Nano-biogenic heavy metals adsorptive remediation for enhanced soil health and sustainable agricultural production

Hazardous heavy metal (HM) pollution constitutes a pervasive global challenge, posing substantial risks to ecosystems and human health. The exigency for expeditious detection, meticulous monitoring, and efficacious remediation of HM within ecosystems is indisputable. Soil contamination, stemming from a myriad of anthropogenic activities, emerges as a principal conduit for HM ingress into the food chain. Traditional soil remediation modalities for HM elimination, while effective are labor-intensive, susceptible to secondary contamination, and exhibit limited efficacy in regions characterized by low metal toxicity. In response to these exigencies, the eco-friendly paradigm of bioremediation has garnered prominence as a financially judicious and sustainable remedial strategy. This approach entails the utilization of hyperaccumulators, Genetically Modified Microorganisms (GMM), and advantageous microbes. The current review offers a comprehensive elucidation of cutting-edge phyto/microbe-based bioremediation techniques, with a specific emphasis on their amalgamation with nanotechnology. Accentuating their pivotal role in advancing sustainable agricultural practices, the review meticulously dissects the synergistic interplay between plants and microbes, underscoring their adeptness in HM remediation sans secondary contamination. Moreover, the review scrutinizes the challenges intrinsic to implementing bioremediation-nanotechnology interface techniques and propounds innovative resolutions. These discernments proffer auspicious trajectories for the future of agriculture. Through the environmentally conscientious marvels of phyto/microbe bioremediation, an optimistic outlook emerges for environmental preservation and the cultivation of a sustainable, salubrious planet via the conduit of cleaner agricultural production.

Constructing α-Fe2O3/g-C3N4/SiO2 S-scheme-based heterostructure for photo-Fenton like degradation of rhodamine B dye in aqueous solution

This work successfully fabricated graphitic carbon nitride and magnetically recoverable α-Fe2O3/g-C3N4/SiO2 photo-Fenton catalysts using thermal polycondensation and in situ-simple precursor drying-calcination process, respectively, was examined for model synthetic rhodamine B (RhB) dye in the presence of H2O2 and acidic pH under simulated visible light irradiation. An aqueous suspension of the reaction mixture of dye-containing wastewater was fully degraded and reached 97% of photo-Fenton degradation efficiency within 120 min followed by the production of hydroxyl radical (•OH). The dominant hydroxyl radical position generated surface charge, electrostatic potential distribution, and average local ionization potential, which contributed to the complete mineralization of RhB dye, according to the density functional theory (DFT) calculations. HPLC and GCMS experiments were performed to examine the degradation fragments of RhB and draw a plausible mechanistic pathway which showed that RhB degradation generated a series of N-deethylated products, followed by a one-time ring-opening, which indicated that photosensitization induced a photocatalysis reaction mechanism.

Cancer treatment and toxicity outlook of nanoparticles

Diversified nanosystems with tunable physicochemical attributes have emerged as potential solution to globally devastating cancer by offering novel possibilities for improving the techniques of cancer detection, imaging, therapies, diagnosis, drug delivery and treatment. Drug delivery systems based on nanoparticles (NPs) with ability of crossing different biological barriers are becoming increasingly popular. Besides, NPs are utilized in pharmaceutical sciences to mitigate the toxicity of conventional cancer therapeutics. However, significant NPs-associated toxicity, off-targeted activities, and low biocompatibility limit their utilization for cancer theranostics and can be hazardous to cancer patients up to life-threatening conditions. NPs interact with the biomolecules and disturb their regular function by aggregating inside cells and forming a protein corona, and the formulation turns ineffective in controlling cancer cell growth. The adverse interactions between NPs and biological entities can lead to life-threatening toxicities. This review focuses on the widespread use of various NPs including zinc oxide, titanium oxide, silver, and gold, which serve as efficient nano-vehicles and demonstrate notable pharmacokinetic and pharmacodynamic advantages in cancer therapy. Subsequently, the mechanism of nanotoxicity attached with these NPs, alternate solutions and their prospect to revolutionize cancer theranostics are highlighted. This review will serve as guide for future developments associated with high-performance NPs with controlled toxicity for establishing them as modern-age nanotools to manage cancer in tailored manner.

Geospatial technology in agroforestry: status, prospects, and constraints

Agroforestry has an indispensable role in food and livelihood security in addition to its capacity to combat the detrimental effects of climate change. However, agroforestry has not been properly promoted and exploited due to lack of precise extent, geographical distribution, and carbon sequestration (CS) assessment. The recent advent of geospatial technologies, as well as free availability of spatial data and software, can provide new insights into agroforestry resources assessment, decision-making, and policy development despite agroforestry's small spatial extent, isolated nature, and higher structural and functional complexity of agroforestry. In this review, the existing application of geospatial technologies together with its constraints and limitations as well as the potential future application for agroforestry has been discussed. The review reveals that the application of optical remote sensing in agroforestry includes spatial extent mapping, production of tree species spectral signature, CS assessment, and suitability mapping. Simultaneously, the recent surge in the use of synthetic aperture radar in conjunction with algorithms based on vegetation photosynthesis and optical data enables a more accurate estimation of gross primary productivity at different scales. However, unmanned aerial vehicles equipped with sensors, such as multispectral, LiDAR, hyperspectral, and thermal, offer a considerably higher potential and accuracy than satellite-based datasets. In the future, the health monitoring of agroforestry systems can be a key concern that may be addressed by utilizing hyperspectral and thermal datasets to analyze plant biochemistry, chlorophyll fluorescence, and water stress. Additionally, current (GEDI, ECOSTRESS) and future space agency missions (BIOMASS, FLEX, NISAR, TRISHNA) have enormous potential to shed fresh light on agroforestry systems.

A Real-World Study of Safety, Immunogenicity and Efficacy of Bevacizumab in Patients With Solid Malignancies: A Phase IV, Post-Marketing Study in India

Objective

The aim of this study was to evaluate the post-marketing safety, tolerability, immunogenicity and efficacy of Bevacizumab (manufactured by Hetero Biopharma) in a broader population of patients with solid tumors.

Patients And Methods

This phase IV, prospective, multi-centric clinical study was carried out in Indian patients with solid malignancies (metastatic colorectal cancer, non-squamous non-small-cell lung cancer, metastatic renal cell carcinoma) treated with Bevacizumab between April 2018 and July 2019. This study included 203 patients from 16 tertiary care oncology centers across India for safety assessment, of which a subset of 115 patients who have consented were also evaluated for efficacy and immunogenicity. This study was prospectively registered in the Clinical Trial Registry of India (CTRI), and was commenced only after receiving approval from the competent authority (Central Drugs Standard Control Organization, CDSCO).

Results

Out of the 203 enrolled patients, 121 (59.6%) patients reported 338 adverse events (AEs) during this study. Of 338 reported AEs, 14 serious adverse events (SAEs) were reported by 13 patients including 6 fatal SAEs, assessed as unrelated to the study medication and 7 non-fatal SAEs, 5 assessed as related, and 3 unrelated to Bevacizumab. Most AEs reported in this study (33.9%) were general disorders and administration site conditions, followed by gastrointestinal disorders (29.1%). The most frequently reported AEs were diarrhea (11.3%), asthenia (10.3%), headache (8.9%), pain (7.4%), vomiting (7.9%), and neutropenia (5.9%). At the end of the study, 2 (1.75%) of 69 patients reported antibodies to Bevacizumab without affecting safety and efficacy. However, at the end of 12 months, no patient had reported antibodies to Bevacizumab. Complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) were reported in 18.3%, 22.6%, 9.6%, and 8.7% of patients, respectively. The overall response rate (CR + PR) was reported in 40.9% of patients at the end of the study. Disease control rate (DCR), also known as the clinical benefit rate (CBR) was reported in 50.4% of patients.

Conclusions

Bevacizumab (Cizumab, Hetero Biopharma) was observed to be safe, well tolerated, lacking immunogenicity, and efficacious in the treatment of solid tumors. The findings of this phase IV study of Bevacizumab, primarily as a combination therapy regimen suggest its suitability and rationality for usage in multiple solid malignancies.

Clinical Trial Registry Number

CTRI/2018/4/13371 [Registered on CTRI http://ctri.nic.in/Clinicaltrials/advsearch.php : 19/04/2018]; Trial Registered Prospectively.

Developing an integrated genomic selection approach beyond biomass for varietal protection and nutritive traits in perennial ryegrass (Lolium perenne L.)

Breeding target traits can be broadened to include nutritive value and plant breeder's rights traits in perennial ryegrass by using in-field regression-based spectroscopy phenotyping and genomic selection. Perennial ryegrass breeding has focused on biomass yield, but expansion into a broader set of traits is needed to benefit livestock industries whilst also providing support for intellectual property protection of cultivars. Numerous breeding objectives can be targeted simultaneously with the development of sensor-based phenomics and genomic selection (GS). Of particular interest are nutritive value (NV), which has been difficult and expensive to measure using traditional phenotyping methods, resulting in limited genetic improvement to date, and traits required to obtain varietal protection, known as plant breeder's rights (PBR) traits. In order to assess phenotyping requirements for NV improvement and potential for genetic improvement, in-field reflectance-based spectroscopy was assessed and GS evaluated in a single population for three key NV traits, captured across four timepoints. Using three prediction approaches, the possibility of targeting PBR traits using GS was evaluated for five traits recorded across three years of a breeding program. Prediction accuracy was generally low to moderate for NV traits and moderate to high for PBR traits, with heritability highly correlated with GS accuracy. NV did not show significant or consistent correlation between timepoints highlighting the need to incorporate seasonal NV into selection indexes and the value of being able to regularly monitor NV across seasons. This study has demonstrated the ability to implement GS for both NV and PBR traits in perennial ryegrass, facilitating the expansion of ryegrass breeding targets to agronomically relevant traits while ensuring necessary varietal protection is achieved.

Exploring phytochemical composition, photocatalytic, antibacterial, and antifungal efficacies of Au NPs supported by Cymbopogon flexuosus essential oil

Biofabrication of gold nanoparticles (AuNPs) using the aromatic essential oils is highlighted due to its simple, economical, low toxicity, and eco-friendly nature. Essential oil of Cymbopogon flexuosus (CF), an economically valuable medicinal plant, exhibits anti-inflammatory, anti-tumor, antioxidant, and antimicrobial activities. For the first time, this research accounts for the biosynthesis, physicochemical, photocatalytic, antifungal, antibacterial properties of biogenic AuNPs, fabricated using CF essential oil collected from different altitudes (S1-Palampur, S2-Haryana, S3-Dehradun). The altitudinal disparity in the phytochemical composition of essential oils is highlighted. The average crystallite size ranged from 10 to 32 nm and was influenced by CF samples used in the synthesis. The spectroscopic outcomes revealed the involvement of bioactive reagents from CF essential oil in the fabrication and stabilization of AuNPs. The fabricated AuNPs exhibited excellent antimicrobial activities against all tested strains (Staphyloccucs aureus, Escherichia coli, Fusarium oxysporum), showing their efficacy as an antimicrobial agent to treat infectious diseases. Moreover, AuNPs exhibited excellent photocatalytic efficacy of around 91.8% for the degradation of methylene blue under exposure of direct sunlight for 3 h without the assistance of an external reducing agent. The outcomes highlight a potential economic and environmentally friendly strategy to fabricate biogenic AuNPs for diversified industrial applications where antimicrobial and photocatalytic efficacies are the key requirements.

Essential oil-mediated biocompatible magnesium nanoparticles with enhanced antibacterial, antifungal, and photocatalytic efficacies

Emergent application of antimicrobial strategies as symptomatic treatment in coronavirus disease (COVID-19) and linkage of severe acute respiratory syndrome coronavirus2 with microbial infections, has created colossal demand for antimicrobials. For the first time, this communication explore the physicochemical, antifungal, antibacterial, and photocatalytic properties of biogenic magnesium nanoparticles (MgNPs), synthesized using essential oil of Cymbopogon flexuosus's as an efficient multifunctional reducing and stabilizing/capping reagent. It is observed that MgNPs (ranging in size: 8–16 nm) of varying phytochemical compositions (MgS1, MgS2, MgS3) exhibited various useful physicochemical, antimicrobial, and photocatalytic properties. FTIR outcomes highlight the functional biomolecules-assisted reduction of Mg from Mg⁺ to Mg⁰. Among all, MgS3-Nps owing to the smallest particle size exhibited superior photocatalytic efficacy (91.2%) for the methylene blue degradation upon direct exposure to the sunlight for 3 h without using any reducing agents. Fabricated MgNPs also exhibited excellent antifungal (against Fusarium oxysporum) and antibacterial (versus Staphylococcus aureus and Escherichia coli) efficacies compared to state-of-the-art antimicrobial agents deployed for the treatment of infectious diseases. Based on this investigated greener approach, imperative from economic and environmental viewpoint, such essential oil based-MgNPs can be a potential nanosystem for various industrial applications where photocatalytic, and biomedical attributes are the key requirements.

Prospects of Biosensors Based on Functionalized and Nanostructured Solitary Materials: Detection of Viral Infections and Other Risks

Advances in nanotechnology over the past decade have emerged as a substitute for conventional therapies and have facilitated the development of economically viable biosensors. Next-generation biosensors can play a significant role in curbing the spread of various viruses, including HCoV-2, and controlling morbidity and mortality. Pertaining to the impact of the current pandemic, there is a need for point-of-care biosensor-based testing as a detection method to accelerate the detection process. Integrating biosensors with nanostructures could be a substitute for ultrasensitive label-free biosensors to amplify sensing and miniaturization. Notably, next-generation biosensors could expedite the detection process. An elaborate description of various types of functionalized nanomaterials and their synthetic aspects is presented. The utility of the functionalized nanostructured materials for fabricating nanobiosensors to detect several types of viral infections is described in this review. This review also discusses the choice of appropriate nanomaterials, as well as challenges and opportunities in the field of nanobiosensors.

Changing Trends In Electrical Burns From A Tertiary Care Centre - Epidemiology And Outcome Analysis

Electrical burn injuries result in significant mortality and morbidity. Most of these injuries are preventable. We conducted a retrospective analysis of various aspects of electrical injuries presenting to our center over a period of 1 year from September 2018 to August 2019. Demographic characteristics of patients along with burn characteristics and associated injuries were analysed. Outcomes including length of hospital stay, need for fasciotomy, amputation, renal failure and mortality were also analysed. A total of 6380 patients presented to our center during the study period, of which 471 (7.38%) had electrical burns. Total burn admissions were 1530, of which 283 (18.49%) patients were admitted with electrical burns. The mean age in our cohort was 25.31±12.76 years and mean TBSA was 29.22±23.81%. The most common cause of electrical burns was occupational (33.3%), followed by those that occurred on the rooftop of houses (31%). A historical comparison with data published from our center in 2011 showed a significant increase in occupational burns (18.72% vs. 33.3%) and rooftop electrical burns (8.21% vs. 31%), and a decrease in agriculture-related (42.46% vs. 9.1%) and domestic electrical burns (26.02% vs. 6.7%). There was also a significant rise in proportion of high voltage injuries (71.23% vs. 86.90%). Logistic regression analysis showed electric contact burn to be a risk factor for fasciotomy and limb gangrene. Risk factors for renal failure were age, percentage burn, electric contact burn and rural residence, and those for mortality were percentage burn and renal failure. Emphasis on preventive strategies, especially against occupational injuries and injuries occurring on rooftops, is necessary to prevent such devastating injuries.

Efficacy and Safety of Acotiamide Versus Mosapride in Patients With Functional Dyspepsia Associated With Meal-Induced Postprandial Distress Syndrome: A Phase III Randomized Clinical Trial

BACKGROUND

 Acotiamide is a novel prokinetic drug that acts by enhancing the release of acetylcholine and is used in the treatment of functional dyspepsia-postprandial distress syndrome (FD-PDS). Mosapride is indicated to FD-PDS as per the Rome III treatment guidelines. Mosapride 5 mg three times daily (TID) is approved by the Drugs Controller General of India (DCGI) for the treatment of FD-PDS. The objective of this study was to determine the efficacy and safety of Acotiamide in comparison with Mosapride on FD-PDS.

METHODS

The 220 patients of either gender (aged 18-64 years) with active PDS included in the study were centrally randomized 1:1 to receive either 100 mg Acotiamide (test product) or 5 mg Mosapride (reference product) TID for four weeks. Responder rates for the overall treatment effect (OTE) at the end of four weeks were the primary efficacy endpoint. Secondary efficacy endpoints included the elimination rate of postprandial fullness, upper abdominal bloating, and early satiation. The study also evaluated the OTE at each week, individual symptom scores, and quality of life (QoL) assessed by the Short Form-Nepean Dyspepsia Index questionnaire (SF-NDI). The safety endpoints included assessments of treatment-emergent adverse events (TEAEs).

RESULTS

 At the end of four weeks, the responders in the Acotiamide versus Mosapride group for OTE was 98% versus 93.27% in the per-protocol (PP) population. Among the intent to treat (ITT) population, the comparison of Acotiamide versus Mosapride stood at 95.15% versus 89.81%. Secondary efficacy endpoints were significantly improved with 100 mg TID Acotiamide, which was evident from the improvement in postprandial fullness (14.56%), upper abdominal bloating (15.53%), early satiation (10.68%), and QoL (13.7 ± 4.67).

CONCLUSIONS

 Our study results demonstrated that Acotiamide is effective, safe, and well-tolerated and had significantly improved the QoL over a four-week treatment period in FD-PDS patients. The efficacy and safety profiles of Acotiamide were similar to Mosapride.

A Phase III Prospective Active and Placebo-Controlled Randomized Trial of Vilazodone in the Treatment of Major Depressive Disorder

Background

Depression is a leading cause of psychiatric morbidity in the modern world, and the introduction of selective serotonin reuptake inhibitors (SSRIs) is a revolution in the treatment of depression. Vilazodone, a novel SSRI and 5-HT1A partial agonist, received FDA approval in 2011 to treat the major depressive disorder (MDD) in adults. This study conducted in India aimed to evaluate the efficacy and safety of vilazodone when compared to escitalopram or placebo in patients with MDD.

Methods

This was a prospective, multicentre, randomized, comparative study of 375 participants over eight weeks of treatment with either vilazodone (10-40mg/day) or escitalopram (10-40 mg/day) or placebo in adult patients with MDD. Primary efficacy was assessed using the Hamilton Rating Scale for Depression (HAM-D-17); secondary efficacy was assessed using the Montgomery-Asberg Depression Rating Scale (MADRS) score and Hamilton Anxiety Scale (HAM-A) score. Safety parameters included adverse events (AEs), clinical laboratory results, vital signs, electrocardiogram ( ECG), and Columbia-Suicide Severity Rating Scale (C-SSRS).

Results

Mean change in the HAM-D-17 total score from baseline to week 8 for vilazodone, escitalopram, and placebo-treated patients in intent-to-treat (ITT) population was: -18.9 (± 7.49), -17.8 (± 6.06), and -7.4 (± 6.32); in ITT population (with Last Observation Carried Forward( LOCF) imputation) was: -17.9 (± 7.71), -17.4 (± 6.19), and -6.4 (± 6.84), and in per-protocol (PP) population was: -19.1 (± 7.20), -17.8 (± 6.08), and -7.7 (± 6.29), respectively. The upper limit of 95% CI (0.56 (ITT); 0.90 (ITT with LOCF Imputation); 0.23 (PP)) of difference in HAM-D-17 between vilazodone 40mg and escitalopram 40mg, which is lower than the defined non-inferiority margin (3.56), proving non-inferiority. The difference between vilazodone 40mg, escitalopram 40mg, and the placebo was statistically significant (p<0.0001). No deaths or serious adverse events were reported in this study.

Conclusion

Vilazodone demonstrated comparable efficacy to escitalopram and superior efficacy over the placebo in the treatment of MDD.

Safety, Tolerability, and Immunogenicity of Prescribed Usage of Darbepoetin-Alfa (Hetero Biopharma) in Patients of Chronic Kidney Disease With Renal Anemia: A Post-Marketing Surveillance Study

Background

This post-marketing surveillance (PMS), observational, prospective, safety study evaluated the safety, tolerability, and long-term immunogenicity of prescribed usage of Darbepoetin alfa (DA-α, manufactured by Hetero Biopharma, Hyderabad, India) in Indian patients having chronic kidney disease (CKD) with anemia.

Methods

All patients having chronic kidney disease with anemia and prescribed Hetero-Darbepoetin were the target patient population. The present study gathered the data from 503 Hetero-Darbepoetin alfa prescribed patients. This study collected information of patient demography, patient's medical history, concomitant medications, action taken with respect to Hetero-Darbepoetin-alfa, adverse events details (AE term, start date, stop date, severity, action taken, outcome, and causality), periodic hemoglobin (Hb) levels, and abnormal laboratory tests results until treatment is discontinued or the patient is lost to follow-up. Immunogenicity data were collected in 121 patients at the end of treatment and after one year.

Results

Eighty-seven AEs were reported in this study and most of them were mild to moderate in intensity. No deaths or serious adverse events (SAEs) were reported in this study. Anti-drug antibodies were not detected in any subject at the end of the treatment phase and after 12 months long-term follow-up period. The baseline mean hemoglobin value was 8.34 (SD 1.24) g/dL and the last visit mean hemoglobin value was 10.42 ± 1.24 (mean ± SD) g/dL. The mean difference between baseline and last visit in hemoglobin value was 2.10 [2.00, 2.20], statistically significant (p-value <0.0001).

Conclusions

The safety and tolerability of the usage of DA-α are similar to that reported in the published literature of the innovator. No patients showed anti-drug antibodies after treatment. Additionally, the patients also showed significant improvement in hemoglobin levels, compared to baseline.

Efficacy and Safety of Orally Administered Acotiamide Extended-Release Tablets Among Functional Dyspepsia-Postprandial Distress Syndrome Patients: A Randomized, Double-Blind, Multicenter Study

Background: Acotiamide, is the world's first-in-class, prokinetic drug and world’s first approved treatment for postprandial distress syndrome (PDS) symptoms of functional dyspepsia (FD). An extended-release (ER) formulation of this drug product, developed first-time in the world has been evaluated in phase 3, a comparative trial to explore the efficacy and safety in patients with FD-PDS.

Methods: In this study, 219 patients with FD-PDS aged 18-65 years were randomized (1:1) to receive either acotiamide ER 300 mg once daily or acotiamide 100 mg three times daily for four weeks. The primary efficacy endpoint was responder rates for the overall treatment effect (OTE) at end of week 4. Secondary efficacy endpoints included OTE at each week, elimination rate of postprandial fullness, upper abdominal bloating and early satiation, improvement of individual symptom scores, and quality of life (QoL). The safety endpoints included assessments of treatment-emergent adverse events (TEAEs).

Results: The responder rate for OTE at the end of the four week period, in acotiamide ER 300 mg OD versus acotiamide 100 mg TID group was 92.66% and 94.39% (97.5% CI −8.3,4.8), respectively, in per-protocol (PP) population and 92.66% and 92.73% (97.5% CI −7.0,6.8), respectively, in intent to treat (ITT) population. All other secondary efficacy endpoints, including QoL, were significantly improved with acotiamide ER 300 mg. Both the formulations of acotiamide significantly improved symptom severity and eliminated meal-related symptoms in patients with FD. Adverse events were reported by 7.9% of patients in acotiamide ER 300 mg and 9.2% in acotiamide 100 mg patients; the most common adverse event reported was a headache.

Conclusions: The efficacy and safety of acotiamide ER 300 mg once daily were observed to be comparable to acotiamide immediate release 100 mg thrice daily. A significant improvement in QoL over a four-week treatment period in FD-PDS patients was observed.

Evaluation of the Efficacy and Safety of Azilsartan in Adult Patients with Essential Hypertension: A Randomized, Phase-III Clinical Study in India

BACKGROUND

Globally, women and men over the age of 25 years suffer from hypertension, the need for new treatment strategies to treat hypertension is due to the multi-faceted nature of the disease. Lack of optimal blood pressure control can lead to multiple complications. Therefore, this phase 3 study was conducted to assess the efficacy, safety and tolerability of potential product azilsartan hydrochloride for reduction in blood pressure in Indian patients with essential hypertension.

METHODS

This was a prospective, multicentre, randomized, comparative, parallel study of 303 participants over six weeks of treatment period with either azilsartan 40 mg or azilsartan 80 mg or telmisartan 40 mg in adult patients with essential hypertension. The primary endpoint was the change in mean trough sitting clinic systolic blood pressure (scSBP) from baseline to week 6. The secondary endpoints were the change in mean trough sitting clinic diastolic blood pressure (scDBP) from baseline and change in the 24-hour mean ambulatory systolic blood pressure (SBP)and diastolic blood pressure (DBP) from baseline.

RESULTS

The change in mean trough scSBP from baseline to week 6 was -27.2 ± 9.99, -28.2 ± 10.06 and -26.7 ± 9.72 (Per Patient (PP) Population) and -27.2 ± 9.93, -28.3 ± 10.01 and -26.7 ± 9.67 (Intent to Treat (ITT) Population) in the azilsartan 40mg, 80mg and telmisartan 40mg groups respectively. The lower limit of 95% CI of difference in change in mean systolic blood pressure was -2.35(Azilsartan 40mg) and 1.32 (Azilsartan 80mg) is less than the non-inferiority margin (i.e. 2.67). The change in mean trough scDBP from baseline to week 6 was -13.1 ± 8.46, -12.9 ± 7.20, and -13.0 ± 7.96 (PP) and -13.1 ± 8.42, -12.9 ± 7.16 and -13.0 ± 7.92 (ITT) in Azilsartna 40 mg, Azilsartan 80 mg and Telmisartan 40 mg respectively. The reduction in trough scDBP in Azilsartan 40 mg (p=0.9461: PP; p=0.9330: ITT) and Azilsartan 80 mg (p=0.9090: PP; p=0.9158: ITT) was not statistically significant compared to Telmisartan 40 mg. The difference in fall in the trough scSBP, scDBP and ambulatory SBP and DBP was similar between the groups from baseline to week 6 (P >0.05). Headache and dizziness were the most frequent treatmentrelated treatment-emergent adverse events.

CONCLUSION

Azilsartan is an effective blood pressure lowering drug and well tolerated and was non- inferior to telmisartan in its safety and efficacy.

Comparative evaluation of efficacy, pharmacodynamics, and safety of Hetero's adalimumab (Mabura®, Hetero Biopharma Ltd.) and reference adalimumab (Humira®, Abbvie Inc.) in patients with active rheumatoid arthritis on concomitant methotrexate therapy

Background

Our study aimed to compare efficacy and safety of Hetero's adalimumab (Mabura®, Hetero Biopharma Limited) versus reference adalimumab (Humira®, Abbvie Inc.) in Indian patients with active rheumatoid arthritis (RA) concomitant on methotrexate (MTX) therapy.

Methods

Patients (n = 168) were randomized (2:1) to receive either test or reference product for 24 weeks with concomitant MTX. Proportion of patients achieving American College of Rheumatology 20 (ACR20) criteria at week 12 was the primary endpoint. Changes in Disease Activity Score of 28 joints-C-reactive protein (DAS28-CRP), Health Assessment Questionnaire-Disability Index (HAQ-DI), and patients achieving ACR20 at week 24, ACR50/70 at weeks 12 and 24 were secondary endpoints.

Results

Patients achieving ACR20 responses with test (96.43%) were similar to reference (96.43%) in intention-to-treat (ITT) analysis at week 12. Proportional difference (PD) between groups (PD [95% CI] 0.0 [- 6.0, 6.0], p = 1.000) for ACR20 at week 12 for ITT analysis showed lower limit of the two-sided 95% CI was above the pre-specified noninferiority margin of - 15%. Similar trend in PP analysis (PD [95% CI] 0.0 [- 0.03, 0.07], p = 1.000), confirmed therapeutic equivalence. No significant difference was noted between arms for patients attaining ACR20 at week 24 and ACR50/70 at weeks 12 and 24 (all p > 0.05). DAS28-CRP and HAQ-DI were similar between groups. Total of 54 patients reported 88 AEs during the study. Out of these, 60 AEs were reported in 34 patients with Hetero-Adalimumab and 28 AEs were reported in 20 patients with Reference-Adalimumab. Total two patients, one in each group reported two serious adverse events (Sinusitis and Viral infection) during the study and resolved completely. No deaths and no life threatening AEs were reported.

Conclusion

Results demonstrated Hetero's adalimumab is as effective and well tolerated as reference adalimumab in patients with active RA concomitantly on MTX therapy.

Trial registration

CTRI/2016/04/006884, Registered on 28/04/2016.

Upper extremity regional anesthesia techniques: A comprehensive review for clinical anesthesiologists

Surgeries and chronic pain states of the upper extremity are quite common and pose unique challenges for the clinical anesthesiology and pain specialists. Most innervation of the upper extremity involves the brachial plexus. The four most common brachial plexus blocks performed in clinical setting include the interscalene, supraclavicular, infraclavicular, and axillary brachial plexus blocks. These blocks are most commonly performed with the use of ultrasound-guided techniques, whereby analgesia is achieved by anesthetizing the brachial plexus at different levels such as the roots, divisions, cords, and branches. Additional regional anesthetic techniques for upper extremity surgery include wrist, intercostobrachial, and digital nerve blocks, which are most frequently performed using landmark anatomical techniques. This review provides a comprehensive summary of each of these blocks including anatomy, best practice techniques, and potential complications.

Dexmedetomidine in Enhanced Recovery After Surgery (ERAS) Protocols for Postoperative Pain

PURPOSE OF REVIEW

Effective acute pain management has evolved considerably in recent years and is a primary area of focus in attempts to defend against the opioid epidemic. Persistent postsurgical pain (PPP) has an incidence of up to 30-50% and has negative outcome of quality of life and negative burden on individuals, family, and society. The 2016 American Society of Anesthesiologists (ASA) guidelines states that enhanced recovery after surgery (ERAS) forms an integral part of Perioperative Surgical Home (PSH) and is now recommended to use a multimodal opioid-sparing approach for management of postoperative pain. As such, dexmedetomidine is now being used as part of ERAS protocols along with regional nerve blocks and other medications, to create a satisfactory postoperative outcome with reduced opioid consumption in the Post anesthesia care unit (PACU).

RECENT FINDINGS

Dexmedetomidine, a selective alpha2 agonist, possesses analgesic effects and has a different mechanism of action when compared with opioids. When dexmedetomidine is initiated at the end of a procedure, it has a better hemodynamic stability and pain response than ropivacaine. Dexmedetomidine can be used as an adjuvant in epidurals with local anesthetic sparing effects. Its use during nerve blocks results in reduced postoperative pain. Also, local infiltration of IV dexmedetomidine is associated with earlier discharge from PACU. Perioperative use of dexmedetomidine has significantly improved postoperative outcomes when used as part of ERAS protocols. An in-depth review of the use of dexmedetomidine in ERAS protocols is presented for clinical anesthesiologists.

Pharmacogenomics of Pain Management: The Impact of Specific Biological Polymorphisms on Drugs and Metabolism

PURPOSE OF REVIEW

Pain is multifactorial and complex, often with a genetic component. Pharmacogenomics is a relative new field, which allows for the development of a truly unique and personalized therapeutic approach in the treatment of pain.

RECENT FINDINGS

Until recently, drug mechanisms in humans were determined by testing that drug in a population and calculating response averages. However, some patients will inevitably fall outside of those averages, and it is nearly impossible to predict who those outliers might be. Pharmacogenetics considers a patient's unique genetic information and allows for anticipation of that individual's response to medication. Pharmacogenomic testing is steadily making progress in the management of pain by being able to identify individual differences in the perception of pain and susceptibility and sensitivity to drugs based on genetic markers. This has a huge potential to increase efficacy and reduce the incidence of iatrogenic drug dependence and addiction. The streamlining of relevant polymorphisms of genes encoding receptors, transporters, and drug-metabolizing enzymes influencing the pain phenotype can be an important guide to develop safe new strategies and approaches to personalized pain management. Additionally, some challenges still prevail and preclude adoption of pharmacogenomic testing universally. These include lack of knowledge about pharmacogenomic testing, inadequate standardization of the process of data handling, questionable benefits about the clinical and financial aspects of pharmacogenomic testing-guided therapy, discrepancies in clinical evidence supporting these tests, and doubtful reimbursement of the tests by health insurance agencies.

Dimethylenebis-(tetra-decyldimethylammonium Bromide)-Driven Metal Nanoparticles: Hg2+ Sensing a Competency

We report an excellent anisotropic Au nanoparticle-based colorimetric probe for the detection of Hg²⁺ ions with higher detection ability and selectivity. The manifestation of different morphologies of Au nanoparticles including round, triangular, rectangular, pentagonal, and hexagonal has been realized by the dimethylenebis-(tetra-decyldimethylammonium bromide) (14-2-14 Gemini surfactant) assisted one-step thermal reduction method where the average size of Au nanoparticles was 54.65 ± 44.3 nm. The growth and frequency of Au nanoparticles were enhanced as a function of Gemini surfactant's concentration. The detection limit as low as 1.8 nM was efficaciously achieved and was considerably lower than the required world standards defined the maximum allowable level of Hg²⁺ ions for health hazards. Notably, the Au nanoparticles showed visible detection for 100 μM Hg²⁺ ion by means of the change in the solution color from red to tarnish blue within 180 s followed by saturation in the absorption ratio (A _LSPR/A _TSPR). These results provide novel insight into the detection of the heavy metal ion using Gemini surfactant-assisted grown anisotropic metal nanoparticles. On the basis of obtained results, it is concluded that the size of metal nanoparticles is no longer critical for preparation of efficient selective chemoprobe; rather, growth of more number of edges provides a large number of sights for incoming moieties and plays an important role in improving the detection capability of the anisotropic metal nanoparticle irrespective of their large sizes. We believe that this work provides valuable insight into researchers working in the area of chemosensor applications.

An Overview of Analytical Methods for in Vitro Bioassay of Actinides

The bioassay of urine and fecal samples has been used since the 1940s to determine an individual's uptake of uranium and actinide elements such as americium and plutonium. Over the years, several analytical separation methods and techniques have been employed for these types of analyses. Analytical separations, ranging from solvent extraction and anion exchange to chromatography, and analytical techniques, ranging from autoradiography to kinetic phosphorescence to fission-track analysis and high-resolution solid-state alpha spectroscopy, have been used at one time or another. Over the last few decades, there have been significant advances in radiochemical separations, as well as an increased use of mass spectroscopy, to determine trace and ultratrace levels of actinides in urine and fecal samples. This review summarizes and discusses developments in radiochemical separation methods and advancements in analytical techniques for actinide bioassay since the early 1940s to the present, followed by a recent development and trend in the bioassay of actinides-particularly in urine and fecal samples.

Efficacy, tolerability and safety of darbepoetin alfa injection for the treatment of anemia associated with chronic kidney disease (CKD) undergoing dialysis: a randomized, phase-III trial

BACKGROUND

Darbepoetin alfa (DA-α) is a long-acting erythropoiesis-stimulating glycoprotein which has half-life three-fold longer than that of Erythropoietin alfa (EPO). The objective of this study was to compare the efficacy and safety of DA-α injection versus EPO for treating renal anemia amongst Indian patients with end-stage renal disease (ESRD) undergoing dialysis.

METHODS

Patients of either gender (aged 18-65 years) with ESRD undergoing dialysis who had hemoglobin (Hb) levels < 10 g/dL after receiving EPO were switched to DA-α (0.45 μg/kg) once weekly subcutaneously or EPO 50 IU/kg thrice weekly subcutaneously (centrally randomized 1:1) for 12-24 weeks (correction phase) followed by 12 weeks maintenance phase (for Hb levels ≥10 g/dL). The primary efficacy endpoint was mean change in Hb level from baseline to end of correction phase.

RESULTS

In the intention-to-treat population (n = 126), the between group difference in mean Hb change was - 0.01 g/dL (95% CI - 0.68 to - 0.66, p = 0.97). After adjusting for covariates, the difference was - 0.2878 g/dL (95% CI -0.936 to0.360). The lower limit of the two-sided 95% CI of primary endpoint was above the pre-specified non-inferiority margin of - 1.0 g/dL. Similar trend of non-inferiority was observed for per-protocol population. Safety profile of DA-α and EPO were observed to be similar.

CONCLUSION

Our study results demonstrated that for patients with ESRD undergoing dialysis, administering DA-α at lower dose frequency, is equally effective and well tolerated as EPO for treating renal anemia.

TRIAL REGISTRATION

CTRI/2012/07/002835 [Registered on: 27/07/2012]; Trial Registered Prospectively.

A Randomized, Multiple-Dose, Multicenter, Comparative Parallel Study to Evaluate the Safety and Efficacy of Intravenous Infusion of Rituximab (Hetero) and Reference Medicinal Product (Rituximab, Roche) in Indian Patients of Non-Hodgkin's Lymphoma (HERILY)

Objective: To compare the antitumor efficacy, safety, and pharmacodynamic (PD) characteristics of Hetero-rituximab (test) with reference medicinal product (rituximab, Roche) in non-Hodgkin's lymphoma. Patients and Methods: One hundred and thirty-five patients with diffuse large B-cell lymphoma (DLBCL) were randomized to receive intravenous infusion of either test or reference product. Efficacy (best overall response [BOR] rate [primary end point]), safety, PD (CD19), and immunological assessments (secondary end points) were done at the end of cycle 3 and cycle 6. Results:: At the end of 6 cycles, BOR rate was 73.47% in Hetero-rituximab test arm compared to the 69.09% in reference arm. Anti-rituximab antibodies were found to be negative at cycle 3 and cycle 6 for all patients. Patients treated with Hetero-rituximab show a significant depletion in CD19+ cell which was comparable with reference drug. Safety and immunogenic potential of the test drug was comparable to the reference drug in the patients of DLBCL. Conclusion: BOR rate at cycle 3, cycle 6, and end of the study lies within the prespecified limit for noninferiority which concludes that test product is therapeutically noninferior to reference medicinal product.

A Prospective, Randomized, Multiple-Dose, Multi-Center, Comparative Clinical Study to Evaluate the Efficacy, Safety, Immunogenicity of a biosimilar Bevacizumab (Test product, Hetero) and Reference Medicinal Product (Bevacizumab, Roche) in Patients of Metastatic Colorectal Cancer

OBJECTIVE

:To compare efficacy and safety of a biosimilar, Bevacizumab (Hetero) vs reference medicinal product (Bevacizumab, Roche) as first line therapy in patients with metastatic colorectal cancer (mCRC) in combination with chemotherapy.

METHODS

Patients of aged 18 to 65 with histologically pre-confirmed mCRC and treatment naïve with unresectable metastatic disease or distant metastases were enrolled and randomized to receive either Hetero-Bevacizumab or RMPBevacizumab along with chemotherapy (XELOX or FOLFOX-4) regimen over a period of 24 weeks (up to 8 cycles of Hetero-Bevacizumab/RMP-Bevacizumab+ XELOX regimen (each cycle of 3 weeks) or up to 12 cycles of Hetero-Bevacizumab/ RMP-Bevacizumab + FOLFOX-4 regimen (each cycle of 2 weeks). Bevacizumab was administered at 7.5 mg/kg as an IV infusion over 60-90 minutes on Day 1 of each treatment cycle. The efficacy endpoints were the overall response rate (CR+PR) and disease control rate (DCR) according to RECIST 1.1. The safety endpoints included assessments of treatment emergent adverse events and immunogenicity.

RESULTS

160 patients were screened; 111 patients were randomized in the study. No statistical significant difference in overall response rate between both the treatment groups (HB-MAB vs. RB-MAB: 35.56 % vs. 20%, P=0.28 at Week 6; 37.50 % vs. 30.77 %, P=0.73 at Week 12). Similar trend was observed for disease control rate (HB-MAB vs. RB-MAB: 100% vs. 96%, P=0.36 at Week 6; 95.83 vs. 100%, P=1.00 at Week 12).

CONCLUSIONS

Herero's Bevacizumab was found to be comparable to reference medical product, Bevacizumab in terms of efficacy and tolerability for the Indian patients with metastatic colorectal cancer.

A rapid method for the sequential separation of polonium, plutonium, americium and uranium in drinking water

A new sequential separation method for the determination of polonium and actinides (Pu, Am and U) in drinking water samples has been developed that can be used for emergency response or routine water analyses. For the first time, the application of TEVA chromatography column in the sequential separation of polonium and plutonium has been studied. This method utilizes a rapid Fe⁺³ co-precipitation step to remove matrix interferences, followed by plutonium oxidation state adjustment to Pu⁴⁺ and an incubation period of ~ 1 h at 50-60 °C to allow Po²⁺ to oxidize to Po⁴⁺. The polonium and plutonium were then separated on a TEVA column, while separation of americium from uranium was performed on a TRU column. After separation, polonium was micro-precipitated with copper sulfide (CuS), while actinides were micro co-precipitated using neodymium fluoride (NdF₃) for counting by the alpha spectrometry. The method is simple, robust and can be performed quickly with excellent removal of interferences, high chemical recovery and very good alpha peak resolution. The efficiency and reliability of the procedures were tested by using spiked samples. The effect of several transition metals (Cu²⁺, Pb²⁺, Fe³⁺, Fe²⁺, and Ni²⁺) on the performance of this method were also assessed to evaluate the potential matrix effects. Studies indicate that presence of up to 25 mg of these cations in the samples had no adverse effect on the recovery or the resolution of polonium alpha peaks.

Radical polymerization approach for ring opened oxanorbornene anhydride based macromonomers

In this work, we synthesized end group functionalization of the cis-Norbornene-5-6-endo-dicarboxylic anhydride species via the ring-opening metathesis polymerization (ROMP) of oxanorbornene derivatives generated a chiseled poly(cis-Norbornene-5-6-endo-Dicarboxylic anhydride) acrylate macromonomer. Further, acrylate oxanorbornene based macromonomer further polymerized via reversible addition fragmentation chain transfer (RAFT) polymerization technique. Chain transfer is exhibited in the structure during the radical polymerizations so that free radical polymerization could also be used to comb structure copolymers with a PDI value below 1.2 with the help of acrylate oxanorbornene. Atomic force microscopy reveals the comb shape of branched polymer brushes structure. This method involves polymerizable end-group attachment to a macromonomer, and the backbone of the comb polymer is created in a second step of the polymerization. We believe that this kind of comb structured polymers can be considered for different biological applications.

Efficacy, Safety and Immunogenecitystudy of Intravenous Infusion of Rituximab (Hetero) and Reference Medicinal Product (Rituximab, Roche) in Indian Patients of Follicular Lymphoma Preliminary report (HERILY)

OBJECTIVE

To compare the antitumor efficacy, safety, and pharmacodynamics (PD) characteristics of Hetero-Rituximab (test) with Reference Medicinal Product (Rituximab, Roche) in Non-Hodgkin's Lymphoma (NHL).

PATIENTS AND METHODS

Total 40 Follicular Lymphoma (FL) patients were randomized to receive intravenous infusion of either test or reference product. Efficacy (best overall response [BOR] rate [primary end point]), safety, PD (CD19), and immunological assessments (secondary end points) were done at the end of cycle 3 and cycle 6.

RESULTS

Out of 40 patients randomized, 17 were in test arm while 23 were in reference arm. At the end of 6 cycles, BOR (complete response [CR] and partial response [PR]) rate was 64.71% (n=11) in Hetero Rituximab compared to the 43.48% (n=10) in reference arm. The difference between test and reference proportions of best overall response rate at cycle 6, lies within the pre-specified limit for noninferiority. Anti-Rituximab antibodies were found to be negative at cycle 3 and cycle 6 for all FL patients. The FL patients who were treated with Hetero Rituximab, showed significant depletion in CD19+ cell which was comparable with Reference drug. Safety and Immunogenic potential of the test drug was comparable to the reference drug in the patients of FL.

CONCLUSION

Best overall response rate at Cycle 3, Cycle 6 and end of the study lies within the pre-specified limit for non-inferiority which concludes that test product is therapeutically non-inferior to reference medicinal product.

Plutonium in the atmosphere: A global perspective

A number of potential source terms have contributed plutonium isotopes to the atmosphere. The atmospheric nuclear weapon tests conducted between 1945 and 1980 and the re-entry of the burned SNAP-9A satellite in 1964, respectively. It is generally believed that current levels of plutonium in the stratosphere are negligible and compared with the levels generally found at surface-level air. In this study, the time trend analysis and long-term behavior of plutonium isotopes (^239+240Pu and ²³⁸Pu) in the atmosphere were assessed using historical data collected by various national and international monitoring networks since 1960s. An analysis of historical data indicates that ^239+240Pu concentration post-1984 is still frequently detectable, whereas ²³⁸Pu is detected infrequently. Furthermore, the seasonal and time-trend variation of plutonium concentration in surface air followed the stratospheric trends until the early 1980s. After the last Chinese test of 1980, the plutonium concentrations in surface air dropped to the current levels, suggesting that the observed concentrations post-1984 have not been under stratospheric control, but rather reflect the environmental processes such as resuspension. Recent plutonium atmospheric air concentrations data show that besides resuspension, other environmental processes such as global dust storms and biomass burning/wildfire also play an important role in redistributing plutonium in the atmosphere.