Retrospective study of the incidence of sarcoidosis-like reaction in patients treated with immunotherapy

AIM

To assess the frequency of radiographically evident drug-induced sarcoidosis-like reaction (DISR) in patients treated with anti-cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4) therapy, anti-programmed cell death protein 1 (PD-1) therapy, or a combination of both in a single centre.

MATERIALS AND METHODS

The images and medical records of 457 patients with metastatic melanoma or head and neck cancer treated with either anti-CTLA-4 therapy, anti-PD-1 therapy, or a combination of both at University of California medical centre were reviewed retrospectively and the incidence of radiological manifestations of DISR was assessed among these treatment groups.

RESULTS

Radiological manifestations of DISR were found in 19/457 patients (4.1%). The mean interval from the initiation of immunotherapy to development of DISR was 5.5 months (range 2.3-13.5 months). Mean interval from radiological detection of DISR to imaging evidence of resolution was 5.8 months (range 1.6-18.3 months). Three patients out of 81 (3.7%), 11/297 (3.7%), and 5/79 (6.3%) developed sarcoidosis-like reaction after treatment with anti-CTLA-4 antibody, anti-PD-1 antibody, and a combination of both, respectively. Most patients with DISR were asymptomatic and did not require systemic therapy. Most patients did not demonstrate concomitant increased maximum standardised uptake value (SUVmax) in other organs on their integrated 2-[¹⁸F]-fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography (PET)/computed tomography (CT).

CONCLUSIONS

In the present retrospective study of patients treated with immune checkpoint inhibitors (ICIs), DISR occurred in approximately 3.7% of patients treated with either anti-CTLA-4 or anti-PD-1 antibody and 6.3% of patients treated with a combination of both.

The Potential Test of the Mosquito Oviposition Preference Using Similar Subtracts: Colonized Water and Aides Larvae Extract

The research on ovitrap using attractants have been extensively developed, but studies on the use of similar substrates in the form of colonized water and Aedes larvae extract as attractants have not been widely published. Adding an attractant to the ovitrap can stimulate the sense of smell for mosquitoes to come to the place to lay their eggs. The use of ovitrap has recently begun to be developed because it is environmentally friendly. The purpose of this study is to determine the attractants potential of colonized water and larvae extract as the oviposition preferences for  of Aedes Sp. to lay eggs in the ovitrap. The type of this research is a true experimental design, the design of The Posttest-Only Control Group Design. Observations are made in the laboratory for nine repetitions. Observational data show that the average number of eggs in ovitraps that uses the colonized water and larvae extract is higher than that of conventional/control water. The results of the Kruskal-Wallis test indicate that there is a significant difference in the average number of eggs in the colonized water attractant, larval extract and conventional water (Asymp. Sig < 0.05). The conclusion is obtained that similar substrate attractants in the form of larvae extract and Aedes colonization water have the potential to be Aedes sp oviposition preferences compared to conventional water. However, it is still necessary to conduct a field study so that it can be used as an environmentally friendly method of the surveillance and control of the vector transmitting Dengue Hemorrhagic Fever.

Prediction and Control Model of Musculoskeletal Disorders in the Instant Noodle Company in Makassar 2020–2050

BACKGROUND: There are many risk factors that result in musculoskeletal disorders because of work. This also occurs in the instant food industry, where apart from manual load handling and repetitive work, the production process can also results in risks. AIM: The aims of this study are to predict the musculoskeletal disorders in the next 50 years and the effectiveness of scenarios for controlling musculoskeletal disorders. METHODS: This study employed Research and Development method through a dynamics system approach. This research was conducted in one of the industries that produce instant food in South Sulawesi, Indonesia. The data obtained was based on interviews, which were further analyzed using Interpretative Structural Modeling. RESULTS: Based on the simulation results for 30 years, it was found that there was an increase in the average musculoskeletal disorder incidence by 20.63% per year. At the end of the simulation in 2050, the number of musculoskeletal disorder incidents became 48481.69. In this case, the simulation for 30 years (2020–2050) was conducted on a model of controlling occupational diseases at an instant noodle company in Makassar by providing treatment in the form of reducing risk factors that cause musculoskeletal disorders. Based on the simulation results for 30 years (2020–2050), musculoskeletal disorders have the most significant contribution to the increase of occupational diseases incidents as a whole. The increase in musculoskeletal disorders is an accumulation of several risk factors that exist in the instant noodle production process. CONCLUSIONS: Prediction of the musculoskeletal disorder incidence using a dynamic system approach for 30 years (2020–2050) has increased by an average of 20.63% per year. The behavior of the model after receiving treatment on the occurrence of musculoskeletal disorders has an average decrease in the average incidence of 51.11% per year. In this case, to control the musculoskeletal disorder incidence, the elements or variables controlled simultaneously are work posture, lifting load, and length of work.

Essential oil as a new tool for larvicidal Aedes aegypti: A systematic review

OBJECTIVE

The study aimed to describe the effectiveness of essential oil plants for Aedes aegypti mosquito vector control.

METHODS

This systematic review selection process following with 2015 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guideline. The source of the articles from databases international journal were Scopus, Pubmed, Scinapse and Google Scholar.

RESULT

Natural control management with essential oil is the way of alternative for larvicidal mosquito control especially A. aegypti. The essential oil for many plants can use for larvicidal against A. aegypti as Piper batle L., Tinospora rhumpii, Azadiractha indica, Persea americana, Piper aduncum, Leucas aspera, Eucaliptus camaldulensis, Ottonia anisum, Salvia Plebeian, Lantana camara, and Syzygium aromaticum with 100% mortality larvae A. aegypti at 48h.

CONCLUSIONS

The vector borne diseases must be used to integrate vector management control with essential oils plants.

Biomarkers of pneumonia disease in under five children in "grill culture"

OBJECTIVE

Based on data WHO in 2018, almost 802,200 cases of pneumonia occur in children. Indonesia data on Riskesdas in 2018, the increase in pneumonia with the prevalence of pneumonia based on the age group 1-4 years was 5.0. This study aims to obtain more information about biomarkers of the clinical assessment on patient cases and prevention management and then whether postpartum culture contributed to the increase in pneumonia.

METHODS

The method used is a Literature review. Search for scientific articles collected through Scopus indexed journals through Science Direct, Pubmed, Elsevier, MDPI, WHO, Riskesdas, Google Scholar.

RESULT

From the literature articles we read, it shows that the incidence of pneumonia increases from year to year and is the leading cause of death. So it needs prevention from use biomarkers as markers and examined the association of Grill Culture with pneumonia in children under five.

CONCLUSION

The results of the biomarker examination are a marker of the case and prevention management will be carried out using existing cultural approaches.

Potentially Toxic Element Levels in Atmospheric Particulates and Health Risk Estimation around Industrial Areas of Maros, Indonesia

Air quality deterioration is a major environmental problem in Indonesia. This study evaluated the levels and health risks of potentially toxic elements (PTEs) in Maros Regency, Indonesia. Total suspended particulate matter was collected from industrial areas for PTE (Al, Pb, Cr, Cu, Ni, As and Zn) analysis using inductively coupled plasma optical emission spectrometry (ICP-OES). Samples were collected from six critical areas in the Bantimurung region as that is where marble, cement and limestone industries are located. A calculation of the non-carcinogenic and cancer risks was performed to determine the potential health exposures in adults and children. A Monte Carlo simulation with 10,000 iterations and a sensitivity analysis was carried out to identify the risk probability and the most sensitive variable contributing to cancer risk from PTE exposure in humans. The results showed that the concentration of PTEs decreased in the order of Zn > Al > Cr > Pb > Cu > Ni > As in the wet season, and Zn > Al > Pb > As > Cr > Cu > Ni in the dry season. The hazard index (HI) value for children was 2.12, indicating a high non-carcinogenic risk for children. The total cancer risk (TCR) values in adults and children were 3.11 × 10⁻⁵ and 1.32 × 10⁻⁴, respectively, implying that both are at risk for developing cancer. The variables with the most contribution to cancer risk from As, Cr and Pb exposure in adults and children were As concentration (33.9% and 41.0%); exposure duration (ED) (34.3%) and SA (40.7%); and SA (98.7 % and 45.4%), respectively. These findings could be used as the scientific basis for public health intervention and to raise awareness of the harmful health effects of particulate bound PTEs

Detection of Exposure to Microplastics in Humans: A Systematic Review

BACKGROUND: Microplastics are able to enter the human body through food chains, personal care products, contact (skin) from the soil, water or inhalation of microplastics in the air. AIM: This article aims to identify the presence of microplastics that are exposed to humans. METHODS: Systematic review using four bibliographic databases (Google Scholar, Wiley Online Library, PubMed, and Science Direct). Literature search from 2016 to 2021, in the search found as many as 10983 papers extracted using PRISMA guidelines, a total of five papers were selected for review. RESULTS: In this review article, the presence of oral, dermal, and inhalation exposed microplastics is found in feces, colon, placenta, scalp hair, hand skin, facial skin, and saliva. Several methods are used to identify microplastics according to polymer types, shape, and sizes microplastics in humans. The polymer type often found in the article is polypropylene. In addition, fibers, fragments and films are detectable shape of microplastic, while the size of microplastics >5 mm. CONCLUSION: This literature study provides evidence that microplastics of various types of polymers, shapes and sizes are ubiquitous in humans. Hence, the possibility of health risks resulting from microplastic exposure in the human body should not be ignored.

Community Health Risk Assessment of Total Suspended Particulates near a Cement Plant in Maros Regency, Indonesia

BACKGROUND

Cement plants generate particulate matter (PM) across processes from raw material preparation to packaging. The presence of total suspended particulates (TSP) coming out of the stack causes a high accumulation of dust in residential areas. Human exposure to TSP could affect human health and wellbeing.

OBJECTIVES

The present study aims to evaluate concentrations of TSP and to estimate the health risks of TSP exposure through the inhalation pathway in communities surrounding a private cement industry in Maros regency, Indonesia.

METHODS

Total suspended particulates were collected using a high-volume air sampler (HVAS) at five locations. Samples were taken by grab sampling for 24 hours. The SCREEN3 program was used to view the maximum range and distribution of pollutants based on the geographical, stack profiles and meteorological factors in the study area. Hazard quotient (HQ) was used to estimate non-carcinogenic risks of TSP in surrounding communities.

RESULTS

Total suspended particulate concentrations were measured with a maximum value of 133.24 μg/m³ and a minimum value of 18.48 μg/m³. This maximum value exceeds the minimum acceptable level from Canadian National Ambient Air Quality Objectives (C-NAAQOs). The non-carcinogenic risks from the inhalation pathway were low except for location 3 (HQ>1) across all locations.

CONCLUSIONS

The cement plant may significantly contribute to total TSP concentrations in air and may potentially have adverse effects on human health. Communities near the cement plant are vulnerable to TSP exposure and measures are needed to reduce TSP in Maros regency, Indonesia.

PARTICIPANT CONSENT

Obtained.

ETHICS APPROVAL

This study was approved by the Health Research Ethics Committee of Hasanuddin University with protocol number 28920093022.

COMPETING INTERESTS

The authors declare no competing financial interests.

Evaluation of efficiency and quality of the multi-disciplinary team handover process in a mother and baby inpatient setting

Introduction

At Coombe Wood Mother and Baby unit (MBU) there are daily multi-disciplinary team (MDT) handover meetings and a weekly MDT ward round attended by 7-8 team members. There are concerns that the handover is too time consuming, utilising time which could be spent on other clinical duties, and concerns regarding the relevance of information that is handed over.

Objectives

To perform a service evaluation to determine the efficiency and quality of MDT handover meetings in an MBU setting.

Methods

Data was collected from September to October 2020. A checklist was designed listing information felt to be relevant to handover and contained the following data points – ‘current situation’, ‘mental health’, ‘level of observations’, ‘risk’, ‘physical health’, ‘baby care’, ‘baby supervision levels’ and ‘tasks and responsibilities’. The start and stop times of each MDT handover meeting were noted and a record was made as to whether these topics were discussed.

Results

Mean meeting duration was 32.2 minutes (range: 13 – 45 minutes) and amounted to 2.68 hours spent in MDT handover over a 5-day working week. This equates to 21.4 person-hours (based on 8 staff) a week. 928 data points were generated. 50.7% (468) data points were recorded and commonly omitted data points were – ‘tasks and responsibilities’, ‘risk’, ‘level of observations’ and ‘physical health’. On all occasions, ‘current situation’, ‘mental health’ and ‘baby care’ were handed over.

Conclusions

The results of this service evaluation provide compelling evidence for a wider improvement project. Involving MDT staff in designing interventions will make handover meetings more meaningful.

Ecological risk assessment of hexavalent chromium and silicon dioxide in well water in Maros Regency, Indonesia

OBJECTIVE

This paper assesses the potential ecological risk of hexavalent chromium (Cr(VI)) and silicon dioxide/silica (SiO₂) in well water. Both of pollutants have been classified as carcinogenic compound. The ecological risk assessment of drinking water is an effective tool to evaluate drinking water quality to reduce further risk.

METHOD

Fourteen well water samples were collected around the residential area near cement industrial activity and karst mining area. Estimating the ecological risk of well water which consumed daily evaluated based on Hazard Quotient (HQ) ratio.

RESULTS

The mean values of Cr(VI) and SiO₂ in well water samples were 0.0017mg/L and 12.94mg/L, respectively. Drinking water in this area are unacceptable. HQ values for SiO₂ at all stations are more than 1 (moderate level).

CONCLUSIONS

Cr(VI) and SiO₂ are discoverable within well water surrounding the research location. This finding is used as scientific data and references for ecological protection of drinking water in Maros.

The relationship of mercury exposure with neurological problems in artisanal gold in Makassar city

Objectives This research aims to analyse the relationship between urine mercury levels and neurological problems. Methods This research is an observational study with a cross-sectional approach. There are 44 goldsmiths in the gold jewellery small scale industry involved in this study. Urine mercury levels were measured using an atomic absorption spectrophotometer. Neurological problems were assessed by a medician. Data collected includes age, time of exposure, work duration, smoking behaviour and nutrition status of the goldsmiths which were obtained by interview. Results The results showed that the concentration of mercury in the goldsmith's urine was around 0.93-64.59 μg/L. The analysis showed that there were 63% of goldsmiths experiencing neurological problems, such as tremors (9.1%) and knee pass reflex (6.8%). The bivariate analysis showed that there is no significant relationship between the concentration of mercury (p=0.133), age (p=0.155), time of exposure (p=0.702), time of working (p=0.354), smoking behaviour (p=0.169) and nutrition status (p=0.541) with neurological problems. Conclusions The goldsmiths who had high levels of mercury in urine samples were diagnosed with at least one of the neurological symptoms. It is recommended that the goldsmith use personal protective equipment during work such as mask, glasses and gloves.

Economic Status of Community Interest in Membership of BPJS Health in Duampanua District, Pinrang Regency

BACKGROUND: Starting from 2017 until 2019, the number of patient visiting public health centers Lampa is always more than the number of patient visits BPJS, it indicates that the public interest in District Duampanua, Pinrang Regency on BPJS Health membership is still lacking. AIM: This study aimed to determine the effect of economic status on community interest in BPJS health membership. METOHDS: This study used a quantitative research with cross-sectional study approach. The location of this research was in the District Duampanua, Pinrang Regency. The population in this study is the community in Duampanua District Pinrang Regency with 51.593 people. The sampling technique in this study used a purposive sampling technique with 100 sample size. Data analysis performed was univariate and bivariate with Chi-square test. RESULTS: The results showed that there are influence of economic status variables (p = 0.016) to community interest in BPJS Health membership in Duampanua District, Pinrang Regency. The conclusion of this study is that there is an influence of economic status on community interest in BPJS Health membership because the higher the economic status of the community, the higher their interest in BPJS Health membership. CONCLUSION: It is expected that stakeholders in each village in the Duampanua District can find out the income of the community by conducting data collection evenly as proof of their worthiness of being members of JKN-KIS participants.

Five-year survival outcomes for patients with advanced melanoma treated with pembrolizumab in KEYNOTE-001

BACKGROUND

Pembrolizumab demonstrated robust antitumor activity and safety in the phase Ib KEYNOTE-001 study (NCT01295827) of advanced melanoma. Five-year outcomes in all patients and treatment-naive patients are reported herein. Patients whose disease progressed following initial response and who received a second course of pembrolizumab were also analyzed.

PATIENTS AND METHODS

Patients aged ≥18 years with previously treated or treatment-naive advanced/metastatic melanoma received pembrolizumab 2 mg/kg every 3 weeks, 10 mg/kg every 3 weeks, or 10 mg/kg every 2 weeks until disease progression, intolerable toxicity, or patient/investigator decision to withdraw. Kaplan-Meier estimates of overall survival (OS) and progression-free survival (PFS) were calculated. Objective response rate and PFS were based on immune-related response criteria by investigator assessment (data cut-off, September 1, 2017).

RESULTS

KEYNOTE-001 enrolled 655 patients with melanoma; median follow-up was 55 months. Estimated 5-year OS was 34% in all patients and 41% in treatment-naive patients; median OS was 23.8 months (95% CI, 20.2-30.4) and 38.6 months (95% CI, 27.2-not reached), respectively. Estimated 5-year PFS rates were 21% in all patients and 29% in treatment-naive patients; median PFS was 8.3 months (95% CI, 5.8-11.1) and 16.9 months (95% CI, 9.3-35.5), respectively. Median response duration was not reached; 73% of all responses and 82% of treatment-naive responses were ongoing at data cut-off; the longest response was ongoing at 66 months. Four patients [all with prior response of complete response (CR)] whose disease progressed during observation subsequently received second-course pembrolizumab. One patient each achieved CR and partial response (after data cut-off). Treatment-related AEs (TRAEs) occurred in 86% of patients and resulted in study discontinuation in 7.8%; 17% experienced grade 3/4 TRAE.

CONCLUSIONS

This 5-year analysis of KEYNOTE-001 represents the longest follow-up for pembrolizumab to date and confirms the durable antitumor activity and tolerability of pembrolizumab in advanced melanoma.

CLINICAL TRIAL REGISTRY

ClinicalTrials.gov, NCT01295827.

Efficacy and safety of nilotinib in patients with KIT-mutated metastatic or inoperable melanoma: final results from the global, single-arm, phase II TEAM trial

Background

The single-arm, phase II Tasigna Efficacy in Advanced Melanoma (TEAM) trial evaluated the KIT-selective tyrosine kinase inhibitor nilotinib in patients with KIT-mutated advanced melanoma without prior KIT inhibitor treatment.

Patients and methods

Forty-two patients with KIT-mutated advanced melanoma were enrolled and treated with nilotinib 400 mg twice daily. TEAM originally included a comparator arm of dacarbazine (DTIC)-treated patients; the design was amended to a single-arm trial due to an observed low number of KIT-mutated melanomas. Thirteen patients were randomized to DTIC before the protocol amendment removing this study arm. The primary endpoint was objective response rate (ORR), determined according to Response Evaluation Criteria In Solid Tumors.

Results

ORR was 26.2% (n = 11/42; 95% CI, 13.9%–42.0%), sufficient to reject the null hypothesis (ORR ≤10%). All observed responses were partial responses (PRs; median response duration, 7.1 months). Twenty patients (47.6%) had stable disease and 10 (23.8%) had progressive disease; 1 (2.4%) response was unknown. Ten of the 11 responding patients had exon 11 mutations, four with an L576P mutation. The median progression-free survival and overall survival were 4.2 and 18.0 months, respectively. Three of the 13 patients on DTIC achieved a PR, and another patient had a PR following switch to nilotinib.

Conclusion

Nilotinib activity in patients with advanced KIT-mutated melanoma was similar to historical data from imatinib-treated patients. DTIC treatment showed potential activity, although the low patient number limits interpretation. Similar to previously reported results with imatinib, nilotinib showed greater activity among patients with an exon 11 mutation, including L576P, suggesting that nilotinib may be an effective treatment option for patients with specific KIT mutations.

Clinical Trial Registration

ClinicalTrials.gov, NCT01028222.

A phase I trial of panobinostat and epirubicin in solid tumors with a dose expansion in patients with sarcoma

BACKGROUND

Treatment options for sarcoma are limited. Histone deacetylase inhibitors increase the efficacy of topoisomerase II inhibitors by promoting access to chromatin and by down-regulating DNA repair. Thus, combined panobinostat and epirubicin therapy was evaluated to treat refractory sarcoma.

PATIENTS AND METHODS

Patients with advanced solid tumors were enrolled in a 3 + 3 dose-escalation phase I trial of panobinostat given on days 1, 3, and 5 followed by 75 mg/m(2) of epirubicin on day 5 in 21-day cycles, with a dose expansion at maximum tolerated dose (MTD) in 20 sarcoma patients. Peripheral blood mononucleocyte histone acetylation was also evaluated.

RESULTS

Forty patients received 20-60 mg panobinostat. Dose-limiting toxicities included thrombocytopenia, febrile neutropenia, and fatigue at 60 mg, defining a panobinostat MTD at 50 mg. Four responses were seen in 37 assessable patients, all after progression on prior topoisomerase II inhibitors. For those with sarcoma, 12 of 20 derived clinical benefit (1 partial response and 11 stable disease, median overall survival 8.3 months), including 8 of 14 previously progressed on topoisomerase II therapy. Treatment benefits correlated with increased histone acetylation and decreased neutrophil count on day 5.

CONCLUSIONS

Panobinostat and epirubicin treatment is well tolerated and may reverse anthracycline resistance. Changes in histone acetylation and associated decrease in neutrophil count correlated with clinical benefit and warrant investigation as predictive biomarkers.

CLINICAL TRIAL

This trial is registered at www.Clinicaltrials.gov, Identifier: NCT00878904.

Applying the WHO conceptual framework for the International Classification for Patient Safety to a surgical population

OBJECTIVE

Efforts to improve patient safety are challenged by the lack of universally agreed upon terms. The International Classification for Patient Safety (ICPS) was developed by the World Health Organization for this purpose. This study aimed to test the applicability of the ICPS to a surgical population.

DESIGN

A web-based safety debriefing was sent to clinicians involved in surgical care of abdominal organ transplant patients. A multidisciplinary team of patient safety experts, surgeons and researchers used the data to develop a system of classification based on the ICPS. Disagreements were reconciled via consensus, and a codebook was developed for future use by researchers.

RESULTS

A total of 320 debriefing responses were used for the initial review and codebook development. In total, the 320 debriefing responses contained 227 patient safety incidents (range: 0-7 per debriefing) and 156 contributing factors/hazards (0-5 per response). The most common severity classification was 'reportable circumstance,' followed by 'near miss.' The most common incident types were 'resources/organizational management,' followed by 'medical device/equipment.' Several aspects of surgical care were encompassed by more than one classification, including operating room scheduling, delays in care, trainee-related incidents, interruptions and handoffs.

CONCLUSIONS

This study demonstrates that a framework for patient safety can be applied to facilitate the organization and analysis of surgical safety data. Several unique aspects of surgical care require consideration, and by using a standardized framework for describing concepts, research findings can be compared and disseminated across surgical specialties. The codebook is intended for use as a framework for other specialties and institutions.

Randomized phase II study evaluating veliparib (ABT-888) with temozolomide in patients with metastatic melanoma

BACKGROUND

Veliparib (ABT-888) is a potent, orally bioavailable, small-molecule inhibitor of the DNA repair enzymes poly ADP-ribose polymerase-1 and -2. Veliparib enhances the efficacy of temozolomide (TMZ) and other cytotoxic agents in preclinical tumor models.

PATIENTS AND METHODS

In this multicenter, double-blind trial, adults with unresectable stage III or IV metastatic melanoma were randomized 1:1:1 to TMZ plus veliparib 20 or 40 mg, or placebo twice daily. Efficacy end points included progression-free survival (PFS), overall survival (OS), and objective response rate (ORR).

RESULTS

Patients (N = 346) were randomized between February 2009 and January 2010. Median [95% confidence interval (CI)] PFS was 3.7 (3.0-5.5), 3.6 (1.9-4.1), and 2 (1.9-3.7) months in the 20-mg, 40-mg, and placebo arms, respectively. Median (95% CI) OS was 10.8 (9.0-13.1), 13.6 (11.4-15.9), and 12.9 (9.8-14.3) months, respectively; ORR was 10.3%, 8.7%, and 7.0%. Exploratory analyses showed patients with low ERCC1 expression had longer PFS when TMZ was combined with veliparib. Toxicities were as expected for TMZ. The frequencies of thrombocytopenia, neutropenia, and leukopenia were significantly increased in the veliparib groups. Grade 3 or 4 adverse events, mainly hematologic toxicities, were seen in 55%, 63%, and 41% of patients in the 20-mg, 40-mg, and placebo arms, respectively.

CONCLUSIONS

Median PFS with 20 and 40 mg veliparib almost doubled numerically compared with placebo, but the improvements did not reach statistical significance. OS was not increased with veliparib. Toxicities were similar to TMZ monotherapy, but with increased frequency.

Characteristics of pyrexia in BRAFV600E/K metastatic melanoma patients treated with combined dabrafenib and trametinib in a phase I/II clinical trial

BACKGROUND

Pyrexia is a frequent adverse event with combined dabrafenib and trametinib therapy (CombiDT), but little is known of its clinical associations, etiology, or appropriate management.

PATIENTS AND METHODS

All patients on the BRF133220 phase I/II trial of CombiDT treated at the standard dose (150/2) were included for assessment of pyrexia (n = 201). BRAF and MEK inhibitor-naïve patients (n = 117) were included for efficacy analyses. Pyrexia was defined as temperature ≥38°C (≥100.4(°)F) or related symptoms.

RESULTS

Fifty-nine percent of patients developed pyrexia during treatment, 24% of which had pyrexia symptoms without a recorded elevation in body temperature. Pyrexia was grade 2+ in 60% of pyrexia patients. Median time to onset of first pyrexia was 19 days, with a median duration of 9 days. Pyrexia patients had a median of two pyrexia events, but 21% had three or more events. Various pyrexia management approaches were conducted in this study. A trend was observed between dabrafenib and hydroxy-dabrafenib exposure and pyrexia. No baseline clinical characteristics predicted pyrexia, and pyrexia was not statistically significantly associated with treatment outcome.

CONCLUSIONS

Pyrexia is a frequent and recurrent toxicity with CombiDT treatment. No baseline features predict pyrexia, and it is not associated with clinical outcome. Dabrafenib and metabolite exposure may contribute to the etiology of pyrexia. The optimal secondary prophylaxis for pyrexia is best studied in a prospective trial.

In vitro evaluation of Moringa oleifera gum for colon-specific drug delivery

Background:

Moringa gum obtained from stem of the plant Moringa oleifera Lam. belonging to family Moringaceae. Number of naturally occurring polysaccharides obtained from plant (guar gum, inulin), animal (chitosan, chondrotin sulphate), algal (alginates) or microbial (dextran) origin.

Objective:

The present study was evaluated Moringa oleifera gum as a carrier for colon specific drug delivery using in vitro drug release studies.

Materials and Methods:

Six formulations of curcumin were prepared using varying concentration of Moringa oleifera gum containing 50 mg curcumin by wet granulation method. Tablets were subjected for evaluation by studying the parameter like hardness, friability, drug content uniformity and in vitro drug release study. Hardness was found to be in the range of 5.5 to 7.3 kg/cm², the percentage friability was in the range of 0.60 to 0.89%, and tablet showed 98.99% to 99.89% of the labeled amount of curcumin indicating uniformity in drug content.

Results and Discussion:

In vitro drug release study was performed using simulated stomach, intestinal and colonic fluid. The susceptibility of Moringa gum to colonic bacteria was also assessed using drug release study with rat caecal contents. 30% Moringa gum containing formulation (F-3) was shown better drug released that is 90.46%, at the end of 24 h of dissolution study in the presence of rat caecal contents in comparison to 40% Moringa gum containing formulation (F-4) that was 78.03%.

Conclusion:

The results illustrate the usefulness of Moringa olefera gum as a potential carrier for colon-specific drug delivery.