"Shunt pumping test": detecting its efficacy through an experimental model.

PURPOSE: Shunt pumping test has often been used clinically to detect functional status of ventriculoperitoneal (VP) shunt. Its ability to correctly predict the status is not reliably known. Ethical dilemmas make it difficult to perform any studies in patients with blocked shunts, and hence, a requirement of devising an experimental model was felt. METHOD: An experimental model was devised using a Chhabra Slit N Spring shunt. The pressures were maintained in the proximal and distal chamber by real-time monitoring and maintained similar to intra-ventricular and intra-abdominal pressures. Three such models with scenarios of proximal block (PB), distal block (DB), and a functional shunt (BO) were created. Twenty-five participants were tested using these models to assess the efficacy of shunt pumping test. RESULTS: The experimental model could be used successfully to perform the test. The sensitivity of the test to detect a shunt with block on any side (AB) was found to be 0.79 (95% confidence interval 0.72-0.85) and specificity to be 0.69 (95% confidence interval 0.59-0.80). Its ability to detect the side of block was also evaluated. Absolute correctness value, odds ratio, and interpersonal heterogeneity were also evaluated. Pressure changes in proximal and distal catheter on compressing the chamber in various scenarios were recorded. CONCLUSION: The shunt pumping test has moderate ability to predict a blocked shunt and can aid clinical assessment of shunt block. It has only limited ability to detect the side of block. Pressure changes in the proximal and distal catheters on chamber compression are commensurate with the rationale of "shunt pumping test."

A single-center experience in use of tocilizumab in COVID-19 pneumonia in India.

BACKGROUND: IL-6 receptor antagonist tocilizumab (TCZ) has been used in several reported studies in the treatment of COVID-19 pneumonia and pieces of evidence are still emerging. METHODS: All patients with COVID-19 pneumonia showing features of hyperinflammatory syndrome receiving TCZ at a tertiary care center in India were included in the study and a retrospective descriptive analysis was done. RESULTS: Between May 2020 to August 2020, 21 patients received TCZ out of which 13 survived and 8 died. All non-survivors had longer duration (median 12 days, minimum 9, maximum 15 days compared to median 6 days, minimum 3 and maximum 14 days in survivors) of symptoms and severe disease requiring mechanical ventilation at the time of TCZ administration. Among survivors, 8 patients had severe disease, 3 had moderate disease, and 2 patients had mild disease. Six out of 8 (75%) among non-survivors and 8 out of 13 (62%) among survivors had preexisting medical comorbidities. The non-survivors had higher baseline neutrophil-to-leukocyte ratio (10.5 vs 8.8), serum ferritin (960 ng/ml vs 611 ng/ml), lactate dehydrogenase (795 IU/L vs 954 IU/L), and D-dimer (5900 µg/ml vs 1485 mg/ml) levels. No drug-related serious adverse effect was noted among the patients. CONCLUSION: In a scenario of emerging evidence for the role of TCZ in the management of severe COVID-19, our study provides useful data on its use in the Indian scenario. Deliberate patient selection and timing initiation of TCZ at a crucial stage of the disease may be beneficial in COVID-19 pneumonia with good safety returns.

Indian Clinician's Perspective on the Approach to the Management of Hypertension: A Cross-Sectional Study.

Introduction Hypertension (HTN) is considered one of the most frequent life-threatening noncommunicable illnesses. Because HTN has a significant public health impact on cardiovascular health status and healthcare systems in India, it is critical to study Indian clinicians' approaches to HTN management. Methodology This was a cross-sectional, multicentric, non-interventional, and single-visit study that aimed to gather data from across India and examine sociodemographic characteristics and clinician treatment choices in the management of HTN in Indian individuals. As a result, building an information platform about HTN is critical to preventing and controlling this growing burden. Results A total of 5298 patients were recruited in the study from 1061 study centers across India. Among the study patients, 66.67% were females with a mean age of 53.95 ± 14.4, and 66.28% of hypertensive patients presented comorbidities. Among the known risk factors for HTN, 2227 (44.5%) were smokers, while 2587 (51.7%) had sedentary lifestyles. A family history of HTN in either one or both parents was seen in 1076 (21.50%) patients. In management, 40.40% of patients were on anti-hypertensive monotherapy. Amlodipine (41.8%) in monotherapy and amlodipine + metoprolol (32.34%) in combination therapy were the most commonly prescribed antihypertensive. Conclusion Management of HTN can be improved by imparting patient education and awareness about the need for medication compliance, lifestyle modifications, and regular follow-up clinic visits.

Efficacy, safety, and tolerability of lifitegrast 5% eye drops: A randomized, double-blind, active-controlled trial in Indian patients with dry eye disease.

PURPOSE: To compare the efficacy, safety, and tolerability of lifitegrast 5% versus carboxymethylcellulose (CMC) 0.5% in adult patients with dry eye disease (DED). METHODS: A total of 370 eligible patients with DED were randomized equally to receive twice-daily doses of a single drop in each eye of either lifitegrast 5% or CMC 0.5% for 12 weeks. Follow-up at weeks 2, 6, and 12 evaluated changes from baseline in primary [eye dryness score (EDS), ocular discomfort score (ODS), ocular surface disease index (OSDI), and tear film break-up time (TFBUT)] and secondary [Schirmer tear test (STT) score and corneal fluorescein staining (CFS) score] endpoints. Global improvement, safety, and tolerability were also assessed. RESULTS: At week 2, values of ocular discomfort score, OSDI, and conjunctival redness were significantly more favorable in patients treated with lifitegrast compared to CMC. At week 6, values of all study variables were better in patients treated with lifitegrast compared to CMC; differences between the groups were statistically significant for all except photophobia. This trend was also maintained at week 12. Global improvement and tolerability were found to be better with lifitegrast than with CMC. No serious safety concerns were reported in any treatment group. CONCLUSION: To our knowledge, this is the first active-controlled trial informing on the efficacy, safety, and tolerability of lifitegrast 5%. Significantly more favorable values for EDS (except photophobia), ODS, OSDI, TFBUT, STT score, CFS score, and conjunctival redness score were achieved at week 12 with lifitegrast 5% compared to CMC 0.5%.

Comparison of the efficacy, safety, and tolerability of the FDC of telmisartan + bisoprolol with telmisartan + metoprolol succinate ER combination therapy for stage 1 and stage 2 hypertension: A double-blind, multicentric, phase-III clinical study.

AIM: The present study compared the safety, efficacy, and tolerability of the new fixed-dose combination (FDC) of telmisartan 40 mg + bisoprolol 5 mg (TBP) tablets with the existing comparator FDC telmisartan 40 mg + metoprolol succinate ER 50 mg (TMS) tablets in patients with stage 1 and stage 2 hypertension. METHODOLOGY: The multicentric, double-blind, parallel-group, comparative, prospective, phase-III clinical study involved 264 subjects with stage 1 and stage 2 hypertension from 10 centres across India. The selected subjects were randomized into two groups: group A received the TMS and group B received the new FDC TBP. The primary endpoint was the mean change in seated systolic blood pressure (SeSBP) and seated diastolic blood pressure (SeDBP) from baseline to week 12 in both the control and study arms. The secondary endpoint was achieving the target of SeSBP <140 mmHg and SeDBP <90 mmHg from baseline to week 12 in both groups. Safety and tolerability parameters were evaluated in both groups based on adverse effects (AEs) reported by the patients and the physician. RESULTS: Both treatment groups exhibited a reduction in BP after 2 weeks of treatment, which was sustained until 12 weeks. The mean change in SeSBP and SeDBP at weeks 2, 6, and 12 compared to the previous visit showed statistical significance (p < 0.001) in all cases for both groups A and B. The mean changes in SeSBP and SeDBP from baseline to study end were numerically higher in group B than in group A. The mean difference in SeSBP from baseline to study end was significantly higher in group B compared to group A (p = 0.029). By week 12, 88.28 % and 89.84 % of subjects in group B achieved SeSBP <140 mmHg and SeDBP <90 mmHg respectively, while 86.71 % and 91.40 % of subjects in group A achieved the same targets. Reported AEs were mostly mild to moderate in both treatment groups, and no serious AEs or deaths were reported. Tolerability was rated as 'excellent' by 93.75 % of subjects in group B and 91.40 % of subjects in group A. CONCLUSION: Both the new FDC TBP and the existing comparator TMS combination therapy have comparable efficacy, tolerability, and safety for the management of stage 1 and stage 2 hypertension. TRIAL REGISTRY NAME: Clinical Trials Registry of India (CTRI) TRIAL REGISTRATION NO: CTRI/2021/11/037,926 PROTOCOL NO: MLBTL/05/2021 PROTOCOL URL: https://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=62069&EncHid=&userName=bisoprolol.

4-Nitro-anilinium 3-carb-oxy-4-hy-droxy-benzene-sulfonate monohydrate.

In the title hydrated salt, C6H7N2O2 (+)·C7H5O6S(-)·H2O, the benzene ring of the cation makes a dihedral angle of 1.32 (19)° with the attached nitro group. In the anion, an intra-molecular O-H⋯O hydrogen bond with an S(6) ring motif is formed between the carb-oxyl and hy-droxy groups; the dihedral angle between the carb-oxyl group and the benzene ring is 8.76 (8)°. The crystal structure exhibits inter-molecular N-H⋯O, O-H⋯O, C-H⋯O, and π-π [centroid-centroid distances = 3.6634 (9) and 3.7426 (9) Å] inter-actions to form a three-dimensional network.

Uronium 3-carb-oxy-4-hy-droxy-benzene-sulfonate.

In the title compound, CH5N2O(+)·C7H5O6S(-), the dihedral angle between the benzene ring and the mean plane of the uronium cation is 76.02 (8)°. The carboxyl group in the anion is twisted by 1.47 (9)° from the benzene ring. In the crystal, the cation is linked to the anion by weak O-H⋯O and N-H⋯O hydrogen bonds and π-π inter-actions [centroid-centroid distance = 3.8859 (8) Å], forming a three-dimensional network.

4-(4-Bromo-styr-yl)-1-methylpyridinium tosyl-ate.

In the cation of the title compound, C14H13BrN(+)·C7H7O3S(-), the dihedral angle between the benzene and pyridine rings is 8.34 (11)°. The Br atom is disordered over two positions with site occupancies of 0.74 (2) and 0.26 (2). The mol-ecular structure is stabilized by a weak intra-molecular C-H⋯O inter-actions. The crystal structure exhibits weak C-H⋯O and π-π [centroid-centroid distance = 3.7466 (17) Å] inter-actions, forming a three dimensional network.

4-[2-(4-But-oxy-phen-yl)ethen-yl]-1-methyl-pyridinium tosylate.

In the title mol-ecular salt, C18H22NO(+)·C7H7O3S(-), the dihedral angle between the aromatic rings in the cation is 10.00 (9)°; its alkyl side chain adopts an extended conformation. In the crystal, weak C-H⋯O and π-π [centroid-centroid distance = 3.7658 (17) Å] inter-actions link the components, generating a three-dimensional network.

Clinical Triaging in Cough Clinic Alleviates COVID-19 Overload in Emergency Department in India.

The importance of this study is the efficacy of "symptoms only" approach at a screening clinic for coronavirus disease 2019 (COVID-19) diagnosis in low- and middle-income countries (LMIC) setting. The objective of this study was to assess how efficiently primary care physicians at the screening clinic were able to predict whether a patient had COVID-19 or not, based on their symptom-based assessment alone. The current study is a cross-sectional retrospective observational study. This study was conducted at a single-center, tertiary care setting with a dedicated COVID-19 facility in a metropolitan city in eastern India. Participants are all suspected COVID-19 patients who presented themselves to this center during the outbreak from 1 August 2020 to 30 August 2020. Patients were referred to the Cough Clinic from the various outpatient departments of the hospital or from smaller satellite centers located in different parts of the city and other dependent geographical areas. The main outcome(s) and measure(s) is to study whether outcome of confirmatory test results can be predicted accurately by history taking alone. From 01 August 2020 to 30 Aug 2020, 511 patients with at least one symptom suggestive of COVID-19 reported to screening clinic. Out of these, 65.4% were males and 34.6% were females. Median age was 45 years with range being 01 to 92 years. Fever was seen in 70.4% while cough was present in 22% of cases. Overall positivity for SARS-CoV-2 during this period in this group was 54.21%. At 50% pre-test probability, the sensitivity of trained doctors working at the clinic, in predicting positive cases based on symptoms alone, was approximately 74.7%, and specificity for the same was 58.12%. The positive predictive value of the doctors' assessment was 67.87%, and the negative predictive value was 66.02%. Rapid triaging for confirmatory diagnosis of COVID-19 is feasible at screening clinic based on history taking alone by training of primary care physicians. This is particularly relevant in LMIC with scarce healthcare resources to overcome COVID-19 pandemic.

Nanostructured Pt functionlized multiwalled carbon nanotube based hydrogen sensor.

Nanostructured Pt functionalized multiwalled carbon nanotubes (MWNTs) produced by catalytic chemical vapor deposition are good room-temperature hydrogen sensors. MWNTs have been synthesized by catalytic chemical vapor deposition of acetylene using a fixed-bed catalytic reactor over hydrides of Mm(0.2)Tb(0.8)CO2 obtained through hydrogen decrepitation technique. Purified and chemically treated MWNTs have been functionalized by Pt resulting in nanostructured dispersion of Pt on CNTs. Structural, morphological, and vibrational characterizations have been carried out using XRD, SEM, TEM, HRTEM, Raman spectroscopy, and FTIR spectroscopy, respectively. Dispersion of Pt on MWNTs was confirmed by elemental analysis using EDX. Systematic investigations of hydrogen sensing properties of Pt-MWNT ensembles have been carried out. The Pt-MWNTs thin films are stable after several cycles of adsorption and desorption. The change in electrical resistance due to hydrogen adsorption is reversible, with increases to saturation on exposure to hydrogen gas. The result demonstrates that the Pt-MWNTs are p-type semiconductor materials, and chemically treated MWNTs functionalized with Pt show the better hydrogen sensing response at room temperature.

Crystal structure of 4-amino-benzoic acid-4-methyl-pyridine (1/1).

In the title 1:1 adduct, C6H7N·C7H7NO2, the carb-oxy-lic acid group is twisted at an angle of 4.32 (18)° with respect to the attached benzene ring. In the crystal, the carb-oxy-lic acid group is linked to the pyridine ring by an O-H⋯N hydrogen bond, forming a dimer. The dimers are linked by N-H⋯O hydrogen bonds, generating (010) sheets.

Crystal structure of 4-bromo-anilinium 4-methyl-benzene-sulfonate.

In the crystal of the title mol-ecular salt, C6H7BrN(+)·C7H7O3S(-), the anions and cations are linked via N-H⋯O hydrogen bonds forming layers, enclosing R 2 (2)(4) ring motifs, lying parallel to (001). Within the layers there are short O⋯O contacts of 2.843 (2) Å.

Validated HPLC method for the determination of celecoxib in human serum and its application in a clinical pharmacokinetic study.

A simple high performance liquid chromatographic method using UV detection for the determination of celecoxib, a specific COX 2 inhibitor, in serum was developed. Serum samples containing the internal standard, tolbutamide, are eluted through a C18, Wakosil column. After extracting with dichloromethane, the eluent is monitored at 250 nm. The mobile phase comprised of 10 mM potassium dihydrogen ortho phosphate (pH 3.2) and acetonitrile (50:50 v/v) with a flow rate of 1 ml/min. Retention times of celecoxib and tolbutamide were 9.6 and 3.5 min, respectively. The mean absolute recovery value was about 70-80%, while the intra day and inter day coefficient of variation and percent error values of the assay method were less than 10%. The calibration curve was linear over a concentration range of 10-1000 ng/ml.

Synthesis, structural, optical and thermal studies of an organic nonlinear optical 4-aminopyridinium maleate single crystal.

Synthesis and growth of a novel organic nonlinear optical (NLO) crystal of 4-aminopyridinium maleate (4APM) in larger size by the slow evaporation solution growth technique are reported. Single crystal and powder X-ray diffraction analyses reveal that 4APM crystallizes in monoclinic system with space group P2(1) with cell parameters a=8.140(4)Å, b=5.457(5)Å, c=10.926(10)Å and volume=481.4(7)Å(3). The grown crystal has been characterized by Fourier transform infrared and UV-visible spectral analyses. Thermogravimetric analysis (TGA) and differential thermal analysis (DTA) have been carried out to study its thermal properties. Dielectric measurements have been carried out to study the distribution of charges within the crystal. The mechanical strength of the crystal has been studied by using Vickers' microhardness test. The etching studies have been carried out on the grown crystal. The Kurtz and Perry powder SHG technique confirms the NLO property of the grown crystal and the SHG efficiency of 4APM was found to be 4.8 times greater than that of KDP crystal.