Long COVID-19 and primary care: Challenges, management and recommendations

Long COVID-19, also known as post-acute sequelae of SARS-CoV-2 infection (PASC), is characterized by persistent symptoms after COVID-19 onset. This article explores the challenges, management strategies, and recommendations for addressing long COVID-19 in primary care settings. The epidemiology of long COVID-19 reveals significant variability, with a substantial portion of COVID-19 survivors experiencing post-acute symptoms. Pathophysiological mechanisms include viral persistence, endothelial dysfunction, autoimmunity, neurological dysregulation, and gastrointestinal dysbiosis. Multiple risk factors, including age, sex, pre-existing comorbidities, smoking, BMI, and acute COVID-19 severity, influence the development of long COVID-19. Effective management requires proactive measures such as vaccination, identification of high-risk populations, public awareness, and post-infection vaccination. Collaboration of primary care physicians with specialists is essential for holistic and individualized patient care. This article underscores the role of primary care physicians in diagnosing, managing, and mitigating the long-term effects of COVID-19.

Bioequivalence assessment of two Ticagrelor formulations under fasting condition in healthy Pakistani subjects

Objective

To investigate the Bioequivalence of Anplag® 90mg (Ticagrelor) tablet and Brilinta® 90 mg (Ticagrelor) tablet under fasting conditions in healthy Pakistani subjects.

Method

This was an open-label, cross-over, randomized, single-dose, two-period, single-center Bioequivalence Study conducted at Center of Bioequivalence Studies and Clinical Research (CBSCR), ICCBS, University of Karachi, Karachi, Pakistan from September 2020 to January 2021. This was an open-label, randomized, single-dose, two-period, cross-over Bioequivalence Study. After randomization, a single dose of Ticagrelor 90mg tablet (test or reference drug) were administered orally in 1:1 ratio to each subject under fasting conditions. Seven days washout period was kept between the two periods in order to avoid carry over. Blood samples were then taken up to 48th hours post-dose. Point estimates and 90% confidence intervals (CI) for the ratio of the log-transformed values were calculated. Bioequivalence assessment of both, the reference and the test drugs were based on the primary Pharmacokinetic PK metrics including peak maximum concentration (Cmax), area under the curve (AUC) from zero to last quantifiable concentration (AUClast), and AUC from zero to infinity (AUCtotal) after log-transformation of data with ANOVA. In this bioequivalence study, the primary pharmacokinetic parameters were assessed for both Ticagrelor and its Active Metabolite (AR-C124910XX). Safety endpoints were evaluated by monitoring adverse events (AEs).

Results

The 90% Confidence Intervals (CIs) of the Geometric Mean Ratio for primary PK parameters including Cmax, AUClast, and AUCtotal all were within the accepted bioequivalence range of 80%- 125%. In the current study, no serious adverse events were reported.

Conclusion

Our results showed that the two tested formulations of Ticagrelor tablets were bioequivalent and well tolerated.Trial Registration: ClinicalTrials.gov Identifier: NCT04941196.

Comparison of plasma from healthy nonsmokers, smokers, and lung cancer patients: pattern-based differentiation profiling of low molecular weight proteins and peptides by magnetic bead technology with MALDI-TOF MS

CONTEXT

Smoking is the major contributor of lung cancer (LC), which accounts for millions of death.

OBJECTIVE

This study focused on the correlation between the proteomic profiling of LC patients, and healthy nonsmokers and smokers.

METHOD

Pattern-based peptide profiling of 186 plasma samples was performed through reversed-phase chromatography-18 magnetic bead fractionation coupled with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry analysis and resulted data were evaluated statistically by ClinProTool.

RESULTS

Marker peaks at m/z 1760, 5773, 5851, 2940, and 7172 were found with an excellent statistical figure.

CONCLUSION

Selected marker peaks can be served as a differentiated tool of LC patients with high sensitivity and specificity.

Infant neurodevelopment following fetal growth restriction: relationship with antepartum surveillance parameters

OBJECTIVES

To evaluate the relationship between fetal Doppler parameters, biophysical profile score (BPP) and neurodevelopmental delay at 2 years of corrected age in infants who had been growth-restricted in utero.

METHODS

This was a prospective observational study including 113 pregnancies complicated by intrauterine growth restriction (IUGR) (abdominal circumference<5th percentile and elevated umbilical artery (UA) pulsatility index). The relationships of UA, middle cerebral artery and ductus venosus (DV) Doppler features, BPP, birth acidemia (artery pH<7.0+/or base deficit>12), gestational age at delivery, birth weight and neonatal morbidity (i.e. bronchopulmonary dysplasia, >Grade 2 intraventricular hemorrhage, or necrotizing enterocolitis) with a 2-year neurodevelopmental delay were evaluated. Best Beginnings Developmental Screen, Bayley Scale of Infant Development II (BSID) and Clinical Adaptive/Clinical Linguistic Auditory Milestone Stage were used. BSID<70, cerebral palsy, abnormal tone, hearing loss and/or blindness defined neurodevelopmental delay.

RESULTS

Seventy-two of the 113 pregnancies completed assessment; there were 10 stillbirths, 19 neonatal deaths, three infant deaths and nine pregnancies with no follow-up. Twenty fetuses (27.8%) had UA reversed end-diastolic velocity (REDV), 34 (47.2%) abnormal DV Doppler features and 31 (43.1%) an abnormal BPP. Median gestational age at delivery and birth weight were 30.4 weeks and 933 g, respectively. Twelve infants had acidemia and 28 neonatal morbidity. There were 38 (52.8%) infants with neurodevelopmental delay, including 37 (51.4%) with abnormal tone, 20 (27.8%) with speech delay, 23 (31.9%) with an abnormal neurological examination, eight (11.1%) with a hearing deficit and six (8.3%) with cerebral palsy. Gestational age at delivery was associated with cerebral palsy (r2=0.52, P<0.0001; 92% sensitivity and 83% specificity for delivery at <27 weeks). UA-REDV was associated with global delay (r2=0.31, P=0.006) and birth weight with neurodevelopmental delay (r2=0.54, P<0.0001; 82% sensitivity and 64% specificity for BW<922 g).

CONCLUSIONS

Although UA-REDV is an independent contributor to poor neurodevelopment in IUGR no such effect could be demonstrated for abnormal venous Doppler findings or BPP. Gestational age and birth weight remain the predominant factors for poor neurodevelopment in growth-restricted infants.

Formulation of inhaled medicines: effect of delivery vehicle on immortalized epithelial cells

The small volume of airway lining fluid renders it susceptible to alteration by the deposition of inhaled formulations. The increasing popularity of the pulmonary route for drug delivery has led to an increasing number of pharmaceutical excipients being incorporated into inhaled dosage forms. The effects of drug delivery vehicle on airway epithelial cells can be studied with the aid of cell culture models of the respiratory epithelium. The effects of pH, osmolarity, and lactose on epithelial cell layers were studied using 16HBE14o- cells. Mannitol flux was used to assess epithelial permeability, enzymatic conversion of 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) was used as a measure of epithelial cell metabolism, and release of the cytosolic enzyme lactate dehydrogenase was used as a measure of cell integrity. The effect of buffer composition on epithelial cell mucus secretion was studied using HT29-clone H cells, with mucus secretion measured using an enzyme-linked lectin assay. The permeability of 16HBE14o- cell layers was increased by apical fluid of pH 5, 6, and 9 as well as osmolarities of 96 and 545 mOsm. MTT conversion was reduced by apical fluid of pH 5 and 6 and osmolarity of 96 mOsm. Lactate dehydrogenase release was only increased by apical fluid of pH 9. No effect of lactose solution (100 mM) on the epithelial cells was observed. Mucus secretion by HT29-clone H cells was lowest in Dulbecco's modified Eagle medium (2.92 +/- 0.23 ng per cell layer) and was increased in phosphate-buffered saline with magnesium and calcium (4.28 +/- 0.38 ng per cell layer) and phosphate-buffered saline without magnesium and calcium (6.56 +/- 0.72 ng per cell layer). These results suggest that the physicochemical properties of inhaled formulations should be carefully controlled. The effect of buffer composition on mucus secretion suggests that even the application of "physiological" solutions may affect the epithelium. These cell models represent an opportunity to investigate the interaction of drug delivery vehicles with the epithelium.

Comparison of aspiration, touch and scrape preparations simultaneously obtained from surgically excised specimens. Effect of different methods of smear preparation on interpretive cytologic features

OBJECTIVE

To determine whether three commonly used methods of obtaining and preparing cells for cytologic evaluation--touch preparation (TP), fine needle aspiration (FNA) and scrape preparation--yield essentially comparable material for evaluation or whether important differences exist between them that may influence interpretation.

STUDY DESIGN

FNA, TP and scrape preparations were made simultaneously on surgically excised specimens. Thirty breast, 6 lung and 12 colon lesions were studied. Each slide was assessed for qualitative and quantitative features. Cellularity was semiquantitatively scored.

RESULTS

Scrape preparations were the most cellular (P < .0001). Scrape and TPs often had larger tissue fragments than FNA. However, fragmentation of epithelial groups into smaller clusters and single cells was often noted on scrape preparations. FNAs tended to have cleaner backgrounds than the other two methods.

CONCLUSION

Most often, there are few differences between smears prepared by the three techniques studied. However, scrape preparations may yield smears with smaller clusters and single cells as compared to the other two methods; that is a potential source of diagnostic confusion, particularly with respect to benign breast lesions. Scrape preparations uniformly yield more cellular smears. To the extent that cellularity is an interpretive factor in assessing cytologic specimens, it is important to be aware of the increased cellularity of scrape preparations as compared to the other two techniques.