Drug-induced acute interstitial nephritis: A clinicopathological study and comparative trial of steroid regimens

Steroids are used in the management of drug-induced acute interstitial nephritis (AIN). The present study was undertaken to compare the efficacy of pulse methyl prednisolone with oral prednisolone in the treatment of drug-induced AIN. Patients with biopsy-proven AIN with a history of drug intake were randomized to oral prednisolone (Group 1) 1 mg/kg for 3 weeks or a pulse methyl prednisolone (Group II) 30 mg/kg for 3 days followed by oral prednisolone 1 mg/kg for 2 weeks, tapered over 3 weeks. Kidney biopsy scoring was done for interstitial edema, infiltration and tubular damage. The response was reported as complete remission (CR) (improvement in estimated glomerular filtration rate [eGFR] to ≥60 ml/min/1.73 m(2)), partial remission (PR) (improvement but eGFR <60 ml/min/1.73 m(2)) or resistance (no CR/PR). A total of 29 patients, Group I: 16 and Group II: 13 were studied. Offending drugs included nonsteroidal anti-inflammatory drugs, herbal drugs, antibiotics, diuretic, rifampicin and omeprazole. There was no difference in the baseline parameters between the two groups. The biopsy score in Groups I and II was 5.9 ± 1.1 and 5.1 ± 1.2, respectively. At 3 months in Group I, eight patients each (50%) achieved CR and PR. In Group II, 8 (61%) achieved CR and 5 (39%) PR. This was not significantly different. Percentage fall in serum creatinine at 1 week (56%) was higher in CR as compared to (42%) those with PR. (P = 0.14). Patients with neutrophil infiltration had higher CR compared to patients with no neutrophil infiltration (P = 0.01). Early steroid therapy, both oral and pulse steroid, is equally effective in achieving remission in drug-induced AIN.

Enhanced temperature sensing response of upconversion luminescence in ZnO-CaTiO3: Er(3+)/Yb(3+) nano-composite phosphor

Upconversion emission and temperature sensing of the Er(3+)/Yb(3+) doped ZnO-CaTiO3 nano-composite phosphor is studied by varying the ZnO concentration. The XRD and EDX studies reveal the formation of composite phase when ZnO doping exceeds above 10 mw%. Five prominent upconversion emission bands at 410, 492, 524, 545 and 662 nm corresponding to (2)H9/2→(4)I15/2, (4)F3/2→(4)I15/2, (2)H11/2→(4)I15/2, (4)S3/2→(4)I15/2 and (4)F9/2→(4)I15/2 transitions, respectively are found under 980 nm excitation from a diode laser. On the basis of rise time analysis it was found that energy transfer process is responsible for the intense upconversion emission. Large reduction in decay time of (4)S3/2 level is observed on the ZnO incorporation in host matrix. Moreover, the absolute sensor sensitivity, relative sensor sensitivity and calculated color coordinates of the samples are also determined. These results indicate the potentiality of this composite phosphor for various applications.

Efficacy and safety of extended dosing schedules of CC-486 (oral azacitidine) in patients with lower-risk myelodysplastic syndromes

CC-486, the oral formulation of azacitidine (AZA), is an epigenetic modifier and DNA methyltransferase inhibitor in clinical development for treatment of hematologic malignancies. CC-486 administered for 7 days per 28-day treatment cycle was evaluated in a phase 1 dose-finding study. AZA has a short plasma half-life and DNA incorporation is S-phase-restricted; extending CC-486 exposure may increase the number of AZA-affected diseased target cells and maximize therapeutic effects. Patients with lower-risk myelodysplastic syndromes (MDS) received 300 mg CC-486 once daily for 14 days (n=28) or 21 days (n=27) of repeated 28-day cycles. Median patient age was 72 years (range 31–87) and 75% of patients had International Prognostic Scoring System Intermediate-1 risk MDS. Median number of CC-486 treatment cycles was 7 (range 2–24) for the 14-day dosing schedule and 6 (1–24) for the 21-day schedule. Overall response (complete or partial remission, red blood cell (RBC) or platelet transfusion independence (TI), or hematologic improvement) (International Working Group 2006) was attained by 36% of patients receiving 14-day dosing and 41% receiving 21-day dosing. RBC TI rates were similar with both dosing schedules (31% and 38%, respectively). CC-486 was generally well-tolerated. Extended dosing schedules of oral CC-486 may provide effective long-term treatment for patients with lower-risk MDS.

Descriptive analysis of diabetes-related amputations at the Colonial War Memorial Hospital, Fiji, 2010-2012

SETTING

The Colonial War Memorial Hospital (CWMH) in Fiji.

OBJECTIVE

To determine the characteristics of patients with diabetes mellitus (DM) who underwent lower limb amputations at the CWMH from 2010 to 2012.

DESIGN

This was a retrospective review of data contained in operating theatre registers and clinical records of DM patients who had undergone amputations during the study period.

RESULT

Of the 938 amputations performed at the CWMH during the study period, significantly more patients were male than female (54.1% vs. 45.9%) and more i-Taukei (indigenous Fijian) than Indo-Fijian (71% vs. 26.2%); 15.9% of patients had not previously been diagnosed as having DM when they presented with foot sepsis. The rate of smoking was highest in male i-Taukei patients. A large proportion of patients (76.8%) had poor glycaemic control.

CONCLUSION

This study suggests that male i-Taukeis are most at risk, and that uncontrolled DM is a significant factor associated with amputations. There is a need to strengthen DM screening and improve glycaemic control. Foot care education needs to be implemented at diagnosis and re-enforced with regular clinic visits and complication screening sessions.

Classic Tower of Hanoi, Planning Skills, and the Indian Elderly

OBJECTIVE

Elderly populations are vulnerable to age-related cognitive decline. Planning, a frontal lobe function, is reported to be affected in the elderly population. There is a paucity of studies which assessed planning skills in the elderly Indian population. The present study aimed to examine the utility of the classic Tower of Hanoi in the assessment of planning skills of elderly Indian subjects.

METHODS

A total of 215 (60 of whom were females, all aged 55-80 years) cognitively normal elders and 24 patients with mild Alzheimer's disease were recruited. All subjects provided informed consent and their planning skills were assessed using the classic Tower of Hanoi. Performance at each level was measured by the total time taken to solve, number of moves to solve, and the number of rule violations. Receiver operating characteristic curve analysis was exploratively performed to test the utility of the Tower of Hanoi in differentiating patients with mild Alzheimer's disease from those who were cognitively normal.

RESULTS

Performance measures of cognitively normal group steeply worsened with increasing complexity. With receiver operating characteristic curve analysis, patients with mild Alzheimer's disease were poorly differentiated from cognitively normal group according to their Tower of Hanoi performance.

CONCLUSION

The Tower of Hanoi test is of limited value for the assessment of planning skills in the Indian elderly population. There is a need to modify and develop a suitable neuropsychology tool to assess the planning skills of elderly Indian subjects and further validate it.

Doctor, what are my options? A prospective cohort study of an individualized care plan for patients with gastrointestinal cancer

BACKGROUND

For cancer patients, information about their disease and its treatment is often delivered within a short time period, potentially leading to patient misunderstanding, which can impede optimal patient care. In this 3-part clinical study, we investigated the utility of an individualized care plan for patients with gastrointestinal (gi) cancer starting a new treatment.

METHODS

In part 1, a comprehensive literature search identified items for potential inclusion in the care plan. Those items were formatted into a questionnaire. The questionnaire was then administered to patients as a structured interview. In part 2, health care professionals involved in the care of patients with gi cancer evaluated the resulting care plan for content and relevancy. In part 3, a 20-week prospective cohort study (10 weeks using standard of care, 10 weeks using individualized care plans) was conducted. Outcomes were assessed at baseline and at 2-4 weeks after administration of the care plan.

RESULTS

In part 1, a 73-item questionnaire was developed and completed by 20 patients in semi-structured interviews. In part 2, long and short versions of the care plan were created. Most health care professionals preferred the long version. Based on their comments, a final version of the care plan was created. The part 3 study enrolled 104 patients. Overall satisfaction scores were significantly higher in the intervention group at baseline (p = 0.010) and follow-up (p = 0.005). Compared with control patients, the intervention cohort also reported significantly higher overall quality of life (p = 0.044) and fewer symptoms of anxiety (p = 0.048) at follow-up.

CONCLUSIONS

Provision of an individualized care plan resulted in improvements in outcome measures at both baseline and follow-up. Future studies are needed to confirm these findings.

Effectiveness of psycho-educational intervention in improving outcome of unipolar depression: results from a randomised clinical trial

OBJECTIVES

Depressive disorders are one of the leading components of the global burden of disease with a prevalence of up to 14% in the general population. Numerous studies have demonstrated that pharmacotherapy combined with non-pharmacological measures offer the best treatment approach. Psycho-education as an intervention has been studied mostly in disorders such as schizophrenia and dementia, less so in depressive disorders. The present study aimed to assess the impact of psycho-education of patients and their caregivers on the outcome of depression.

METHODS

A total of 80 eligible depressed subjects were recruited and randomised into 2 groups. The study group involved an eligible family member and all were offered individual structured psycho-educational modules. Another group (controls) received routine counselling. The subjects in both groups also received routine pharmacotherapy and counselling from the treating clinician and were assessed at baseline, 2, 4, 8, and 12 weeks using the Hamilton Depression Rating Scale (HDRS), Global Assessment of Functioning (GAF), and Psychological General Well-Being Index (PGWBI). Results from both groups were compared using statistical methods including Chi-square test, Fisher's exact test, Student's t test, Pearson's correlation coefficient, as well as univariate and multiple regression analyses.

RESULTS

Baseline socio-demographic and assessment measures were similar in both groups. The study group had consistent improvement in terms of outcome measures with HDRS, GAF, and PGWBI scores showing respective mean change of -15.08, 22, and 60 over 12 weeks. The comparable respective changes in the controls were -8.77, 18.1, and 43.25.

CONCLUSION

Structured psycho-education combined with pharmacotherapy is an effective intervention for people with depressive disorders. Psycho-education optimises the pharmacological treatment of depression in terms of faster recovery, reduction in severity of depression, and improvement in subjective wellbeing and social functioning.

Estimation of Costunolide and Dehydrocostus Lactone in Saussurea lappa and its Polyherbal Formulations followed by their Stability Studies Using HPLC-DAD

BACKGROUND

Saussurea lappa is one of the popular Ayurvedic herb; costunolide and dehydrocostus lactones are well-known sesquiterpene lactones contained in many plants used as popular herbs, such as S. lappa, and have been considered as potential candidates for the treatment of various types of tumor.

OBJECTIVE

The present study was used for the quantification of costunolide and dehydrocostus lactone in S. lappa and its polyherbal formulations, stability studies of markers and characterization of their degradants.

MATERIALS AND METHODS

HPLC analysis was performed on Waters NOVAPAK HR C18 column (300 mm × 3.9 mm i.d., 6 μm) using isocratic elution with acetonitrile and water (60:40% v/v).

RESULTS

The calibration curves of both analytes showed good linearity within the established range 5-100 μg/ml. The limits of detection (LOD) and quantification (LOQ) were 1.5 and 4.6 μg/ml for costunolide and 1.3 and 4.0 μg/ml for dehydrocostus lactone, respectively. Good results were achieved with respect to repeatability (%RSD < 2.0) and recovery (99.3-101.8%).

CONCLUSION

The method was found to be precise, accurate, specific, and was successfully used for analyzing costunolide and dehydrocostus lactone in S. lappa and its polyherbal formulations. The developed method was found to be suitable for stability studies of markers and characterization of their degradation products.