH3 and siderophore), salt and acid tolerance; we have chosen ten potential isolates and identified them through 16SrRNA gene sequencing and analysis. Disease suppression and plant growth studies were evaluated in pot experiments. Results and conclusion: Three isolates namely, Enterobacter hormaechei (LRP-2), Bacillus mycoides (HF-1) and B. aryabhattai (UR-6) showed potential antagonistic activities and PGP traits which were selected for disease suppression and PGP studies. Application of PGPR consortia (LRP-2+HF-1) could suppress the plants from A. ricini infection in challenged inoculation. Mix inoculation of LRP-2 and UR-6 showed synergistic effect and enhanced plant growth in pot experiments. Combinations of E. hormaechei (LRP-2), B. mycoides (HF-1) and B. aryabhattai (UR-6) can be applied as bio-control and bio-fertilizer formulation to protect castor from Alternaria blight and also to enhance plant growth.

Effect of Emotional Valence on Working Memory of Psychogenic Non-Epileptic Seizures (PNES) Patients.

Background The present study investigated how emotional valence influenced the working memory of patients with psychogenic non-epileptic seizures (PNES) as compared to healthy individuals. Methods Emotional-N-Back task (E-N-back task) was administered to 15 PNES patients and equal number of healthy individuals. A 2 × 3 one-way analysis of variance (ANOVA) was used. Correct detection (accuracy) and reaction (RT) time were recorded as behavioral performance measures. Results The ANOVA result of correct detection (accuracy) measure revealed significant difference in the performance of patients with PNES as compared with healthy individual, F (2, 48) = 17.08, p = 0.001. However, on the measure of reaction time (RT), both groups performed equally and there was no significant difference, F (2, 48) = 1.13, p = 0.33. Also the results of present study showed that patients with PNES are quicker in identifying unpleasant picture stimuli, which is evident from their mean comparison: unpleasant ( M = 65.55, SD = 15.66), pleasant ( M = 58.22, SD = 20.03), and neutral ( M = 45.11, SD = 23.13). Conclusion Conclusively, the finding of the present study shows a significant effect of emotional valence on working memory of patients with PNES on the measure of correct detection (accuracy), but not for second measure, i.e., reaction time this clearly reveals that patients with PNES are poor at emotional-cognitive integration, specifically at working memory level.

Early Detection and Successful Management of Acute Mesenteric Ischaemia in Symptomatic COVID-19 Patient.

Acute mesenteric ischaemia is a life-threatening vascular emergency that requires early diagnosis and intervention to adequately restore mesenteric blood flow and to prevent bowel necrosis and patient death. Its overall mortality is 60-80% and the reported incidence is increasing. This case report emphasises that a patient with early detection and radiological management of acute mesenteric ischaemia being symptomatic for COVID-19 can avoid major bowel surgery and negate any morbidity or mortality associated with the same.

Clinical and Demographic Profile of COVID-19 Patients: A Tertiary Level Hospital-Based Study From Northeast India.

Background and objective The coronavirus disease 2019 (COVID-19) outbreak, which was first detected in Wuhan, China, has turned into a rapidly spreading global healthcare crisis. The clinical and laboratory features of COVID-19 are associated with significant regional variations. In this study, we aimed to describe the clinical and demographic profile of COVID-19 patients from a tertiary care hospital in Northeast India. Materials and methods This was a hospital-based cross-sectional study that included all laboratory-confirmed COVID-19 cases admitted to the institution from 1st July to 31st October 2020. The information was collected on a predesigned proforma, which included patients' demographic profiles, clinical presentations, and outcomes as per treatment by trained doctors. Results The study included 180 laboratory-confirmed COVID-19 cases. A history of contact with laboratory-confirmed COVID-19-affected individuals was found in 92 (51.1%) patients. The median age of the patients was 37.17 years (range: 18-80 years), and there were 104 (57.78%) males in the cohort. Of the total enrolled patients, 102 (56.67%) were asymptomatic from the time of exposure till their admission. The common presenting complaints were fever (n=55, 70.51%), cough (n=42, 53.85%), and shortness of breath (n=32, 42.02%). The case fatality rate among the admitted cases was 15%. Comorbidities were found in 84 (46.67%) patients with the most common one being diabetes mellitus (n=31, 36.9%) followed by hypertension (n=29, 34.52%). Patients with advanced age (more than 60 years) and coexisting comorbidities were at higher risk of progression of disease and death. Conclusion The COVID-19 pandemic is not only a huge burden on healthcare facilities but also a significant cause of disruption in societies globally. The majority of the patients with COVID-19 infection presenting to our hospital were young and asymptomatic. Patients of advanced age with comorbidities were found to have more complications. An analysis of the trends related to COVID-19 in different hospital and institutional settings will help to achieve better preparedness and lead to improved patient care to combat the COVID-19 pandemic in a more efficient manner.

Changes in Carcinoid Syndrome Symptoms Among Patients Receiving Telotristat Ethyl in US Clinical Practice: Findings from the TELEPRO-II Real-World Study.

BACKGROUND: Inadequately controlled symptoms incur a substantial burden on patients with neuroendocrine tumors and carcinoid syndrome (CS). The effectiveness of telotristat ethyl (TE) with a somatostatin analog for uncontrolled CS diarrhea has been demonstrated in clinical trials and observational studies. TELEPRO-II was a prospective observational study evaluating TE's effectiveness in clinical practice over the first 3 months of treatment. METHODS: Patients initiating TE in 2018 participated in an optional nurse support program reporting CS symptoms during interviews at baseline and 1, 2, and 3 months after TE initiation. Eligible patients received TE for ≥3 months and reported symptom burden at baseline and ≥1 follow-up visit within the first 3 months. Daily bowel movement (BM) frequency and flushing episodes were reported as events/episodes per day. Stool consistency, nausea severity, urgency severity, and abdominal pain were reported on a severity scale (1-10). Symptom changes were evaluated using paired-sample t-tests and Wilcoxon signed-rank tests. Analysis of symptoms based on achievement of <30% or ≥30% reduction in daily BM frequency was conducted using a cumulative distribution function. RESULTS: A total of 684/1603 (43%) patients were eligible for analysis. At baseline, patients reported a mean of 6.3 BM/day, nausea severity of 8.4/10 and stool urgency of 8.2/10. Significant improvements in all CS symptoms were observed after 3 months of TE. Mean daily BMs were reduced 64% after 3 months of TE (mean reduction [SD], -3.99 [3.8]; P<0.0001). Most patients (74%, n=503) reported ≥30% reduction in daily BM frequency; these patients also reported improvements in other symptoms (76-87%). Patients with <30% reduction in daily BMs also reported improvements in nausea severity (62%, n=24), daily flushing episodes (66%, n=98), abdominal pain (50%, n=60), urgency severity (38%, n=64), and stool consistency (24%, n=44). CONCLUSION: Patients treated with TE in a real-world setting experienced significant, clinically meaningful improvements in CS symptoms.

Serotype and genotype diversity of dengue viruses circulating in India: a multi-centre retrospective study involving the Virus Research Diagnostic Laboratory Network in 2018.

OBJECTIVES: A retrospective study was undertaken to investigate the circulating dengue virus (DENV) serotypes and genotypes in India in 2018. METHODS: In total, 4963 samples referred to virus research diagnostic laboratories (n=21), the Indian Council of Medical Research-National Institute of Virology (ICMR-NIV) and ICMR-NIV field units (n=2) for diagnosis of dengue in 2018 were tested using a real-time reverse transcription polymerase chain reaction assay for the presence of DENV serotypes. Representative samples were sequenced for the envelope (E) gene. RESULTS: Regional diversity was observed with regard to the dominant circulating serotypes. DENV-2 was found to be the most common serotype in many states. Thrombocytopenia, petechiae and malaise were associated with DENV-2 infection. Phylogenetic analyses of DENV E gene sequences revealed the circulation of genotypes I and V of DENV-1, two lineages of DENV-2 genotype IV, DENV-3 genotype III and DENV-4 genotype I. CONCLUSIONS: This study found regional differences in the prevalence of circulating DENV serotypes in India, and provides baseline data for continuous molecular surveillance. Molecular surveillance may have implications for predicting large-scale outbreaks of dengue if regional shifts in the predominantly circulating serotypes and genotypes are detected during the early phase of the dengue season.

Single Nucleotide Polymorphisms of BMP2 Gene Association with Skeletal Class I Crowding: A PCR Study.

AIM AND OBJECTIVE: This study is conducted to find the association of BMP2 (bone morphogenic protein 2) gene variant rs1005464 and rs15705 with skeletal class I crowding cases. MATERIALS AND METHODS: Blood samples from 60 subjects who visited the Department of Orthodontics and Dentofacial Orthopaedics, D.A.P.M.R.V. Dental College, Bengaluru, were taken after written informed consent. These were divided into two groups: group A with 30 subjects having skeletal class I bases with crowding and group B with 30 subjects having skeletal class I bases without visible crowding or spacing (±2 mm). Around 2 mL of venous blood sample was procured from cases and controls after careful examination. All the samples were then subjected to polymerase chain reaction followed by DNA sequencing and capillary electrophoresis. BMP2 rs1005464 and rs15705 gene variants were assessed and Z-Test was used for statistical analysis. RESULT: GG (p = 0.001) and CC (p = 0.0024) genotype of BMP2 gene variant rs1005464 and rs15705, respectively, are significantly associated with skeletal class I crowding cases. CONCLUSION: This study concludes that BMP2 variants rs1005464 and rs15705 can be used as genetic markers for skeletal class I bases having crowding. CLINICAL SIGNIFICANCE: Predisposing genetic markers BMP2 can be identified prior and this would help in predicting the probability of potential crowding in the future and this would help in early prevention and intervention of crowding.

Inadequate Disease Control, Treatment Dissatisfaction, and Quality-of-Life Impairments Among US Patients Receiving Topical Therapy for Atopic Dermatitis.

INTRODUCTION: Patients with atopic dermatitis (AD) experience burdensome symptoms and impaired quality of life (QoL). The objective of this study was to investigate the effects of topical AD therapies on disease control, physician and patient treatment satisfaction, and QoL in a real-world setting. METHODS: This was a retrospective, point-in-time study of physician-completed medical records and patient surveys drawn from two Adelphi AD Disease Specific Programmes™ (1. adults ≥ 18 years old; 2. pediatrics ≤ 17 years old) in the USA. Eligible physicians completed patient record forms and provided disease control assessments. Physicians and matched patients were surveyed regarding their satisfaction with current treatment. Patient-reported outcomes included the Dermatology Life Quality Index (DLQI), Children's DLQI (CDLQI), Patient-Oriented Eczema Measure (POEM), and the Work Productivity and Activity Impairment (WPAI) questionnaire. RESULTS: A total of 394 adult (topicals only, n = 284; topical plus systemic, n = 110) and 144 adolescent (aged 12-17 years; topicals only, n = 114; topical plus systemic, n = 30) patients who had received their current treatment for at least 1 month were included. Overall, 24.5% of patients had physician-reported uncontrolled disease (adults, 22.8%; adolescents, 29.2%). Rates of physician- and patient-reported dissatisfaction with current treatment were 32.0% (adults, 28.2%; adolescents, 42.4%) and 24.8% (adults, 24.0%; adolescents, 26.8%), respectively, and were higher for patients with uncontrolled versus controlled disease. Poorer disease control and higher rates of treatment dissatisfaction were generally reported among patients receiving topical plus systemic therapy versus topicals alone. Patients with uncontrolled versus controlled disease reported more impairment in the DLQI, CDLQI, POEM, and WPAI (P < 0.05 for all), with generally greater impairments observed among patients on topical plus systemic therapy versus topicals alone. CONCLUSION: Patients receiving topical AD therapies experienced uncontrolled disease and reported decreased overall functioning and lower QoL. An unmet need for topical AD treatments that improve disease control and patient outcomes exists.

Atopic dermatitis (or eczema) is a common skin condition that causes dry, cracked, and itchy skin. Patients are frequently prescribed topical therapy, such as ointments and creams, to apply directly to the affected skin. Additionally, patients may be prescribed systemic therapies, which are oral or injectable medications that work throughout the entire body. This study included 394 adults and 144 adolescents (aged 12­17 years) with atopic dermatitis. All patients in the study were receiving topical therapy, and some received both topical and systemic therapy. The goal of the study was to evaluate how satisfied patients and their doctors were with current treatment and to learn how patients in the study felt about their quality of life. Patients and their doctors completed surveys that asked about feelings, symptoms, and whether their condition affects their work. The study results showed that patients had high levels of dissatisfaction with their treatment. Doctors reported that between one-fifth and one-quarter of adult patients and up to one-half of adolescent patients had uncontrolled disease (defined as changeable or worsening). Patients with uncontrolled disease reported higher dissatisfaction with their therapy and a negative outlook on their quality of life versus those with controlled disease (defined as stable or improving by their doctors). In summary, doctors and their patients currently using topical medications to treat atopic dermatitis reported that treatments were not working well enough and that uncontrolled disease was negatively affecting patients' quality of life and work, indicating that additional treatment options are needed.

Evaluation of bioefficacy potential of entomopathogenic fungi against the whitefly (Bemisia tabaci Genn.) on cotton under polyhouse and field conditions.

The whitefly, Bemisia tabaci Gennadius (Hemiptera: Aleyrodidae), is becoming a serious problem on Bt cotton. It causes enormous crop loss through its direct feeding and as a vector of cotton leaf curl virus. Chemical-dependent management is harming the environment and increased insecticide resistance is often observed in the fields. Identification of most virulent strains of entomopathogenic fungi (EPF) is essential to serve as an important component of an IPM program for management of B. tabaci. Compared to B. tabaci adults, the nymphal stage is reported to be more susceptible to entomopathogens, and targeting nymphs also helps vector management. We evaluated the bioefficacy of EPF and chemical pesticides against nymphs of B. tabaci on Bt cotton under polyhouse and field conditions. The bioefficacy index (BI) was considered as a mechanism to select the most effective EPF strains for field evaluation. The highest nymphal mortality under polyhouse conditions was recorded for Metarhizium anisopliae NA-01299 (86.7%), Beauveria bassiana MT-4511 (85.1%), Cordyceps javanica IT-10498 (81.1%), IT-10499 (81%), and B. bassiana NA-0409 (78.2%) relative to other EPF strains, spiromesifen (69.6%), buprofezin (62.2%) and pyriproxyfen (52.7%) at 7-days-post-spray treatment (DAS). However, among all the EPF, the highest BI was recorded in C. javanica IT-10499 (77%), IT-10495 (75.4%), Fusarium verticillioides IT-10493 (74.6%), and B. bassiana MT-4511 (73.1%). The pooled data of two-year field trials (2017-18 & 2018-19) revealed that the highest nymphal mortality was recorded for MT-4511 (85%), IT-10499 (83.2%), and pyriproxyfen 10% EC (78.6%) at 7-DAS. The BI-based selection of EPF proved to be a useful predictor of field efficacy. A sequential spray of the selected EPF would be a vital approach for resilient and sustainable integrated management of the B. tabaci nymphal population under field conditions.

Comparison of the Performance of a Novel, Smartphone-based, Head-mounted Perimeter (GearVision) With the Humphrey Field Analyzer.

PRECIS: The agreement between a head-mounted perimeter [GearVision (GV)] and Humphrey field analyzer (HFA) for total threshold sensitivity was a mean difference of -1.9 dB (95% limits of agreement -5 to 1). GV was the preferred perimeter in 68.2% of participants. PURPOSE: The purpose of this study was to compare reliability indices and threshold sensitivities obtained using a novel, smartphone-based, head-mounted perimeter (GV) with the HFA in normal, glaucoma suspect and glaucoma patients. A secondary objective was to evaluate the subjective experience participants had with both perimeters using a questionnaire. METHODS: In a prospective, cross-sectional study; 107 eyes (34 glaucoma, 18 glaucoma suspect, and 55 normal) of 54 participants underwent HFA and GV in random order. The main outcome measure was the agreement of threshold sensitivities using Bland and Altman analysis. Participants also completed a questionnaire about their experience with the devices. RESULTS: Median false-positive response rate for GV was 7% (4% to 12%), while for HFA it was 0% (0% to 6%, P<0.001). Median false-negative response rate was similar for both tests. In all, 84 eyes with reliable HFA and GV results were included in the final analysis. Median threshold sensitivity of all 52 points on HFA was 29.1 dB (26.5 to 30.7 dB) and for GV was 30.6 dB (29.1 to 32.6 dB; P<0.001). Mean difference (95% limits of agreement) in total threshold sensitivity between HFA and GV was -1.9 dB (-5 to 1 dB). The 95% limits of agreement were fairly narrow (-8 to 2 dB) across the 6 Garway-Heath sectors. Most participants preferred to perform GV (68.2%) if required to repeat perimetry compared with HFA (20.6%, P<0.001). CONCLUSIONS: There was fairly good agreement between the threshold sensitivities of GV and HFA. GV was also preferred by most patients and could potentially supplement HFA as a portable or home perimeter.

Robotic transduodenal excision of duodenal duplication cyst: Case report and review.

Duodenal duplication cysts are rare congenital anomalies that generally present with abdominal pain and vomiting or may have nonspecific symptoms. Surgical excision is the recommended treatment owing to possible complications, including malignancy. However, difficult locations like the periampullary region are problematic and major surgical procedures, for example, pancreaticoduodenectomy is necessary for total resection. These have a high complication rate resulting in a poor quality of life, especially in children and young adults. Here, we describe a case of duodenal duplication cyst managed by robotic (transduodenal) excision along with a brief review of the literature.

Improvement in Patient-Reported Outcomes in Adults with Type 1 Diabetes Treated with Sotagliflozin plus Insulin Versus Insulin Alone.

Background: Diabetes-related distress is common among persons affected by diabetes and is associated with suboptimal glycemic control and complications, thus constituting a relevant patient-report outcome (PRO). Improving glycemic control may reduce diabetes distress and improve treatment satisfaction. This post hoc analysis evaluated PRO data for a pooled cohort of adults with type 1 diabetes (T1D) receiving sotagliflozin as adjunct to optimized insulin in the inTandem1 and inTandem2 studies. Methods: Clinically meaningful changes in the Diabetes Treatment Satisfaction Questionnaire status version (DTSQs) and the two-item Diabetes Distress Scale (DDS2) total and individual scores were examined in the pooled data from the first 24 weeks of the studies. Results: In the cohort of patients with a baseline DTSQs total score ≤32 (∼76% of entire cohort), nearly twice as many patients treated with sotagliflozin 200 (45.9%) or 400 mg (42.3%) experienced a >3-point improvement from baseline versus those treated with placebo (24%). Treatment with sotagliflozin led to statistically significant (P < 0.05) improvements across all DTSQs items. Approximately 42% of all patients were considered to have a high risk of diabetes distress (total DDS2 score ≥6) at baseline following insulin optimization. More patients shifted from high to low risk with sotagliflozin compared with placebo (∼40% vs. 23%; P ≤ 0.0002). The baseline-adjusted difference in DDS2 from placebo was significantly (P < 0.001) reduced by -0.5 and -0.6 for sotagliflozin 200 and 400 mg, respectively. Conclusions: Patients with T1D treated with sotagliflozin in addition to optimized insulin therapy reported meaningful improvements in treatment satisfaction and diabetes distress. NCT02384941 and NCT02421510.