Novel FDA-approved zavegepant drug for treating migraine

Migraine is a complex neurological disorder characterized by recurring episodes of severe headaches. The pathophysiology of migraine involves abnormalities in neuronal networks, cortical spreading depression, and sensitization of trigeminovascular pathways. The global prevalence of migraine has increased substantially, warranting advancements in treatment strategies. A significant trigger in migraine pathophysiology is calcitonin gene-related peptide (CGRP). Several drugs, such as gepants and monoclonal antibodies (MABs) targeting CGRP or its receptor, have been developed to antagonize CGRP signaling. Zavegepant (Zavzpret), a novel CGRP receptor antagonist, has recently been approved by the FDA for the acute treatment of migraine. Clinical trials have demonstrated its efficacy in providing headache and symptom relief, with a statistically significant percentage of patients achieving freedom from headaches and most bothersome symptoms. Despite mild adverse effects, such as taste disorders and nausea, Zavzpret's overall safety profile remains acceptable.

429 Clinical Audit Ankle Fractures

Aim

Ankle fractures are common among adult age group with an incidence of 174 per 100000 per year and they pose serious problems in management of geriatric age group because of osteoporotic bone. Our aim of current clinical audit was to introduce changes in current clinical practice by recommendations according to Standard BOAST guidelines of management of Ankle Fractures.

Method

Clinical Audit was carried out in Department of Orthopedics Benazir Bhutto Hospital in Outdoor and Emergency in March 2021 in patients of age group 20–70 years taking 50 patients for pre- and post-audit assessment. Emergency, Outdoor Slips were evaluated according to Standards of Practice formulated. Then a presentation was given to medical staff on Guidelines of Ankle fractures management, and they were informed about the deficiencies in their documentation and management. Panaflexes of Guidelines were displayed in ER, ward and then re-evaluation was done after 4 weeks in April 2021 using proformas in which clinical notes, discharge certificates and emergency slips were used for data analysis and observing improvement.

Results

The results of asymmetric data were calculated by Fischer Exact Test and with a p-value of <0.05 considered as significant. Results were very pleasing as they showed great improvements in documentation as well as management of patients in accordance with the set guidelines and protocols.

Conclusion

Clinical Audits should be carried out on regular basis in hospital settings as they help to improve the standards of care as well as proper documentation which has medico-legal importance.

Morphometric measurements and carcass characteristics of Black Australorp, Naked Neck, and Rhode Island Red crossbreds under alternative production systems

The present trial explained the effect of alternative production systems on growth, morphometric and carcass traits of four different chicken genotypes. The second generation of two genotypes RNN (Rhode Island Red × Naked Neck) and BNN (Black Australorp × Naked Neck) obtained by two self-crosses (RNN × RNN = RR and BNN × BNN = BB) and two reciprocal crosses (RNN × BNN = RB and BNN × RNN = BR) were evaluated in three alternative production systems (conventional cages, enriched cages, and aviary). At the 6th week of age after sexing, a total of 600 birds, comprising 150 from each crossbred with a total of 300 pullets and 300 cockerels were divided into conventional cages, enriched cages, and aviary systems having 200 birds in each.Birds were organized into 3×4 factorial arrangements under Completely Randomized Design (3 production systems × 4 genotypes × 2 sexes × 25 birds = 600 birds). Regarding genotypes, RB and BR males showed higher (p < 0.01) carcass yield, drumstick weight, breast weight, and thigh weight than BB and RR genotypes. Females of BR genotype showed higher (p < 0.01) breast weight, thigh weight and drumstick weight. As far as production systems are concerned, higher (p < 0.01) liver weight, heart weight, breast weight, intestinal weight, drumstick weight, and thigh weight were observed in the males reared in enriched cages compared with conventional cages and aviary system. Females reared in enriched cages showed higher (p < 0.01) heart weight, breast weight, intestinal weight, drumstick weight, and thigh weight when compared with those reared in conventional cages and aviary. It is concluded that chickens (both sexes) of BR and RB genotypes had better morphological measurements and carcass traits than those of RR and BB genotype chickens. Among alternative production systems, chickens reared in enriched cages had better traits than those of reared in conventional cages and aviary during the growing phase.

Design and analysis of four-jaws microgripper with integrated thermal actuator and force sensor for biomedical applications

This research paper presents design and analysis of the multi-jaw microgripper that can manipulate microbiological organisms and species, cell probing and measurement, biomedical sample sorting, and preparation. Four jaws, actuated with a single thermal chevron actuator, can grip microbiological species ranging from 300 to 700 μm, 1 to 340 μm, 100 μm pool, and 1 to 120 μm spongy cells, respectively. Jaws are designed in such a way that they can grip regular, irregular, and spongy shaped biological species and their organelles. Parametric analysis of the microgripper exhibited that at 10 V, the efficiency of the thermal actuator is at maximum with respect to displacement, force, and temperature. To enhance displacement to voltage ratio and increase the energy efficiency, a class 3 lever mechanism has been incorporated. The amplification factors at four jaws are 17.21, 13.82, 4.02, and 4.93, respectively. For controlled application of the force to microspecies, two electrostatic force sensors have been amalgamated with jaws having capacitive sensitivities of 1.59 nf/μm, 1.91 nf/μm, 17 nf/μm, and 14.5 nf/μm, respectively. Electrothermal, static, and electrostatic analyses have been carried out with the finite element methods based software IntelliSuite^®. Stress magnitudes are within the limits of structural integrity of silicon having a factor of safety 2.5. Thermal analysis revealed that at a differential voltage of 10 V, the maximum temperature goes up to 425 °C. Buckling analysis results depicted that the critical load for the thermal actuator is 241 μN with the buckling load factor greater than unity. This paper focuses on microbiological applications only; however, the designed microgripper can be used to manipulate micro-objects, microstructures, microelectronics parts, and micro assembly.

Chylopericardium presenting as cardiac tamponade secondary to mediastinal lymphangioma

Mediastinal lymphangioma is a rare entity and chylopericardium is a rare form of pericardial effusion. We report a case of acute chylous cardiac tamponade due to a cervicomediastinal lymphangioma in a one-year-old boy. A chest x-ray revealed marked cardiac enlargement and echocardiography showed massive pericardial effusion. Emergency surgery was performed whereby a pericardial window was created, followed by excision of the lymphangioma.

Congenital massive hiatus hernia type IV; initial experience with laparoscopic repair in young infant

Congenital massive hiatus hernia (CMHH) is an uncommon disorder during childhood. It can be associated with grave complications especially if presented in the highest grade; type IV, when the hernia contains other intra-peritoneal organ beside the stomach through a large hiatus defect. The insidious form of clinical presentation can be deceptive in diagnosis and may mimic congenital diaphragmatic hernia or other chest pathologies. The basic principle of surgical repair is to reduce the herniated organs, excise the hernia sac, and repair the crural defect and to add anti-reflux procedure with or without gastropexy. Traditionally, this has been done by open approach. Nowadays, the minimally invasive approach is the preferred method of treatment. A sixteen-month-old boy with history of recurrent respiratory symptoms was diagnosed with CMHH type IV for which laparoscopic repair was performed. Few reports in using minimally invasive technique in the management of CMHH in the pediatric age group are present in the literature, to the best of our knowledge type IV had never been described in young infants. We present a new case repaired by laparoscope in a young infant with CMHH type IV from the Middle East.

Cost-effective central venous line for infants in the developing world

INTRODUCTION

The aim of the study was to look into the feasibility, safety, efficacy and cost-effectiveness of utilising the remains of central venous catheters in infants from a developing country.

METHODS

Between June 2005 and December 2006, 96 neonates and infants with various illnesses and required the insertion of central venous access, were divided into two groups; those who required it for a short to medium term (44 patients) received a piece of the remains of catheters, and those who required conventional catheter insertion intended for long-term use (52 patients) received a regular catheter. The same principle of insertion was used as for regular central venous access. The external jugular vein was used when possible or the internal jugular vein was used otherwise. After appropriate insertion, the catheter was mounted on an appropriately-sized cannula. A three-way stopcock connection was used to minimise manipulation of the cannula. Postoperative care was the same as for routine central venous lines. Complications encountered in the two groups were recorded and analysed.

RESULTS

Of the short- and medium-term catheters, 32 out of 44 patients (72.7 percent) completed the intended course of treatment successfully, and of the long-term catheters, 42 out of 52 patients (80.8 percent) completed the treatment successfully. Recorded complications were dislodgement, thrombosis and infection. These were, in the short-term group, as follows: five (11.4 percent), three (6.8 percent) and four (9.1 percent), respectively; and for the long-term group, two (3.8 percent), four (7.7 percent) and four (7.7 percent), respectively.

CONCLUSION

Utilisation of the remains of venous catheters in properly-selected patients for short- and medium-term treatment is feasible, cost-effective and safe, and the rates of complications are comparable to cases with conventional catheter insertion.

Acquired oesophageal strictures in children: emphasis on the use of string-guided dilatations

INTRODUCTION

Acquired oesophageal strictures are common in children. Treatment is either surgical or conservative by dilatations. String-guided dilators (SGD) are not well popularised. This is a report of the paediatric surgery experience at Jordan University Hospital on a group of 38 children, with emphasis on the use of SGD.

METHODS

Between January 1998 and January 2006, a total of 38 children (median age 3.2 years; range one month to ten years) with acquired oesophageal strictures were managed in the paediatric surgery unit. Main causes of strictures were corrosive strictures (18, 47.3 percent), post-oesophageal atresia repair (9, 23.6 percent) and post-hiatus hernia repair (4, 10.5 percent). SGD was used in 18 children, six following perforation and 12 classified as severe according to the established criteria. 14 were secondary to corrosive strictures.

RESULTS

There were 801 dilatation sessions with an average of 20.1 +/- 17.3 dilatation sessions per patient. Corrosive strictures were more severe, and required more dilatations per patient. The mean dilatation was 34.2 +/- 16.6 for corrosive strictures vs. 10.4 +/- 8.2 for non-corrosive strictures (p-value is less than 0.0001). 32 (84.2 percent) were successfully dilatated. Two are currently still under treatment and four failed conservative treatment after dilatation for one year. Two underwent oesophageal replacement and two refused surgery but continued to receive dilatation at 4-6 week intervals. SGD was used on 18 patients, six following perforation episodes. Two (5.3 percent) complications resulted in oesophageal perforations.

CONCLUSION

Tucker's dilators, with or without string, are safe, cost-effective and the use of string is a safeguard against perforations.

Digital imaging by parents: an aid to the diagnosis of inguinal hernia in infants and children

INTRODUCTION

The aim of the study is to see the feasibility of utilisation of digital imaging by parents in the diagnosis of inguinal hernia in children, and reduce the rate of occasional negative groin exploration.

METHODS

During a two and a half year period, 155 inguinal hernias were diagnosed and operated on in our university teaching hospital. The diagnosis was based on the history and physical examinations of all patients. In 21 patients, the diagnosis was made based on the examination of history alone, as they did not demonstrate the hernia at presentation. In the last year, digital imaging by parents was utilised to aid in the diagnosis of difficult cases. There were ten cases, in addition to the history and physical examinations, that were confirmed by this method. All hernias were confirmed at exploration during surgery.

RESULTS

Out of 155 inguinal hernias, 21 (13.5 percent) were diagnosed by history alone, of which four (2.5 percent) had negative exploration, eight (5.1 percent) were positive for hernia, supported with digital imaging by parents' pictures, and nine (5.8 percent) were positive at exploration, without any additional means of diagnosis.

CONCLUSION

History-taking and physical examinations are the mainstay of diagnosis of inguinal hernia in children. The capture of a digital image of the presenting complaint by the patients' parents, can be used as an additional aid in the diagnosis of difficult cases to demonstrate inguinal hernia, as demonstrated in a selected group of children.

The effect of crude Cerastes cerastes gasperetti venom on the activity of key metabolic enzymes in cultured human fibroblasts

Cultured human fibroblasts were used to study the effect of a crude extract of Cerastes cerastes gasperetti venom on the activity of a profile of key enzymes of metabolism. A single concentration of the crude venom was incubated with confluent fibroblasts established from six normal subjects for a period of three hours. A dramatic reduction in the specific activities of glucose and glycogen degradative enzymes was observed (23.7 +/- 3.9%, 36.3 +/- 8.7% and 71.1 +/- 5.7% of control for citrate synthase, glucose-6-phosphate and phosphofructokinase respectively). Furthermore, the specific activity of creatine kinase was doubled. No significant change in activity of three transaminases was noticed. Incubation of the same concentration of venom for the same period of time with serum did not result in any change in the activity of the enzymes studied. It is suggested that the cells mobilize stored phosphocreatine for the production of adenosine triphosphate (ATP) to compensate for the reduced rate of sugar catabolism. Furthermore, it is hereby suggested that the effects noticed on the enzyme activities are not directed at the enzyme protein itself, but are of mediated nature.

Alcohol dehydrogenase activity in the human tissues

Total and specific alcohol dehydrogenase activity has been compared in homogenates of 19 different types of human tissues from different sources. ADH activities were detected in tissues which have not been tested yet, e.g., thyroid gland, adrenal gland, fat tissue, skin tissue, peritoneal membrane, breast tissue, duodenum, and gall bladder. Healthy and pathological human tissue differ in their ADH activity. The percentage of the total activity has been estimated in each tested organ in relation to the total activity of the whole body.

Resection with primary anastomosis for necrotizing enterocolitis

Primary anastomosis following the resection of bowel for necrotizing enterocolitis (NEC) can be done with acceptable morbidity and mortality rates. Twenty-seven patients are reported with three deaths. Primary anastomosis will avoid problems seen with small-bowel stomas. The concomitant ligation of a significant patent ductus arteriosus (PDA) should be considered for patients undergoing abdominal procedures for NEC.

Kinetic studies on the reduction of cytochrome c. Reaction with dihydroxy conjugated compounds (catechols and quinols)

The kinetics of reduction of cytochrome c by catechol(s), quinol(s) and related compounds were investigated by stopped-flow spectrophotometry. Studies on the influence of pH on the rates indicate that only deprotonated forms of these compounds act as reducing agents, with the dianionic forms being the most effective. The pH-independent second-order rate constants are reported. Hammett treatment of the effects of substituents on the aromatic ring structure of the reductants show that for electron transfer to occur the charge on the deprotonated species must not be withdrawn on to the substituents. Possible sites for electron donation to cytochrome c are discussed, and the results indicate that the haem edge is a likely candidate.