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Banerjee A, Datta Kanjilal S, Biswas T, Ghoshal A, Sarkar S. Congenital myasthenic syndrome: a tale of two siblings. Int J Neurosci 2024; 134:253-255. [PMID: 36018836 DOI: 10.1080/00207454.2022.2100774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 10/15/2022]
Abstract
Congenital myasthenic syndromes are a group of rare neuromuscular junction disorders. Traditional anticholinesterase inhibitors may not help in congenital myasthenic syndromes and in some variants may actually cause deterioration of symptoms. In this report, we describe a rare case of congenital myasthenic syndrome with heterozygous mutations in CHRNE gene (c.128A > T; heterozygous; exon 11) and COLQ gene (c.1201T > A; heterozygous; exon 16), which did not show improvement on neostigmine test but responded to treatment with oral salbutamol.
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Affiliation(s)
- Ahitagni Banerjee
- Department of Pediatrics, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Sumana Datta Kanjilal
- Department of Pediatrics, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Tamoghna Biswas
- Department of Pediatrics, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Arnab Ghoshal
- Department of Pediatrics, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Sumit Sarkar
- Department of Pediatrics, Institute of Post Graduate Medical Education and Research, Kolkata, India
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2
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Nagakumar P, Evans T, Frost S. Identifying empty salbutamol inhalers by weighing the canister. Arch Dis Child 2024; 109:446-447. [PMID: 38429066 DOI: 10.1136/archdischild-2024-326839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 03/03/2024]
Affiliation(s)
- Prasad Nagakumar
- Department of Paediatric Respiratory Medicine, Birmingham Women's and Children's Hospital NHS Trust, Birmingham, UK
| | - Teresa Evans
- Department of Paediatric Respiratory Medicine, Birmingham Women's and Children's Hospital NHS Trust, Birmingham, UK
| | - Susan Frost
- Department of Paediatric Respiratory Medicine, Birmingham Women's and Children's Hospital NHS Trust, Birmingham, UK
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Merckx P, Conickx G, Blomme E, Maes T, Bracke KR, Brusselle G, De Smedt SC, Raemdonck K. Evaluating β 2-agonists as siRNA delivery adjuvants for pulmonary surfactant-coated nanogel inhalation therapy. Eur J Pharm Biopharm 2024; 197:114223. [PMID: 38367760 DOI: 10.1016/j.ejpb.2024.114223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/23/2024] [Accepted: 02/08/2024] [Indexed: 02/19/2024]
Abstract
The lung is an attractive target organ for inhalation of RNA therapeutics, such as small interfering RNA (siRNA). However, clinical translation of siRNA drugs for application in the lung is hampered by many extra- and intracellular barriers. We previously developed hybrid nanoparticles consisting of an siRNA-loaded nanosized hydrogel (nanogel) core coated with Curosurf®, a clinically used pulmonary surfactant. The surfactant shell was shown to markedly improve particle stability and promote intracellular siRNA delivery, both in vitro and in vivo. However, the full potential of siRNA nanocarriers is typically not reached as they are rapidly trafficked towards lysosomes for degradation and only a fraction of the internalized siRNA cargo is able to escape into the cytosol. We recently reported on the repurposing of widely applied cationic amphiphilic drugs (CADs) as siRNA delivery enhancers. Due to their physicochemical properties, CADs passively accumulate in the (endo)lysosomal compartment causing a transient permeabilization of the lysosomal membrane, which facilitates cytosolic drug delivery. In this work, we assessed a selection of cationic amphiphilic β2-agonists (i.e., salbutamol, formoterol, salmeterol and indacaterol) for their ability to enhance siRNA delivery in a lung epithelial and macrophage cell line. These drugs are widely used in the clinic for their bronchodilating effect in obstructive lung disease. As opposed to the least hydrophobic drugs salbutamol and formoterol, the more hydrophobic long-acting β2-agonist (LABA) salmeterol promoted siRNA delivery in both cell types for both uncoated and surfactant-coated nanogels, whereas indacaterol showed this effect solely in lung epithelial cells. Our results demonstrate the potential of both salmeterol and indacaterol to be repurposed as adjuvants for nanocarrier-mediated siRNA delivery to the lung, which could provide opportunities for drug combination therapy.
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Affiliation(s)
- Pieterjan Merckx
- Ghent Research Group on Nanomedicines, Laboratory of General Biochemistry and Physical Pharmacy, Faculty of Pharmaceutical Sciences, Department of Pharmaceutics, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium.
| | - Griet Conickx
- Laboratory for Translational Research in Obstructive Pulmonary Diseases, Faculty of Medicine and Health Sciences, Department of Respiratory Medicine, Ghent University Hospital, Medical Research Building 2, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Evy Blomme
- Laboratory for Translational Research in Obstructive Pulmonary Diseases, Faculty of Medicine and Health Sciences, Department of Respiratory Medicine, Ghent University Hospital, Medical Research Building 2, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Tania Maes
- Laboratory for Translational Research in Obstructive Pulmonary Diseases, Faculty of Medicine and Health Sciences, Department of Respiratory Medicine, Ghent University Hospital, Medical Research Building 2, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Ken R Bracke
- Laboratory for Translational Research in Obstructive Pulmonary Diseases, Faculty of Medicine and Health Sciences, Department of Respiratory Medicine, Ghent University Hospital, Medical Research Building 2, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Guy Brusselle
- Laboratory for Translational Research in Obstructive Pulmonary Diseases, Faculty of Medicine and Health Sciences, Department of Respiratory Medicine, Ghent University Hospital, Medical Research Building 2, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Stefaan C De Smedt
- Ghent Research Group on Nanomedicines, Laboratory of General Biochemistry and Physical Pharmacy, Faculty of Pharmaceutical Sciences, Department of Pharmaceutics, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium.
| | - Koen Raemdonck
- Ghent Research Group on Nanomedicines, Laboratory of General Biochemistry and Physical Pharmacy, Faculty of Pharmaceutical Sciences, Department of Pharmaceutics, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium.
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4
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Feng Z, Han Z, Wang Y, Guo H, Liu J. Comparison of the Application of Vibrating Mesh Nebulizer and Jet Nebulizer in Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-analysis. Int J Chron Obstruct Pulmon Dis 2024; 19:829-839. [PMID: 38562440 PMCID: PMC10984201 DOI: 10.2147/copd.s452191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/24/2024] [Indexed: 04/04/2024] Open
Abstract
Objective To comparison of the application of Vibrating Mesh Nebulizer and Jet Nebulizer in chronic obstructive pulmonary disease (COPD). Research Methods This systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) statements. The primary outcome measures analyzed included: The amount of inhaler in the urine sample at 30 minutes after inhalation therapy (USAL0.5), The total amount of inhaler in urine sample within 24 hours (USAL24), Aerosol emitted, Forced expiratory volume in 1 second (FEV1), Forced vital capacity (FVC). Results Ten studies were included with a total of 314 study participants, including 157 subjects in the VMN group and 157 subjects in the JN group. The data analysis results of USAL0.5, MD (1.88 [95% CI, 0.95 to 2.81], P = 0.000), showed a statistically significant difference. USAL24, MD (1.61 [95% CI, 1.14 to 2.09], P = 0.000), showed a statistically significant difference. The results of aerosol emitted showed a statistically significant difference in MD (3.44 [95% CI, 2.84 to 4.04], P = 0.000). The results of FEV1 showed MD (0.05 [95% CI, -0.24 to 0.35], P=0.716), the results were not statistically significant. The results of FVC showed MD (0.11 [95% CI, -0.18 to 0.41], P=0.459), the results were not statistically significant. It suggests that VMN is better than JN and provides higher aerosols, but there is no difference in improving lung function between them. Conclusion VMN is significantly better than JN in terms of drug delivery and utilization in the treatment of patients with COPD. However, in the future use of nebulizers, it is important to select a matching nebulizer based on a combination of factors such as mechanism of action of the nebulizer, disease type and comorbidities, ventilation strategies and modes, drug formulations, as well as cost-effectiveness, in order to achieve the ideal treatment of COPD.
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Affiliation(s)
- Zhouzhou Feng
- The First Clinical Medical College of Lanzhou University, Lanzhou City, People’s Republic of China
| | - Zhengcai Han
- The First Clinical Medical College of Lanzhou University, Lanzhou City, People’s Republic of China
| | - Yaqin Wang
- The First Clinical Medical College of Lanzhou University, Lanzhou City, People’s Republic of China
| | - Hong Guo
- The First Clinical Medical College of Lanzhou University, Lanzhou City, People’s Republic of China
| | - Jian Liu
- The First Clinical Medical College of Lanzhou University, Lanzhou City, People’s Republic of China
- Gansu Maternal and Child Health Hospital/Gansu Central Hospital, Lanzhou City, People’s Republic of China
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Balan D, Shetty MR, Mohan MK. Bronchodilator reversibility testing in morbidly obese non-smokers: a comparative study- few concerns. BMC Pulm Med 2024; 24:132. [PMID: 38491503 PMCID: PMC10943866 DOI: 10.1186/s12890-024-02951-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/05/2024] [Indexed: 03/18/2024] Open
Abstract
This is a letter in response to an article by Ahmed et al., which concluded that in comparison to salbutamol, Fluticasone/salmeterol combination increases FEV1, FEV1% of predicted, and FEV1/FVC ratio, however it did not offer novel insights, as both agents met the 12%- and 200-mL reversibility benchmarks and Concerns about incorporating a combination medication that includes an inhaled corticosteroid, inhaled corticosteroids are not typically associated with bronchodilation.
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Affiliation(s)
- Divya Balan
- Department of Respiratory medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Manish R Shetty
- Department of Respiratory medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Manu K Mohan
- Department of Respiratory medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Mahase E. Doctors are told to ration salbutamol amid shortage. BMJ 2024; 384:q673. [PMID: 38490648 DOI: 10.1136/bmj.q673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
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Chen W, Li S, Huang D, Su Y. Drugs associated with a risk of supraventricular tachycardia: analysis using the OpenVigil database. J Int Med Res 2024; 52:3000605241238993. [PMID: 38530149 DOI: 10.1177/03000605241238077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVE The OpenVigil database can be used to assess medications that may cause supraventricular tachycardia (SVT) and to produce a reference for their safe use in clinical settings. METHODS We analyzed first-quarter data from 2004 to 2023, obtained by searching the OpenVigil database using the keyword "supraventricular tachycardia." Trade names and generic names were obtained by querying the RxNav database, and the proportions were summarized. The proportionate reporting ratio (PRR), reporting odds ratio, and chi-square values were also summarized. We created Asahi diagrams and set the screening criteria to drug events ≥30, PRR >2, and chi-square >4. Outcomes were evaluated using the Side Effect Resource database, several scientific literature databases, and the Hangzhou Yiyao Rational Medication System. RESULTS A total of 2435 distinct medications were found to induce SVT between the first quarter of 2004 and 2023, leading to 22,375 documented adverse events related to SVT. Further investigation revealed that salbutamol, paroxetine, formoterol, paclitaxel, venlafaxine, and theophylline were most likely to cause SVT. CONCLUSION We conducted signal mining of adverse drug events using the OpenVigil database and evaluated the six drugs most likely to cause SVT. The results of this research can serve as a drug safety reference in the clinic.
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Affiliation(s)
- Weihong Chen
- Department of Anxi County Hospital, Quanzhou, China
| | - Shaobin Li
- Department of Anxi County Hospital, Quanzhou, China
| | | | - Yuchao Su
- Department of Anxi County Hospital, Quanzhou, China
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Chweich H, Idrees N, Rideout J, Barnewolt B, Rice L, Hill NS. Randomized Controlled Trial Assessing a Vibrating Mesh Nebulizer Compared to a Jet Nebulizer in Severe Asthma Exacerbations. Respir Care 2024; 69:345-348. [PMID: 37816543 PMCID: PMC10984592 DOI: 10.4187/respcare.10980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Affiliation(s)
- Haval Chweich
- Drs Chweich and Hill are affiliated with Division of Pulmonary, Critical Care and Sleep Medicine, Internal Medicine, Tufts Medical Center, Boston, Massachusetts. Dr Idrees is affiliated with Division of Nephrology, Internal Medicine, Boston Medical Center, Boston, Massachusetts. Drs Rideout, Barnewolt, and Rice are affiliated with Department of Emergency Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Najia Idrees
- Drs Chweich and Hill are affiliated with Division of Pulmonary, Critical Care and Sleep Medicine, Internal Medicine, Tufts Medical Center, Boston, Massachusetts. Dr Idrees is affiliated with Division of Nephrology, Internal Medicine, Boston Medical Center, Boston, Massachusetts. Drs Rideout, Barnewolt, and Rice are affiliated with Department of Emergency Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Jesse Rideout
- Drs Chweich and Hill are affiliated with Division of Pulmonary, Critical Care and Sleep Medicine, Internal Medicine, Tufts Medical Center, Boston, Massachusetts. Dr Idrees is affiliated with Division of Nephrology, Internal Medicine, Boston Medical Center, Boston, Massachusetts. Drs Rideout, Barnewolt, and Rice are affiliated with Department of Emergency Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Brien Barnewolt
- Drs Chweich and Hill are affiliated with Division of Pulmonary, Critical Care and Sleep Medicine, Internal Medicine, Tufts Medical Center, Boston, Massachusetts. Dr Idrees is affiliated with Division of Nephrology, Internal Medicine, Boston Medical Center, Boston, Massachusetts. Drs Rideout, Barnewolt, and Rice are affiliated with Department of Emergency Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Lauren Rice
- Drs Chweich and Hill are affiliated with Division of Pulmonary, Critical Care and Sleep Medicine, Internal Medicine, Tufts Medical Center, Boston, Massachusetts. Dr Idrees is affiliated with Division of Nephrology, Internal Medicine, Boston Medical Center, Boston, Massachusetts. Drs Rideout, Barnewolt, and Rice are affiliated with Department of Emergency Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Nicholas S Hill
- Drs Chweich and Hill are affiliated with Division of Pulmonary, Critical Care and Sleep Medicine, Internal Medicine, Tufts Medical Center, Boston, Massachusetts. Dr Idrees is affiliated with Division of Nephrology, Internal Medicine, Boston Medical Center, Boston, Massachusetts. Drs Rideout, Barnewolt, and Rice are affiliated with Department of Emergency Medicine, Tufts Medical Center, Boston, Massachusetts.
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Arunsurat I, Rittayamai N, Chuaychoo B, Tangchityongsiva S, Promsarn S, Yuenyong S, Chow CW, Brochard L. Bronchodilator Efficacy of High-Flow Nasal Cannula in COPD: Vibrating Mesh Nebulizer Versus Jet Nebulizer. Respir Care 2024; 69:157-165. [PMID: 37607815 PMCID: PMC10898469 DOI: 10.4187/respcare.11139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/10/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Jet nebulizers are commonly used for bronchodilator therapy in COPD. High-flow nasal cannula with vibrating mesh nebulizer (HFNC-VMN) is a recently developed system; however, few studies have compared the efficacy of bronchodilator administration via HFNC-VMN to jet nebulizer in stable COPD. This study aimed to compare the effect of salbutamol administered via HFNC-VMN versus jet nebulizer on airway and lung function in subjects with stable COPD. METHODS This randomized non-inferiority crossover physiologic study enrolled subjects with stable COPD. Salbutamol was nebulized via HFNC-VMN or jet nebulizer in random order with a 4-h washout period between crossover sequences. Spirometry, lung volume, and impulse oscillometry were performed at baseline and after each intervention. The primary outcome was change in FEV1 from baseline. Secondary outcomes included changes in other respiratory-related parameters and nebulization time compared between the 2 devices. RESULTS Seventeen subjects were enrolled. HFNC-VMN and jet nebulizer both significantly improved FEV1 from baseline (P = .005 and P = .002, respectively). The difference between respiratory resistance at 5 Hz and 20 Hz significantly decreased after HFNC-VMN compared to baseline (P = .02), while no significant change was observed after jet nebulizer (P = .056). Area of reactance and resonant frequency of reactance were both significantly decreased (P = .035 and P = .03, respectively), and respiratory reactance at 5 Hz significantly increased (P = .02) in the HFNC-VMN group compared to baseline indicating improved lung mechanics, with no significant changes with the jet nebulizer. HFNC-VMN had a shorter nebulization time (6 [5-9] min vs 20 [16-22] min, respectively, P < .001). CONCLUSIONS Bronchodilator therapy via HFNC-VMN was not inferior to jet nebulizer for subjects with stable COPD and can significantly improve airway oscillometry mechanics and decrease nebulization time compared to jet nebulizer.
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Affiliation(s)
- Itthiphat Arunsurat
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nuttapol Rittayamai
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Benjamas Chuaychoo
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suwat Tangchityongsiva
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Simaporn Promsarn
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Somruthai Yuenyong
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chung-Wai Chow
- Division of Respirology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada; and Toronto Lung Transplant Programme, Multi-Organ Transplant Unit, University Health Network, Toronto, Ontario, Canada
| | - Laurent Brochard
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
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Jin Z, Jia W, Sheng W, Sun M, Ren L, Bai D, Wang S, Ya T, Wang Z, Tang X. Fluorescence immunoassay for simultaneous detection typical β-agonists in animal derived food using blue-green upconversion nanoparticles as labels. Spectrochim Acta A Mol Biomol Spectrosc 2023; 303:123253. [PMID: 37579663 DOI: 10.1016/j.saa.2023.123253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/25/2023] [Accepted: 08/09/2023] [Indexed: 08/16/2023]
Abstract
Common typical β-agonists mainly include ractopamine (RAC), salbutamol (SAL), and clenbuterol (CLB). In view of the harm to human health causes by the ingestion of animal derived food containing β-agonists, and a series of regulations have been issued to restrict the usage of β-agonists as growth promoters. In this work, a fluorescence immunoassay is developed for the simultaneous detection of typical β-agonists based on blue-green upconversion nanoparticles (UCNPs) combine with magnetic separation. Here, blue-green UCNPs act as a signal amplification source, and magnetic polystyrene microspheres (MPMs) act as an ideal separation medium. Based on a competitive form, capture probe competes (RAC-OVA@MPMs and SAL-OVA@MPMs) with targets to bind corresponding signal probe (anti-RAC antibody@NaYF4:Yb, Tm UCNPs and anti-SAL antibody@NaYF4:Yb, Er UCNPs). The fluorescence difference values of the competitive immune-complex obtained via magnetic separation at 483 nm and 550 nm are proportional to concentrations of RAC and SAL, respectively. The immunoassay has the wide detection linear range from 0.001 to 100 μg L-1, and the low limit of detection (LOD) is 5.04 × 10-4 μg L-1 for RAC, 1.97 × 10-4 μg L-1 for SAL, respectively. Meanwhile, use of antibody with same recognition ability for SAL and CLB makes that the fluorescence immunoassay can achieve simultaneous detection of three typical β-agonists (RAC, SAL, and CLB). This fluorescence immunoassay has good application value and practicability for simultaneous detection of typical β-agonists in animal derived food.
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Affiliation(s)
- Zixin Jin
- State Key Laboratory of Food Nutrition and Safety, Key Laboratory of Food Quality and Health of Tianjin, College of Food Science and Engineering, Tianjin University of Science and Technology, Tianjin 300457, PR China
| | - Wenjing Jia
- State Key Laboratory of Food Nutrition and Safety, Key Laboratory of Food Quality and Health of Tianjin, College of Food Science and Engineering, Tianjin University of Science and Technology, Tianjin 300457, PR China
| | - Wei Sheng
- State Key Laboratory of Food Nutrition and Safety, Key Laboratory of Food Quality and Health of Tianjin, College of Food Science and Engineering, Tianjin University of Science and Technology, Tianjin 300457, PR China.
| | - Meiyi Sun
- State Key Laboratory of Food Nutrition and Safety, Key Laboratory of Food Quality and Health of Tianjin, College of Food Science and Engineering, Tianjin University of Science and Technology, Tianjin 300457, PR China
| | - Lishuai Ren
- State Key Laboratory of Food Nutrition and Safety, Key Laboratory of Food Quality and Health of Tianjin, College of Food Science and Engineering, Tianjin University of Science and Technology, Tianjin 300457, PR China
| | - Dongmei Bai
- State Key Laboratory of Food Nutrition and Safety, Key Laboratory of Food Quality and Health of Tianjin, College of Food Science and Engineering, Tianjin University of Science and Technology, Tianjin 300457, PR China
| | - Shuo Wang
- Tianjin Key Laboratory of Food Science and Health, School of Medicine, Nankai University, Tianjin 300071, China
| | - Tingting Ya
- State Key Laboratory of Food Nutrition and Safety, Key Laboratory of Food Quality and Health of Tianjin, College of Food Science and Engineering, Tianjin University of Science and Technology, Tianjin 300457, PR China
| | - Ziwuzhen Wang
- State Key Laboratory of Food Nutrition and Safety, Key Laboratory of Food Quality and Health of Tianjin, College of Food Science and Engineering, Tianjin University of Science and Technology, Tianjin 300457, PR China
| | - Xinshuang Tang
- State Key Laboratory of Food Nutrition and Safety, Key Laboratory of Food Quality and Health of Tianjin, College of Food Science and Engineering, Tianjin University of Science and Technology, Tianjin 300457, PR China
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Dalmia S, Sharma R, Ramaswami U, Hughes D, Jahnke N, Cole D, Smith S, Remmington T. Enzyme replacement therapy for late-onset Pompe disease. Cochrane Database Syst Rev 2023; 12:CD012993. [PMID: 38084761 PMCID: PMC10714667 DOI: 10.1002/14651858.cd012993.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND Pompe disease is caused by a deficiency of the enzyme acid alpha-glucosidase (GAA). People with infantile-onset disease have either a complete or a near-complete enzyme deficiency; people with late-onset Pompe disease (LOPD) retain some residual enzyme activity. GAA deficiency is treated with an intravenous infusion of recombinant human acid alglucosidase alfa, an enzyme replacement therapy (ERT). Alglucosidase alfa and avalglucosidase alfa are approved treatments, but cipaglucosidase alfa with miglustat is not yet approved. OBJECTIVES To assess the effects of enzyme replacement therapies in people with late-onset Pompe disease. SEARCH METHODS We searched the Cochrane Inborn Errors of Metabolism Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched MEDLINE OvidSP, clinical trial registries, and the reference lists of relevant articles and reviews. Date of last search: 21 April 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) of ERT in people with LOPD of any age. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility, extracted data, assessed the risk of bias and the certainty of the evidence (using GRADE). We resolved disagreements through discussion and by consulting a third author. MAIN RESULTS We included six trials (358 randomised participants) lasting from 12 to 78 weeks. A single trial reported on each comparison listed below. None of the included trials assessed two of our secondary outcomes: need for respiratory support and use of a walking aid or wheelchair. Certainty of evidence was most commonly downgraded for selective reporting bias. Alglucosidase alfa versus placebo (90 participants) After 78 weeks, alglucosidase alfa probably improves the six-minute walk test (6MWT) distance compared to placebo (mean difference (MD) 30.95 metres, 95% confidence interval (CI) 7.98 to 53.92; moderate-certainty evidence) and probably improves respiratory function, measured as the change in per cent (%) predicted forced vital capacity (FVC) (MD 3.55, 95% CI 1.46 to 5.64; moderate-certainty evidence). There may be little or no difference between the groups in occurrence of infusion reactions (risk ratio (RR) 1.21, 95% CI 0.57 to 2.61; low-certainty evidence), quality of life physical component score (MD -1.36 points, 95% CI -5.59 to 2.87; low-certainty evidence), or adverse events (RR 0.94, 95% CI 0.64 to 1.39; low-certainty evidence). Alglucosidase alfa plus clenbuterol versus alglucosidase alfa plus placebo (13 participants) The evidence is very uncertain about the effect of alglucosidase alfa plus clenbuterol compared to alglucosidase alfa plus placebo on: change in 6MWT distance after 52 weeks (MD 34.55 metres, 95% CI-10.11 to 79.21; very low-certainty evidence) and change in % predicted FVC (MD -13.51%, 95% CI -32.44 to 5.41; very low-certainty evidence). This study did not measure infusion reactions, quality of life, and adverse events. Alglucosidase alfa plus albuterol versus alglucosidase alfa plus placebo (13 participants) The evidence is very uncertain about the effect of alglucosidase alfa plus albuterol compared to alglucosidase alfa plus placebo on: change in 6MWT distance after 52 weeks (MD 30.00 metres, 95% CI 0.55 to 59.45; very low-certainty evidence), change in % predicted FVC (MD -4.30%, 95% CI -14.87 to 6.27; very low-certainty evidence), and risk of adverse events (RR 0.67, 95% CI 0.38 to 1.18; very low-certainty evidence). This study did not measure infusion reactions and quality of life. VAL-1221 versus alglucosidase alfa (12 participants) Insufficient information was available about this trial to generate effect estimates measured at one year or later. Compared to alglucosidase alfa, VAL-1221 may increase or reduce infusion-associated reactions at three months, but the evidence is very uncertain (RR 2.80, 95% CI 0.18 to 42.80). This study did not measure quality of life and adverse events. Cipaglucosidase alfa plus miglustat versus alglucosidase alfa plus placebo (125 participants) Compared to alglucosidase alfa plus placebo, cipaglucosidase alfa plus miglustat may make little or no difference to: 6MWT distance at 52 weeks (MD 13.60 metres, 95% CI -2.26 to 29.46); infusion reactions (RR 0.94, 95% CI 0.49 to 1.80); quality of life scores for physical function (MD 1.70, 95% CI -2.13 to 5.53) and fatigue (MD -0.30, 95% CI -2.76 to 2.16); and adverse effects potentially related to treatment (RR 0.83, 95% CI 0.49 to 1.40) (all low-certainty evidence). Cipaglucosidase alfa plus miglustat probably improves % predicted FVC compared to alglucosidase alfa plus placebo (MD 3.10%, 95% CI 1.04 to 5.16; moderate-certainty evidence); however, it may make little or no change in % predicted sniff nasal inspiratory pressure (MD -0.06%, 95% CI -8.91 to 7.71; low-certainty evidence). Avalglucosidase alfa versus alglucosidase alfa (100 participants) After 49 weeks, avalglucosidase alfa probably improves 6MWT compared to alglucosidase alfa (MD 30.02 metres, 95% CI 1.84 to 58.20; moderate-certainty evidence). Avalglucosidase alfa probably makes little or no difference to % predicted FVC compared to alglucosidase alfa (MD 2.43%, 95% CI -0.08 to 4.94; moderate-certainty evidence). Avalglucosidase alfa may make little or no difference to infusion reactions (RR 0.78, 95% CI 0.42 to 1.45), quality of life (MD 0.77, 95% CI -2.09 to 3.63), or treatment-related adverse events (RR 0.92, 95% CI 0.61 to 1.40), all low-certainty evidence. AUTHORS' CONCLUSIONS One trial compared the effect of ERT to placebo in LOPD, showing that alglucosidase alfa probably improves 6MWT and respiratory function (both moderate-certainty evidence). Avalglucosidase alfa probably improves 6MWT compared with alglucosidase alfa (moderate-certainty evidence). Cipaglucosidase plus miglustat probably improves FVC compared to alglucosidase alfa plus placebo (moderate-certainty evidence). Other trials studied the adjunct effect of clenbuterol and albuterol along with alglucosidase alfa, with little to no evidence of benefit. No significant rise in adverse events was noted with all ERTs. The impact of ERT on some outcomes remains unclear, and longer RCTs are needed to generate relevant information due to the progressive nature of LOPD. Alternative resources, such as post-marketing registries, could capture some of this information.
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Affiliation(s)
| | - Reena Sharma
- Adult Inherited Metabolic Disorders, The Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, Salford, UK
| | - Uma Ramaswami
- Lysosomal Storage Disorders Unit, Royal Free London NHS Foundation Trust, University College London, London, UK
| | - Derralynn Hughes
- Lysosomal Storage Disorders Unit, Royal Free London NHS Foundation Trust, University College London, London, UK
| | - Nikki Jahnke
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Duncan Cole
- Department of Metabolic Medicine, University Hospital of Wales, Cardiff, UK
| | - Sherie Smith
- Division of Child Health, Obstetrics & Gynaecology (COG), School of Medicine, University of Nottingham, Nottingham, UK
| | - Tracey Remmington
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
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12
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Gahagen RE, Beardsley AL, Maue DK, Ackerman LL, Rowan CM, Friedman ML. Early-Onset Ventilator-Associated Pneumonia in Pediatric Severe Traumatic Brain Injury. Neurocrit Care 2023; 39:669-676. [PMID: 36635493 DOI: 10.1007/s12028-022-01663-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/22/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Early-onset ventilator-associated pneumonia (VAP) is associated with poor outcomes in patients with severe traumatic brain injury (TBI). The primary aim of this study was to describe VAP, including the microbiology of VAP and differences in frequency of VAP when various definitions are applied. The secondary aim was to determine the clinical variables associated with the development of VAP in children with severe TBI. METHODS This is a retrospective cohort study at a quaternary referral children's hospital with a level I trauma center designation. Inclusion criteria were patients aged 0-18 years admitted to the pediatric intensive care unit between 2015 and 2020 with severe TBI requiring at least 2 days of invasive ventilation. VAP was defined by using Center of Disease Control (CDC) definition or clinical VAP, based on physician diagnosis. We compared general demographics, reviewed trauma and injury data, and outcomes to assess any differences between patients with VAP and non-VAP patients. Associations were tested with regression models. RESULTS After applying all inclusion and exclusion criteria, 90 patients were included in the analysis. Patients with VAP were older (8.5 vs. 5.6 years, P = 0.03). Patients with VAP were less likely to have suffered from abusive head trauma (P = 0.01). Patients who received continuous neuromuscular blockade or targeted temperature management did not have different frequencies of VAP. CDC-defined VAP was diagnosed in 27% of patients. Number of patients with VAP increased to 41% for physician-diagnosed or clinical VAP. Methicillin-sensitive Staphylococcus aureus was the most common isolate grown, followed by Hemophilus influenza, with most VAP occurring on days 2-5 of intubation. VAP was not associated with mortality but was associated with worse functional status scale in patients who survived to discharge (8 vs. 7.5, P = 0.048). Over a cumulative period of days, nebulized 3% and albuterol were associated with decreased incidence of VAP. CONCLUSIONS Ventilator-associated pneumonia occurs commonly in children with severe TBI, with rates of 27-41%, depending on CDC-defined VAP or clinical VAP. The discrepancy between clinical VAP and CDC-defined VAP further illustrates the need for a standardized definition for VAP. Although most interventions were not associated with VAP, nebulized 3% saline and albuterol were associated with reduced incidence of VAP; future investigation is needed to determine whether mucolytic agents can decrease the rate of VAP in children with severe TBI.
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Affiliation(s)
- Rachel E Gahagen
- Division of Pediatric Critical Care, Indiana University School of Medicine, Indianapolis, IN, USA.
- Riley Hospital for Children at Indiana University Health, 705 Riley Hospital Dr. Phase 2, Room 4900, Indianapolis, IN, USA.
| | - Andrew L Beardsley
- Division of Pediatric Critical Care, Peyton Manning Children's Hospital, Indianapolis, IN, USA
| | - Danielle K Maue
- Division of Pediatric Critical Care, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Laurie L Ackerman
- Division of Pediatric Neurosurgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Courtney M Rowan
- Division of Pediatric Critical Care, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Matthew L Friedman
- Division of Pediatric Critical Care, Indiana University School of Medicine, Indianapolis, IN, USA
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13
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Cabrera M, Le Pennec D, Le Guellec S, Pardessus J, Ehrmann S, MacLoughlin R, Heuzé-Vourc'h N, Vecellio L. Influence of mesh nebulizer characteristics on aerosol delivery in non-human primates. Eur J Pharm Sci 2023; 191:106606. [PMID: 37832856 DOI: 10.1016/j.ejps.2023.106606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/05/2023] [Accepted: 09/30/2023] [Indexed: 10/15/2023]
Abstract
Non-Human Primates (NHPs) are particularly relevant for preclinical studies during the development of inhaled biologics. However, aerosol inhalation in NHPs is difficult to evaluate due to a low lung deposition fraction and high variability. The objective of this study was to evaluate the influence of mesh nebulizer parameters to improve lung deposition in macaques. We developed a humidified heated and ventilated anatomical 3D printed macaque model of the upper respiratory tract to reduce experiments with animals. The model was compared to in vivo deposition using 2D planar scintigraphy imaging in NHPs and demonstrated good predictivity. Next, the anatomical model was used to evaluate the position of the nebulizer on the mask, the aerosol particle size and the aerosol flow rate on the lung deposition. We showed that placing the mesh-nebulizer in the upper part of the mask and in proximal position to the NHP improved lung delivery prediction. The lower the aerosol size and the lower the aerosol flow rate, the better the predicted aerosol deposition. In particular, for 4.3 ± 0.1 µm in terms of volume mean diameter, we obtained 5.6 % ± 0.2 % % vs 19.2 % ± 2.5 % deposition in the lung model for an aerosol flow rate of 0.4 mL/min vs 0.03 mL/min and achieved 16 % of the nebulizer charge deposited in the lungs of macaques. Despite the improvement of lung deposition efficiency in macaques, its variability remained high (6-21 %).
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Affiliation(s)
- Maria Cabrera
- INSERM, Research Center for Respiratory Diseases, U1100, Tours, France; University of Tours, Tours, France
| | - Déborah Le Pennec
- INSERM, Research Center for Respiratory Diseases, U1100, Tours, France; University of Tours, Tours, France
| | - Sandrine Le Guellec
- INSERM, Research Center for Respiratory Diseases, U1100, Tours, France; University of Tours, Tours, France; DTF-Aerodrug, Tours, France
| | - Jeoffrey Pardessus
- INSERM, Research Center for Respiratory Diseases, U1100, Tours, France; University of Tours, Tours, France
| | - Stephan Ehrmann
- INSERM, Research Center for Respiratory Diseases, U1100, Tours, France; CHRU de Tours, Médecine Intensive Réanimation, 2 boulevard Tonnellé, Tours, France
| | - Ronan MacLoughlin
- Research and Development, Science and Emerging Technologies, Aerogen, Galway, Ireland
| | - Nathalie Heuzé-Vourc'h
- INSERM, Research Center for Respiratory Diseases, U1100, Tours, France; University of Tours, Tours, France
| | - Laurent Vecellio
- INSERM, Research Center for Respiratory Diseases, U1100, Tours, France; University of Tours, Tours, France.
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14
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Hong SW, Chang KH, Woo CJ, Kim HC, Kwak BS, Park BJ, Nam KC. Evaluation of antibody drug delivery efficiency via nebulizer in various airway models and breathing patterns. BMC Pharmacol Toxicol 2023; 24:70. [PMID: 38041207 PMCID: PMC10691028 DOI: 10.1186/s40360-023-00711-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/22/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Nebulizers are commonly used to treat respiratory diseases, which are a major cause of morbidity and mortality. While inhalation therapy with antibodies has been evaluated in preclinical studies and clinical trials for respiratory diseases, it has not yet been approved for treatment. Moreover, there is limited information regarding the delivery efficiency of therapeutic antibodies via nebulizer. METHODS In this study, the nebulization characteristics and drug delivery efficiencies were compared when immunoglobulin G (IgG) was delivered by five nebulizers using two airway models and five breathing patterns. The study confirmed that the delivered dose and drug delivery efficiency were reduced in the child model compared to those in the adult model and in the asthma pattern compared to those in the normal breathing pattern. RESULTS The NE-SM1 NEPLUS vibrating mesh nebulizer demonstrated the highest delivery efficiency when calculated as a percentage of the loading dose, whereas the PARI BOY SX + LC SPRINT (breath-enhanced) jet nebulizer had the highest delivery efficiency when calculated as a percentage of the emitted dose. CONCLUSION The results suggest that the total inspiration volume, output rate, and particle size should be considered when IgG nebulization is used. We, therefore, propose a method for evaluating the efficiency of nebulizer for predicting antibody drug delivery.
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Affiliation(s)
- Soon Woo Hong
- Department of Medical Engineering, Dongguk University College of Medicine, Goyang-si, 10326, Gyeonggi-do, Korea
| | - Kyung Hwa Chang
- Department of Medical Engineering, Dongguk University College of Medicine, Goyang-si, 10326, Gyeonggi-do, Korea
| | - Chang Jae Woo
- Department of Medical Engineering, Dongguk University College of Medicine, Goyang-si, 10326, Gyeonggi-do, Korea
- Office of Technology Transfer, National Cancer Center, Goyang-si, 10408, Gyeonggi-do, Korea
| | - Ho Chul Kim
- Department of Radiological Science, Eulji University, Seongnam-si, 13135, Gyeonggi-do, Korea
| | - Bong Seop Kwak
- Department of Medical Engineering, Dongguk University College of Medicine, Goyang-si, 10326, Gyeonggi-do, Korea
| | - Bong Joo Park
- Department of Electrical & Biological Physics and Institute of Biomaterials, Kwangwoon University, Seoul, 01897, Korea
| | - Ki Chang Nam
- Department of Medical Engineering, Dongguk University College of Medicine, Goyang-si, 10326, Gyeonggi-do, Korea.
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15
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Eno EA, Cheng CR, Louis H, Gber TE, Emori W, Ita IAT, Unimke TO, Ling L, Adalikwu SA, Agwamba EC, Adeyinka AS. Investigation on the molecular, electronic and spectroscopic properties of rosmarinic acid: an intuition from an experimental and computational perspective. J Biomol Struct Dyn 2023; 41:10287-10301. [PMID: 36546691 DOI: 10.1080/07391102.2022.2154841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022]
Abstract
Various drugs such as corticosteroids, salbutamol, and β2 agonist are available for the treatment of asthma an inflammatory disease and its symptoms, although the ingredient and the mode of action of these drugs are not clearly elucidated. Hence this research aimed at carrying out improved scientific research with respect to the use of natural product rosmarinic acid which poses minima, side effects. Herein, we first carried out extraction, isolation, and spectroscopic (FT-IR, 1H-NMR and 13C-NMR) investigation, followed by molecular modeling analysis on the naturally occurring rosmarinic acid extracted from Rosmarinus officinalis. A detailed comparison of the experimental and theoretical vibrational analysis has been carried out using five DFT functionals: BHANDH, HSEH1PBE, M06-2X, MPW3PBE and THCTHHYB with the basis set 6-311++G (d, p) to investigate into the structural, reactivity, and stability of the isolated compound. Frontier molecular orbital analysis and appropriate quantum descriptors were calculated. Results showed that the compound was more stable at M06-2X and more reactive at HSEH1PBE with an energy gap of 6.43441 eV and 3.8047 eV, respectively, which was later affirmed by the global quantum reactivity parameters. From natural bond orbital analysis, π* → π* is the major contributor to electron transition with the summation perturbation energy of 889.57 kcal/mol, while π → π* had the perturbation energy totaling of 145.3 kcal/mol. Geometry analysis shows BHANDH to have lower bond length values and lesser deviation from 120° in carbon-carbon angle. The potency of the title molecule as an asthma drug was tested via a molecular docking approach and the binding score of -8.2 kcal/mol was observed against -7.0 of salbutamol standard drug, suggesting romarinic acid as a potential natural organic treatment for asthma.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Ededet A Eno
- Computational and Bio-Simulation Research Group, University of Calabar, Calabar, Nigeria
- Department of Pure and Applied Chemistry, Faculty of Physical Sciences, University of Calabar, Calabar, Nigeria
| | - Chun-Ru Cheng
- Key Laboratory of Material Corrosion and Protection of Sichuan Province, Zigong, Sichuan, PR China
- College of Chemical Engineering, Institute of Pharmaceutical Engineering Technology and Application, Key Laboratory of Green Chemistry of Sichuan Institutes of Higher Education, Sichuan University of Science & Engineering, Zigong, Sichuan, PR China
| | - Hitler Louis
- Computational and Bio-Simulation Research Group, University of Calabar, Calabar, Nigeria
- Department of Pure and Applied Chemistry, Faculty of Physical Sciences, University of Calabar, Calabar, Nigeria
| | - Terkumbur E Gber
- Computational and Bio-Simulation Research Group, University of Calabar, Calabar, Nigeria
- Department of Pure and Applied Chemistry, Faculty of Physical Sciences, University of Calabar, Calabar, Nigeria
| | - Wilfred Emori
- Key Laboratory of Material Corrosion and Protection of Sichuan Province, Zigong, Sichuan, PR China
- School of Materials Science and Engineering, Sichuan University of Science and Engineering, Zigong, Sichuan, PR China
| | - Ima-Abasi T Ita
- Computational and Bio-Simulation Research Group, University of Calabar, Calabar, Nigeria
- Department of Pure and Applied Chemistry, Faculty of Physical Sciences, University of Calabar, Calabar, Nigeria
| | - Tomsmith O Unimke
- Computational and Bio-Simulation Research Group, University of Calabar, Calabar, Nigeria
- Department of Pure and Applied Chemistry, Faculty of Physical Sciences, University of Calabar, Calabar, Nigeria
| | - Liu Ling
- College of Chemical Engineering, Institute of Pharmaceutical Engineering Technology and Application, Key Laboratory of Green Chemistry of Sichuan Institutes of Higher Education, Sichuan University of Science & Engineering, Zigong, Sichuan, PR China
| | - Stephen A Adalikwu
- Computational and Bio-Simulation Research Group, University of Calabar, Calabar, Nigeria
| | - Ernest C Agwamba
- Computational and Bio-Simulation Research Group, University of Calabar, Calabar, Nigeria
- Department of Chemistry, Covenant University Ota, Ota, Nigeria
| | - Adedapo S Adeyinka
- Research Centre for Synthesis and Catalysis, Department of Chemical sciences, University of Johannesburg, Johannesburg, South Africa
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16
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Milton-Jones H, Soussi S, Davies R, Charbonney E, Charles WN, Cleland H, Dunn K, Gantner D, Giles J, Jeschke M, Lee N, Legrand M, Lloyd J, Martin-Loeches I, Pantet O, Samaan M, Shelley O, Sisson A, Spragg K, Wood F, Yarrow J, Vizcaychipi MP, Williams A, Leon-Villapalos J, Collins D, Jones I, Singh S. An international RAND/UCLA expert panel to determine the optimal diagnosis and management of burn inhalation injury. Crit Care 2023; 27:459. [PMID: 38012797 PMCID: PMC10680253 DOI: 10.1186/s13054-023-04718-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Burn inhalation injury (BII) is a major cause of burn-related mortality and morbidity. Despite published practice guidelines, no consensus exists for the best strategies regarding diagnosis and management of BII. A modified DELPHI study using the RAND/UCLA (University of California, Los Angeles) Appropriateness Method (RAM) systematically analysed the opinions of an expert panel. Expert opinion was combined with available evidence to determine what constitutes appropriate and inappropriate judgement in the diagnosis and management of BII. METHODS A 15-person multidisciplinary panel comprised anaesthetists, intensivists and plastic surgeons involved in the clinical management of major burn patients adopted a modified Delphi approach using the RAM method. They rated the appropriateness of statements describing diagnostic and management options for BII on a Likert scale. A modified final survey comprising 140 statements was completed, subdivided into history and physical examination (20), investigations (39), airway management (5), systemic toxicity (23), invasive mechanical ventilation (29) and pharmacotherapy (24). Median appropriateness ratings and the disagreement index (DI) were calculated to classify statements as appropriate, uncertain, or inappropriate. RESULTS Of 140 statements, 74 were rated as appropriate, 40 as uncertain and 26 as inappropriate. Initial intubation with ≥ 8.0 mm endotracheal tubes, lung protective ventilatory strategies, initial bronchoscopic lavage, serial bronchoscopic lavage for severe BII, nebulised heparin and salbutamol administration for moderate-severe BII and N-acetylcysteine for moderate BII were rated appropriate. Non-protective ventilatory strategies, high-frequency oscillatory ventilation, high-frequency percussive ventilation, prophylactic systemic antibiotics and corticosteroids were rated inappropriate. Experts disagreed (DI ≥ 1) on six statements, classified uncertain: the use of flexible fiberoptic bronchoscopy to guide fluid requirements (DI = 1.52), intubation with endotracheal tubes of internal diameter < 8.0 mm (DI = 1.19), use of airway pressure release ventilation modality (DI = 1.19) and nebulised 5000IU heparin, N-acetylcysteine and salbutamol for mild BII (DI = 1.52, 1.70, 1.36, respectively). CONCLUSIONS Burns experts mostly agreed on appropriate and inappropriate diagnostic and management criteria of BII as in published guidance. Uncertainty exists as to the optimal diagnosis and management of differing grades of severity of BII. Future research should investigate the accuracy of bronchoscopic grading of BII, the value of bronchial lavage in differing severity groups and the effectiveness of nebulised therapies in different severities of BII.
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Affiliation(s)
| | - Sabri Soussi
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris Cité, Paris, France
| | - Roger Davies
- Department of Intensive Care and Anaesthesia, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Emmanuel Charbonney
- Department of Médicine, Critical Care Division, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
- Department of Medicine, Université de Montréal, Montréal, Canada
| | - Walton N Charles
- Department of Surgery and Cancer, Imperial College London, London, UK
- Intensive Care National Audit and Research Centre, London, UK
| | - Heather Cleland
- Victorian Adult Burns Service, Alfred Health, Melbourne, Australia
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | - Ken Dunn
- University Hospital South Manchester, Wythenshawe, UK
| | - Dashiell Gantner
- Department of Intensive Care, Alfred Health, Melbourne, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
| | - Julian Giles
- Department of Anaesthesia, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - Marc Jeschke
- Ross Tilley Burn Center, Department of Surgery, Sunnybrook Health Science Center, Toronto, ON, Canada
- Departments of Surgery and Immunology, University of Toronto, Toronto, ON, Canada
| | - Nicole Lee
- Department of Burns, Plastic and Reconstructive Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Matthieu Legrand
- Department of Anesthesia and Perioperative Care, Division of Critical Care Medicine, University of California, San Francisco, USA
- Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists Network, Nancy, France
| | - Joanne Lloyd
- Department of Anaesthesia and Burns Intensive Care, St Andrew's Centre for Burns and Plastic Surgery, Broomfield Hospital, Chelmsford, UK
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James Hospital, Dublin, Ireland
- Department of Respiratory Medicine, Hospital Clinic, IDIBAPS, CIBERes, Barcelona, Spain
- Universitat Barcelona, Barcelona, Spain
| | - Olivier Pantet
- Service of Adult Intensive Care, Lausanne University Hospital, Lausanne, Switzerland
| | - Mark Samaan
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Odhran Shelley
- Trinity College, Dublin, Ireland
- Department of Plastic and Reconstructive Surgery, St James' Hospital, Dublin, Ireland
| | - Alice Sisson
- Department of Intensive Care and Anaesthesia, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Kaisa Spragg
- Burns Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - Fiona Wood
- Fiona Stanley Hospital, Perth, Australia
- Perth Children's Hospital, Perth, Australia
- University of Western Australia, Perth, Australia
| | - Jeremy Yarrow
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - Marcela Paola Vizcaychipi
- Department of Intensive Care and Anaesthesia, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Médicine, Critical Care Division, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Andrew Williams
- Department of Médicine, Critical Care Division, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
- Department of Burns, Plastic and Reconstructive Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Jorge Leon-Villapalos
- Department of Médicine, Critical Care Division, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
- Department of Burns, Plastic and Reconstructive Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Declan Collins
- Department of Médicine, Critical Care Division, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
- Department of Burns, Plastic and Reconstructive Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Isabel Jones
- Department of Médicine, Critical Care Division, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
- Department of Burns, Plastic and Reconstructive Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Suveer Singh
- Faculty of Medicine, Imperial College London, London, UK.
- Department of Intensive Care and Anaesthesia, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
- Department of Médicine, Critical Care Division, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.
- Department of Research and Development, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
- Academic Department of Anaesthesia, Pain Management and Intensive Care (APMIC), Imperial College London, London, UK.
- Royal Brompton Hospital, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK.
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17
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Alanazi O, Li J. The Impact of Various High-Flow Nasal Cannula Devices on Transnasal Aerosol Delivery. Respir Care 2023; 68:1657-1661. [PMID: 37553215 PMCID: PMC10676246 DOI: 10.4187/respcare.10777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
BACKGROUND Aerosol delivery via high-flow nasal cannula (HFNC) has gained popularity due to the increased use of the modality for treating hypoxemic and hypercapnic respiratory failure. Various HFNC devices are available in the United States; however, the effectiveness of aerosol delivery via HFNC devices remains unclear. Thus, this study aimed to investigate the impact of various commercially available devices on transnasal aerosol delivery. METHODS This was a bench study that used a 2-chamber lung model, in which one chamber was connected to an adult manikin with anatomically correct upper-airway proportions. The other chamber was connected to a critical care ventilator used to simulate spontaneous breathing. A size large nasal cannula was placed at the nasal opening of the manikin. Five different HFNC devices (Hamilton-C1, OptiFlow, Airvo2, V60 Plus, and Vapotherm) were compared. Four flow settings were used on each device, with a vibrating mesh nebulizer placed at the humidifier. Salbutamol (2.5 mg/3 mL) was used during the experiments to quantify inhaled drug doses. A collection filter was placed between the manikin's trachea and the lung model. The drug was eluted from the filter and assayed with ultraviolet spectrophotometry (276 nm). RESULTS Among the 5 HFNC devices, OptiFlow had the highest inhaled dose at 10 L/min (mean ± SD 18.2% ± 1.2%). At 20 L/min, the Hamilton-C1 (mean ± SD 13.5% ± 0.4%) performed marginally better than the OptiFlow (mean ± SD 12.6% ± 1.9%) and Airvo2 (mean ± SD 12.8% ± 1%). At high flow settings (40-60 L/min), the inhaled dose of Hamilton-C1 was 2-3 times that of the Airvo2 and V60 Plus. When compared with the other devices, the mean inhaled dose with the Vapotherm was lower (0.9-2.5%). In all devices, the inhaled dose decreased as the flow increased. CONCLUSIONS Transnasal aerosol delivery was significantly impacted by the types of HFNC devices and flow settings. Nominal doses might need to be adjusted if changing HFNC devices or flow is not an option.
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Affiliation(s)
- Osama Alanazi
- Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois
| | - Jie Li
- Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois.
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Smith EF, Bradshaw TK, Urs RC, Evans DJ, Hemy NR, Hall GL, Wilson AC, Simpson SJ. Oscillometry and spirometry are not interchangeable when assessing the bronchodilator response in children and young adults born preterm. Pediatr Pulmonol 2023; 58:3122-3132. [PMID: 37539845 PMCID: PMC10947568 DOI: 10.1002/ppul.26632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION The European Respiratory Society Oscillometry Taskforce identified that clinical correlates of bronchodilator responses are needed to advance oscillometry in clinical practice. The understanding of bronchodilator-induced oscillometry changes in preterm lung disease is poor. Here we describe a comparison of bronchodilator assessments performed using oscillometry and spirometry in a population born very preterm and explore the relationship between bronchodilator-induced changes in respiratory function and clinical outcomes. METHODS Participants aged 6-23 born ≤32 (N = 288; 132 with bronchopulmonary dysplasia) and ≥37 weeks' gestation (N = 76, term-born controls) performed spirometry and oscillometry. A significant bronchodilator response (BDR) to 400 μg salbutamol was classified according to published criteria. RESULTS A BDR was identified in 30.9% (n = 85) of preterm-born individuals via spirometry and/or oscillometry, with poor agreement between spirometry and oscillometry definitions (k = 0.26; 95% confidence interval [CI] 0.18-0.40, p < .001). Those born preterm with a BDR by oscillometry but not spirometry had increased wheeze (33% vs. 11%, p = .010) and baseline resistance (Rrs5 z-score mean difference (MD) = 0.86, 95% CI 0.07-1.65, p = .025), but similar baseline spirometry to the group without a BDR (forced expiratory volume in 1 s [FEV1 ] z-score MD = -0.01, 95% CI -0.66 to 0.68, p > .999). Oscillometry was more feasible than spirometry (95% success rate vs. 85% (FEV1 ), 69% (forced vital capacity) success rate, p < .001), however being born preterm did not affect test feasibility. CONCLUSION In the preterm population, oscillometry is a feasible and clinically useful supportive test to assess the airway response to inhaled salbutamol. Changes measured by oscillometry reflect related but distinct physiological changes to those measured by spirometry, and thus these tests should not be used interchangeably.
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Affiliation(s)
- Elizabeth F. Smith
- Wal‐Yan Respiratory Research Centre, Telethon Kids InstitutePerth Children's HospitalNedlandsAustralia
- Curtin School of Allied HealthFaculty of Health SciencesBentleyAustralia
| | - Tiffany K. Bradshaw
- Wal‐Yan Respiratory Research Centre, Telethon Kids InstitutePerth Children's HospitalNedlandsAustralia
| | - Rhea C. Urs
- Wal‐Yan Respiratory Research Centre, Telethon Kids InstitutePerth Children's HospitalNedlandsAustralia
- Curtin School of Allied HealthFaculty of Health SciencesBentleyAustralia
| | - Denby J. Evans
- Wal‐Yan Respiratory Research Centre, Telethon Kids InstitutePerth Children's HospitalNedlandsAustralia
- Curtin School of Allied HealthFaculty of Health SciencesBentleyAustralia
| | - Naomi R. Hemy
- Wal‐Yan Respiratory Research Centre, Telethon Kids InstitutePerth Children's HospitalNedlandsAustralia
| | - Graham L. Hall
- Wal‐Yan Respiratory Research Centre, Telethon Kids InstitutePerth Children's HospitalNedlandsAustralia
- Curtin School of Allied HealthFaculty of Health SciencesBentleyAustralia
| | - Andrew C. Wilson
- Wal‐Yan Respiratory Research Centre, Telethon Kids InstitutePerth Children's HospitalNedlandsAustralia
- Curtin School of Allied HealthFaculty of Health SciencesBentleyAustralia
- Child and Adolescent Health ServicePerth Children's HospitalNedlandsAustralia
| | - Shannon J. Simpson
- Wal‐Yan Respiratory Research Centre, Telethon Kids InstitutePerth Children's HospitalNedlandsAustralia
- Curtin School of Allied HealthFaculty of Health SciencesBentleyAustralia
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Abstract
BACKGROUND Secondhand exposure to fugitive aerosols may cause airway diseases in health providers. We hypothesized that redesigning aerosol masks to be closed-featured would reduce the fugitive aerosol concentrations during nebulization. This study aimed to evaluate the influence of a mask designed for a jet nebulizer on the concentration of fugitive aerosols and delivered doses. METHODS An adult intubation manikin was attached to a lung simulator to mimic normal and distressed adult breathing patterns. The jet nebulizer delivered salbutamol as an aerosol tracer. The nebulizer was attached to 3 aerosol face masks: an aerosol mask, a modified non-rebreathing mask (NRM, with no vent holes), and an AerosoLess mask. An aerosol particle sizer measured aerosol concentrations at parallel distances of 0.8 m and 2.2 m and a frontal distance of 1.8 m from the manikin. The drug dose delivered distal to the manikin's airway was collected, eluted, and analyzed using a spectrophotometer at a 276 nm wavelength. RESULTS With a normal breathing pattern, the trends of aerosol concentrations were higher with an NRM followed by an aerosol mask and AerosoLess mask (P < .001) at 0.8 m; however, the concentrations were higher with an aerosol mask followed by NRM and AerosoLess mask at 1.8 m (P < .001) and 2.2 m (P < .001). With a distressed breathing pattern, the aerosol concentrations were higher with an aerosol mask followed by an NRM and AerosoLess mask at 0.8 m, 1.8 m (P < .001), and 2.2 m (P = .005). The delivered drug dose was significantly higher with AerosoLess mask with a normal breathing pattern and with an aerosol mask with a distressed breathing pattern. CONCLUSIONS Mask design influences fugitive aerosol concentrations in the environment, and a filtered mask reduces the concentration of aerosols at 3 different distances and with 2 breathing patterns.
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Affiliation(s)
- Chen-En Chiang
- Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Hsien Li
- Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
| | - Daniel D Rowley
- Department of Respiratory Therapy, University of Virginia Medical Center, Charlottesville, Virginia
| | - Tien-Pei Fang
- Department of Respiratory Care, Chang Gung University of Technology and Science, Chiayi, Taiwan; and Department of Respiratory Therapy, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Hui-Ling Lin
- Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan; Department of Respiratory Care, Chang Gung University of Technology and Science, Chiayi, Taiwan; and Department of Respiratory Therapy, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
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Yin B, Wan X, Yue W, Zhou T, Shi L, Wang S, Lin X. A portable automated chip for simultaneous rapid point-of-care testing of multiple β-agonists. Biosens Bioelectron 2023; 239:115586. [PMID: 37603988 DOI: 10.1016/j.bios.2023.115586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023]
Abstract
Abusive use of β-agonists as feed additives for animals and medication is detrimental to human health and food safety. Conventional assays are restricted to a single type of β-agonists detection and cannot match the multiplexing features to perform automated, high throughput, and rapid quantitative analysis in real samples. In this research, we develop a portable automated chip system (PACS) with highly integrated automated devices in conjunction with portable microfluidic chips to provide simultaneous point-of-care testing of multiple β-agonists in the field, simplifying complex manual methods, shortening assay times, and improving sensitivity. Specifically, silicon film is used as reaction substrates for immobilizing the conjugates of β-agonists to increase the sensitivity of the assay result. Then, the PACS with a chemiluminescence imaging detector is established for automatic high-throughput and sensitive detection of Clenbuterol, Ractopamine, and Salbutamol based on the indirect immunoassay. Newly developed chip with high mixing performance can improve the sensitivity of target determination. Multiplex assays were carried out using the developed system for Clenbuterol, Ractopamine, and Salbutamol with a limit of detection of 54 pg mL-1,59 pg mL-1, and 93 pg mL-1, respectively. Except for sample preparation and coating, the detection in the PACS takes less than 47 min. A satisfactory sample recovery (86.33%-108.12%) was obtained, validating the reliability and practical applicability of this PACS. Meanwhile, the PACS enables sensitive and rapid detection of multiple β-agonists in farms or markets where lacking advanced laboratory facilities.
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Affiliation(s)
- Binfeng Yin
- School of Mechanical Engineering, Yangzhou University, Yangzhou, 225127, China.
| | - Xinhua Wan
- School of Mechanical Engineering, Yangzhou University, Yangzhou, 225127, China
| | - Wenkai Yue
- School of Mechanical Engineering, Yangzhou University, Yangzhou, 225127, China
| | - Teng Zhou
- Mechanical and Electrical Engineering College, Hainan University, Haikou, 570228, China
| | - Liuyong Shi
- Mechanical and Electrical Engineering College, Hainan University, Haikou, 570228, China
| | - Songbai Wang
- School of Chemistry and Chemical Engineering, Shanxi University, Taiyuan, 030006, China.
| | - Xiaodong Lin
- Zhuhai UM Science & Technology Research Institute, Zhuhai, 519000, China.
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Hempel P, Klein V, Michely A, Böll S, Rieg AD, Spillner J, Braunschweig T, von Stillfried S, Wagner N, Martin C, Tenbrock K, Verjans E. Amitriptyline inhibits bronchoconstriction and directly promotes dilatation of the airways. Respir Res 2023; 24:262. [PMID: 37907918 PMCID: PMC10617234 DOI: 10.1186/s12931-023-02580-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/25/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION The standard therapy for bronchial asthma consists of combinations of acute (short-acting ß2-sympathomimetics) and, depending on the severity of disease, additional long-term treatment (including inhaled glucocorticoids, long-acting ß2-sympathomimetics, anticholinergics, anti-IL-4R antibodies). The antidepressant amitriptyline has been identified as a relevant down-regulator of immunological TH2-phenotype in asthma, acting-at least partially-through inhibition of acid sphingomyelinase (ASM), an enzyme involved in sphingolipid metabolism. Here, we investigated the non-immunological role of amitriptyline on acute bronchoconstriction, a main feature of airway hyperresponsiveness in asthmatic disease. METHODS After stimulation of precision cut lung slices (PCLS) from mice (wildtype and ASM-knockout), rats, guinea pigs and human lungs with mediators of bronchoconstriction (endogenous and exogenous acetylcholine, methacholine, serotonin, endothelin, histamine, thromboxane-receptor agonist U46619 and leukotriene LTD4, airway area was monitored in the absence of or with rising concentrations of amitriptyline. Airway dilatation was also investigated in rat PCLS by prior contraction induced by methacholine. As bronchodilators for maximal relaxation, we used IBMX (PDE inhibitor) and salbutamol (ß2-adrenergic agonist) and compared these effects with the impact of amitriptyline treatment. Isolated perfused lungs (IPL) of wildtype mice were treated with amitriptyline, administered via the vascular system (perfusate) or intratracheally as an inhalation. To this end, amitriptyline was nebulized via pariboy in-vivo and mice were ventilated with the flexiVent setup immediately after inhalation of amitriptyline with monitoring of lung function. RESULTS Our results show amitriptyline to be a potential inhibitor of bronchoconstriction, induced by exogenous or endogenous (EFS) acetylcholine, serotonin and histamine, in PCLS from various species. The effects of endothelin, thromboxane and leukotrienes could not be blocked. In acute bronchoconstriction, amitriptyline seems to act ASM-independent, because ASM-deficiency (Smdp1-/-) did not change the effect of acetylcholine on airway contraction. Systemic as well as inhaled amitriptyline ameliorated the resistance of IPL after acetylcholine provocation. With the flexiVent setup, we demonstrated that the acetylcholine-induced rise in central and tissue resistance was much more marked in untreated animals than in amitriptyline-treated ones. Additionally, we provide clear evidence that amitriptyline dilatates pre-contracted airways as effectively as a combination of typical bronchodilators such as IBMX and salbutamol. CONCLUSION Amitriptyline is a drug of high potential, which inhibits acute bronchoconstriction and induces bronchodilatation in pre-contracted airways. It could be one of the first therapeutic agents in asthmatic disease to have powerful effects on the TH2-allergic phenotype and on acute airway hyperresponsiveness with bronchoconstriction, especially when inhaled.
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Affiliation(s)
- Paulina Hempel
- Department of Pediatrics, Medical Faculty, RWTH Aachen, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- Institute of Pharmacology and Toxicology, Medical Faculty, RWTH Aachen, University Hospital Aachen, Aachen, Germany
| | - Virag Klein
- Department of Pediatrics, Medical Faculty, RWTH Aachen, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- Institute of Pharmacology and Toxicology, Medical Faculty, RWTH Aachen, University Hospital Aachen, Aachen, Germany
| | - Anna Michely
- Department of Pediatrics, Medical Faculty, RWTH Aachen, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- Institute of Pharmacology and Toxicology, Medical Faculty, RWTH Aachen, University Hospital Aachen, Aachen, Germany
| | - Svenja Böll
- Department of Pediatrics, Medical Faculty, RWTH Aachen, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- Institute of Pharmacology and Toxicology, Medical Faculty, RWTH Aachen, University Hospital Aachen, Aachen, Germany
| | - Annette D Rieg
- Institute of Pharmacology and Toxicology, Medical Faculty, RWTH Aachen, University Hospital Aachen, Aachen, Germany
- Department of Anaesthesiology, Medical Faculty, RWTH Aachen, University Hospital Aachen, Aachen, Germany
| | - Jan Spillner
- Department of Thoracic and Cardiovascular Surgery, Medical Faculty, RWTH Aachen, University Hospital Aachen, Aachen, Germany
| | - Till Braunschweig
- Institute of Pathology, Medical Faculty, RWTH Aachen, University Hospital Aachen, Aachen, Germany
| | - Saskia von Stillfried
- Institute of Pathology, Medical Faculty, RWTH Aachen, University Hospital Aachen, Aachen, Germany
| | - Norbert Wagner
- Department of Pediatrics, Medical Faculty, RWTH Aachen, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Christian Martin
- Institute of Pharmacology and Toxicology, Medical Faculty, RWTH Aachen, University Hospital Aachen, Aachen, Germany
| | - Klaus Tenbrock
- Department of Pediatrics, Medical Faculty, RWTH Aachen, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Eva Verjans
- Department of Pediatrics, Medical Faculty, RWTH Aachen, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
- Institute of Pharmacology and Toxicology, Medical Faculty, RWTH Aachen, University Hospital Aachen, Aachen, Germany.
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Zhong Y, Hou C, Gao X, Wang M, Yao Y, Chen M, Di B, Su M. Application of wastewater-based epidemiology to estimate the usage of beta-agonists in 31 cities in China. Sci Total Environ 2023; 894:164956. [PMID: 37343858 DOI: 10.1016/j.scitotenv.2023.164956] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 06/23/2023]
Abstract
The illegal use of beta-agonists could cause severe problems to human health. In this study, the usage of beta-agonists in 31 cities across China was estimated using wastewater-based epidemiology (WBE). The proposed method is based on solid-phase extraction (SPE) and LC-MS/MS and was developed and validated to determine the concentration of seven beta-agonists in wastewater. A population model based on cotinine (COT), NH4-N and the flow volume was constructed to estimate the population equivalents for different wastewater treatment plants (WWTPs). Clenbuterol and ractopamine are banned in China for both animal husbandry and medical use, but were nevertheless detected in some wastewater samples at rates of 6.2 % and 4.7 %, respectively (n = 339). The WBE-based consumption of clenbuterol and ractopamine were compared with the acceptable daily intake (ADI) and the health risks were assessed by their hazard quotients (0.26-6.62 for clenbuterol and 9.27 × 10-4-0.05 for ractopamine). Salbutamol, clorprenaline and terbutaline were observed in practically all wastewater samples at concentrations of up to several ng/L, whereas the formoterol and bambuterol concentrations were below the detection limit in all samples. Salbutamol consumption (7.35 ± 4.14 mg/1000 inh/day) was highest among the examined beta-agonists and varied regionally. Beta-agonist consumption based on WBE was higher in some cities than that based on medical survey data, indicating potential illegal use. These results show that WBE can be a straightforward and supplementary method for monitoring beta-agonist usage at the population level and spatially.
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Affiliation(s)
- Yuling Zhong
- School of Pharmacy, China Pharmaceutical University, No. 24 Tongjiaxiang Road, Nanjing, 210009, China; China National Narcotics Control Commission, China Pharmaceutical University Joint Laboratory on Key Technologies of Narcotics Control, No. 24 Tongjiaxiang Road, Nanjing, 210009, China
| | - Chenzhi Hou
- School of Pharmacy, China Pharmaceutical University, No. 24 Tongjiaxiang Road, Nanjing, 210009, China; China National Narcotics Control Commission, China Pharmaceutical University Joint Laboratory on Key Technologies of Narcotics Control, No. 24 Tongjiaxiang Road, Nanjing, 210009, China
| | - Xinyi Gao
- School of Pharmacy, China Pharmaceutical University, No. 24 Tongjiaxiang Road, Nanjing, 210009, China
| | - Mingyu Wang
- School of Pharmacy, China Pharmaceutical University, No. 24 Tongjiaxiang Road, Nanjing, 210009, China
| | - Yan Yao
- School of Pharmacy, China Pharmaceutical University, No. 24 Tongjiaxiang Road, Nanjing, 210009, China; China National Narcotics Control Commission, China Pharmaceutical University Joint Laboratory on Key Technologies of Narcotics Control, No. 24 Tongjiaxiang Road, Nanjing, 210009, China
| | - Mengyi Chen
- School of Pharmacy, China Pharmaceutical University, No. 24 Tongjiaxiang Road, Nanjing, 210009, China; China National Narcotics Control Commission, China Pharmaceutical University Joint Laboratory on Key Technologies of Narcotics Control, No. 24 Tongjiaxiang Road, Nanjing, 210009, China
| | - Bin Di
- School of Pharmacy, China Pharmaceutical University, No. 24 Tongjiaxiang Road, Nanjing, 210009, China; China National Narcotics Control Commission, China Pharmaceutical University Joint Laboratory on Key Technologies of Narcotics Control, No. 24 Tongjiaxiang Road, Nanjing, 210009, China; Key Laboratory of Drug Quality Control and Pharmacovigilance, China Pharmaceutical University, Ministry of Education, No. 639 Longmian Avenue, Nanjing, 211100, China.
| | - Mengxiang Su
- School of Pharmacy, China Pharmaceutical University, No. 24 Tongjiaxiang Road, Nanjing, 210009, China; China National Narcotics Control Commission, China Pharmaceutical University Joint Laboratory on Key Technologies of Narcotics Control, No. 24 Tongjiaxiang Road, Nanjing, 210009, China; Key Laboratory of Drug Quality Control and Pharmacovigilance, China Pharmaceutical University, Ministry of Education, No. 639 Longmian Avenue, Nanjing, 211100, China.
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Ahmed MI, Ahmed RI, Osama H, Khalifa AK, Alshehri AA, El-Saber Batiha G, Negm WA, Kamal M. Bronchodilator reversibility testing in morbidly obese non-smokers: fluticasone/salmeterol efficacy versus salbutamol bronchodilator. BMC Pulm Med 2023; 23:381. [PMID: 37814253 PMCID: PMC10563321 DOI: 10.1186/s12890-023-02682-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 09/27/2023] [Indexed: 10/11/2023] Open
Abstract
A positive response in reversibility testing is widely used to diagnose patients with airway limitations. However, despite its simple procedure, it doesn't accurately reflect the exact airway irreversibility. This study aimed to investigate the efficacy of a bronchodilation reversibility test using salbutamol and fluticasone/salmeterol combination in obese non-smoker subjects.The study included patients without a history of obstructive lung disease or bronchodilators. A sub-classification of patients based on body mass index (BMI) was carried out into normal (< 24.9 kg/m2), overweight (25-29.9 kg/m2), and obese (BMI ≥ 30). Spirometry measurements were performed before and after salbutamol or fluticasone/salmeterol administration.The study included 415 (49.9% male) patients with a mean age of 40.92 ± 10.86 years. Obese subjects showed a high prevalence of restrictive patterns (23.4%), with non-significantly lower spirometric values compared to normal and overweight subjects (p > 0.05). The magnitude of bronchodilation, as identified by spirometry, following fluticasone/salmeterol was higher in all participants, with a significant increase in obese subjects with a p-value of 0.013, 0.002, and 0.035 for FEV1, FEV1% predicted, and FEV1/FVC, respectively.Fluticasone/salmeterol combination increases FEV1, FEV1% of predicted, and FEV1/FVC ratio than the conventional test using salbutamol inhaler, and it can be a potential candidate for assessment of airway obstruction using reversibility test, especially among the obese population.
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Affiliation(s)
- Mona Ibrahim Ahmed
- Department of chest Ds & TB, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Randa Ibrahim Ahmed
- Department of chest Ds & TB, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Hasnaa Osama
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-suef University, Beni-suef, Egypt
| | - Amira Karam Khalifa
- Department of Medical pharmacology, Kasr El-Ainy School of Medicine, Cairo University, El Manial, Cairo, 11562, Egypt
- Department of Medical Pharmacology, Nahda Faculty of Medicine, Beni Suef, 62521, Egypt
| | - Abdullah Ali Alshehri
- Department of Clinical Pharmacy, College of Pharmacy, Taif University, Al Hawiyah, Taif, Saudi Arabia
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour, AlBeheira, 22511, Egypt
| | - Walaa A Negm
- Department of Pharmacognosy, Faculty of Pharmacy, Tanta University, Tanta, 31527, Egypt.
| | - Marwa Kamal
- Clinical Pharmacy Department, Faculty of Pharmacy, Fayoum University, Fayoum, 63514, Egypt
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Almalki AH, Ramzy S, Almrasy AA. Development and validation of analytical methods for selective determination of albuterol and budesonide in Airsupra inhalation aerosol using spectrophotometry. Sci Rep 2023; 13:16587. [PMID: 37789024 PMCID: PMC10547681 DOI: 10.1038/s41598-023-42766-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/14/2023] [Indexed: 10/05/2023] Open
Abstract
Airsupra inhalation aerosol is a recently approved FDA medication that combines albuterol and budesonide for treating or preventing bronchoconstriction and lowering the risk of relapses in asthma patients who are 18 years of age and older. To selectively determine albuterol and budesonide in both pure and pharmaceutical dosage forms, two analytical methods were developed: the zero-order absorption method and the dual-wavelength method. Even though the two drugs absorption spectra overlapped, the distinctive peak of budesonide at the zero absorbance point of albuterol, 245 nm, allowed for direct detection of budesonide in the combination using the zero-order absorption method. The mathematical dual-wavelength method, on the other hand, allowed for the measurement of both albuterol and budesonide by choosing two wavelengths for each drug in such a way that the absorbance difference for the second drug was zero. Budesonide exhibited comparable absorbance values at wavelengths 227 and 261.40 nm; hence, these two wavelengths were utilized to identify albuterol; similarly, 221.40 and 231.20 nm were chosen to determine budesonide in their binary mixes. The methods were validated according to the ICH guideline for validation of analytical procedures Q2(R1) and demonstrated excellent linearity, sensitivity, accuracy, precision, and selectivity for determining both drugs in synthetic mixed solutions and pharmaceutical formulations. The availability of these analytical methods would be valuable for the pharmaceutical industry and regulatory authorities for quality control and assessment of pharmaceutical formulations containing albuterol and budesonide.
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Affiliation(s)
- Atiah H Almalki
- Department of Pharmaceutical Chemistry, College of Pharmacy, Taif University, P.O. Box 11099, 21944, Taif, Saudi Arabia
- Addiction and Neuroscience Research Unit, Health Science Campus, Taif University, P.O. Box 11099, 21944, Taif, Saudi Arabia
| | - Sherif Ramzy
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Al-Azhar University, Cairo, 11751, Egypt.
| | - Ahmed A Almrasy
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Al-Azhar University, Cairo, 11751, Egypt
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Mishra S, Nair KV, Shukla A. Delineation of molecular characteristics of congenital myasthenic syndromes in Indian families and review of literature. Clin Dysmorphol 2023; 32:162-167. [PMID: 37646703 DOI: 10.1097/mcd.0000000000000465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Congenital myasthenic syndromes (CMS) are rare, heterogeneous, and often treatable genetic disorders depending on the underlying molecular defect. We performed a detailed clinical evaluation of seven patients from five unrelated families. Exome sequencing was performed on five index patients. Clinically significant variants were identified in four CMS disease-causing genes: COLQ (3/7), CHRNE (2/7), DOK7 (1/7), and RAPSN (1/7). We identified two novel variants, c.930_933delCATG in DOK7 and c.1016_1032 + 2dup in CHRNE . A common pathogenic variant, c.955-2A>C, has been identified in COLQ -related CMS patients. Homozygosity mapping of this COLQ variant in patients from two unrelated families revealed that it was located in a common homozygous region of 3.2 Mb on chromosome 3 and was likely to be inherited from a common ancestor. Patients with COLQ variants had generalized muscle weakness, those with DOK7 and RAPSN variants had limb-girdle weakness, and those with CHRNE variants had predominant ocular weakness. Patients with COLQ and DOK7 variants showed improvement with salbutamol and CHRNE with pyridostigmine therapy. This study expands the mutational spectrum and adds a small but significant cohort of CMS patients from India. We also reviewed the literature to identify genetic subtypes of CMS in India.
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Affiliation(s)
- Shivani Mishra
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Lau S, Sprung J, Volcheck GW, Butterfield JH, Divekar RD, Weingarten TN. Perioperative management of mastocytosis. J Anesth 2023; 37:741-748. [PMID: 37466804 DOI: 10.1007/s00540-023-03228-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/11/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE Patients with mastocytosis have an increased risk of anaphylaxis during surgical procedures with general anesthesia. Therefore, we reviewed the anesthesia course of a large cohort of patients with mastocytosis. METHODS We retrospectively reviewed adult and pediatric patients with mastocytosis who underwent surgical procedures with general anesthesia at Mayo Clinic from January 1, 2000, through June 30, 2021. We also included any procedures with general anesthesia that occurred during the 3-year period preceding mastocytosis diagnosis and designated the patients who underwent these procedures as having an unknown diagnosis at the time of their surgical procedure. We analyzed whether patients received chronic antimediator treatment for mastocytosis and/or prophylactic medications before the procedures. We also determined whether medications indicative of mastocytosis-related adverse events were intraoperatively administered. RESULTS We identified 113 patients who underwent 219 procedures during the study period; 25 procedures were performed before mastocytosis diagnosis. Of 194 procedures in patients with known mastocytosis, patients received chronic antimediator therapy and/or perioperative prophylactic medications for 178 (91.8%) procedures. Among these procedures, 10 were potentially complicated by mast cell activation, which was inferred from administration of inhaled albuterol (n = 3) or intravenous diphenhydramine (n = 8). In addition, there was only one case of intraoperative anaphylaxis which occurred in a patient who underwent anesthesia before mastocytosis diagnosis and therefore did not receive prophylaxis. CONCLUSION Intraoperative anaphylaxis can be the first presenting sign of mastocytosis. Patients with mastocytosis who received chronic antimediator therapy and/or preoperative prophylactic medications had an uneventful surgical course.
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Affiliation(s)
- Sirimas Lau
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Juraj Sprung
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | | | | | - Rohit D Divekar
- Division of Allergic Diseases, Mayo Clinic, Rochester, MN, USA
| | - Toby N Weingarten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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Burgraff NJ, Baertsch NA, Ramirez JM. A comparative examination of morphine and fentanyl: unravelling the differential impacts on breathing and airway stability. J Physiol 2023; 601:4625-4642. [PMID: 37778015 DOI: 10.1113/jp285163] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
This study provides an in-depth analysis of the distinct consequences of the opioid drugs morphine and fentanyl during opioid-induced respiratory depression (OIRD). We explored the physiological implications of both drugs on ventilation and airway patency in anaesthetized mice. Our results revealed a similar reduction in respiratory frequency with equivalent scaled dosages of fentanyl and morphine, though the onset of suppression was more rapid with fentanyl. Additionally, fentanyl resulted in transient airflow obstructions during the inspiratory cycle, which were absent following morphine administration. Notably, these fentanyl-specific obstructions were eliminated with tracheostomy, implicating the upper airways as a major factor contributing to fentanyl-induced respiratory depression. We further demonstrate that bronchodilators salbutamol and adrenaline effectively reversed these obstructions, highlighting the bronchi's contribution to fentanyl-induced airflow obstruction. Our study also uncovered a significant reduction in sighs during OIRD, which were eliminated by fentanyl and markedly reduced by morphine. Finally, we found that fentanyl-exposed mice had reduced survival under hypoxic conditions compared to mice given morphine, demonstrating that fentanyl becomes more lethal in the context of hypoxaemia. Our findings shed light on the distinct and profound impacts of these opioids on respiration and airway stability and lay the foundation for improved opioid use guidelines and more effective OIRD prevention strategies. KEY POINTS: Both morphine and fentanyl significantly suppressed respiratory frequency, but the onset of suppression was faster with fentanyl. Also, while both drugs increased tidal volume, this effect was more pronounced with fentanyl. Fentanyl administration resulted in transient obstructions during the inspiratory phase, suggesting its unique impact on airway stability. This obstruction was not observed with morphine. The fentanyl-induced obstructions were reversed by administering bronchodilators such as salbutamol and adrenaline. This suggests a possible therapeutic strategy for mitigating the adverse airway effects of fentanyl. Both drugs reduced the frequency of physiological sighs, a key mechanism to prevent alveolar collapse. However, fentanyl administration led to a complete cessation of sighs, while morphine only reduced their occurrence. Fentanyl-treated mice showed a significantly reduced ability to survive under hypoxic conditions compared to those administered morphine. This indicates that the impacts of hypoxaemia during opioid-induced respiratory depression can vary based on the opioid used.
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Affiliation(s)
- Nicholas J Burgraff
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Nathan A Baertsch
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Jan-Marino Ramirez
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
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Emel E, Ayhan O, Recep B, Ulku S. Gamma irradiation effect on some asthma drugs: EPR detection of radiosterilization. Radiat Prot Dosimetry 2023; 199:1600-1604. [PMID: 37721068 DOI: 10.1093/rpd/ncad165] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 04/24/2023] [Accepted: 05/01/2023] [Indexed: 09/19/2023]
Abstract
Among many sterilization methods, radiosterilization is a preferred method in the pharmaceutical industry because of its advantages. However, the detection of radiosterilization of drugs is a growing concern for many government regulatory agencies around the world because of changes in the drug's structure because of exposure to radiation. Electron Paramagnetic Resonance (EPR) proved to be a very sensitive technique to discriminate between irradiated and nonirradiated drugs and detect radicals for days even to years. In this study, the focus is on the detection of radiosterilization of irradiated three asthma drugs (Airfix, Ventolin and Prednol) by using EPR spectroscopy. Regarding the commercial aspects of drugs, it was found that radicals can be detected at least 2 y after irradiation. Therefore, paramagnetic centers formed by the effect of radiation in the samples were determined and the stability of these centers was examined for 2 y by performing the fading study.
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Affiliation(s)
- Ece Emel
- Kamil Özdağ Faculty of Science, Department of Physics, Karamanoğlu Mehmetbey University, Karaman 70100, Türkiye
| | - Ozmen Ayhan
- Faculty of Science, Department of Physics, Selçuk University, Konya 42200, Türkiye
- Advanced Technology Research and Application Center, Selçuk University, Konya 42200, Türkiye
| | - Biyik Recep
- Turkish Energy, Nuclear and Mineral Research Agency, İstanbul 34303, Türkiye
| | - Sayin Ulku
- Faculty of Science, Department of Physics, Selçuk University, Konya 42200, Türkiye
- Advanced Technology Research and Application Center, Selçuk University, Konya 42200, Türkiye
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Moon J, McPeck M, Jayakumaran J, Smaldone GC. Enhanced Aerosol Delivery During High-Flow Nasal Cannula Therapy. Respir Care 2023; 68:1221-1228. [PMID: 37253612 PMCID: PMC10468167 DOI: 10.4187/respcare.10644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Aerosolized drug delivery via high-flow nasal cannula (HFNC) decreases as gas flow is increased. To improve aerosol delivery, breath-enhanced jet nebulizer may increase aerosol output. This study tested that hypothesis and compared breath-enhanced jet nebulizer to vibrating mesh nebulizer technology. METHODS First, in an isolated circuit, breath-enhanced jet nebulizer and vibrating mesh nebulizer aerosol outputs were measured during simulated HFNC by using infused saline solution at rates of 5-60 mL/h. Limits were defined when nebulizer filling was detected. The devices were then tested by using 99mTc/saline solution to measure maximum rates of aerosol production. After the output experiments, drug delivery was measured in vitro by using a model that consisted of an HFNC circuit interfaced to a realistic 3-dimensional printed head. The 99mTc/saline solution was infused at rates of 5 to 60 mL/h for the breath-enhanced jet nebulizer and 5 to 20 mL/h for the vibrating mesh nebulizer with HFNC gas flows of 10 to 60 L/min. Aerosol delivery to the trachea was measured by using a shielded ratemeter, which defined the rate of drug delivery (µg NaCl/min). RESULTS With increasing gas flow, breath-enhanced jet nebulizer output increased to a maximum of 50 mL/h, the vibrating mesh nebulizer maximum was 12 mL/h. At HFNC gas flow of 60 L/min, breath-enhanced jet nebulizer delivered 3.16 to 316.8 µg NaCl/min, the vibrating mesh nebulizer delivered 23.5 to 61.7 µg NaCl/min. For infusion pump flows of 5 to 12 mL/h, the rate of drug delivery was independent of nebulizer type (P = .19) and dependent on infusion pump flow (P < .001) and gas flow (P < .001). CONCLUSIONS Increasing gas flow increased breath-enhanced jet nebulizer output, which demonstrated the effects of breath enhancement. At 60 L/min, breath enhanced jet nebulizer delivered up to 5 times more aerosol compared with conventional vibrating mesh nebulizer technology. Breath-enhanced jet nebulizer delivered a wide range of dose rates at all high flows. In patients who are critically ill, breath-enhanced jet nebulizer technology may allow titration of bedside dosing based on clinical response by simple adjustment of the infusion rate.
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Affiliation(s)
- Jane Moon
- Pulmonary, Critical Care and Sleep Medicine Division, Department of Medicine, Stony Brook University Medical Center, Stony Brook, New York.
| | - Michael McPeck
- Pulmonary, Critical Care and Sleep Medicine Division, Department of Medicine, Stony Brook University Medical Center, Stony Brook, New York
| | - Jeyanthan Jayakumaran
- Pulmonary, Critical Care and Sleep Medicine Division, Department of Medicine, Stony Brook University Medical Center, Stony Brook, New York
| | - Gerald C Smaldone
- Pulmonary, Critical Care and Sleep Medicine Division, Department of Medicine, Stony Brook University Medical Center, Stony Brook, New York
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Chipps BE, Israel E, Beasley R, Panettieri RA, Albers FC, Rees R, Dunsire L, Danilewicz A, Johnsson E, Cappelletti C, Papi A. Albuterol-Budesonide Pressurized Metered Dose Inhaler in Patients With Mild-to-Moderate Asthma: Results of the DENALI Double-Blind Randomized Controlled Trial. Chest 2023; 164:585-595. [PMID: 37003355 DOI: 10.1016/j.chest.2023.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/16/2023] [Accepted: 03/26/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND In the phase 3 MANDALA trial, as-needed albuterol-budesonide pressurized metered-dose inhaler significantly reduced severe exacerbation risk vs as-needed albuterol in patients with moderate-to-severe asthma receiving inhaled corticosteroid-containing maintenance therapy. This study (DENALI) was conducted to address the US Food and Drug Administration combination rule, which requires a combination product to demonstrate that each component contributes to its efficacy. RESEARCH QUESTION Do both albuterol and budesonide contribute to the efficacy of the albuterol-budesonide combination pressurized metered-dose inhaler in patients with asthma? STUDY DESIGN AND METHODS This phase 3 double-blind trial randomized patients aged ≥ 12 years with mild-to-moderate asthma 1:1:1:1:1 to four-times-daily albuterol-budesonide 180/160 μg or 180/80 μg, albuterol 180 μg, budesonide 160 μg, or placebo for 12 weeks. Dual-primary efficacy end points included change from baseline in FEV1 area under the curve from 0 to 6 h (FEV1 AUC0-6h) over 12 weeks (assessing albuterol effect) and trough FEV1 at week 12 (assessing budesonide effect). RESULTS Of 1,001 patients randomized, 989 were ≥ 12 years old and evaluable for efficacy. Change from baseline in FEV1 AUC0-6h over 12 weeks was greater with albuterol-budesonide 180/160 μg vs budesonide 160 μg (least-squares mean [LSM] difference, 80.7 [95% CI, 28.4-132.9] mL; P = .003). Change in trough FEV1 at week 12 was greater with albuterol-budesonide 180/160 and 180/80 μg vs albuterol 180 μg (LSM difference, 132.8 [95% CI, 63.6-201.9] mL and 120.8 [95% CI, 51.5-190.1] mL, respectively; both P < .001). Day 1 time to onset and duration of bronchodilation with albuterol-budesonide were similar to those with albuterol. The albuterol-budesonide adverse event profile was similar to that of the monocomponents. INTERPRETATION Both monocomponents contributed to albuterol-budesonide lung function efficacy. Albuterol-budesonide was well tolerated, even at regular, relatively high daily doses for 12 weeks, with no new safety findings, supporting its use as a novel rescue therapy. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; No.: NCT03847896; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
| | - Elliot Israel
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Reynold A Panettieri
- Rutgers Institute for Translational Medicine and Science, Child Health Institute of New Jersey, Rutgers, State University of New Jersey, New Brunswick, NJ
| | | | | | - Lynn Dunsire
- BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | | | - Eva Johnsson
- BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | | | - Alberto Papi
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
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McPeck M, Moon J, Jayakumaran J, Smaldone GC. In Vitro Model for Analysis of High-Flow Aerosol Delivery During Continuous Nebulization. Respir Care 2023; 68:1213-1220. [PMID: 37253606 PMCID: PMC10468165 DOI: 10.4187/respcare.10643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND To understand the fate of aerosols delivered by high-flow nasal cannula using continuous nebulization, an open-source anatomical model was developed and validated with a modified real-time gamma ratemeter technique. Mass balance defined circuit losses. Responsiveness to infusion rate and device technology were tested. METHODS A nasal airway cast derived from a computed tomography scan was converted to a 3-dimensional-printed head and face structure connected to a piston ventilator (breathing frequency 30 breaths/min, tidal volume 750 mL, duty cycle 0.50). For mass balance experiments, saline mixed with Technetium-99m was infused for 1 h. Aerosol delivery was measured using a gamma ratemeter oriented to an inhaled mass filter at the hypopharynx of the model. Background and dead-space effects were minimized. All components were imaged by scintigraphy. Continuous nebulization was tested at infusion rates of 10-40 mL/h with gas flow of 60 L/min using a breath-enhanced jet nebulizer (BEJN), and a vibrating mesh nebulizer. Drug delivery rates were defined by the slope of ratemeter counts/min (CPM/min) versus time (min). RESULTS The major source of aerosol loss was at the nasal interface (∼25%). Significant differences in deposition on circuit components were seen between nebulizers. The nebulizer residual was higher for BEJN (P = .006), and circuit losses, including the humidifier, were higher for vibrating mesh nebulizer (P = .006). There were no differences in delivery to the filter and head model. For 60 L/min gas flow, as infusion pump flow was increased, the rate of aerosol delivery (CPM/min) increased, for BEJN from 338 to 8,111; for vibrating mesh nebulizer, maximum delivery was 2,828. CONCLUSIONS The model defined sites of aerosol losses during continuous nebulization and provided a realistic in vitro system for testing aerosol delivery during continuous nebulization. Real-time analysis can quantify effects of multiple changes in variables (nebulizer technology, infusion rate, gas flow, and ventilation) during a given experiment.
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Affiliation(s)
- Michael McPeck
- Pulmonary, Critical Care and Sleep Medicine Division, Department of Medicine, Stony Brook University Medical Center, Stony Brook, New York
| | - Jane Moon
- Pulmonary, Critical Care and Sleep Medicine Division, Department of Medicine, Stony Brook University Medical Center, Stony Brook, New York
| | - Jeyanthan Jayakumaran
- Pulmonary, Critical Care and Sleep Medicine Division, Department of Medicine, Stony Brook University Medical Center, Stony Brook, New York
| | - Gerald C Smaldone
- Pulmonary, Critical Care and Sleep Medicine Division, Department of Medicine, Stony Brook University Medical Center, Stony Brook, New York.
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Jayasooriya S, Stolbrink M, Khoo EM, Sunte IT, Awuru JI, Cohen M, Lam DC, Spanevello A, Visca D, Centis R, Migliori GB, Ayuk AC, Buendia JA, Awokola BI, Del-Rio-Navarro BE, Muteti-Fana S, Lao-Araya M, Chiarella P, Badellino H, Somwe SW, Anand MP, Garcí-Corzo JR, Bekele A, Soto-Martinez ME, Ngahane BHM, Florin M, Voyi K, Tabbah K, Bakki B, Alexander A, Garba BL, Salvador EM, Fischer GB, Falade AG, ŽivkoviĆ Z, Romero-Tapia SJ, Erhabor GE, Zar H, Gemicioglu B, Brandão HV, Kurhasani X, El-Sharif N, Singh V, Ranasinghe JC, Kudagammana ST, Masjedi MR, Velásquez JN, Jain A, Cherrez-Ojeda I, Valdeavellano LFM, Gómez RM, Mesonjesi E, Morfin-Maciel BM, Ndikum AE, Mukiibi GB, Reddy BK, Yusuf O, Taright-Mahi S, Mérida-Palacio JV, Kabra SK, Nkhama E, Filho NR, Zhjegi VB, Mortimer K, Rylance S, Masekela RR. Clinical standards for the diagnosis and management of asthma in low- and middle-income countries. Int J Tuberc Lung Dis 2023; 27:658-667. [PMID: 37608484 PMCID: PMC10443788 DOI: 10.5588/ijtld.23.0203] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND: The aim of these clinical standards is to aid the diagnosis and management of asthma in low-resource settings in low- and middle-income countries (LMICs).METHODS: A panel of 52 experts in the field of asthma in LMICs participated in a two-stage Delphi process to establish and reach a consensus on the clinical standards.RESULTS: Eighteen clinical standards were defined: Standard 1, Every individual with symptoms and signs compatible with asthma should undergo a clinical assessment; Standard 2, In individuals (>6 years) with a clinical assessment supportive of a diagnosis of asthma, a hand-held spirometry measurement should be used to confirm variable expiratory airflow limitation by demonstrating an acute response to a bronchodilator; Standard 3, Pre- and post-bronchodilator spirometry should be performed in individuals (>6 years) to support diagnosis before treatment is commenced if there is diagnostic uncertainty; Standard 4, Individuals with an acute exacerbation of asthma and clinical signs of hypoxaemia or increased work of breathing should be given supplementary oxygen to maintain saturation at 94-98%; Standard 5, Inhaled short-acting beta-2 agonists (SABAs) should be used as an emergency reliever in individuals with asthma via an appropriate spacer device for metered-dose inhalers; Standard 6, Short-course oral corticosteroids should be administered in appropriate doses to individuals having moderate to severe acute asthma exacerbations (minimum 3-5 days); Standard 7, Individuals having a severe asthma exacerbation should receive emergency care, including oxygen therapy, systemic corticosteroids, inhaled bronchodilators (e.g., salbutamol with or without ipratropium bromide) and a single dose of intravenous magnesium sulphate should be considered; Standard 8, All individuals with asthma should receive education about asthma and a personalised action plan; Standard 9, Inhaled medications (excluding dry-powder devices) should be administered via an appropriate spacer device in both adults and children. Children aged 0-3 years will require the spacer to be coupled to a face mask; Standard 10, Children aged <5 years with asthma should receive a SABA as-needed at step 1 and an inhaled corticosteroid (ICS) to cover periods of wheezing due to respiratory viral infections, and SABA as-needed and daily ICS from step 2 upwards; Standard 11, Children aged 6-11 years with asthma should receive an ICS taken whenever an inhaled SABA is used; Standard 12, All adolescents aged 12-18 years and adults with asthma should receive a combination inhaler (ICS and rapid onset of action long-acting beta-agonist [LABA] such as budesonide-formoterol), where available, to be used either as-needed (for mild asthma) or as both maintenance and reliever therapy, for moderate to severe asthma; Standard 13, Inhaled SABA alone for the management of patients aged >12 years is not recommended as it is associated with increased risk of morbidity and mortality. It should only be used where there is no access to ICS.The following standards (14-18) are for settings where there is no access to inhaled medicines. Standard 14, Patients without access to corticosteroids should be provided with a single short course of emergency oral prednisolone; Standard 15, Oral SABA for symptomatic relief should be used only if no inhaled SABA is available. Adjust to the individual's lowest beneficial dose to minimise adverse effects; Standard 16, Oral leukotriene receptor antagonists (LTRA) can be used as a preventive medication and is preferable to the use of long-term oral systemic corticosteroids; Standard 17, In exceptional circumstances, when there is a high risk of mortality from exacerbations, low-dose oral prednisolone daily or on alternate days may be considered on a case-by-case basis; Standard 18. Oral theophylline should be restricted for use in situations where it is the only bronchodilator treatment option available.CONCLUSION: These first consensus-based clinical standards for asthma management in LMICs are intended to help clinicians provide the most effective care for people in resource-limited settings.
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Affiliation(s)
- S Jayasooriya
- Academic Unit of Primary Care, University of Sheffield, Sheffield
| | - M Stolbrink
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - E M Khoo
- Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia, International Primary Care Respiratory Group, Edinburgh, Scotland, UK
| | - I T Sunte
- Global Allergy and Airways Patient Platform, Vienna, Austria
| | - J I Awuru
- Global Allergy and Airways Patient Platform, Vienna, Austria
| | - M Cohen
- Hospital Centro Médico, Guatemala City, Guatemala, Mexico, Asociación Latinoamericana de Tórax, Montevideo, Uruguay
| | - D C Lam
- Department of Medicine, University of Hong Kong, Hong Kong, Asian Pacific Society of Respirology, Hong Kong, China
| | - A Spanevello
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Tradate, Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como
| | - D Visca
- Asociación Latinoamericana de Tórax, Montevideo, Uruguay, Department of Medicine, University of Hong Kong, Hong Kong
| | - R Centis
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri, Tradate, Italy
| | - G B Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri, Tradate, Italy
| | - A C Ayuk
- College of Medicine, University of Nigeria, Enugu, Nigeria
| | - J A Buendia
- Affiliation Departamento de Farmacologia y Tóxicologia, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - B I Awokola
- Medical Research Council, The Gambia at the London School of Tropical Medicine, The Gambia
| | | | - S Muteti-Fana
- Department of Primary Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - M Lao-Araya
- Division of Allergy and Clinical Immunology, Chian Mai University, Chiang Mai, Thailand
| | - P Chiarella
- Health Sciences School, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - H Badellino
- Head Pediatric Respiratory Medicine Department, Clinica Regional del Este, San Francisco, Argentina
| | - S W Somwe
- Paediatrics and Child Health, University of Lusaka, Lusaka, Zambia
| | - M P Anand
- Department of Respiratory Medicine, JSS Medical College, Mysore, India
| | - J R Garcí-Corzo
- Department of Pediatrics, Universidad Industrial de Santander, Santander, Colombia
| | - A Bekele
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - M E Soto-Martinez
- Department of Pediatrics, Universidad de Costa Rica, San Jose, Costa Rica
| | - B H M Ngahane
- Douala General Hospital, University of Douala, Douala, Cameroon
| | - M Florin
- Institute of Pneumology M. Nasta, Bucharest, Romania
| | - K Voyi
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - K Tabbah
- College of Medicine, Ajman University, Ajman, United Arab Emirates
| | - B Bakki
- University of Maiduguri Teaching Hospital, Maiduguri
| | - A Alexander
- Deparment of Medicine, University of Abuja, Abuja
| | - B L Garba
- Department of Paediatrics, Usmanu Danfodiyo, University Teaching Hospital, Sokoto, Nigeria
| | - E M Salvador
- Deparment of Biological Sciences, Eduardo Mondlane University, Maputo, Mozambique
| | - G B Fischer
- University of Medical Sciences, Porto Alegre, RS, Brazil
| | - A G Falade
- Department of Paediatrics, University of Ibadan, Ibadan, Nigeria
| | - Zorica ŽivkoviĆ
- Dragiša Mišovic, Childrens Hsopital for Lung Disease and TB, Belgrade, Serbia
| | - S J Romero-Tapia
- Health Sciences, Academic Division, Juarez Autononous, University of Tabasco, Villahermosa, Mexico
| | - G E Erhabor
- Department of Medicine, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria
| | - H Zar
- Department of Paediatrics & Child Health & SA MRC Unit on Children & Adolescent Health, Red Cross Childrens Hospital, University of Cape Town, Cape Town, South Africa
| | - B Gemicioglu
- Department of Pulmonary Diseases, Istanbul University, Cerrahpasa, Turkey
| | - H V Brandão
- State University of Feira de Santana, Feira de Santana, BA, Brazil
| | - X Kurhasani
- UBT Higher Education Institution, Prishtina, Kosovo
| | | | - V Singh
- MJ Rajasthan Hospital, Jaipur, India
| | | | - S T Kudagammana
- Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - M R Masjedi
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - J N Velásquez
- Medical School, Santander Industrial, Bucaramanga, Colombia
| | - A Jain
- Department of Community Medicine, Kasturba Medical College, Mangalore
| | | | - L F M Valdeavellano
- Asociación Latinoamericana de Tórax, Montevideo, Uruguay, Francisco Morroguín University, Guatemala City, Guatemala
| | - R M Gómez
- Faculty of Health Sciences, Catholic University of Salta, Salta, Argentina
| | - E Mesonjesi
- Department of Allergy and Clinical Immunology, University Hospital Centre "Mother Teresa", Tirana, Albania
| | | | - A E Ndikum
- The University of Yaounde 1, Yaounde, Cameroon
| | | | - B K Reddy
- Shishuka Children's Speciality Hospital, Bangalore, India
| | - O Yusuf
- The Allergy and Asthma Institute, Islamabad, Pakistan
| | - S Taright-Mahi
- Medecin Faculty, Mustapha Universitary Hospital Algiers, Algeria
| | - J V Mérida-Palacio
- Centrode Investigación de Enfermedades Alérgicas y Respiratorias SC, Mexico DF, Mexico
| | - S K Kabra
- Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - E Nkhama
- Levy Mwanawasa Medical University, School of Public Health and Environmental Sciences, Lusaka, Zambia
| | - N R Filho
- Federal University of Parana, Curitiba, PA, Brazil
| | - V B Zhjegi
- Social Medicine, Medical Faculty, University of Prishtina, Prishtina, Kosovo
| | - K Mortimer
- University of Cambridge, Cambridge, Imperial College, London, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK, Department of Paediatrics and Child Health, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa
| | - S Rylance
- Department of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
| | - R R Masekela
- Department of Paediatrics and Child Health, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa
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Anderson K, Gerald LB, Hall-Lipsy E, McCulley K, Vuong E, Phan H. Pharmacists' perspectives on school stock inhaler access for children. J Public Health Policy 2023; 44:464-476. [PMID: 37344541 DOI: 10.1057/s41271-023-00423-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 06/23/2023]
Abstract
Several states in the United States (U.S.) have laws permitting stock inhalers, including short-acting beta-agonist inhalers, such as albuterol, and spacers to be prescribed to, dispensed to, and stocked in schools for use in students in respiratory distress, based on a protocol. This survey study assessed Arizona pharmacists' (1) levels of comfort for dispensing a short-acting beta-agonist inhaler to an individual child versus a stock inhaler to a school, and (2) awareness of the related Arizona state law. Researchers surveyed pharmacists licensed in Arizona who self-reported practicing in an outpatient pharmacy setting. Among 251 pharmacist participants, 62% practiced in a chain community pharmacy. About 80.8% felt comfortable filling a prescription for an albuterol inhaler in a pediatric patient case, whereas only 26.7% felt comfortable filling a prescription for albuterol inhalers to be used as stock inhalers for a given school. Among those who would not fill the stock inhaler prescription, only 5.5% reported awareness of the state law compared to 42.6% of those who would fill it (p < 0.0001). This survey identified a lack of pharmacist awareness of state laws pertaining to stock inhalers for schools.
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Affiliation(s)
- Kalia Anderson
- R. Ken Coit College of Pharmacy, University of Arizona (UA), Tucson, AZ, USA
- Department of Pharmacy, Banner University Medical Center, Tucson, USA
| | - Lynn B Gerald
- UA Asthma and Airway Disease Research Center, UA College of Public Health, Tucson, AZ, USA
- University of Illinois Chicago, Chicago, IL, USA
| | | | - Kathryn McCulley
- R. Ken Coit College of Pharmacy, University of Arizona (UA), Tucson, AZ, USA
| | - Elizabeth Vuong
- R. Ken Coit College of Pharmacy, University of Arizona (UA), Tucson, AZ, USA
| | - Hanna Phan
- University of Michigan College of Pharmacy; Susan B. Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, MI, USA.
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Barchilon M, Reinero CR. Breathe easy: inhalational therapy for feline inflammatory airway disease. J Feline Med Surg 2023; 25:1098612X231193054. [PMID: 37675792 DOI: 10.1177/1098612x231193054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
PRACTICAL RELEVANCE Feline inflammatory airway diseases, including (but not limited to) asthma, chronic bronchitis and bronchiectasis, are common and incurable disorders. These diseases require lifelong therapy and may result in substantial morbidity and, in some cases, mortality. Goals of therapy include reduction or resolution of clinical signs and the underlying pathologic processes driving those clinical signs. Inhalational therapy has the advantage of topical delivery of drugs to target tissues at higher doses with fewer systemic effects than oral medications. There are multiple options for delivery devices, and proper selection and training on the use of these devices - including acclimation of the cat to the device - can maximize therapeutic efficacy. AIM As inhalational therapy is uncommonly used by many veterinarians and owners, this review article provides a foundation on the selection and use of devices and inhalant medications for specific feline inflammatory airway diseases. Cats present a unique challenge with respect to the use of inhalers, and easy-to-follow steps on acclimating them to the devices are provided. The review also discusses the mechanics of inhalational therapy and helps clarify why certain medications, such as albuterol (salbutamol), fluticasone or budesonide, are chosen for certain diseases. The ultimate aim is that the practitioner should feel more comfortable managing common airway diseases in cats. EVIDENCE BASE In compiling their review, the authors searched the veterinary literature for articles in English that discuss inhalational therapy in cats, and which focus primarily on inhaled glucocorticoids and bronchodilators. While most literature on inhalational therapy in cats is based on experimental feline asthma models, there are some studies demonstrating successful treatment in cats with naturally occurring inflammatory airway disease.
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Affiliation(s)
- Michael Barchilon
- University of Missouri, College of Veterinary Medicine, Columbia, MO 65211, USA
| | - Carol R Reinero
- University of Missouri, College of Veterinary Medicine, Columbia, MO 65211, USA
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Nikjoo D, van der Zwaan I, Rudén J, Frenning G. Engineered microparticles of hyaluronic acid hydrogel for controlled pulmonary release of salbutamol sulphate. Int J Pharm 2023; 643:123225. [PMID: 37451326 DOI: 10.1016/j.ijpharm.2023.123225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/30/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
Most pulmonary drugs are immediate-release formulations with short duration of action. Controlled release systems provide the ability to deliver drugs at a controlled rate, which helps maintain drug concentrations within the therapeutic window for a longer period of time. This study aimed to produce microparticles (MPs) of hyaluronic acid hydrogel (HAGA) loaded with salbutamol sulphate (SS) for controlled release in the lung. The drug-loaded MPs were prepared via spray drying and underwent extensive characterization, which revealed that SS was successfully encapsulated in the HAGA matrix. The prepared MPs (denoted as HASS) ranged in size from 1.6 ± 0.4 μm to 1.7 ± 0.5 μm with a fine particle fraction (FPF) of 48-56% and showed improvement in aerodynamic properties compared to unloaded HAGA hydrogel MPs. In vitro drug release studies performed in a Transwell system confirmed the potential of the particles to release the drug in a sustained manner. The drug release was delayed for all formulations, with a t63 between 5 and 30 min, compared to <1min for pure SS. This study advances our understanding of the formulation of a highly soluble drug to achieve controlled release in the lung.
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Affiliation(s)
- Dariush Nikjoo
- Department of Pharmaceutical Biosciences, Uppsala University, P.O. Box 591, 751 24 Uppsala, Sweden; Division of Material Science, Department of Engineering Science and Mathematics, Luleå University of Technology, 971 87 Luleå, Sweden.
| | - Irès van der Zwaan
- Department of Pharmaceutical Biosciences, Uppsala University, P.O. Box 591, 751 24 Uppsala, Sweden
| | - Jonas Rudén
- Pharmaceutical Development, Orexo AB, 751 05, Uppsala, Sweden
| | - Göran Frenning
- Department of Pharmaceutical Biosciences, Uppsala University, P.O. Box 591, 751 24 Uppsala, Sweden.
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Sahu PL, Maurya AK, Priyadarshini S, Siddiqui AA, Sahu K. Measurement Uncertainty and Validation for Quantitation of Salbutamol in Human Urine by Gas Chromatography-Tandem Mass Spectrometry. J Chromatogr Sci 2023; 61:605-611. [PMID: 36214345 DOI: 10.1093/chromsci/bmac079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Indexed: 08/22/2023]
Abstract
A simple, rapid, sensitive and specific gas chromatography-tandem mass spectrometry (GC-MS/MS) method was developed for quantitation of salbutamol in human urine using salbutamol-d3 as the internal standard. The processing of urines samples includes deconjugation with enzymatic hydrolysis, solid phase extraction procedure utilizing XAD2 column and liquid-liquid extraction accompanied by the derivatization by means of MSTFA/IODO-TMS/DTE mixture. The GC column was a HP Ultra-1 (17 m × 0.22 mm × 0.11 μm) used to separate the peak of interest. The data for GC-MS/MS were acquired and processed utilizing GC Labs Solution and Insight GCMS Software. The detection of spectra was performed on TQ 8050. This method included a chromatographic run of 13.67 min and the linearity was found over the concentration range of 250-2000 ng/mL with a regression coefficient (r2) of 0.99. The coefficient of variation for intra and interday assay precision was between 1.85 and 2.85% and the accuracy was between 95.50 and 107.04% for low quality control (QC), medium QC and high QC. The recovery was adequate to reliable detect the analyte at or below the level recommended by the World Anti-Doping Agency i.e., threshold 1000 ng/mL. The limit of detection and limit of quantification were found to be 10 and 100 ng/mL, respectively. The expanded measurement uncertainty (Uexp%) was found to be 8.28%.
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Affiliation(s)
- Puran Lal Sahu
- National Dope Testing Laboratory, Ministry of Youth Affairs & Sports (MYAS), Government of India, New Delhi 110003, India
| | - Ashok Kumar Maurya
- National Dope Testing Laboratory, Ministry of Youth Affairs & Sports (MYAS), Government of India, New Delhi 110003, India
| | - Subhasmita Priyadarshini
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Jamia Hamdard (Hamdard University), New Delhi 110062, India
| | - Anees Ahmad Siddiqui
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Jamia Hamdard (Hamdard University), New Delhi 110062, India
| | - Kapendra Sahu
- National Dope Testing Laboratory, Ministry of Youth Affairs & Sports (MYAS), Government of India, New Delhi 110003, India
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Cuccia AD, McPeck M, Lee JA, Smaldone GC. Multidrug Aerosol Delivery During Mechanical Ventilation. J Aerosol Med Pulm Drug Deliv 2023; 36:154-161. [PMID: 37256713 PMCID: PMC10457632 DOI: 10.1089/jamp.2022.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 03/24/2023] [Indexed: 06/02/2023] Open
Abstract
Background: In the critically ill, pulmonary vasodilators are often provided off label to intubated patients using continuous nebulization. If additional aerosol therapies such as bronchodilators or antibiotics are needed, vasodilator therapy may be interrupted. This study assesses aerosol systems designed for simultaneous delivery of two aerosols using continuous nebulization and bolus injection without interruption or circuit disconnection. Methods: One i-AIRE dual-port breath-enhanced jet nebulizer (BEJN) or two Aerogen® Solo vibrating mesh nebulizers (VMNs) were installed on the dry side of the humidifier. VMN were stacked; one for infusion and the second for bolus drug delivery. The BEJN was powered by air at 3.5 L/min, 50 psig. Radiolabeled saline was infused at 5 and 10 mL/h with radiolabeled 3 and 6 mL bolus injections at 30 and 120 minutes, respectively. Two adult breathing patterns (duty cycle 0.13 and 0.34) were tested with an infusion time of 4 hours. Inhaled mass (IM) expressed as % of initial syringe activity (IM%/min) was monitored in real time with a ratemeter. All delivered radioaerosol was collected on a filter at the airway opening. Transients in aerosol delivery were measured by calibrated ratemeter. Results: IM%/h during continuous infusion was linear and predictable, mean ± standard deviation (SD): 2.12 ± 1.45%/h, 2.47 ± 0.863%/h for BEJN and VMN, respectively. BEJN functioned without incident. VMN continuous aerosol delivery stopped spontaneously in 3 of 8 runs (38%); bolus delivery stopped spontaneously in 3 of 16 runs (19%). Tapping restarted VMN function during continuous and bolus delivery runs. Bolus delivery IM% (mean ± SD): 20.90% ± 7.01%, 30.40% ± 11.10% for BEJN and VMN, respectively. Conclusion: Simultaneous continuous and bolus nebulization without circuit disconnection is possible for both jet and mesh technology. Monitoring of VMN devices may be necessary in case of spontaneous interruption of nebulization.
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Affiliation(s)
- Ann D. Cuccia
- Respiratory Care Program, School of Health Professions, Stony Brook University, Stony Brook, New York, USA
| | - Michael McPeck
- Pulmonary Mechanics and Aerosol Research Laboratory, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Stony Brook University Medical Center, Stony Brook, New York, USA
| | - Janice A. Lee
- Pulmonary Mechanics and Aerosol Research Laboratory, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Stony Brook University Medical Center, Stony Brook, New York, USA
| | - Gerald C. Smaldone
- Pulmonary Mechanics and Aerosol Research Laboratory, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Stony Brook University Medical Center, Stony Brook, New York, USA
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Sinaiko AD, Ross-Degnan D, Wharam JF, LeCates RF, Wu AC, Zhang F, Galbraith AA. Utilization and Spending With Preventive Drug Lists for Asthma Medications in High-Deductible Health Plans. JAMA Netw Open 2023; 6:e2331259. [PMID: 37642963 PMCID: PMC10466161 DOI: 10.1001/jamanetworkopen.2023.31259] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/23/2023] [Indexed: 08/31/2023] Open
Abstract
Importance High-deductible health plans with health savings accounts (HDHP-HSAs) incentivize patients to use less health care, including necessary care. Preventive drug lists (PDLs) exempt high-value medications from the deductible, reducing out-of-pocket cost sharing; the associations of PDLs with health outcomes among patients with asthma is unknown. Objective To evaluate the associations of a PDL for asthma medications on utilization, adverse outcomes, and patient spending for HDHP-HSA enrollees with asthma. Design, Setting, and Participants This case-control study used matched groups of patients with asthma before and after an insurance design change using a national commercial health insurance claims data set from 2004-2017. Participants included patients aged 4 to 64 years enrolled for 1 year in an HDHP-HSA without a PDL in which asthma medications were subject to the deductible who then transitioned to an HDHP-HSA with a PDL that included asthma medications; these patients were compared with a matched weighted sample of patients with 2 years of continuous enrollment in an HDHP-HSA without a PDL. Models controlled for patient demographics and asthma severity and were stratified by neighborhood income. Analyses were conducted from October 2020 to June 2023. Exposures Employer-mandated addition of a PDL that included asthma medications to an existing HDHP-HSA. Main Outcomes and Measures Outcomes of interest were utilization of asthma medications on the PDL (controllers and albuterol), asthma exacerbations (oral steroid bursts and asthma-related emergency department use), and out-of-pocket spending (all and asthma-specific). Results A total of 12 174 participants (mean [SD] age, 36.9 [16.9] years; 6848 [56.25%] female) were included in analyses. Compared with no PDL, PDLs were associated with increased rates of 30-day fills per enrollee for any controller medication (change, 0.10 [95% CI, 0.03 to 0.17] fills per enrollee; 12.9% increase) and for combination inhaled corticosteroid long-acting β2-agonist (ICS-LABA) medications (change, 0.06 [95% CI, 0.01 to 0.10] fills per enrollee; 25.4% increase), and increased proportion of days covered with ICS-LABA (6.0% [0.7% to 11.3%] of days; 15.6% increase). Gaining a PDL was associated with decreased out-of-pocket spending on asthma care (change, -$34 [95% CI, -$47 to -$21] per enrollee; 28.4% difference), but there was no significant change in asthma exacerbations and no difference in results by income. Conclusions and Relevance In this case-control study, reducing cost-sharing for asthma medications through a PDL was associated with increased adherence to controller medications, notably ICS-LABA medications used by patients with more severe asthma, but was not associated with improved clinical outcomes. These findings suggest that PDLs are a potential strategy to improve access and affordability of asthma care for patients in HDHP-HSAs.
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Affiliation(s)
- Anna D. Sinaiko
- Department of Health Policy & Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - J. Frank Wharam
- Department of Medicine, Duke University, Durham, North Carolina
- Duke-Margolis Center for Health Policy, Durham, North Carolina
| | - Robert F. LeCates
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Ann Chen Wu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Fang Zhang
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Alison A. Galbraith
- Department of Pediatrics, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
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Hsu YC, Li HH, Chiu LC, Chiang WC, Fang TP, Lin HL. Predicting Inhaled Drug Dose Generated by Mesh Nebulizers. J Aerosol Med Pulm Drug Deliv 2023; 36:162-170. [PMID: 37219568 DOI: 10.1089/jamp.2022.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Background: The lung dose of nebulized drugs for spontaneous breathing is influenced by breathing patterns and nebulizer performance. This study aimed to develop a system for measuring breath patterns and a formula for estimating inhaled drugs, and then to validate the hypothesized prediction formula. Methods: An in vitro model was first used to determine correlations among the delivered dose, breath patterns, and doses deposited on the accessories and reservoirs testing with a breathing simulator to generate 12 adult breathing patterns (n = 5). A pressure sensor was developed to measure breathing parameters and used along with a prediction formula that accounted for the initial charge dose, respiratory pattern, and dose on the accessory and reservoir of a nebulizer. Three brands of nebulizers were tested by placing salbutamol (5.0 mg/2.5 mL) in the drug holding chamber. Ten healthy individuals participated in the ex vivo study to validate the prediction formula. The agreement between the predicted and inhaled doses was analyzed using the Bland-Altman plot. Results: The in vitro model showed that the inspiratory time to total respiratory cycle time (Ti/Ttotal; %) was significantly directly correlated with the delivered dose among the respiratory factors, followed by inspiratory flow, respiratory rate, and tidal volume. The ex vivo model showed that Ti/Ttotal was significantly directly correlated with the delivered dose among the respiratory factors, in addition to the nebulization time and accessory dose. The Bland-Altman plots for the ex vivo model showed similar results between the two methods. Large differences in inhaled dose measured at the mouth were observed among the subjects, ranging from 12.68% to 21.68%; however, the difference between the predicted dose and inhaled dose was lower, at 3.98%-5.02%. Conclusions: The inhaled drug dose could be predicted with the hypothesized estimation formula, which was validated by the agreement between the inhaled and predicted doses of breathing patterns of healthy individuals.
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Affiliation(s)
| | - Hsin-Hsien Li
- Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
| | - Li-Chung Chiu
- Department of Pulmonary and Critical Care, Chang Gung Memorial Hospital-Linkou Branch, Taoyuan, Taiwan
| | | | - Tien-Pei Fang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Respiratory Care, Chang Gung University of Technology and Science, Chiayi, Taiwan
| | - Hui-Ling Lin
- Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Respiratory Care, Chang Gung University of Technology and Science, Chiayi, Taiwan
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Montigaud Y, Georges Q, Leclerc L, Clotagatide A, Louf-Durier A, Pourchez J, Prévôt N, Périnel-Ragey S. Impact of gas humidification and nebulizer position under invasive ventilation: preclinical comparative study of regional aerosol deposition. Sci Rep 2023; 13:11056. [PMID: 37422519 PMCID: PMC10329710 DOI: 10.1038/s41598-023-38281-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/06/2023] [Indexed: 07/10/2023] Open
Abstract
Successful aerosol therapy in mechanically ventilated patients depends on multiple factors. Among these, position of nebulizer in ventilator circuit and humidification of inhaled gases can strongly influence the amount of drug deposited in airways. Indeed, the main objective was to preclinically evaluate impact of gas humidification and nebulizer position during invasive mechanical ventilation on whole lung and regional aerosol deposition and losses. Ex vivo porcine respiratory tracts were ventilated in controlled volumetric mode. Two conditions of relative humidity and temperature of inhaled gases were investigated. For each condition, four different positions of vibrating mesh nebulizer were studied: (i) next to the ventilator, (ii) right before humidifier, (iii) 15 cm to the Y-piece adapter and (iv) right after the Y-piece. Aerosol size distribution were calculated using cascade impactor. Nebulized dose, lung regional deposition and losses were assessed by scintigraphy using 99mtechnetium-labeled diethylene-triamine-penta-acetic acid. Mean nebulized dose was 95% ± 6%. For dry conditions, the mean respiratory tract deposited fractions reached 18% (± 4%) next to ventilator and 53% (± 4%) for proximal position. For humidified conditions, it reached 25% (± 3%) prior humidifier, 57% (± 8%) before Y-piece and 43% (± 11%) after this latter. Optimal nebulizer position is proximal before the Y-piece adapter showing a more than two-fold higher lung dose than positions next to the ventilator. Dry conditions are more likely to cause peripheral deposition of aerosols in the lungs. But gas humidification appears hard to interrupt efficiently and safely in clinical use. Considering the impact of optimized positioning, this study argues to maintain humidification.
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Affiliation(s)
- Yoann Montigaud
- Mines Saint-Etienne, Univ Jean Monnet, INSERM, U1059 Sainbiose; Centre CIS, 42023, Saint-Etienne, France
| | - Quentin Georges
- Intensive Care Unit G, CHU Saint-Etienne, 42055, Saint-Etienne, France
| | - Lara Leclerc
- Mines Saint-Etienne, Univ Jean Monnet, INSERM, U1059 Sainbiose; Centre CIS, 42023, Saint-Etienne, France
| | | | | | - Jérémie Pourchez
- Mines Saint-Etienne, Univ Jean Monnet, INSERM, U1059 Sainbiose; Centre CIS, 42023, Saint-Etienne, France
| | - Nathalie Prévôt
- Nuclear Medicine Unit, CHU Saint-Etienne, 42055, Saint-Etienne, France
- Université Jean Monnet, Mines Saint-Etienne, INSERM, U1059 Sainbiose, 42023, Saint-Etienne, France
| | - Sophie Périnel-Ragey
- Intensive Care Unit G, CHU Saint-Etienne, 42055, Saint-Etienne, France.
- Université Jean Monnet, Mines Saint-Etienne, INSERM, U1059 Sainbiose, 42023, Saint-Etienne, France.
- Intensive Care Unit G, Saint Etienne University Hospital, North Hospital, UMR INSERM U1059, Avenue Albert Raymond, 42270, Saint Priest en Jarez, France.
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Lucas JA, Marino M, Bailey SR, Hsu A, Datta R, Cottrell E, Kim YJ, Suglia SF, Bazemore A, Heintzman J. Comparison of associations of household-level and neighbourhood-level poverty markers with paediatric asthma care utilisation by race/ethnicity in an open cohort of community health centre patients. Fam Med Community Health 2023; 11:e001760. [PMID: 37524521 PMCID: PMC10391793 DOI: 10.1136/fmch-2022-001760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE The objective of this research was to examine how different measurements of poverty (household-level and neighborhood-level) were associated with asthma care utilisation outcomes in a community health centre setting among Latino, non-Latino black and non-Latino white children. DESIGN, SETTING AND PARTICIPANTS We used 2012-2017 electronic health record data of an open cohort of children aged <18 years with asthma from the OCHIN, Inc. network. Independent variables included household-level and neighborhood-level poverty using income as a percent of federal poverty level (FPL). Covariate-adjusted generalised estimating equations logistic and negative binomial regression were used to model three outcomes: (1) ≥2 asthma visits/year, (2) albuterol prescription orders and (3) prescription of inhaled corticosteroids over the total study period. RESULTS The full sample (n=30 196) was 46% Latino, 26% non-Latino black, 31% aged 6-10 years at first clinic visit. Most patients had household FPL <100% (78%), yet more than half lived in a neighbourhood with >200% FPL (55%). Overall, neighbourhood poverty (<100% FPL) was associated with more asthma visits (covariate-adjusted OR 1.26, 95% CI 1.12 to 1.41), and living in a low-income neighbourhood (≥100% to <200% FPL) was associated with more albuterol prescriptions (covariate-adjusted rate ratio 1.07, 95% CI 1.02 to 1.13). When stratified by race/ethnicity, we saw differences in both directions in associations of household/neighbourhood income and care outcomes between groups. CONCLUSIONS This study enhances understanding of measurements of race/ethnicity differences in asthma care utilisation by income, revealing different associations of living in low-income neighbourhoods and households for Latino, non-Latino white and non-Latino black children with asthma. This implies that markers of family and community poverty may both need to be considered when evaluating the association between economic status and healthcare utilisation. Tools to measure both kinds of poverty (family and community) may already exist within clinics, and can both be used to better tailor asthma care and reduce disparities in primary care safety net settings.
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Affiliation(s)
- Jennifer A Lucas
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Steffani R Bailey
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Audree Hsu
- California University of Science and Medicine, Colton, California, USA
| | - Roopradha Datta
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Ye Ji Kim
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Shakira F Suglia
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - John Heintzman
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
- OCHIN Inc, Portland, Oregon, USA
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Rafique Z, Budden J, Quinn CM, Duanmu Y, Safdar B, Bischof JJ, Driver BE, Herzog CA, Weir MR, Singer AJ, Boone S, Soto-Ruiz KM, Peacock WF. Patiromer utility as an adjunct treatment in patients needing urgent hyperkalaemia management (PLATINUM): design of a multicentre, randomised, double-blind, placebo-controlled, parallel-group study. BMJ Open 2023; 13:e071311. [PMID: 37308268 PMCID: PMC10277034 DOI: 10.1136/bmjopen-2022-071311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/11/2023] [Indexed: 06/14/2023] Open
Abstract
INTRODUCTION Hyperkalaemia is common, life-threatening and often requires emergency department (ED) management; however, no standardised ED treatment protocol exists. Common treatments transiently reducing serum potassium (K+) (including albuterol, glucose and insulin) may cause hypoglycaemia. We outline the design and rationale of the Patiromer Utility as an Adjunct Treatment in Patients Needing Urgent Hyperkalaemia Management (PLATINUM) study, which will be the largest ED randomised controlled hyperkalaemia trial ever performed, enabling assessment of a standardised approach to hyperkalaemia management, as well as establishing a new evaluation parameter (net clinical benefit) for acute hyperkalaemia treatment investigations. METHODS AND ANALYSIS PLATINUM is a Phase 4, multicentre, randomised, double-blind, placebo-controlled study in participants who present to the ED at approximately 30 US sites. Approximately 300 adult participants with hyperkalaemia (K+ ≥5.8 mEq/L) will be enrolled. Participants will be randomised 1:1 to receive glucose (25 g intravenously <15 min before insulin), insulin (5 units intravenous bolus) and aerosolised albuterol (10 mg over 30 min), followed by a single oral dose of either 25.2 g patiromer or placebo, with a second dose of patiromer (8.4 g) or placebo after 24 hours. The primary endpoint is net clinical benefit, defined as the mean change in the number of additional interventions less the mean change in serum K+, at hour 6. Secondary endpoints are net clinical benefit at hour 4, proportion of participants without additional K+-related medical interventions, number of additional K+-related interventions and proportion of participants with sustained K+ reduction (K+ ≤5.5 mEq/L). Safety endpoints are the incidence of adverse events, and severity of changes in serum K+ and magnesium. ETHICS AND DISSEMINATION A central Institutional Review Board (IRB) and Ethics Committee provided protocol approval (#20201569), with subsequent approval by local IRBs at each site, and participants will provide written consent. Primary results will be published in peer-reviewed manuscripts promptly following study completion. TRIAL REGISTRATION NUMBER NCT04443608.
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Affiliation(s)
- Zubaid Rafique
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA
| | | | | | - Youyou Duanmu
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Basmah Safdar
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jason J Bischof
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Brian E Driver
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Charles A Herzog
- Division of Cardiology, Department of Internal Medicine, Hennepin Healthcare/University of Minnesota, Minneapolis, Minnesota, USA
| | - Matthew R Weir
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Adam J Singer
- Department of Emergency Medicine, SUNY Stony Brook, Stony Brook, New York, USA
| | - Stephen Boone
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA
| | | | - W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA
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Matthews PJ, Ader DR, Harrison CK, Ostahowski PJ, Nomura JT. The Safety, Efficacy, and Expediency of Albuterol Nebulizer Administration by BLS Providers. Prehosp Disaster Med 2023; 38:149-152. [PMID: 36856022 DOI: 10.1017/s1049023x23000249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
INTRODUCTION Many Emergency Medical Service (EMS) systems in the United States restrict albuterol therapy by scope of practice to Advanced Life Support (ALS). The State of Delaware has a two-tiered EMS system in which Basic Life Support (BLS) arrives on scene prior to ALS in the majority of respiratory distress calls. STUDY OBJECTIVE This study sought to evaluate the safety, efficacy, and expedience of albuterol administration by BLS compared to ALS. METHODS This retrospective observational study used data collected from July 2015 through January 2017 throughout a State BLS albuterol pilot program. Pilot BLS agencies participated in a training session on the indications and administration of albuterol, and were then authorized to carry and administer nebulized albuterol. Heart rate (HR), respiratory rate (RR), and pulse oximetry (spO2) were obtained before and after albuterol administration by BLS and ALS. The times from BLS arrival to the administration of albuterol by pilot BLS agencies versus ALS were compared. Study encounters required both BLS and ALS response. Data were analyzed using chi-square and t-test as appropriate. RESULTS Three hundred eighty-eight (388) incidents were reviewed. One hundred eighty-five (185) patients received albuterol by BLS pilot agencies and 203 patients received albuterol by ALS. Of note, the population treated by ALS was significantly older than the population treated by BLS (61.9 versus 51.6 years; P <.001). A comparison of BLS arrival time to albuterol administration time showed significantly shorter times in the BLS pilot group compared to the ALS group (3.50 minutes versus 8.00 minutes, respectively; P <.001). After albuterol administration, BLS pilot patients showed improvements in HR (P <.01), RR (P <.01), and spO2 (P <.01). Alternately, ALS treatment patients showed improvement in spO2 (P <.01) but not RR (P = .17) or HR (P = 1.00). Review by ALS or hospital staff showed albuterol was indicated in 179 of 185 BLS patients and administered correctly in 100% of these patients. CONCLUSION Patients both received albuterol significantly sooner and showed superior improvements in vital signs when treated by BLS agencies carrying albuterol rather than by BLS agencies who required ALS arrival for albuterol. Two-tiered EMS systems should consider allowing BLS to carry and administer albuterol for safe, effective, and expedient treatment of respiratory distress patients amenable to albuterol therapy.
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Affiliation(s)
- Patrick J Matthews
- Christiana Care Health System, Newark, DelawareUSA
- Delaware Office of Emergency Medical Services, Smyrna, DelawareUSA
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Gu X, Wang K, Tian S, Shao X, Li J, Deng A. A SERS/electrochemical dual-signal readout immunosensor using highly-ordered Au/Ag bimetallic cavity array as the substrate for simultaneous detection of three β-adrenergic agonists. Talanta 2023; 254:124159. [PMID: 36470022 DOI: 10.1016/j.talanta.2022.124159] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/27/2022] [Accepted: 11/29/2022] [Indexed: 12/02/2022]
Abstract
A surface-enhanced Raman scattering (SERS)/electrochemical dual-signal readout immunosensor was developed for simultaneous detection of β-adrenergic agonists salbutamol (SAL), ractopamine (RAC) and phenylethanolamine A (PA). The highly-ordered gold/silver bimetallic cavity array (BMCA) was prepared by electrodepositing Au/Ag nanoparticles to the interstice of highly ordered close-packed polystyrene templates. After electrochemical and SERS characterization, the BMCA was used as the substrate for constructing SERS/electrochemical dual-signal readout immunosensor. 3,3',5,5'-tetramethylbenzidine (TMB), methylene blue (MB) and Nile blue (NB) were selected as the dual-signal reporters, and hybridization chain reaction (HCR) was used as the signal amplifier. The immunoprobe was prepared by absorption of the antibody (Ab) and constructing HCR system embedded with electro/SERS reporter on Au nanoparticles (NPs). After competitive immuno-reaction between coating antigen and analyte for limited Ab on immunoprobe, the SERS/electrochemical dual-signals on BMCA were measured for quantitatively detecting SAL, RAC and PA simultaneously. SAL, RAC and PA were detected in concentration range of 1 pg mL-1 to 100 ng mL-1 with LOD of 0.8, 0.4, and 1.3 pg mL-1, respectively. The applicability of the proposed immunosensor in spiked pork liver samples was verified by the recovery of 95.0%-108.5% with RSD of 6.9%-10.7%. It was proven that the immunosensor was able to detect multiple β-adrenergic agonists with high sensitivity, specificity, accuracy and precision. The immunosensor can be used as a platform for the determination of other small molecular compounds in biological, food and environmental analytical fields.
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Affiliation(s)
- Xuefang Gu
- The Key Lab of Health Chemistry & Molecular Diagnosis of Suzhou, College of Chemistry, Chemical Engineering & Materials Science, Soochow University, Suzhou, 215123, China; School of Chemistry and Chemical Engineering, Nantong University, Nantong, 226007, Jiangsu, PR China
| | - Kaiyue Wang
- School of Chemistry and Chemical Engineering, Nantong University, Nantong, 226007, Jiangsu, PR China
| | - Shu Tian
- School of Chemistry and Chemical Engineering, Nantong University, Nantong, 226007, Jiangsu, PR China.
| | - Xinyi Shao
- School of Chemistry and Chemical Engineering, Nantong University, Nantong, 226007, Jiangsu, PR China
| | - Jianguo Li
- The Key Lab of Health Chemistry & Molecular Diagnosis of Suzhou, College of Chemistry, Chemical Engineering & Materials Science, Soochow University, Suzhou, 215123, China.
| | - Anping Deng
- The Key Lab of Health Chemistry & Molecular Diagnosis of Suzhou, College of Chemistry, Chemical Engineering & Materials Science, Soochow University, Suzhou, 215123, China.
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Shao H, Ren Y, Lei C, Xu G. Electron beam degradation of the cardiovascular drug salbutamol: Mechanisms and degradation pathways. Chemosphere 2023; 318:137939. [PMID: 36702419 DOI: 10.1016/j.chemosphere.2023.137939] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/20/2023] [Accepted: 01/21/2023] [Indexed: 06/18/2023]
Abstract
With the increasing incidence and mortality of cardiovascular diseases, high consumption of the cardiovascular drug salbutamol (SAL) has made this compound an emerging pollutant in natural water and a challenge for traditional wastewater treatment. In this paper, an efficient advanced oxidation process was used to degrade SAL by electron beam (EB) irradiation. The results revealed that 100 mg L-1 of SAL could be nearly completely removed (95.1%) at 10 kGy and the degradation kinetic well followed pseudo first-order kinetic model. Different factors, including pH, inorganic ions and water matrix, had varying effects on the degradation of SAL owing to their important influence on the formation of reactive species in the aqueous solution. And it was found that eaq- played a major role in the degradation of SAL parent. Moreover, the addition of K2S2O8 (20 mM) increased the SAL mineralization rate from 2.9% to 64.2%, suggesting that oxidation free radicals could greatly improve the mineralization rate of SAL. Combining with the theoretical calculations and determined degradation by-products, four possible degradation pathways of SAL by EB irradiation were proposed, including H•, •OH and eaq- all participated in the degradation of SAL. Finally, toxicity evaluation suggested that the toxicity of SAL aqueous solution reduced after EB irradiation, indicating that it is an effective method to degrade SAL.
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Affiliation(s)
- Haiyang Shao
- School of Environmental and Chemical Engineering, Shanghai University, 99 Shangda Road, Shanghai, 200444, PR China
| | - Yingfei Ren
- School of Environmental and Chemical Engineering, Shanghai University, 99 Shangda Road, Shanghai, 200444, PR China
| | - Chen Lei
- School of Environmental and Chemical Engineering, Shanghai University, 99 Shangda Road, Shanghai, 200444, PR China
| | - Gang Xu
- School of Environmental and Chemical Engineering, Shanghai University, 99 Shangda Road, Shanghai, 200444, PR China; Key Laboratory of Organic Compound Pollution Control Engineering, Ministry of Education, Shanghai, 200444, PR China.
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Ohno K, Ohkawara B, Shen XM, Selcen D, Engel AG. Clinical and Pathologic Features of Congenital Myasthenic Syndromes Caused by 35 Genes-A Comprehensive Review. Int J Mol Sci 2023; 24:ijms24043730. [PMID: 36835142 PMCID: PMC9961056 DOI: 10.3390/ijms24043730] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/09/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Congenital myasthenic syndromes (CMS) are a heterogeneous group of disorders characterized by impaired neuromuscular signal transmission due to germline pathogenic variants in genes expressed at the neuromuscular junction (NMJ). A total of 35 genes have been reported in CMS (AGRN, ALG14, ALG2, CHAT, CHD8, CHRNA1, CHRNB1, CHRND, CHRNE, CHRNG, COL13A1, COLQ, DOK7, DPAGT1, GFPT1, GMPPB, LAMA5, LAMB2, LRP4, MUSK, MYO9A, PLEC, PREPL, PURA, RAPSN, RPH3A, SCN4A, SLC18A3, SLC25A1, SLC5A7, SNAP25, SYT2, TOR1AIP1, UNC13A, VAMP1). The 35 genes can be classified into 14 groups according to the pathomechanical, clinical, and therapeutic features of CMS patients. Measurement of compound muscle action potentials elicited by repetitive nerve stimulation is required to diagnose CMS. Clinical and electrophysiological features are not sufficient to identify a defective molecule, and genetic studies are always required for accurate diagnosis. From a pharmacological point of view, cholinesterase inhibitors are effective in most groups of CMS, but are contraindicated in some groups of CMS. Similarly, ephedrine, salbutamol (albuterol), amifampridine are effective in most but not all groups of CMS. This review extensively covers pathomechanical and clinical features of CMS by citing 442 relevant articles.
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Affiliation(s)
- Kinji Ohno
- Division of Neurogenetics, Center for Neurological Diseases and Cancer, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
- Correspondence: (K.O.); (A.G.E.)
| | - Bisei Ohkawara
- Division of Neurogenetics, Center for Neurological Diseases and Cancer, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Xin-Ming Shen
- Department of Neurology and Neuromuscular Research Laboratory, Mayo Clinic, Rochester, MN 55905, USA
| | - Duygu Selcen
- Department of Neurology and Neuromuscular Research Laboratory, Mayo Clinic, Rochester, MN 55905, USA
| | - Andrew G. Engel
- Department of Neurology and Neuromuscular Research Laboratory, Mayo Clinic, Rochester, MN 55905, USA
- Correspondence: (K.O.); (A.G.E.)
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Kabra VD, Lahoti SR, Sugandhi VV. Development of Novel Spray-dried Microparticles to Treat Cystic Fibrosis: A Tri-drug Approach. Recent Adv Drug Deliv Formul 2023; 17:286-299. [PMID: 38018213 DOI: 10.2174/0126673878245506231031124020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 09/05/2023] [Accepted: 09/25/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Cystic fibrosis is the predominant autosomal recessive disorder known to reduce life expectancy. Research findings indicate that around 60 to 70% of adult individuals with this condition carry infections of Pseudomonas aeruginosa. OBJECTIVE The ongoing research investigates the potential synergy of merging ivacaftor and ciprofloxacin to address bacterial infections. METHODS The two drugs were spray-dried into microparticles, which were then coated with Lsalbutamol and were to be delivered by a dry powder inhaler. Microparticles were generated by applying the spray drying method, utilizing bovine serum albumin and L-leucine in their preparation. Additionally, L-salbutamol was mixed and adsorbed onto the surface of the spray-dried microparticles, and it acted as a bronchodilator. RESULTS The microparticles produced via spray drying exhibited a particle size measuring 1.6 ± 0.04 μm, along with a polydispersity ratio of 0.33. Their zeta potential measured -27.3 ± 1.1 mV, while the mass median aerodynamic diameter of these microparticles was 3.74 ± 0.08 μm. SEM, XRD, and FTIR studies confirmed the entrapment of ivacaftor and ciprofloxacin. The morphology was observed by SEM and TEM scans. Antibacterial synergy was confirmed through the agar broth and dilution method, and the formulation's safety was established based on the outcomes of the MTT assay. CONCLUSION Using spray-dried microparticles containing ciprofloxacin, ivacaftor, and L-salbutamol presents a novel approach to the treatment of cystic fibrosis.
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Affiliation(s)
- Vinayak D Kabra
- Y. B. Chavan College of Pharmacy, Roza Bagh, Aurangabad, MH, 431001, India
| | - Swaroop R Lahoti
- Y. B. Chavan College of Pharmacy, Roza Bagh, Aurangabad, MH, 431001, India
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Abstract
Docking protein 7 (DOK7) congenital myasthenic syndrome (CMS) is characterized by limb-girdle weakness and lack of fluctuating fatigability simulating many familial myopathies. Albuterol is the first line of therapy in view of consistent improvement. Two brothers with progressive predominant biceps weakness for 1-3 years responded to prednisone treatment for 40-50 years. Various studies including muscle biopsy and many laboratory studies were unsuccessful for the definite diagnosis. Gene study, 40 years after the initial evaluation, confirmed the diagnosis of DOK7 CMS. These are the first reported cases of DOK7 CMS associated with a sustained benefit from corticosteroids.
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Affiliation(s)
- Shin J Oh
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL; and
| | - Peter H King
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL; and
| | - Alice Schindler
- Neurogenetics Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
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Willis LD, Danner NP, Lloyd TL, Carper NL, Berlinski A. Safe and Effective Use of Score-Based Continuous Albuterol Therapy in a Pathway for Treatment of Pediatric Asthma Exacerbation. Respir Care 2022; 67:1396-1404. [PMID: 35944965 PMCID: PMC9993962 DOI: 10.4187/respcare.10083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Standardized acute asthma management with score-based, respiratory therapist (RT)-driven pathways and protocols improves outcomes including decreased length of stay (LOS) and time on continuous albuterol therapy. Limited data are available for the safety of continuous albuterol used outside of pediatric ICU (PICU). We use a modified pediatric asthma score (PAS) for the asthma pathway at our institution. The safety and effectiveness of using PAS to initiate/stop continuous albuterol as part of a score-based, RT-driven asthma pathway were evaluated. METHODS A retrospective review of children ≥ 2 y admitted for asthma exacerbation to the PICU and step-down unit who received continuous albuterol as part of the asthma pathway during 2017-2019 was completed. Demographic and clinical data were extracted including PAS, dose and duration of continuous albuterol, LOS, and complications. Outcomes of subjects admitted to the PICU and step-down unit were compared. RESULTS Results are expressed as median (interquartile range). The study included 412 children (61% male, 59.9% Black, 92.7% non-Hispanic, 44.9% moderate persistent asthma) with age and weight of 6.4 (4.0-10.0) y and 24.8 (17.3-39.5) kg, respectively. Most children were admitted to step-down unit (71.1%). Initial albuterol dose, duration, and LOS were 15 (10-20) mg/h, 9.1 (5.7-16.0) h, and 1.4 (0.9-2.3) d, respectively. Respiratory support was required by 29% of subjects. Need to restart therapy (2.9%), transfer to PICU (1.7%), and intubation (0.5%) were infrequent. No pneumothoraces or deaths were reported. Emergency department visits (3.9%) or readmissions (0.7%) within 30 d of discharge were low. Subjects admitted to the PICU were sicker and required more therapies and respiratory support than those admitted to the step-down unit. CONCLUSIONS Use of an RT-driven, score-based pathway for initiation and discontinuation of continuous albuterol for treatment of pediatric asthma exacerbation was safe and effective in the PICU and step-down unit.
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Affiliation(s)
- L Denise Willis
- Respiratory Care Services, Arkansas Children's Hospital, Little Rock, Arkansas
| | - Nikki P Danner
- Respiratory Care Services, Arkansas Children's Hospital, Little Rock, Arkansas
| | - Tera L Lloyd
- Respiratory Care Services, Arkansas Children's Hospital, Little Rock, Arkansas
| | - Naisha L Carper
- Respiratory Care Services, Arkansas Children's Hospital, Little Rock, Arkansas
| | - Ariel Berlinski
- Department of Pediatrics, University of Arkansas for Medical Sciences, College of Medicine, Little Rock, Arkansas; and Pediatric Aerosol Research Laboratory, Arkansas Children's Research Institute, Little Rock, Arkansas.
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Kosoko AA, Khoei AA, Khose S, Genisca AE, Mackey JM. Evaluating the Clinical Impact of a Novel Pediatric Emergency Medicine Curriculum on Asthma Outcomes in Belize. Pediatr Emerg Care 2022; 38:598-604. [PMID: 36314861 PMCID: PMC9640288 DOI: 10.1097/pec.0000000000002850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Respiratory-related complaints prompt most pediatric visits to Karl Heusner Memorial Hospital Authority's (KHMHA) Emergency Department (ED) in Belize. We developed and taught a novel pediatric respiratory emergencies module for generalist practitioners there. We assessed the curriculum's clinical impact on pediatric asthma emergency management. OBJECTIVE This study assesses the clinical impact of a pediatric emergency medicine curriculum on management of pediatric asthma emergencies at KHMHA in Belize City, Belize. METHODS We conducted a randomized chart review of pediatric (aged 2-16 y) visits for asthma-related diagnosis at the KHMHA ED between 2015 and 2018 to assess the training module's clinical impact. Primary outcomes included time to albuterol and steroids. Secondary outcomes included clinical scoring tool (Pediatric Respiratory Assessment Measure [PRAM]) usage, ED length of stay, usage of chest radiography, return visit within 7 days, and hospital admission rates. Kaplan-Meier survival analysis and Cox proportional hazard regression were used. RESULTS Two hundred eighty-three pediatric asthma-related diagnoses met our inclusion criteria. The patients treated by trained and untrained physician groups were demographically and clinically similar. The time to albuterol was significantly faster in the trained (intervention) group compared with the untrained (control) physician group when evaluating baseline of the group posttraining (P < 0.05). However, the time to steroids did not reach statistical significance posttraining (P = 0.93). The PRAM score utilization significantly increased among both control group and intervention group. The untrained physician group was more likely to use chest radiography or admit patients. The trained physician group had higher return visit rates within 7 days and shorter ED length of stay, but this did not reach statistical significance. CONCLUSIONS The curriculum positively impacted clinical outcomes leading to earlier albuterol administration, increased PRAM score use, obtaining less chest radiographs, and decreased admission rates. The timeliness of systemic steroid administration was unaffected.
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Affiliation(s)
- Adeola A. Kosoko
- From the Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | | | - Swapnil Khose
- From the Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | - Alicia E. Genisca
- Departments of Emergency Medicine and Pediatrics, The Warren Alpert Medical School of Medicine, Brown University/Hasbro Children's Hospital, Providence, RI
| | - Joy M. Mackey
- Henry J.N. Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX
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