Ann Palliat Med. 2022 May;11(5):1752-1761. doi: 10.21037/apm-22-324.

ABSTRACT

BACKGROUND: Yinhua Miyanling tablet (YMT) not only has the functions of clearing away heat and toxin, dredging drenching and diuresis, but also has antibacterial activity. The formation of bacterial biofilm in ureteral stent and its related infection have plagued the clinic. Antibacterial traditional Chinese medicine is a potential method.

METHODS: This multicenter, randomized, double-blind, placebo-controlled study was designed to enroll patients who underwent ureteroscopic lithotripsy associated with indwelling ureteral stents at six centers between March 2019 and June 2020. The eligible patients were randomly assigned to the experimental group to take YMT 2 g qid orally or the control group to take dummy YMT 2 g qid orally from the first day after the operation according to a random number table. The unused drugs were recalled 14±3 days after the operation and record the body temperature. Relevant laboratory tests (urinalysis and urine culture) were performed before extubation. The ureteral stent was removed. The specimen was collected for scanning electron microscopy (SEM). Biofilm formation, USSQ scores, postoperative infectious complications, stone formation, and adverse drug reactions were compared between the two groups.

RESULTS: Of the 211 patients enrolled, 165 were included in the per-protocol set (PPS), including 86 in the control group and 79 in the experimental group. No significant difference was found between the two groups in baseline parameters (P>0.05). The prevalence of biofilm formation in the control group (47%) was significantly higher than that in the experimental group (22.7%, P=0.001). There was no significant difference in total USSQ score and domain score between the two groups (all P>0.05). There were more patients with symptomatic urinary tract infection (UTI) in the control group (12.9%) than in the experimental group (2.6%, P=0.017). The incidence of other complications did not show a significant difference between the two groups (all P>0.05). The incidence of stone formation on the ureteral stent surface and adverse drug reactions did not show a significant difference between the two groups (all P>0.05).

CONCLUSIONS: YMT is helpful to reduce the formation of bacterial biofilms on ureteral stents and the incidence of symptomatic UTIs related to ureteral stenting after surgery for ureteral calculi.

TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2000041399.

PMID:35672892 | DOI:10.21037/apm-22-324

Stud Health Technol Inform. 2022 Jun 6;290:767-771. doi: 10.3233/SHTI220182.

ABSTRACT

Recently, an active area of research in pharmacovigilance is to use social media such as Twitter as an alternative data source to gather patient-generated information pertaining to medication use. Most of thr published work focuses on identifying mentions of adverse effects in social media data but rarely investigating the relationship between a mentioned medication and any mentioned effect expressions. In this study, we treated this relation extraction task as a classification problem, and represented the Twitter text with neural embedding which was fed to a recurrent neural network classifier. The classification performance of our method was investigated in comparison with 4 baseline word embedding methods on a corpus of 9516 annotated tweets.

PMID:35673121 | DOI:10.3233/SHTI220182

Stud Health Technol Inform. 2022 Jun 6;290:552-556. doi: 10.3233/SHTI220138.

ABSTRACT

As Twitter emerged as an important data source for pharmacovigilance, heterogeneous data veracity becomes a major concern for extracted adverse drug reactions (ADRs). Our objective is to categorize different levels of data veracity and explore linguistic features of tweets and Twitter variables as they may be used for automatic screening high-veracity tweets that contain ADR-related information. We annotated a published Twitter corpus with linguistic features from existing studies and clinical experts. Multinomial logistic regression models found that first-person pronouns, expressing negative sentiment, ADR and drug name being in the same sentence were significantly associated with higher levels of data veracity (p<0.05), using medical terminology and fewer indications were associated with good data veracity (p<0.05), less drug numbers were marginally associated with good data veracity (p=0.053). These findings suggest opportunities for developing machine learning models for automatic screening of ADR-related tweets using key linguistic features, Twitter variables, and association rules.

PMID:35673077 | DOI:10.3233/SHTI220138

Stud Health Technol Inform. 2022 Jun 6;290:91-95. doi: 10.3233/SHTI220038.

ABSTRACT

INTRODUCTION: Chemotherapies against cancers are often interrupted due to severe drug toxicities, reducing treatment opportunities. For this reason, the detection of toxicities and their severity from EHRs is of importance for many downstream applications. However toxicity information is dispersed in various sources in the EHRs, making its extraction challenging.

METHODS: We introduce OntoTox, an ontology designed to represent chemotherapy toxicities, its attributes and provenance. We illustrated the interest of OntoTox by integrating toxicities and grading information extracted from three heterogeneous sources: EHR questionnaires, semi-structured tables, and free-text.

RESULTS: We instantiated 53,510, 2,366 and 54,420 toxicities from questionnaires, tables and free-text respectively, and compared the complementarity and redundancy of the three sources.

DISCUSSION: We illustrated with this preliminary study the potential of OntoTox to guide the integration of multiple sources, and identified that the three sources are only moderately overlapping, stressing the need for a common representation.

PMID:35672977 | DOI:10.3233/SHTI220038

Pharmacoepidemiol Drug Saf. 2022 Jun 7. doi: 10.1002/pds.5486. Online ahead of print.

ABSTRACT

PURPOSE: Antibacterials induce a differential risk of acute kidney injury (AKI) in older adults. This study investigated the reporting risk of AKI associated with antibacterials using the individual case safety reports (ICSRs) submitted to the Food and Drug Administration Adverse Event Reporting System (FAERS) database.

METHODS: A case/non-case method was used to assess AKI risk associated with antibacterials between January 1, 2000, and September 30, 2021. Cases were ICSRs for antibacterials with AKI as preferred terms included in the Medical Dictionary of Regulatory Activities (MedDRA) system organ classes 'Renal and urinary disorders' disorders. The analyses were completed on a de-duplicated dataset containing only the recent version of the ICSR. Signals were defined by a lower 95% confidence interval (CI) of reporting odds-ratio (ROR) ≥ 2, proportional reporting ratio (PRR) ≥ 2, information component (IC) > 0, Empirical Bayes Geometric Mean (EBGM) > 1, and reports ≥ 4. Sensitivity analyses were conducted a priori to assess the robustness of signals.

RESULTS: A total of 3,680,621 reports on ADEs were retrieved from FAERS over the study period, of which 92,194 were antibacterial reports. Gentamicin, sulfamethoxazole, trimethoprim, and vancomycin consistently gave strong signals of disproportionality on all four disproportionality measures and across the different sensitivity analyses: gentamicin (ROR = 2.95[2.51-3.46]), sulfamethoxazole (ROR = 2.97[2.68-3.29]), trimethoprim (ROR = 2.81[2.29-3.46]), and vancomycin (ROR = 3.35[3.08-3.64]).

CONCLUSION: Signals for gentamicin, sulfamethoxazole, trimethoprim, and vancomycin were confirmed by using antibacterials as a comparator, adjusting for drug-related competition bias and event-related competition bias.

PMID:35670078 | DOI:10.1002/pds.5486

New Microbes New Infect. 2022 Jun 1:100986. doi: 10.1016/j.nmni.2022.100986. Online ahead of print.

ABSTRACT

The safety and efficacy of tafenoquine administered as a 200 mg dose once per day on Days 1, 2, 3, and 10 was evaluated over a 28-day period in mild-moderate COVID-19 patients. The primary endpoint was Day 14 clinical recovery from COVID-19 symptoms, defined as cough mild or absent, respiratory rate < 24 bpm, and no shortness of breath or fever. Following a successful futility analysis after n=86 patients out of a target n=275 were randomized, the study was terminated and unblinded early to facilitate planning for confirmatory studies. The proportion of patients not recovered on Day 14 was numerically decreased by 27% in the ITT population [8/45 v 10/42 not recovered in the tafenoquine and placebo arms, P=0.60] and 47% in the PP population [5/42 v 9/41, P=0.25]. Amongst individuals who recorded responses in an electronic diary at Day 28, all tafenoquine patients were recovered, whereas up to 12% of placebo patients exhibited lingering dyspnea. Time to clinical recovery from COVID-19 symptoms was accelerated in the tafenoquine arm by about 2-2.5 days. There were two COVID-19 related hospitalizations in the placebo arm and one in the tafenoquine arm. Mild, drug related adverse events occurred in 8.4% of individuals in the tafenoquine arm [v 2.4% in the placebo]. Although this trial was underpowered for the primary endpoint due to its early termination, the data are suggestive of a therapeutic benefit associated with tafenoquine administration in outpatients with mild to moderate COVID-19 disease, and larger studies are planned.

PMID:35668841 | PMC:PMC9158239 | DOI:10.1016/j.nmni.2022.100986

J Child Adolesc Psychopharmacol. 2022 Jun;32(5):296-303. doi: 10.1089/cap.2022.0021. Epub 2022 Jun 3.

ABSTRACT

Introduction: Prescription of second-generation antipsychotics (SGAs) in youth is rapidly increasing globally and in Australia. Lack of timely metabolic monitoring for potential adverse effects puts youth at greater risk for lifelong adverse health impact. Metabolic monitoring is recommended as best practice to prevent and/or manage SGA-induced weight gain/metabolic syndrome. The adherence to clinical guidelines remains suboptimal. It is crucial to gauge insight to challenges and strategies from the perspective of prescribers and to recommend strategies in promoting quality use of SGAs and adherence to pharmacovigilance standards. Methods: Psychiatrists participated through semistructured interviews within the community mental health clinics in the Queensland State of Australia. The interviews focused on barriers to monitoring and strategies to enhance rate of monitoring with key focus on practical strategies for future implications in community setting. Results: Ten participants completed the interviews. Barriers were specified such as lack of adequate resources to conduct monitoring, carers' disengagement in their youth's treatments, and patients' refusal to undergo blood tests. Strategies to enhance metabolic monitoring heavily relied on organizational support, provision of training, and education opportunities. Conclusions: Clinical recommendations require mental health providers to facilitate conduction of metabolic monitoring among youth prescribed SGA/s. However, they are not provided with enough support and there are challenges that prevent such care. It is crucial to understand the challenges in managing a complex and vulnerable patient cohort. This research has thrown light on these key aspects of existing gap between best practice standards and clinical practice in youth prescribed SGAs.

PMID:35666251 | DOI:10.1089/cap.2022.0021

Comput Math Methods Med. 2022 May 26;2022:7882277. doi: 10.1155/2022/7882277. eCollection 2022.

ABSTRACT

OBJECTIVE: As the most commonly used drug in the world, aspirin has shown benefits for myocardial infarction, stroke, and vascular death in many secondary prevention trials and their meta-analysis. The purpose of this study was to evaluate the association between aspirin and its adverse reactions as a preventive drug using the FDA adverse event reporting system (FAERS).

METHODS: The FAERS database was queried for the adverse drug events (ADE) reported from the first quarter of 2004 to the second quarter of 2021. We counted and trended reports to FAERS in which aspirin was associated with anaphylaxis or anaphylaxis followed by death.

RESULTS: The search retrieved 858 aspirin-associated cases within the reporting period; 108 AE pairs with significant disproportionality were retained. The top 10 AE pairs associated with using aspirin for prophylaxis were melaena, duodenal ulcer, gastritis erosive, gastric ulcer hemorrhage, etc. The top 10 AE pairs for thrombosis prophylaxis were melaena, duodenal ulcer, microcytic anemia, lip erosion, vascular stent thrombosis, etc. The screened adverse event reports are classified and counted according to the system organ class (SOC); it mainly focuses on gastrointestinal disorders, general disorders, and administration site conditions. Among the 858 cases of aspirin used as prophylaxis medication in the FAERS database, the reporting areas were mainly in Europe and the Americas.

CONCLUSION: Adverse drug reactions may occur in the clinical use of aspirin. It should strengthen patient medication education, pay close attention to adverse reactions, and adjust the administration method in time to ensure the safety of medication.

PMID:35664643 | PMC:PMC9162824 | DOI:10.1155/2022/7882277

Best Pract Res Clin Anaesthesiol. 2022 May;36(1):135-155. doi: 10.1016/j.bpa.2022.02.002. Epub 2022 Feb 10.

ABSTRACT

Uterotonics play an important role in the management of postpartum haemorrhage (PPH), often caused by uterine atony. The World Health Organization (WHO) recommends the application of uterotonics for all births. Oxytocin, considered the first-line uterotonic, binds to a G protein-coupled receptor which is subject to down sensitization upon repeated or prolonged administration of oxytocin. Consequently, a uterotonic with a different mechanism of action should be chosen early when oxytocin does not restore uterine tone. Choice of the second-line uterotonic is determined by institutional preferences as well as by maternal co-morbidities since most uterotonics have cardiovascular side effects. Slow injection of all uterotonics is strongly recommended to blunt these reactions. Methylergometrine and carboprost should, therefore, be avoided in many cardiovascular pathologies. Carbetocin is a chemical modification of oxytocin with a longer half-time, and therefore one bolus of carbetocin is usually sufficient. Its heat stability makes it an ideal candidate in resource-restricted settings.

PMID:35659950 | DOI:10.1016/j.bpa.2022.02.002

Virol J. 2022 Jun 5;19(1):100. doi: 10.1186/s12985-022-01831-0.

ABSTRACT

Recently, The Lancet published a study on the effectiveness of COVID-19 vaccines and the waning of immunity with time. The study showed that immune function among vaccinated individuals 8 months after the administration of two doses of COVID-19 vaccine was lower than that among the unvaccinated individuals. According to European Medicines Agency recommendations, frequent COVID-19 booster shots could adversely affect the immune response and may not be feasible. The decrease in immunity can be caused by several factors such as N1-methylpseudouridine, the spike protein, lipid nanoparticles, antibody-dependent enhancement, and the original antigenic stimulus. These clinical alterations may explain the association reported between COVID-19 vaccination and shingles. As a safety measure, further booster vaccinations should be discontinued. In addition, the date of vaccination should be recorded in the medical record of patients. Several practical measures to prevent a decrease in immunity have been reported. These include limiting the use of non-steroidal anti-inflammatory drugs, including acetaminophen to maintain deep body temperature, appropriate use of antibiotics, smoking cessation, stress control, and limiting the use of lipid emulsions, including propofol, which may cause perioperative immunosuppression. In conclusion, COVID-19 vaccination is a major risk factor for infections in critically ill patients.

PMID:35659687 | PMC:PMC9167431 | DOI:10.1186/s12985-022-01831-0

Cutis. 2022 Mar;109(3):170-171. doi: 10.12788/cutis.0478.

ABSTRACT

Localized flushing after alcohol ingestion is a reported adverse effect of 2 topical calcineurin inhibitors, tacrolimus and pimecrolimus, which are approved to treat atopic dermatitis and used off label for other dermatologic conditions. We propose techniques for alleviating this phenomenon.

PMID:35659131 | DOI:10.12788/cutis.0478

Haemophilia. 2022 Jun 6. doi: 10.1111/hae.14595. Online ahead of print.

ABSTRACT

INTRODUCTION: Befovacimab (formerly BAY 1093884) is a fully human monoclonal antibody able to bind to tissue factor pathway inhibitor (TFPI) and developed as a non-replacement therapy for individuals with haemophilia A/B, with or without inhibitors.

AIM: To assess the safety of multiple escalating doses of befovacimab in individuals with severe haemophilia A/B with or without inhibitors.

METHODS: In this non-randomised, open-label Phase 2 study (NCT03597022), adult males with <1% factor VIII or <2% factor IX and ≥4 bleeds in the previous six months were enrolled in three dose cohorts (100/225/400 mg). Participants received befovacimab subcutaneously once weekly. The primary endpoint was safety; secondary endpoints included annualised bleeding rate (ABR) and pharmacokinetics/pharmacodynamics (PK/PD) of befovacimab.

RESULTS: A total of 24 participants (n = 8 in each dose cohort) were treated for 2-47 weeks. Patients treated with 100 mg and 225 mg doses of befovacimab demonstrated improved bleeding control compared with pre-study bleeding rates, with a dose-dependent effect. Dosing was suspended and the study prematurely terminated following three drug-related thrombotic serious adverse events (SAEs): two at the 225 mg dose and one at the 400 mg dose. These occurred in the absence of bleeding episodes or concomitant use of replacement/bypass therapies. No laboratory abnormalities were observed, and PK/PD data did not show correlation between SAE occurrence and levels of circulating befovacimab or free TFPI.

CONCLUSION: Despite favourable initial results from preclinical and clinical studies, a positive safety profile of befovacimab was not confirmed. The lack of SAE-related laboratory abnormalities or differentiating PK/PD characteristics in participants experiencing SAEs raises concerns about the predictability of thrombosis following befovacimab treatment and emphasises the need for further investigation into the therapeutic window of anti-TFPI treatment.

PMID:35667016 | DOI:10.1111/hae.14595

N Engl J Med. 2022 Jun 5. doi: 10.1056/NEJMoa2203690. Online ahead of print.

ABSTRACT

BACKGROUND: Among breast cancers without human epidermal growth factor receptor 2 (HER2) amplification, overexpression, or both, a large proportion express low levels of HER2 that may be targetable. Currently available HER2-directed therapies have been ineffective in patients with these "HER2-low" cancers.

METHODS: We conducted a phase 3 trial involving patients with HER2-low metastatic breast cancer who had received one or two previous lines of chemotherapy. (Low expression of HER2 was defined as a score of 1+ on immunohistochemical [IHC] analysis or as an IHC score of 2+ and negative results on in situ hybridization.) Patients were randomly assigned in a 2:1 ratio to receive trastuzumab deruxtecan or the physician's choice of chemotherapy. The primary end point was progression-free survival in the hormone receptor-positive cohort. The key secondary end points were progression-free survival among all patients and overall survival in the hormone receptor-positive cohort and among all patients.

RESULTS: Of 557 patients who underwent randomization, 494 (88.7%) had hormone receptor-positive disease and 63 (11.3%) had hormone receptor-negative disease. In the hormone receptor-positive cohort, the median progression-free survival was 10.1 months in the trastuzumab deruxtecan group and 5.4 months in the physician's choice group (hazard ratio for disease progression or death, 0.51; P<0.001), and overall survival was 23.9 months and 17.5 months, respectively (hazard ratio for death, 0.64; P = 0.003). Among all patients, the median progression-free survival was 9.9 months in the trastuzumab deruxtecan group and 5.1 months in the physician's choice group (hazard ratio for disease progression or death, 0.50; P<0.001), and overall survival was 23.4 months and 16.8 months, respectively (hazard ratio for death, 0.64; P = 0.001). Adverse events of grade 3 or higher occurred in 52.6% of the patients who received trastuzumab deruxtecan and 67.4% of those who received the physician's choice of chemotherapy. Adjudicated, drug-related interstitial lung disease or pneumonitis occurred in 12.1% of the patients who received trastuzumab deruxtecan; 0.8% had grade 5 events.

CONCLUSIONS: In this trial involving patients with HER2-low metastatic breast cancer, trastuzumab deruxtecan resulted in significantly longer progression-free and overall survival than the physician's choice of chemotherapy. (Funded by Daiichi Sankyo and AstraZeneca; DESTINY-Breast04 ClinicalTrials.gov number, NCT03734029.).

PMID:35665782 | DOI:10.1056/NEJMoa2203690

J Oncol Pharm Pract. 2022 Jun 5:10781552221105572. doi: 10.1177/10781552221105572. Online ahead of print.

ABSTRACT

INTRODUCTION: Nivolumab, the monoclonal antibody inhibitor of programmed cell death protein 1, enhances the T-cell response, including anti-tumour responses, by blocking the attachment of programmed death-ligand 1 and programmed death-ligand 2 ligands to the programmed cell death protein 1 receptor, which in turn leads to a reduction in tumour growth. Nivolumab has been approved in relapsed or refractory classic Hodgkin's lymphoma after autologous transplantation of haematopoietic stem cell and treatment with brentuximab as monotherapy.

CASE REPORT: We herewith report a case of 65-year-old woman who developed an interstitial pneumonitis and a global cardiac hypokinesis following a treatment with Nivolumab for a refractory Hodgkin's Lymphoma. Nivolumab was administered as the fifth line of therapy. Some concomitant patient treatments include drug with known autoimmune toxicities. Although the patient had a persistent complete remission following the sixth infusion, it was discontinued as she developed dyspnea of NYHA stage IV and orthopnea. The chest tomography revealed a bilateral micronodular pattern of organizing pneumonia with bilateral pleural effusion. The forced expiratory volume was decreased to 50%. In parallel her transthoracic echocardiography revealed a global hypokinesis with a left ventricular ejection fraction of 20%.

MANAGEMENT AND OUTCOME: The patient was treated with empiric antibiotics although the microbial assessments were negative. She was also treated with beta-blocker and angiotensin-converting enzyme inhibitors. The cardiac magnetic resonance imaging performed after 4 months confirmed the hypokinetic cardiopathy with an ejection fraction of 48%. The patient had a significant clinical improvement. The tomography emission positron scan conducted 8 months after interruption of Nivolumab showed complete remission with some moderate activation of residual lesion basal posterior lobe of left lung field.

DISCUSSION: Early and effective diagnosis of immune-related adverse events through the search for predictive biomarkers like drug factors and individual risk factors will allow targeted surveillance leading to a better tolerance.

PMID:35658620 | DOI:10.1177/10781552221105572

Biomed Pharmacother. 2022 Jun;150:113000. doi: 10.1016/j.biopha.2022.113000. Epub 2022 Apr 29.

ABSTRACT

Asparaginase is an integral component of acute lymphoblastic leukemia (ALL)3 treatment. Hepatotoxicity related to asparaginase is one of the most common treatment-related toxicities in ALL therapy. Hispanic children are at higher risk of developing ALL, and toxicities from ALL therapy. The rs4880 variant in the superoxide dismutase 2 (SOD2)4 gene, a critical mitochondrial enzyme that protects cells against oxidative stress, was found to be associated with increased incidence of asparaginase-related hepatotoxicity in adult cohort of largely White non-Hispanics patients with ALL. The risk genotype (rs4880-CC) is more frequent among adult Hispanic patients with ALL. To assess the prevalence of hepatotoxicity and risk genotype among pediatric patients with ALL, particularly of Hispanic ethnicity, we conducted a prospective study of 143 pediatric patients with ALL (62.2% Hispanic). Bilirubin and hepatic transaminase levels were collected at different times during multiagent therapy including asparaginase treatment. Germline DNA blood samples were genotyped for the SOD2 rs4880. We found that the frequency of hepatotoxicity and the rs4880-CC risk genotype are higher in Hispanic patients than non-Hispanic. Patients with the CC genotype exhibit higher bilirubin and hepatic transaminase levels compared with patients with the TT and CT genotypes. In a multivariate Cox analysis, Hispanic ethnicity was identified as a strong predictor of hepatotoxicity (hazard ratio [HR] = 1.9, 95% confidence interval [95% CI] 1.0-3.5, p = 0.05). Altogether, these findings demonstrate that hepatotoxicity is highly prevalent among Hispanic pediatric patients with ALL, and those with rs4880-CC genotype.

PMID:35658244 | DOI:10.1016/j.biopha.2022.113000

Biomed Pharmacother. 2022 Jun;150:113067. doi: 10.1016/j.biopha.2022.113067. Epub 2022 May 5.

ABSTRACT

Methotrexate (MTX) is a first line anti-rheumatic drug. This study was designed to investigate the impact of rheumatoid arthritis (RA) conditions on its oral absorption, and clarify the relevance with changes of MTX absorption-related transporters in rheumatic models. MTX was orally administered to healthy, collagen-induced arthritis (CIA), and adjuvant-induced arthritis (AIA) rats. MTX plasma concentrations were determined by a validated liquid chromatography-mass spectrometry method. We found that intestinal MTX absorption was significantly increased in CIA/AIA rats versus healthy controls. This finding was supported by small intestine-based MTX uptake assay in vitro. Meanwhile, intestinal expression of both reduced folate carrier 1 (RCF1) and proton-coupled folate transporter (PCFT) remained unchanged. The everted intestinal sac assay confirms RFC1 is the key transporter accounting for intestinal MTX absorption, as its antagonist salicylazosulfapyridine showed potent capacity in reducing MTX uptake. No correlation between RA-related cytokines and RCF1 expression was observed in clinical samples. We further revealed that when cultured with AIA rat or RA patient serum, lactate and adenosine triphosphate (ATP) production as well as MTX uptake in MDCKII cells were significantly increased, and this increase was completely abrogated by ATP production-related metabolic inhibitors. Thanks to its inhibitory effects on MTX bioavailability, the glycolysis inhibitor shikonin diminished MTX-induced injuries of kidney and liver in AIA rats. These data demonstrate that glycolysis-driven high energy metabolism increases MTX absorption in rheumatic subjects, leading to the exacerbated toxicity. These findings will have important implications in optimizing MTX regimens for RA treatment with better efficacy and lower toxicity.

PMID:35658235 | DOI:10.1016/j.biopha.2022.113067

J Contemp Dent Pract. 2022 Jan 1;23(1):83-88.

ABSTRACT

AIM: The goal of this study was to compare the effects of magnetized water and 0.2% chlorhexidine mouthwash on gingivitis and plaque prevention in children aged 12-15 years for a period of 21 days.

MATERIALS AND METHODS: A total of 24 youngsters between the ages of 12 and 15 years were chosen. A computer-generated random number sequence was used to split the research participants into two groups. Magnetized water was utilized as a mouthrinse in Category 1, while 0.2% chlorhexidine was employed in Category 2. Water purified with reverse osmosis was stored in glass bottles, which were then put near the magnets to create magnetic water. The magnets had 1000 Gauss power. The bottles were put for a period of 24 hours. The youngsters were given 140 mL of mouthrinse. These mouthrinses were to be used at home, they were told. The Gilmore Turesky adaptation of Quigley Hein's plaque index was used to assess the plaque whereas the gingival index recommended by Loe and Sillness was utilized to assess the gingiva. The plaque index and gingival index were analyzed at baseline, 14 days, and 21 days, as well as history and examination for adverse effects such as bitter taste, brownish discoloration, and so on, were recorded. The trial lasted 21 days with a follow-up period of another 21 days.

RESULTS: Both magnetic water and chlorhexidine were similarly successful in managing periodontal and gingival infections; however, magnetized water had less side effects, such as a bitter metallic taste and brown stains.

CONCLUSION: Because of its well-accepted flavor, softer nature, and lower frequency of brown stains, magnetized water can be a safer and more acceptable alternative to chlorhexidine mouthwashes, especially in youngsters.

CLINICAL SIGNIFICANCE: The use of chlorhexidine as a mouthrinse in the oral cavity has been linked to side effects. These side effects are mostly localized, such as brownish discoloration of teeth, alterations in taste perception, and erosion of the oral mucosa. As chlorhexidine has such negative side effects, it was necessary to do research, particularly in children, to identify a replacement that is similarly efficient against germs but does not have these side effects. Water treated with a magnetic field (magnetized water) was compared with chlorhexidine in the current study.

PMID:35656663

Ugeskr Laeger. 2022 May 30;184(22):V01220060.

ABSTRACT

While the Danish Health Authority has withdrawn the vaxzevria vaccine from the Danish vaccination programme due to reports of rare cases of severe side effects, this case report presents a potential beneficial side effect of this vaccine. A patient presented, three days after her first jab, with localized itching and bleeding from a pigmented tumour on her lower leg, which was therefore excised, and, unexpectedly, diagnosed as a melanoma. We speculate if the vaccine-induced immune reaction resulted in increased immune activity within the tumour environment, and thus facilitated the early diagnosis of melanoma.

PMID:35656609

J Diabetes Res. 2022 May 23;2022:2420857. doi: 10.1155/2022/2420857. eCollection 2022.

ABSTRACT

BACKGROUND: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) reduce blood glucose, blood pressure, and body weight in patients with type 2 diabetes (T2D). However, the comparative long-term effectiveness and safety of SGLT2i among similar drugs, administered at different doses, have not been assessed. In this study, we compared the long-term effectiveness and safety of SGLT2i (dapagliflozin versus empagliflozin) as add-on therapy to hypoglycemic agents in T2D patients.

METHODS: This study was a single-center, 3-year, retrospective, observational study. For all patients in the study, drugs were evaluated for safety by documenting adverse drug reactions. The primary effectiveness was evaluated as the difference between hemoglobin A1c (HbA1c) values obtained at baseline and those obtained after 36 months of treatment. The proportion of participants with HbA1c levels <7.0% and <6.5% was also analyzed.

RESULTS: In total, 680 patients were enrolled in this study. Using propensity score matching, 234 patients each from the dapagliflozin and empagliflozin groups were selected based on patient characteristics. After 36 months of treatment, clinical parameters (including HbA1c, fasting plasma glucose, alanine aminotransferase, triglyceride levels, body weight, and systolic blood pressure) decreased significantly in these groups. The changes from the baseline for the physiological values and clinical parameters did not vary among the different dose groups of SGLT2i. The incidence of adverse drug reactions was approximately 7-8%. All patients with observed serious adverse reactions were hospitalized for urinary tract infections.

CONCLUSION: Our study showed that the long-term continuous use of either dapagliflozin or empagliflozin as add-on therapy to hypoglycemic drugs for T2D patients is synergistically effective for lowering blood glucose, reducing body weight, and stabilizing blood pressure. Additionally, there was no significant difference in efficacy between dapagliflozin and empagliflozin, even with the administration of different doses of these agents.

PMID:35656359 | PMC:PMC9152409 | DOI:10.1155/2022/2420857

Curr Med Res Opin. 2022 Jun 3:1-20. doi: 10.1080/03007995.2022.2085964. Online ahead of print.

ABSTRACT

Molecular targeted therapy significantly improved the therapeutic efficacy in non-small cell lung cancer (NSCLC) patients with driver gene mutations but also with new toxicity profiles. Although most patients treated with these drugs developed relatively controllable toxicity, significant pulmonary toxicity events, including interstitial lung disease (ILD), occurred in a small proportion of patients and can lead to discontinuation or even be life-threatening. Pulmonary toxicity associated with these anti-tumor drugs is a problem that cannot be ignored in clinical practice. The prompt diagnosis of drug-related lung injury and the consequent differential diagnosis with other forms of pulmonary disease are critical in the management of pulmonary toxicity. Current knowledge of the pathophysiology and management of pulmonary toxicity associated with these targeted drugs is limited, and participants should be able to identify and respond to the development of drug-induced pulmonary toxicity. This review offers information about the potential pathogenesis, risk factors and management for the development of these events based on the available literature. This review focused on pulmonary toxicities in driver gene-positive NSCLC therapy by describing the related adverse events to promote the awareness and management of this important toxicity related to antitumor-targeted therapy.

PMID:35656938 | DOI:10.1080/03007995.2022.2085964