Enrollment and dropout rates of individuals with chronic obstructive pulmonary disease approached for telehealth interventions: A systematic review and meta-regression analysis.

Introduction: Telehealth interventions have the potential of improving health outcomes for individuals with chronic obstructive pulmonary disease (COPD). However, the precise impact of telehealth on exacerbation and hospital readmissions remains inconclusive. This lack of knowledge on the effectiveness of telehealth for COPD care might be due to lack of clarity regarding which variables are most strongly associated with enrolment and dropout rates. Objectives: Among individuals with COPD in telehealth studies, we aimed to: (1) estimate the extent to which trial-related variables are associated with enrolment and dropout rates, and identify reasons for dropouts; (2) estimate the extent to which patients-related and intervention-related variables are associated with dropout rates; (3) estimate the effect of enrolment rate and dropout rate on effect size; (4) estimate the effect of trial-related, patient-related, and intervention-related variables on effect size. Methods: A systematic literature search was conducted using four electronic databases. Two independent reviewers screened all retrieved titles, abstracts and full texts according to the inclusion criteria and extracted the data. A random-effect meta-regression analysis was conducted to estimate the overall enrolment and dropout rates, and estimated the different variables' effects on the enrolment rate, dropout rate, and effect sizes in the studies included in the review. Results: A total of 56 studies comprising 7530 participants were identified. The estimated enrolment and dropout rates were 50.3 % and 14.9 %, respectively. Trial-related variables influence enrollment and dropout rates, including RCT designs and the recruitments. The patient-related variables, including age and severity of the disease, and intervention-related variables, including the components of the intervention and mode of delivery, influence dropout rates. Studies with low dropout rates had a bigger effect size by 0.23. The main reported reasons for dropping out of the intervention were related to death (21 %) followed by lost to follow-up (14 %). Conclusion: Trial, patient, and intervention-related variables were found to influence the enrolment and dropout rates. This would help plan and develop a more appealing telehealth intervention that patients can easily accept and incorporate into their everyday lives. Registration information: International Prospective Register of Systematic Reviews (PROSPERO); ID: CRD42017078541.

An efficient metal-free and catalyst-free C-S/C-O bond-formation strategy: synthesis of pyrazole-conjugated thioamides and amides.

An operationally simple and metal-free approach is described for the synthesis of pyrazole-tethered thioamide and amide conjugates. The thioamides were generated by employing a three-component reaction of diverse pyrazole C-3/4/5 carbaldehydes, secondary amines, and elemental sulfur in a single synthetic operation. The advantages of this developed protocol refer to the broad substrate scope, metal-free and easy to perform reaction conditions. Moreover, the pyrazole C-3/5-linked amide conjugates were also synthesized via an oxidative amination of pyrazole carbaldehydes and 2-aminopyridines using hydrogen peroxide as an oxidant.

Infant with a parotid swelling: beware of the rare.

Salivary gland tumours are rare in children. We present the case of an infant who presented with a progressively increasing swelling of short duration in the parotid region accompanied by a small preauricular cutaneous haemangioma. Failing to comply with the commoner diagnoses like parotitis, help of imaging was taken that pointed towards the rarer diagnosis of parotid haemangioma. The child was started on oral propranolol and dramatic reduction in parotid and cutaneous swelling was seen after three months of therapy without any side effects.

Early hematological parameters as predictors for outcomes in children with dengue in northern India: A retrospective analysis.

INTRODUCTION: Dengue presents with a variable clinical course, ranging from mild illness to potentially fatal hemorrhage and shock. We aimed to evaluate the capabilities of various hematological parameters observed early in the course of illness for predicting the clinical outcomes of illness. METHODS: We retrospectively analyzed the records of children admitted in the pediatric inpatient services of the institute with dengue between 2017 and 2019. We determined the relationships between the hematological parameters observed during the first evaluation and the various clinical outcomes. RESULTS: We evaluated data from 613 patients (age range, 26 days to 17 years). Of these, 29.85% exhibited fever with warning signs, and 8.97% had severe dengue. Lower values of hemoglobin, platelet count, mean corpuscular volume, mean corpuscular hemoglobin concentration, and mean platelet volume, and higher values of total leukocyte count (TLC), hematocrit, and red cell distribution width variably correlated with numerous clinical outcomes-duration of hospital stay, development of complications, requirement of blood component transfusion, inotropic support, and mortality. Among the parameters, TLC ≥20,000/mL and initial platelet count ≤20,000/mL significantly associated with mortality, with odds ratios (95% confidence interval) of 11.81 (4.21-33.80) and 5.53 (1.90-16.09), respectively. CONCLUSIONS: Hematological parameters observed early during dengue infection may predict its clinical outcomes in infected children. Initial high TLC and low platelet count are potential predictors of fatal outcomes in the course of disease.

Early hematological parameters as predictors for outcomes in children with dengue in northern India: A retrospective analysis

Abstract INTRODUCTION: Dengue presents with a variable clinical course, ranging from mild illness to potentially fatal hemorrhage and shock. We aimed to evaluate the capabilities of various hematological parameters observed early in the course of illness for predicting the clinical outcomes of illness. METHODS: We retrospectively analyzed the records of children admitted in the pediatric inpatient services of the institute with dengue between 2017 and 2019. We determined the relationships between the hematological parameters observed during the first evaluation and the various clinical outcomes. RESULTS: We evaluated data from 613 patients (age range, 26 days to 17 years). Of these, 29.85% exhibited fever with warning signs, and 8.97% had severe dengue. Lower values of hemoglobin, platelet count, mean corpuscular volume, mean corpuscular hemoglobin concentration, and mean platelet volume, and higher values of total leukocyte count (TLC), hematocrit, and red cell distribution width variably correlated with numerous clinical outcomes-duration of hospital stay, development of complications, requirement of blood component transfusion, inotropic support, and mortality. Among the parameters, TLC ≥20,000/mL and initial platelet count ≤20,000/mL significantly associated with mortality, with odds ratios (95% confidence interval) of 11.81 (4.21-33.80) and 5.53 (1.90-16.09), respectively. CONCLUSIONS: Hematological parameters observed early during dengue infection may predict its clinical outcomes in infected children. Initial high TLC and low platelet count are potential predictors of fatal outcomes in the course of disease.

Et3N/DMSO-supported one-pot synthesis of highly fluorescent ß-carboline-linked benzothiophenones via sulfur insertion and estimation of the photophysical properties.

A robust transition-metal-free strategy is presented to access novel ß-carboline-tethered benzothiophenone derivatives from 1(3)-formyl-ß-carbolines using elemental sulfur activated by Et3N/DMSO. This expeditious catalyst-free reaction proceeds through the formation of ß-carboline-based 2-nitrochalcones followed by an incorporation of sulfur to generate multifunctional ß-carboline-linked benzothiophenones in good to excellent yields. The synthetic strategy could also be extended towards the synthesis of ß-carboline-linked benzothiophenes. Moreover, the afforded products emerged as promising fluorophores and displayed excellent light-emitting properties with quantum yields (ΦF) up to 47%.

An AcOH-mediated metal free approach towards the synthesis of bis-carbolines and imidazopyridoindole derivatives and assessment of their photophysical properties.

An AcOH-mediated concise, atom-economical and environmentally sustainable tandem strategy has been formulated to access highly fluorescent (ΦF up to 40%) N-fused bis-carbolines, imidazopyrido[3,4-b]indoles and imidazo[1,5-a]pyridines via the formation of three C-N bonds in a single operation. The multicomponent character of the reaction, easy to execute reaction conditions, simple purification procedure and excellent light emitting properties of the product afforded thereof provide a huge scope.

Natural product inspired design and synthesis of ß-carboline and γ-lactone based molecular hybrids.

ß-Carboline and γ-lactone moieties have been selected by nature as privileged scaffolds and display a wide range of pharmacological properties. Following nature, we envisaged the preparation of new ß-carboline and γ-lactone based molecular hybrids incorporating both the pharmacophores. In this regard, a water-assisted In-mediated environmentally benign and easy to execute single-step tandem Barbier type allylation-lactonisation process has been devised in order to afford the targeted molecular architectures. It is anticipated that aqueous medium plays the key role in allylation as well as in the subsequent lactonisation process for the diastereo-selective synthesis of these conjugates. It is believed that water drives the reaction pathway through dual activation, it increases the electrophilic character of formyl and ester functionalities and simultaneously enhances the nucleophilic potential of the hydroxyl group to facilitate the in situ intramolecular condensation. Importantly, during this synthetic strategy no column chromatographic purification was required at any stage.

Pulmonary Hypertension and Pulmonary Aspergilloma-Coexistence of Two Rare Sequelae of Pulmonary Embolism.

We report a 42 year old non-smoker male who presented with progressive exertional dyspnoea, productive cough with streaky hemoptysis and progressive pedal edema. His physical examination, ECG, chest X-ray and 2D-ECHO revealed features suggestive of right heart failure and pulmonary hypertension. On further evaluation for the cause of pulmonary hypertension, his CT pulmonary angiography revealed features of chronic pulmonary thromboembolism with calcified thrombus in the main pulmonary artery along with pulmonary hypertension. Incidentally the CT also revealed a cavity in the right lung with soft tissue within it. A, trans-thoracic needle aspiration of this tissue was suggestive of an aspergilloma. This is a rare case report of co-existence of two uncommon complications of pulmonary embolism-chronic thrombo-embolic pulmonary hypertension and pulmonary Aspergilloma in the same patient.

Medicinal Attributes of Imidazo[1,2-a]pyridine Derivatives: An Update.

The imidazo[1,2-a]pyridine scaffold is recognized as a privileged structure as it represents a promising area for identification of lead structures towards the discovery of new synthetic drug molecules. Several commercial drugs such as Zolpidem, Olprinone, Soraprazan and many other compounds in biological testing and preclinical evaluation, illustrate the wide therapeutic spectrum in this class of drug scaffolds. The present manuscript represents the assimilation of literature pertaining to medicinal aspects of this pharmacophore including the structure-activity relationships.

Sedative-hypnotic medicines and falls in community-dwelling older adults: a cost-effectiveness (decision-tree) analysis from a US Medicare perspective.

BACKGROUND: Both the 2012 Beers list and the American Geriatric Society 'Choosing Wisely' campaign suggest restraint in the use of sedative-hypnotics for the treatment of insomnia in older people. Sedative hypnotic agents continue to be widely prescribed even though their use in the elderly is associated with an increased risk of falls, fractures, and emergency hospitalizations. OBJECTIVE: The aim of this study was to estimate the cost effectiveness of cognitive behavioral therapy (CBT) compared with sedative-hypnotics and no treatment for insomnia in the US Medicare population, adjusting for the risk of falls and related consequences. METHODS: A model-based economic evaluation (decision tree) using the US Medicare perspective and a conservative annual temporal framework was conducted. Simulations were performed in a hypothetical cohort of Medicare beneficiaries suffering from insomnia. The main outcome measure was the incremental cost per quality-adjusted life year (QALY) gained. Sensitivity analyses assessed the robustness of the base-case analysis. RESULTS: On an annual basis, CBT showed a dominance (cost: US$19,442; QALYs: 0.594) over sedative hypnotics (cost: US$32,452; QALYs: 0.552) and no treatment (cost: US$33,853; QALYs: 0.517). Assuming a willingness to pay of US$50,000, the net monetary benefit was positive for CBT (US$10,287) and negative for sedative hypnotics (-US$4,851) and no treatment (-US$7,993). CBT had a 95% chance of being the dominant strategy, with results most sensitive to an older adult's baseline risk of falling. CONCLUSION: Failure to consider drug harms such as drug-induced falls and hospitalization represents a growing public health concern, significantly underestimating the cost of sedative-hypnotic therapy and loss in quality of life for the elderly. Public payers should reconsider reimbursement of sedative-hypnotic drugs as first-line treatment for insomnia in older adults.

Detection and prevention of drug-drug interactions in the hospitalized elderly: utility of new cytochrome p450-based software.

BACKGROUND: Polypharmacy increases the risk of cytochrome P450-based drug-drug interactions (CYP450-DDIs), leading to decreased therapeutic efficacy or increased drug toxicity. OBJECTIVE: The aims of this study were to investigate the utility of a new CYP450-DDI software, InterMED-Rx, in aiding pharmacists in detecting CYP450-DDIs in hospitalized elderly patients and to ascertain pharmacists' agreement on how to intervene for each CYP450-DDI. METHODS: A consensus panel of geriatric pharmacists first established guidelines for managing clinically relevant pharmacokinetic CYP450-DDIs. A prospective study was then conducted of patients newly admitted to a geriatric hospital whose pharmaceutical profile underwent analysis with InterMED-Rx. Rates and types of interventions were recorded. RESULTS: Pharmacists' interrater agreement on how to manage CYP450-DDIs was initially only moderate (Cohen's κ, 0.51; 95% CI, 0.39-0.62), but improved subsequent to deliberation (Cohen's κ, 0.79; 95% CI, 0.70-0.88). Persistent disagreement involved interactions between 2 drugs with similar affinities for the same cytochrome. One hundred patients with polypharmacy (≥5 medications) aged 82.3 years (range, 65-96), with a mean (SD) of 12.2 (4.1) drugs (range, 5-27) were recruited for the prospective study. Eighty percent of patients had at least 1 CYP450 DDI detected with InterMED-Rx. A total of 238 CYP450-DDIs were identified involving CYP3A4 (70.2%), CYP2D6 (22.7%), and CYP2C9 (3.4%) substrates or inhibitors. Nineteen percent of patients received immediate medication adjustment, and 39% required follow-up of clinical signs, symptoms, and laboratory tests to determine whether future modification was needed. More than one half (56%) of all patients who required clinical follow-up had further medication adjustment prior to discharge. CONCLUSIONS: Use of the InterMED-Rx software identified elderly patients at risk for pharmacokinetic interactions and facilitated interventions aimed at reducing adverse drug events. Although consensus can be reached among pharmacists on how to intervene for many CYP450-DDI scenarios, certain situations allow for multiple intervention strategies.

Asymptomatic infection with visceral leishmaniasis in a disease-endemic area in bihar, India.

A prospective study was carried out in a cohort of 355 persons in a leishmaniasis-endemic village of the Patna District in Bihar, India, to determine the prevalence of asymptomatic persons and rate of progression to symptomatic visceral leishmaniasis (VL) cases. At baseline screening, 50 persons were positive for leishmaniasis by any of the three tests (rK39 strip test, direct agglutination test, and polymerase chain reaction) used. Point prevalence of asymptomatic VL was 110 per 1,000 persons and the rate of progression to symptomatic cases was 17.85 per 1,000 person-months. The incidence rate ratio of progression to symptomatic case was 3.36 (95% confidence interval [CI] = 0.75-15.01, P = 0.09) among case-contacts of VL compared with neighbors. High prevalence of asymptomatic persons and clinical VL cases and high density of Phlebotomus argentipes sand flies can lead to transmission of VL in VL-endemic areas.

Effect of soybean administration on the pharmacokinetics of carbamazepine and omeprazole in rats.

Influence of soybean administration on the bioavailability of carbamazepine and omeprazole was studied after single dose administration of soybean (10 g/kg p.o.) or after chronic administration of soybean (50% w/w mixed with normal feed) for 15 days in rats. Carbamazepine was administered orally at a dose of 10 mg/kg and omeprazole at a dose of 20 mg/kg. Soybean decreased the bioavailability of carbamazepine after both single dose and chronic administration. It produced a significant decrease in C(max), T(max), AUC(0-t) of carbamazepine after single dose administration and increased the plasma clearance and V(d) along with decrease in C(max), T(max), AUC(0-t) and AUC(0-infinity) after chronic administration. On the contrary, soybean administration increased the bioavailability of omeprazole by producing an increase in C(max), AUC(0-t) and AUC(0-infinity) and a decrease in V(d) after single dose administration and a decrease in plasma clearance along with increase in C(max), AUC(0-t) and AUC(0-infinity) after chronic administration. The half-life of omeprazole was also increased after both acute and chronic administration of soybean. It was concluded that soybean decreases the bioavailability of carbamazepine and increases the bioavailability of omeprazole after both single dose and chronic administration.