Mortality comparision in patients receiving either Remdesivir or Remdesivir plus Baricitinib combination in case of moderate to severe COVID-19 Pneumonia: A retrospective study

Remdesivir and Baricitinib have recently been approved by FDA for the treatment of moderate to severe COVID-19 pneumonia. However, there is limited research work available to assess their beneficial effects.

MATERIAL

We conducted retrospective study comparing remdesivir and baricitinib-remdesivir combination therapy in hospitalized adults with moderate to severe Covid-19. All the patients received remdesivir for 5 days and one subgroup had received baricitinib (≤14 days) along with remdesivir. The decision to administer remdesivir only or remdesivir along with baricitinib was the treating clinician's discretion. The primary outcome was to assess the 28-day mortality.

OBSERVATION

A total of 50 patients with moderate or severe COVID-19 pneumonia had received either remdesivir alone or both remdesivir and baricinitib during the duration of 1st April 2021 to 30th June 2021in our hospital. The 28-day mortality was 9.091% in the combination group and 14.29% in the remdesivir only group (risk difference= -5.195%, risk ratio for death=0.3634; 95% CI, 0.1281, 3.161; p=0. 0.3086). Patients who had a FiO2 requirement of 100% at any point of time had 100% mortality, irrespective of the drug received.

CONCLUSION

Baricitinib and remdesivir combination was superior to remdesivir alone in reducing 28-day mortality among patients with moderate to severe Covid-19, although this difference was statistically insignificant.

Treatment and Outcome of Autoimmune Hepatitis (AIH): Audit of 28 UK centres

BACKGROUND

With few data regarding treatment and outcome of patients with AIH outside of large centres we present such a study of patients with AIH in 28 UK hospitals of varying size and facilities.

METHODS

Patients with AIH were identified in 14 University and 14 District General hospitals; incident cases during 2007-2015 and prevalent cases, presenting 2000-2015. Treatment and outcomes were analysed.

RESULTS

In 1267 patients with AIH, followed-up for 3.8(0-15) years, 5- and 10-year death/transplant rates were 7.1+0.8% and 10.1+1.3% (all-cause) and 4.0+0.6% and 5.9+1% (liver-related) respectively. Baseline parameters independently associated with death/transplantation for all-causes were: older age, vascular/respiratory co-morbidity, cirrhosis, decompensation, platelet count, attending transplant centre and for liver-related: the last four of these and peak bilirubin All-cause and liver-related death/transplantation was independently associated with: non-treatment with corticosteroids, non-treatment with a steroid-sparing agent (SSA), non-treatment of asymptomatic or non-cirrhotic patients and initial dose of Prednisolone >35mg/0.5mg/kg/day (all-cause only), but not with type of steroid (Prednisolone versus Budesonide) or steroid duration beyond 12-months. Subsequent all-cause and liver-death/transplant rates showed independent associations with smaller percentage fall in serum ALT after 1 and 3-months, but not with failure to normalise levels over 12-months.

CONCLUSIONS

We observed higher death/transplant rates in patients with AIH who were untreated with steroids (including asymptomatic or non-cirrhotic sub-groups), those receiving higher Prednisolone doses and those who did not receive an SSA. Similar death/transplant rates were seen in those receiving Prednisolone or Budesonide, those continuing steroids after 12-months and patients attaining normal ALT within 12-months versus not.

Prevalence and Risk Factors Analysis of Carotid Stenosis Among Ischaemic Heart Diseases Patient in Bangladesh: A Cross-Sectional Study

Purpose

This study aimed to evaluate the prevalence of carotid stenosis among ischaemic heart disease (IHD) patients undergoing coronary artery bypass graft (CABG) surgery and identify risk factors associated with carotid stenosis at a tertiary-level hospital in Bangladesh.

Patients and Methods

This cross-sectional study examined 200 IHD patients scheduled for isolated and elective CABG surgery, and multivariate regression analysis was used to determine the impact of independent variables on carotid stenosis with coronary artery disease. A vascular surgeon and sonographer assessed carotid stenosis, and the severity of stenosis was classified according to the current Grayscale and Doppler US diagnosis models.

Results

We observed that the prevalence of carotid artery stenosis was 13.5%, and the male was significantly higher (85.2%) in the carotid stenosis group. A multivariate regression analysis observed that age (OR 1.79), dyslipidaemia (OR 2.19), uncontrolled hypertension (OR 2.38), uncontrolled DM (OR 2.51), multivessel coronary artery disease (OR 3.79), and multiple comorbidities (OR 4.46) are potential predictors of having significant carotid stenosis in a patient undergoing CABG surgery.

Conclusion

In Bangladesh, multivessel coronary artery disease, especially in elderly patients with multiple comorbidities, are 4 (four) times higher risk to have significant carotid artery stenosis. Preoperative carotid duplex screening should be performed to curtail the risk of postoperative adverse cerebrovascular events, particularly those who have carotid stenosis associated potential risk factors.

Two-stage integrated process for bio-methanol production coupled with methane and carbon dioxide sequestration: Kinetic modelling and experimental validation

The study demonstrates a two-stage integrated process for bio-methanol production using Methylosinus trichosporium NCIMB 11131, coupled with sequestration of methane and carbon dioxide. The first stage involved generation of methanotrophic biomass via sequestration of methane; which was used as biocatalyst to reduce carbon dioxide into methanol in the second stage. Maximum biomass titer of 3.39 g L^-1 and productivity of 0.60 g L^-1 d^-1 were achieved in semi-batch stirred tank reactor with methane concentration in the inlet gas mixture of 2.5% v/v and gas flow rate of 0.5 vvm. Methane fixation rate was estimated to be 0.32 g L^-1 d^-1. Maximum methanol titer of 0.58 g L^-1 was achieved at headspace carbon dioxide concentration of 50% v/v and liquid to headspace volume ratio 10:90. Subsequently, a kinetic model was developed to predict and understand the system behaviour in terms of dynamic profile of growth, methanol formation, concentration of dissolved methane or carbon dioxide in the aqueous phase and headspace carbon dioxide concentration, in response to varying process parameters. The model can serve as a tool for estimation of process parameters and aid in overall production optimization.

Assessment of prescribing pattern of drugs and completeness of prescriptions as per the World Health Organization prescribing indicators in various Indian tertiary care centers: A multicentric study by Rational Use of Medicines Centers-Indian Council of Medical Research network under National Virtual Centre Clinical Pharmacology activity

OBJECTIVE

The rational use of medicines as per the World Health Organization (WHO) should be practiced globally. However, data regarding the completeness of the prescriptions and their rational use is lacking from developing countries like India. Thus, the aim of this study was to assess the prescribing patterns of drugs and completeness of prescriptions as per WHO core drug use and complementary indicators to provide real-life examples for the Indian Council of Medical Research (ICMR) online prescribing skill course for medical graduates.

METHODS

Prescriptions of the patients, fulfilling inclusion criteria, attending Outpatient Departments of various specialties of tertiary care hospitals, were collected by thirteen ICMR Rational use of medicines centers located in tertiary care hospitals, throughout India. Prescriptions were evaluated for rational use of medicines according to the WHO guidelines and for appropriateness as per standard treatment guidelines using a common protocol approved by local Ethics committees.

RESULTS

Among 4838 prescriptions, an average of about three drugs (3.34) was prescribed to the patients per prescription. Polypharmacy was noted in 83.05% of prescriptions. Generic drugs were prescribed in 47.58% of the prescriptions. Further, antimicrobials were prescribed in 17.63% of the prescriptions and only 4.98% of prescriptions were with injectables. During the prescription evaluation, 38.65% of the prescriptions were incomplete due to multiple omissions such as dose, duration, and formulation.

CONCLUSION

Most of the parameters in the present study were out of the range of WHO-recommended prescribing indicators. Therefore, effective intervention program, like training, for the promotion of rational drug use practice was recommended to improve the prescribing pattern of drugs and the quality of prescriptions all over the country.

Hyperhomocysteinemia presenting as exclusive small vessel coronary artery disease (CAD) in a young

We present an extremely rare case of a 26-year-old young male, an engineering student and a staunch vegetarian from early childhood without conventional cardiac risk factors, with hyperhomocysteinemia presenting as acute lateral wall ST elevation myocardial infarction with angiographic evidence of focal critical occlusion of the first diagonal branch. Although homocysteinemia and its association with coronary artery disease is well known, hyperhomocysteinemia with very high level of plasma homocysteine (>100 mmol/l) presenting as an exclusive small vessel coronary artery disease like involving only diagonal branch sparing major coronary vessels has not yet been described in the literature. Our case is unique and the first description of an exclusive small vessel coronary artery disease sparing major coronary vessels in the presence of paradoxically very high-level serum homocysteine (in a young male without conventional cardiac risk factors). Vegetarians should be encouraged to take Vitamin B6 rich food like potatoes, bananas, and garbanzo beans to decrease the likelihood of having severe coronary artery disease secondary to hyperhomocysteinemia.

The eye of the tongue sole Cynoglossus bilineatus (Lacepède, 1802) (Teleostei: Pleuronectiformes)

We report the ocular features of the tongue sole, Cynoglossus bilineatus (Lacepède, 1802), a marine, bottom-dwelling flatfish. In this species, both eyes are located juxtaposed on the same side of the flat head. Histology revealed the sclera to be fibrous (collagenous) in nature. The choroid possesses the choriocapillaris, and adjacent to it, 3-4 rows of iridophores with stacks of cytoplasmic platelets. No choroidal gland is present. The retinal pigment epithelium (RPE) contains scanty melanin granules. Its vitread half is modified into a dense tapetum with lipid spheres (about 0.34 μm in diameter). In juveniles, the tapetal spheres arise by budding from the smooth endoplasmic reticulum of the RPE. There are blood vessels within the retina; the vitreal vessels penetrate the retina and ramify close to the level of the outer limiting membrane. The vessels are capillaries in nature. The photoreceptor layer contains abundant rods, and twin cones and single cones, being arranged into square mosaics. The optic disc is non-pleated and shows pan- cytokeratin immunopositivity, which is related to the bundled cytokeratin filaments detected in astrocytes by electron microscopy. The retinal tapetum and choroidal iridophores help the species to live in a muddy bottom having dim-light environment. The lack of a choroidal gland, hypoxic aquatic condition and presence of a dense retinal tapetum (that limits O₂ transport to the photoreceptors) appear to have favored the proliferation of vitreal vessels within the retina in this species. The fibrous sclera has probably arisen to provide structural support to the eye in migration from the lateral to the dorsal aspect of the head during larval metamorphosis.