Extended interval dosing of natalizumab in multiple sclerosis

BACKGROUND

Natalizumab (NTZ), a monoclonal antibody to human α4β1/β7 integrin, is an effective therapy for multiple sclerosis (MS), albeit associated with progressive multifocal leukoencephalopathy (PML). Clinicians have been extending the dose of infusions with a hypothesis of reducing PML risk. The aim of the study is to evaluate the clinical consequences of reducing NTZ frequency of infusion up to 8 weeks 5 days.

METHODS

A retrospective chart review in 9 MS centres was performed in order to identify patients treated with extended interval dosing (EID) regimens of NTZ. Patients were stratified into 3 groups based on EID NTZ treatment schedule in individual centres: early extended dosing (EED; n=249) every 4 weeks 3 days to 6 weeks 6 days; late extended dosing (LED; n=274) every 7 weeks to 8 weeks 5 days; variable extended dosing (n=382) alternating between EED and LED. These groups were compared with patients on standard interval dosing (SID; n=1093) every 4 weeks.

RESULTS

17% of patients on SID had new T2 lesions compared with 14% in EID (p=0.02); 7% of patients had enhancing T1 lesions in SID compared with 9% in EID (p=0.08); annualised relapse rate was 0.14 in the SID group, and 0.09 in the EID group. No evidence of clinical or radiographic disease activity was observed in 62% of SID and 61% of EID patients (p=0.83). No cases of PML were observed in EID group compared with 4 cases in SID cohort.

CONCLUSIONS

Dosing intervals up to 8 weeks 5 days did not diminish effectiveness of NTZ therapy. Further monitoring is ongoing to evaluate if the risk of PML is reduced in patients on EID.

SymptoMScreen: A Tool for Rapid Assessment of Symptom Severity in MS Across Multiple Domains

The objective of this study was to describe SymptoMScreen, an in-house developed tool for rapid assessment of MS symptom severity in routine clinical practice, and to validate SymptoMScreen against Performance Scales (PS). MS patients typically experience symptoms in many neurologic domains. A tool that would enable MS patients to efficiently relay their symptom severity across multiple domains to the healthcare providers could lead to improved symptom management. We developed "SymptoMScreen," a battery of 7-point Likert scales for 12 distinct domains commonly affected by MS: mobility, dexterity, body pain, sensation, bladder function, fatigue, vision, dizziness, cognition, depression, and anxiety. We administered SymptoMScreen and PS scales to consecutive MS patients at a specialty MS Care Center. We assessed the criterion and construct validity of SymptoMScreen by calculating Spearmen rank correlations between the SymptoMScreen composite score and PS composite score, and between SymptoMScreen subscale and the respective PS subscale scores, where applicable. A total of 410 patients with MS (age 46.6 ± 12.9 years; 74% female; mean disease duration 12.2 ± 8.7 years) completed the SymptoMScreen and PSs during their clinic visit. Composite SymptoMScreen score correlated strongly with combined PS score (r = 0.88, p < 0.0001). SymptoMScreen sub scores correlated strongly with the criterion measures of the respective PS (r = 0.69-0.87, p < 0.0001). Test-retest reliability of SymptoMScreen and its subscales was excellent (r = 0.71-0.94, p < .0001). SymptoMScreen is a single-page battery of Likert scales that assesses symptom impact in 12 domains commonly affected in MS. It has excellent criterion and construct validity. SymptoMScreen is patient and clinician friendly, takes approximately one minute to complete, and can help better document, understand, and manage patients' symptoms in routine clinical practice. SymptoMScreen is freely available to clinicians and researchers.

Health-related quality of life in patients with chronic obstructive pulmonary disease in North India

BACKGROUND AND OBJECTIVES

Chronic obstructive pulmonary disease (COPD) is a major health problem in India and constitutes an important cause of mortality and morbidity. A cross-sectional study was undertaken to assess health-related quality of life (HRQL) and its determinants in patients with COPD from India.

MATERIALS AND METHODS

A total of 126 patients (73.81% male) were enrolled using convenient sampling prospectively in this cross-sectional study. Eligible patients were assessed for socioeconomic status, anthropometric measures, COPD severity, dyspnea and health status using the Hindi version of St George's Respiratory Questionnaire (SGRQ). Linear regression model was used to examine the association between risk factors and HRQL score (a higher score indicating poorer HRQL), adjusting for age and sex.

RESULTS

The mean total score for SGRQ in the patients was 52.66 ± 12.89, indicating a marked impairment of HRQL. Impairment was associated with the severity of airway obstruction, but within each Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, the variation (SD) was wide [stage I: 47.8 ± 12.3 (n = 14); stage II: 49.28 ± 11.69 (n = 47); stage III: 53.47 ± 11.69 (n = 44); stage IV: 61.75 ± 14.14 (n = 21)]. A regression analysis showed that body mass index, forced expiratory volume in 1 s (FEV 1 ), dyspnea grade, and depression were associated with poor HRQL.

CONCLUSION

HRQL of COPD patients was significantly impaired across stages. Marked impairment of HRQL was found even in patients with mild disease.

Cooperative Emission of a Coherent Superflash of Light

We investigate the transient coherent transmission of light through an optically thick cold strontium gas. We observe a coherent superflash just after an abrupt probe extinction, with peak intensity more than three times the incident one. We show that this coherent superflash is a direct signature of the cooperative forward emission of the atoms. By engineering fast transient phenomena on the incident field, we give a clear and simple picture of the physical mechanisms at play.

Structural Studies on nanocrystalline ZnS and CdS

II-VI semiconductor nanocrystals have attracted much attention due to their size dependent properties ranging from electronic to biological regimes. Herein results of ZnS and CdS ADXRD (Angle dispersive X-ray diffraction) data, recorded in transmission mode, on BL-11 Beamline of INDUS Synchrotron are reported. Semiconductors obtained using wet chemical co-precipitation method, were kept for a few hours in the deep freezer. The wavelength of x-rays was 0.04666 nm (27 keV). A MAR 3450 image plate was used as detector. Sample to detector distance was 185.9178 mm. XRD data were extracted using fit2d. ADXRD pattern was recorded in transmission mode. The fityk program was used to fit pseudo Voigt A function to the ADXRD data to get the half width at half maximum (HWHM) of the peaks. These HWHMs values as well as the Scherrer formula yielded the particle sizes. The Neilson-Riley method was used to refine the lattice parameters. Results of the ADXRD data analyses for both ZnS and CdS are given below:The Particle size (nm), Bravais Lattice, Lattice parameter (nm) and Eg (eV) [UV abs spectra] for ZnS are 2.81, F¯43m, 0.5371 and 3.82 respectively while for CdS these values are 3.03, F¯43m, 0.580, 2.59 respectively. From these data the metal-S and Metal-Metal distances were calculated and were found out for ZnS to be 0.2326 nm and 0.3798 nm while for CdS these distances are 0.251 nm and 0.41 nm respectively. These data match well with the literature/1/. Particle sizes were in agreement with Brus's /2/ method. Acknowledgements: One of the authors (SDD) acknowledges the financial assistance from the University Grant Commission, New Delhi (F-37/147/2009(SR)). The authors are also grateful to Dr. S. K. Deb, Head, INDUS Synchrotron Users' Division, Raja Ramanna Center for Advanced Technology, Indore, (M.P.) India.

Development of post-kala-azar dermal leishmaniasis in AmBisome treated visceral leishmaniasis: a possible challenge to elimination program in India

We report two cases, one male (33 years) and a female (14 years), that developed Post-Kala-azar Dermal Leishmaniasis (PKDL) after successful treatment for visceral leishmaniasis (VL) or Kala-azar with AmBisome, the lipid complex of Amphotericin B. Both cases presented with hypo-pigmented macular lesions all over the body. The patients responded well to AmBisome after treatment with three courses. This first ever case report from India indicates that possibly there is no effective drug for VL until date, which can prevent post-treatment development of PKDL.

Comparative study of microscopy and polymerase chain reaction for the diagnosis of suspected visceral leishmaniasis patients in Nepal

BACKGROUND

Visceral leishmaniasis is potentially fatal protozoan diseases caused by Leishmania donovani. Nepal is an endemic region in which visceral leishmaniasis causes a major public health problem in the lowland areas that border the endemic areas of Bihar state in India. Accurate diagnosis to inform treatment is a first step in achieving the goal of visceral leishmaniasis elimination from South East Asian regions by 2020.

OBJECTIVE

The objective of the present study was to compare between the Microcopy and polymerase chain reaction for diagnosis of visceral leishmaniasis.

METHODS

In the present study, 236 bone marrow aspirations were collected from suspected visceral leishmaniasis patients in Janakpur Zonal Hospital, Dhanusa district, Terai region of Nepal in between 2003-2007. We evaluated bone marrow samples by microscopic examination with subsequent testing of the same sample by polymerase chain reaction and sequence analysis.

RESULTS

Giemsa's solution stained bone marrow slides stored for over five years were used for polymerase chain reaction amplification. The result showed that 71% were polymerase chain reaction positive and 56% were microscopic positive. Out of 104 microscopic negative bone marrow samples, 15% of samples were positive by polymerase chain reaction.

CONCLUSION

Polymerase chain reaction could make a very good option for diagnosis by using less or non-invasive material from visceral leishmaniasis patients in endemic areas of Nepal.

Effect of integrated weed management practices on performance of dry direct seeded rice (Oryza sativa L.)

Weeds are serious problem in dry direct seeded rice (DDSR). A field experiment was conducted during rainy seasons of 2010 and 2011 at research farm of the Regional Agricultural Research Station (RARS) Parwanipur, to study the effect of integrated weed management practices on the performance of dry direct seeded rice. Ten treatment combinations viz; weedy, weed free (weekly), Pendimethalin fb (followed by) Bispyribac, Pendimethalin fb two hand weeding, Stale seedbed fb Bispyribac, Stale seedbed fb Pendimethalin fb Bispyribac, Mulch 4 t/ha fb Bispyribac fb one hand weeding, Stale seedbed fb mulch 4 t/ha fb Bispyribac, Pendimethalin and Sesbania co-culture fb 2,4-D Na salt fb one hand weeding and Pendimethalin fb 2,4-D fb one hand weeding were tested in a randomized complete block design and replicated thrice. Observations were taken on weed, plant growth and yield attributes, yield, and socio-economic parameters. All weed control treatments significantly reduced the weed density and dry weight of weed resulting significant increase in yield of DSR over weedy check in both years. Weed free treatment resulted the highest yield, however, it was not economical due to high cost of cultivation. The use of Pendimethalin fb 2,4-D fb one hand weeding produced yield (5161 in 2010 and 6160 kg/ha in 2011) which were statistically at par with yield (5305 in 2010 and 6319 kg/ha in 2011) obtained under the weed free treatment. Further, the highest benefit cost ratio (CBR) 1.77 and 2.22 and net return Rs 47700 and 75084/ha during 2010 and 2011, respectively, were obtained under this treatment indicating its superiority over other treatments. The grain yield, yield attributing characters viz. panicles per m2, panicle weight, filled grain per panicle, thousand grain weight as influenced by different weed management practices revealed that higher yield resulted from weed free plot followed by Pendimethalin followed by two hand weeding and Pendimethalin followed by 2,4-D followed by one hand weeding. However, the net return per unit investment resulted highest in Pendimethalin followed by 2,4-D followed by one hand weeding. This proved that amid increasing wage rate and labor scarcity integrated weed management through Pendimethalin 30 EC (stomp) @ 1 kg a. i./ha as pre- emergence herbicide application followed by 2,4-D sodium salt 80 WP @ 0.5 kg a.i./ha followed by one hand weeding or stale seed bed followed by Pendimethalin 30 EC (stomp) @ 1 kg a. i./ha followed by Bispyribac (nominee gold) @ 25 g a. i./ha 10 % @ 200 ml/ha at 20 days of seeding resulted best alternative for manual hand weeding practices giving higher net return per unit investment. Agronomy Journal of Nepal (Agron JN) Vol. 3. 2013, Page 53-63 DOI: http://dx.doi.org/10.3126/ajn.v3i0.9006

Relapse of kala-azar after use of multiple drugs: a case report and brief review of literature

We present a case of kala-azar infection that recurred in a patient after completion of the standard treatment course of miltefosine, amphotericin B-deoxycholate (short course), and amphotericin B lipid formulations. The patient was cured after continuous amphotericin B-deoxycholate administration for 4 weeks. This is a unique case of relapse following the use of three important drugs. Although amphotericin B-deoxycholate is a second line drug in Nepal, it has shown a satisfactory clinical response with continuous treatment for 4 weeks. Therefore, an extended course of amphotericin B-deoxycholate may be beneficial in patients with resistance to the standard short course and other anti-leishmania drugs.