In-situ biofabrication of bacterial nanocellulose (BNC)/graphene oxide (GO) nano-biocomposite and study of its cationic dyes adsorption properties

In the present study, bacterial nanocellulose/graphene oxide nano-biocomposites (BNC-GO-NBCs) were fabricated by Komagataeibacter saccharivorans NUWB1 using an in-situ method involving three time-dependent approaches. Physicochemical studies showed that the chosen dried BNC-GO-NBC possessed a three-dimensional interconnected porous structure of BNC with GO layers embedded within the BNC fibrils. BNC-GO-NBC had a crystallinity index of 74.21 %, higher thermostability up to 380 °C and could withstand a tensile load of 84.72 MPa. N2 adsorption-desorption isotherm of the BNC-GO-NBC was found to be of type IV, suggesting a mesoporous type structure with a total pore volume and surface area of 6.232e-04 cc g-1 and 10.498 m2. BNC-GO-NBC exhibited remarkable adsorption capacity for two cationic dyes, Rhodamine B (RhB) and Acridine Orange (AO), and the adsorption data conformed well to the Langmuir isotherm (R2 = 0.99) and pseudo-second-order model. Thermodynamic studies indicated that the adsorption process was spontaneous and endothermic. Additionally, the BNC-GO-NBC displayed the potential for regeneration, with the ability to be recycled up to five times. Further, the antibacterial activity, cell cytotoxicity and oxidative stress assays of the BNC-GO-NBC revealed its non-cytotoxic nature. The findings of the present investigation evidently suggest the potentiality of BNC-GO-NBC in the application of dye adsorption and other environmental applications.

DLTN-LOSP: A Novel Deep-Linear-Transition-Network-Based Resource Allocation Model with the Logic Overhead Security Protocol for Cloud Systems

Cloud organizations now face a challenge in managing the enormous volume of data and various resources in the cloud due to the rapid growth of the virtualized environment with many service users, ranging from small business owners to large corporations. The performance of cloud computing may suffer from ineffective resource management. As a result, resources must be distributed fairly among various stakeholders without sacrificing the organization's profitability or the satisfaction of its customers. A customer's request cannot be put on hold indefinitely just because the necessary resources are not available on the board. Therefore, a novel cloud resource allocation model incorporating security management is developed in this paper. Here, the Deep Linear Transition Network (DLTN) mechanism is developed for effectively allocating resources to cloud systems. Then, an Adaptive Mongoose Optimization Algorithm (AMOA) is deployed to compute the beamforming solution for reward prediction, which supports the process of resource allocation. Moreover, the Logic Overhead Security Protocol (LOSP) is implemented to ensure secured resource management in the cloud system, where Burrows-Abadi-Needham (BAN) logic is used to predict the agreement logic. During the results analysis, the performance of the proposed DLTN-LOSP model is validated and compared using different metrics such as makespan, processing time, and utilization rate. For system validation and testing, 100 to 500 resources are used in this study, and the results achieved a make-up of 2.3% and a utilization rate of 13 percent. Moreover, the obtained results confirm the superiority of the proposed framework, with better performance outcomes.

Systemic immunosuppressive therapies for children with refractory atopic dermatitis: a large real-life cohort study

Systemic immunosuppressants are used off-label to treat paediatric patients with moderate-to severe atopic dermatitis (AD) for whom topical treatment has failed. A large real-life cohort of paediatric patients with AD treated with systemic immunosuppressive treatments is described in order to guide dermatologists’ prescribing practices when faced with a moderate to-severe AD paediatric patient who has failed or has a contraindication to topical treatment, phototherapy, biological agents or Janus kinase inhibitors.

Knock-out of vasotocin reduces reproductive success in female zebrafish, Danio rerio

The vertebrate nonapeptide vasotocin/vasopressin is evolutionarily highly conserved and acts as neuromodulator and endocrine/paracrine signaling molecule. Circumstantial and mechanistic evidence from pharmacological manipulations of the vasotocin system in several teleost fishes suggest sex- and species-specific reproductive roles of vasotocin. While effects of vasotocin on teleost reproductive physiology involve both courtship behaviors and the regulation of the hypothalamic-pituitary-gonadal (HPG) axes, comprehensive studies investigating behavioral and physiological reproductive consequences of genetic ablation of vasotocin in a genetically tractable fish model, such as the zebrafish, are currently lacking. Here, we report the generation of homozygous CRISPR/Cas9-based vasotocin gene knock-out zebrafish. Breeding pairs of vasotocin knock-out fish produce significantly fewer fertilized eggs per clutch compared to wildtype fish, an effect coincident with reduced female quivering courtship behavior. Crossbreeding experiments reveal that this reproductive phenotype is entirely female-dependent, as vasotocin-deficient males reproduce normally when paired with female wild-type fish. Histological analyses of vasotocin knock-out ovaries revealed an overall reduction in oocytes and differential distribution of oocyte maturation stages, demonstrating that the reproductive phenotype is linked to oocyte maturation and release. Ovarian hormone quantification and gene expression analysis in mutant fish indicated reduced synthesis of Prostaglandin F2α, a hormone involved in ovarian maturation, egg release and regulation of female courtship behavior in some cyprinids. However, acute injection of vasotocin did not rescue the female mutant reproductive phenotype, suggesting a contribution of organizational effects of vasotocin. Together, this study provides further support for emerging roles of vasotocin in female teleost reproduction in an important teleost model species.

Biological therapy for severe asthma - Indian perspectives and challenges

Asthma is a complex and heterogeneous disease. Severe asthma makes up only a minority of asthma patients encountered in clinical settings but accounts for substantial healthcare utilisation in terms of manpower as well as economic allocation. The availability of monoclonal antibodies has a major impact on severe asthmatics and has provided excellent clinical results in properly selected patients. The discovery of new molecules might present uncertainties to clinicians as to the best agent to institute in an individual patient. The practice scenario in India is unique when it comes to the commercial availability of monoclonal antibodies, patient attitudes, and allocation of the healthcare budget. The present review dissects and summarises the available monoclonal antibodies for asthma treatment in India, the perspectives of Indian patients on biological therapy, and the challenges encountered by patients and physicians in this regard. We provide practical suggestions for utilising monoclonal antibodies and deciding on the optimal agent for a given patient.

Pneumothorax ex vacuo: Three cases of an uncommon entity

Pneumothorax is a frequently encountered entity in pulmonary practice and can be primary or secondary. Traumatic and iatrogenic causes also account for a minority of cases presenting to the chest physician. The most common therapeutic intervention done is a tube thoracostomy in all but the mildest of cases. Pneumothorax ex vacuo is a distinctly uncommon entity that differs considerably from the rest of the pneumothorax cases in its pathogenesis, clinical manifestations, radiological findings, and management. Pneumothorax in this entity results from the sucking in of air into the pleural space caused by an exaggerated negative intrapleural pressure, which is most frequently secondary to acute lobar collapse. Symptoms attributable to pneumothorax per se are distinctly mild and the vital aspect of treatment is to relieve the bronchial obstruction. Tube thoracostomy fails to relieve the pneumothorax in such cases and should be avoided. We share three cases of pneumothorax ex vacuo encountered in our institution and alert clinicians of the presentation, radiology, and management of this uncommon condition.

Hospitalisation Outcomes in Pneumococcal VaccinatedVersusUnvaccinated Patients with Exacerbation of COPD – Results From TheHOPE COPD Study

Background

Infectious exacerbations are crucial events that dictate the natural course of COPD patients. Pneumococcal vaccination has shown to decrease incidence of community acquired pneumonia in COPD patients. There is paucity of data on outcomes of hospitalisation in pneumococcal vaccinated COPD patients in comparison with unvaccinated subjects.

Objectives

To evaluate the difference in hospitalisation outcomes in pneumococcal vaccinatedversusunvaccinated COPD subjects hospitalized with Acute Exacerbation.

Methods

This was a prospective analytical study on 120 subjects hospitalised with acute COPD exacerbation. 60 patients with prior pneumococcal vaccination and 60 unvaccinated patients were recruited. Outcomes of hospitalisation like mortality rate, need for assisted ventilation, length of hospital stay, need for ICU care, and length of ICU stay were collected and compared between two groups with appropriate statistical tools.

Results

60% of unvaccinated patients (36/60) required assisted ventilation whereas only 43.3% of vaccinated subjects (26/60) needed assisted ventilation (p value 0.04). Most of the secondary outcomes were better in the vaccinated group. The mean length of ICU stay in the vaccinated group was 0.67 days (±1.11) compared to 1.77 (± 1.89) in the unvaccinated group. The mean length of hospital stay was 4.50 days (±1.64) and 5.47 days (±2.03) days in vaccinated and unvaccinated group respectively (p value 0.005).

Conclusions

COPD patients who have received prior pneumococcal vaccination have better outcomes when they are hospitalised for an acute exacerbation. Pneumococcal vaccination may be recommended for all patients with COPD who are at risk of hospitalisation with acute exacerbation.

Development and Validation of Stability Indicating RP-HPLC Method for Quantitative Estimation of Tofacitinib in Tofacitinib Tablets Dosage Form

Aim: The main intention of the research work is to develop an effective, sensitive, economical and uncomplicated reverse phase HPLC technique for the estimation of Tofacitinib in Tofacitinib tablets dosage form. Study Design: HPLC based quantification studies. Place and Duration of Study: Department of Chemistry, Acharya Nagarjuna University, Nagarjuna Nagar, Guntur, Andhra Pradesh, between August 2022 and November 2022. Methodology: Estimation of Tofacitinib in Tofacitinib tablets dosage form. The separation was achieved by using a stationary phase Kromasil C18 (150 x 4.6 mm, 5µ) and the mobile phase consisted of pH 4.0 phosphate buffer and acetonitrile in the ratio of (80:20 volume/volume). The flow rate was 1.5 mL/min. Tofacitinib was detected using UV detector at the wavelength of 215 nm. Column temperature 25°C and sample temperature 25°C and injection volume 20µL, run time was 20 minutes. Results: As there is no meddling between blank and placebo at the retention time of Tofacitinib. Degradation study results were shown significant degradation was observed in alkali (base) stress condition. Hence it can be concluded that Tofacitinib is sensitive to alkali. To obtain system exactitude, a study was conducted with six replicate injections. %RSD was estimated from the peak areas of Tofacitinib found to be 0.16% respectively. The relative standard deviation for method exactitude was found to be 5 mg and 10 mg is 0.26% and 0.75%. The proposed HPLC technique was linear over the range of 24.88-74.64 µg/mL, the correlation coefficient was found to be 1.0000. The accuracy studies were shown as % recovery for Tofacitinib 50% to150% level. The limit of % recovered shown is in the range of 98 and 102% and the results obtained were found to be within the limits. Hence the method was found to be accurate. The solution stability of the standard and samples are stable upto 48 hrs on a bench top and refrigerator (2-8°C). The technique is robust for changes like flow rate, column oven temperature, pH variation and the organic phase of the mobile phase. Performed the filter validation for sample solution 0.45 µm PVDF filterers are suitable for filtration. The technique has authenticated as per ICH instructions and all the validation parameters are satisfy the ICH Q2 specification acceptance limits. Conclusion: The urbanized technique was validated for various parameters as per ICH guidelines like accuracy, precision, linearity, specificity, system suitability, solution stability and robustness. The results obtained were within the acceptance criteria. So, it can be concluded that the developed method is simple, precise, cost-effective, eco-friendly, and safe and can be successfully employed for the routine analysis of Tofacitinib in bulk and pharmaceutical dosage forms.

Determination of Genotoxic Impurities N-nitrosamine's in Efavirenz Drug Substance Using Rp-Hplc Technique

Aim: The main purpose of the research is to  develop a effective, sensitive, economical and simple reverse phase HPLC method for the determination of genotoxic N-Nitrosamine's impurities in Efavirenz drug substance. Study Design: HPLC based quantification studies Place and Duration of Study: Department of Chemistry, Acharya Nagarjuna University, Guntur, Andhra Pradesh between April 2022 and August 2022. Methodology: Determination of genotoxic N-Nitrosamine's in Efavirenz drug substance. N-Nitrosamine's impurities were determined by RP-HPLC method using Zorbax SB C18 (150x4.6mm, 3.5µ) column as stationary phase. Column temperature maintained 25°C, injection volume 20 µL, flow rate 1.0 mL/min and sample cooler temperature 5°C and run time was 15 minutes.  The mixture of 0.1% formic acid buffer and methanol in the ratio of 50:950 (v/v) was used as mobile phase. wavelength 240 nm. respectively. Results:  There is no interference of blank at N-Nitrosamine's impurities peaks. The elution order and the retention times of impurities and Efavirenz obtained from individual standard preparations and mixed standard preparations are comparable. The limit of detection (LOD) and limit of quantitation (LOQ) for NDMA 0.03 & 0.09 µg/mL, NDEA 0.02 & 0.06 µg/mL  and NDIPA 0.03 & 0.09 µg/mL respectively. The linearity results for N-Nitrosamine's impurities in the specified concentration range are found satisfactory, with a correlation coefficient greater than 0.99.Calibration curve was plotted and correlation co-efficient for impurities found to be 1.000, 1.000 and 1.000 respectively. The accuracy studies were shown as %recovery for N-Nitrosamine's impurities at specification level. The limit of % recovered shown is in the range of 80 and 120% and the results obtained were found to be within the limits. Hence the method was found to be accurate. The technique has been validated in accordance with ICH rules, and all validation parameters meet the acceptance criteria of the ICH Q2 specification. Conclusion:  According to ICH guidelines, an RP-HPLC method that can assess genotoxic Nitrosoamines in Efavirenz at trace level concentration has been established. The method's specificity, precision, linearity, and accuracy ensured its efficacy. As a result, the technique is appropriate for the goals it was designed to achieve and can be successfully used for release testing of efavirenz into the market.

Reproductive roles of the vasopressin/oxytocin neuropeptide family in teleost fishes

The vertebrate nonapeptide families arginine vasopressin (AVP) and oxytocin (OXT) are considered to have evolved from a single vasopressin-like peptide present in invertebrates and termed arginine vasotocin in early vertebrate evolution. Unprecedented genome sequence availability has more recently allowed new insight into the evolution of nonapeptides and especially their receptor families in the context of whole genome duplications. In bony fish, nonapeptide homologues of AVP termed arginine vasotocin (Avp) and an OXT family peptide (Oxt) originally termed isotocin have been characterized. While reproductive roles of both nonapeptide families have historically been studied in several vertebrates, their roles in teleost reproduction remain much less understood. Taking advantage of novel genome resources and associated technological advances such as genetic modifications in fish models, we here critically review the current state of knowledge regarding the roles of nonapeptide systems in teleost reproduction. We further discuss sources of plasticity of the conserved nonapeptide systems in the context of diverse reproductive phenotypes observed in teleost fishes. Given the dual roles of preoptic area (POA) synthesized Avp and Oxt as neuromodulators and endocrine/paracrine factors, we focus on known roles of both peptides on reproductive behaviour and the regulation of the hypothalamic-pituitary-gonadal axis. Emphasis is placed on the identification of a gonadal nonapeptide system that plays critical roles in both steroidogenesis and gamete maturation. We conclude by highlighting key research gaps including a call for translational studies linking new mechanistic understanding of nonapeptide regulated physiology in the context of aquaculture, conservation biology and ecotoxicology.

Quantification of Impurity-G Content in Levetiracetam Injection (100 mg/ml) by Using RP-HPLC Technique

Extremely responsive technique for the quantification of impurity-G content in Levetiracetam samples by RP-HPLC method has been presented in the here manuscript. Quantification of impurity-G content in Levetiracetam sample by HPLC with UV Detector. Impurity-G was concluded by RP-HPLC technique by waters X-Terra MS-C18 (250 x 4.6mm, 5µm) column as motionless segment. Column oven preserved 45°C and taster cooler temperature 5°C, injection quantity 50µL, flow rate was 1.0 mL/min, impurity-G was detected using UV detector at the wavelength of 200nm and run time was 30 minutes. The movable segment utilized pH 3.0 buffer and acetonitrile in the proportion of (850:150 v/v) isocratic mode. The technique legalization has been carried as per International Conference on Harmonization guidelines (ICH). Limit of quantitation (LOQ) was found 0.4122 µg/mL for impurity-G.

Inhaled corticosteroids and risk of tuberculosis-How bad is the risk?

Inhaled corticosteroids (ICS) have a central role in the management of obstructive airway diseases. Use of ICS in asthma and chronic obstructive pulmonary disease (COPD) is associated with a small but clear increase in incidence of pneumonia and tuberculosis. Since ICS use in obstructive airway diseases has beneficial effects with regard to symptoms, lung function, quality of life and exacerbations, denying the benefit of ICS solely based on this small elevated risk of pneumonias and tuberculosis is not justified. The present article attempts to elucidate mechanisms contributing to the increased risk, assesses the magnitude and risk factors of tuberculosis in patients using ICS and provides practical suggestions for practising clinicians.

Development & Validation of RP-HPLC Method for Quantitative Estimation of Dasatinib and its Impurities in Pharmaceutical Dosage Form

Aim: The primary objective of the research work is to develop a effective, sensitive, economical and simple reverse phase HPLC method for the separation and quantification of Dasatinib and its impurities are described in tablet formulations. Study Design: HPLC based quantification studies. Place and Duration of Study: Department of Chemistry, Acharya Nagarjuna University, Guntur, Andhra Pradesh between April 2021 and August 2021. Methodology: Separation and quantification of Dasatinib and its impurities are done by using an Inertsil ODS-3V, 250 x 4.6 mm, 5µm and the mobile phase consists of two Channels A and B. Channel-A: pH 5.80 phosphate buffer : acetonitrile (90:10 v/v)   and Channel-B: acetonitrile : water (90:10 v/v). The flow rate is 1.0 ml/min. The column temperature was maintained at 25°C and sample temperature was maintained at 25°C, injection volume 10 µL and wavelength fixed at 320nm UV-detection. Results: There is no interference of diluent and placebo at Dasatinib and impurities peaks. The elution order and the retention times of impurities and Dasatinib obtained from individual standard preparations and mixed standard preparations are comparable. The limit of detection (LOD) and limit of quantitation (LOQ) for Dasatinib standard 0.147&0.048 µg/mL, impurity-A 0.334&0.110 µg/mL, impurity-C 0.184&0.061 µg/mL,  impurity-D 0.136&0.045 µg/mL, impurity-E 0.089&0.029 µg/mL  and impurity-F 0.222 & 0.073 µg/mL respectively. The linearity results for Dasatinib and all the impurities in the specified concentration range are found satisfactory, with a correlation coefficient greater than 0.99.Calibration curve was plotted and correlation co-efficient for Dasatinib and its impurities found to be 1.000, 0.9999, 0.9912, 1.000, 0.9932 and 0.9922 respectively. The accuracy studies were shown as % recovery for Dasatinib and its impurities at specification level. The limit of % recovered shown is in the range of 80 and 120% and the results obtained were found to be within the limits. Hence the method was found to be accurate. The method has validated as per ICH guidelines and all the validation parameters are satisfy the ICH Q2 specification acceptance limits Conclusion:  The developed LC method was validated with respect to specificity, precision, linearity, ruggedness and robustness. Therefore this method has high probability to adopt in pharmaceutical industry for regular analysis of Dasatinib tablet formulations.

A successful salvage story: Uveitis with nontuberculous mycobacterial infection in a patient on secukinumab

The reported occurrence of ocular infections with nontuberculous mycobacterial (NTM) infections has been increasing in the past few decades. NTM are known to cause intraocular infections as well as infections of the ocular appendages and are often recalcitrant to medical therapy. Uveal involvement due to NTM is rare and most reported cases have predisposing factors such as cataract surgery or immunocompromised states. Diagnosis and treatment pose challenge due to difficulty in procuring sufficient clinical material to obtain microbial diagnosis and inadequate response to medical therapy. The clinical challenge is further heightened in the presence of an underlying rheumatologic disease that is known to cause uveitis. We share the case of a young gentleman with ankylosing spondylitis who was being treated with secukinumab with good response to joint symptoms. He developed sudden onset uveitis which was diagnosed to be due to NTM infection based on aqueous humor polymerase chain reaction studies. He had a good clinical response to an empirical anti-mycobacterial regime with the restoration of vision. This report narrates the first case of NTM uveitis secondary to secukinumab therapy.

Short-Term Aging of Pod-Derived Biochar Reduces Soil Cadmium Mobility and Ameliorates Cadmium Toxicity to Soil Enzymes and Tomato

Contamination of agricultural soil with cadmium (Cd) has become a global concern because of its adverse effects on ecohealth and food safety. Soil amendment with biochar has become one of the phytotechnologies to reduce soil metal phyto-availability and its potential risks along the food chain. Biochar, derived from cocoa pod, was evaluated in soil Cd fractions (exchangeable, reducible, oxidizable, and residual) by modified Commission of the European Communities Bureau of Reference sequential extraction and its efficacy to ameliorate Cd toxicity to soil enzymes and leaf bioactive compounds. A pot experiment was conducted using Cd-spiked soil at 10 mg/kg with tomato (Solanum lycopersicum L.) at a biochar application rate of 1 and 3% (w/w) for 6 wk. The addition of biochar significantly reduced (p < 0.05) the exchangeable, reducible, and residual fractions by at least approximately 23%, with a consequential decrease in Cd root uptake and transport within tomato tissues. The activity of soil enzymes (catalase, dehydrogenase, alkaline phosphatase, and urease) was affected by Cd toxicity. However, with the exception of dehydrogenase, biochar application significantly enhanced the activity of these enzymes, especially at the 3% (w/w) rate. As for the secondary metabolites we studied, Cd toxicity was observed for glutathione, terpenoids, and total phenols. However, the biochar application rate of 1% (w/w) significantly ameliorated the effects of toxicity on the secondary metabolites. In conclusion, biochar demonstrated the potential to act as a soil amendment for Cd immobilization and thereby reduce the bioavailability of Cd in soil, mitigating food security risks. Environ Toxicol Chem 2021;40:3306-3316. © 2020 SETAC.

Weight stigma and obesity-related policies: A systematic review of the state of the literature

Weight stigma is an important issue colliding with obesity-related policies; both have population health and social impacts. Our aim was to conduct a systematic review of the peer-reviewed literature that combined the concepts of stigma, obesity, and policy. We searched PsycINFO, Medline, Scopus, and Google Scholar for peer-reviewed articles amalgamating terms relevant to stigma, obesity, and policy. Of 3219 records identified, 47 were included in the narrative synthesis. Two key types of studies emerged: studies investigating factors associated with support for obesity-related policies and those exploring policy implementation and evaluation. We found that support for nonstigmatizing obesity-related policies was higher when obesity was attributed as an environmental rather than individual problem. An undercurrent theme suggested that views that blame individuals for their obesity were associated with support for punitive policies for people living in larger bodies. Real-world policies often implicitly condoned stigma through poor language choice and conflicting discourse. Our findings inform recommendations for policy makers that broader socioecological stigma-reduction approaches are needed to fully address the issue of weight stigma in obesity-related policies. Efforts are needed in the research and policy sectors to understand how to improve the design and support of nonstigmatizing obesity-related policies.

RP-HPLC Method for Quantification of Emtricitabine and Tenofovir Alafenamide Fumarate Drug Substance and Tablet Dosage Form

Aim: The primary objective of the research work is to develop a effective, sensitive, economical and simple reverse phase HPLC method to estimate Emtricitabine and tenofovir alafenamide fumarate in its pure and binary mixture of tablets. Study Design: HPLC based Quantification Studies. Place and Duration of Study: 1Department of Chemistry, Acharya Nagarjuna University,Guntur, Andhra Pradesh between April 2019 and August 2020. Methodology: Separation of the analytes were done by  using Eclipse XDB-Phenyl (250 x 4.6mm, 5µ,100 A0) column and a mobile phase ratio of 30:10:70 percentage of 0.1% trifluoro acetic acid: acetonitile: methanol  at a  flow rate of 1 ml/min. The injected standard and sample solutions were detected 260nm wavelength. Results: The retention time of Emtricitabine and tenofovir alafenamide fumarate were found at 2.3min and 2.8 min respectively. The method has good linearity range about 50 to 150µg/ml of Emtricitabine  and 6.5 to 19.5 µg/ml of  tenofovir alafenamide fumarate. The method has validated as per ICH guidelines and all the validation parameterwere satisfy the ICH Q2 specification acceptance limits Conclusion: The developed method said to be highly sensitive, accurate, specific and robust, therefore this method has high probability to adopt in pharmaceutical industry for regular analysis of   Emtricitabine  and tenofovir alafenamide.

Acceptance and Results of Therapy with Omalizumab in Real world Kerala setting - Reports from the ARTWORK study, Kerala, South India

BACKGROUND

Despite the availability of effective medications, only a minority of asthma patients achieve guideline defined asthma control. Treatment success depends on patient concurrence to the prescribed drug and adherence to treatment. It is therefore crucial to identify the patient preferences as well as attitudes towards asthma medications. Omalizumab is recommended as a preferred option in step five of asthma therapy. There have been few studies to address patient perspectives on omalizumab therapy in India.

METHODS

This was a retrospective study. Patients with inadequate asthma control were considered for the study. Systematic evaluation was done to identify and correct modifiable factors that can worsen asthma control. Patients with persisting poor asthma control who were deemed suitable to receive this agent were evaluated with their attitudes towards acceptance or refusal and the reasons for opting out were noted. The patients who received omalizumab were followed up to determine the results of treatment and duration of adherence to therapy.

RESULTS

35 patients out of 51 patients chose to avoid this drug. The reasons for opting out included erroneous perception of optimal asthma control, cost of therapy, and concern about adverse effects. Patients took omalizumab for a median duration of 6 months. Improved asthma control and decreased frequency of exacerbation was noted in all patients which persisted during the six month follow up.

CONCLUSIONS

Majority of patients needing step five therapy opt out of omalizumab. Cost of drug, duration of therapy and erroneous perception of good asthma control account for refusing treatment. Omalizumab affords excellent clinical benefits to patients who receive it, and the benefits extend beyond the duration of therapy.

Expecting the unexpected - Primary mediastinal large B cell lymphoma presenting as huge lung parenchymal mass

The first possibility considered in the etiology of large lung masses is neoplastic lesions. The differential diagnoses of these masses include bronchogenic carcinoma, pulmonary sarcoma, primitive neuroectodermal tumor etc. Primary or secondary pulmonary parenchymal lymphomas presenting as large mass is distinctly rare. We share the case of a young lady who presented with a large left lung mass almost entirely replacing the left lung parenchyma, with associated intrathoracic lymphadenopathy. On evaluation she was proved to have primary mediastinal large B-cell lymphoma. Treatment with an aggressive chemotherapy regimen led to complete remission of the parenchymal and nodal disease. The uncommon radiological presentation and the excellent therapeutic response despite huge tumor load merit clinical attention.

Product of Investigator Global Assessment and Body Surface Area (IGAxBSA): A practice-friendly alternative to the Eczema Area and Severity Index to assess atopic dermatitis severity in children

BACKGROUND

Accurately documenting pediatric atopic dermatitis (AD) severity is important, but research tools, such as Eczema Area and Severity Index (EASI), are too time consuming for clinical settings. Product of the Physician Global Assessment and affected percentage of body surface area (PGA×BSA) is a new, rapid measure of psoriasis severity.

OBJECTIVE

To evaluate an Investigator Global Assessment and body surface area product (IGA×BSA) as an easy-to-use severity measure for pediatric AD.

METHODS

Patient-reported and objective disease severity measures were collected from 195 caretaker/child dyads (child age range, 5-17 years) with almost clear (Validated Investigator Global Assessment for AD [vIGA] of 1) to severe (vIGA of 4) AD. Data were assessed with Spearman coefficients and plots. Severity strata were proposed by using an anchoring approach based on the EASI.

RESULTS

IGA×BSA correlates better with the EASI than IGA alone (r = 0.924 vs r = 0.757, P < .001). Bland-Altman plot indicates high and consistent agreement between IGA×BSA and the EASI. Suggested severity strata for IGA×BSA are 0-30, mild; 30.1-130, moderate; and 130.1-400, severe (κ = 0.760).

LIMITATIONS

The patient cohort was predominantly from the midwestern United States.

CONCLUSIONS

IGA×BSA (using the vIGA) is a simple measure that correlates well with the EASI in patients with mild to severe pediatric AD. Future work is needed to affirm reliability across IGA scales and responsiveness to change.

Acute Presentation of Amiodarone Toxicity with Pleural Involvement

Amiodarone is a frequently prescribed anti-arrhythmic drug which is used to treat ventricular and supraventricular tachyarrhythmia. Although it has excellent efficacy in controlling or preventing common arrhythmias, it is potentially associated with a variety of adverse effects, the most serious of these being pulmonary toxicity. Amiodarone-associated toxicities are usually seen in solid organs like lung, spleen and thyroid due to extension of its pharmacokinetic properties. The presentation is often subacute. Acute presentation with pleural involvement is distinctly uncommon in amiodarone toxicity and can pose diagnostic challenges. Here the case presented is of a 67 year old female with multiple co-morbidities on amiodarone therapy, who presented with massive pleural effusion and respiratory failure. Typical radiological findings along with exclusion of alternate causes with appropriate tests led to a diagnosis of amiodarone toxicity involving lung parenchyma, pleura, liver and other organs. She responded to withdrawal of drug, steroid therapy and supportive care.

Standard baseline data collections in obesity management clinics: A Delphi study with recommendations from an expert panel

We aimed to develop an expert consensus on standardizing data collections in specialist obesity management clinics in Australia. A panel of 16 experts participated in a structured consensus-driven Delphi process to reach agreement on a minimum set of baseline patient data collections for consideration in specialist obesity services. The panel included surgeons, clinicians, allied health professionals (dietician, exercise physiologist, psychologist), a bariatric nurse and obesity researchers. We produced a recommended list of core and useful data items that should comprise the baseline patient data set. Consensus was achieved for recommended measures of demographic, anthropometric, biochemical, weight-loss history, medication, medical history and comorbidity data items using a 70% agreement threshold. In this iterative process, there was also consideration of specific data items for patients referred for bariatric surgery. We present the first expert panel consensus on recommendations for a minimum and standard set of baseline patient data collections in obesity management services in Australia. These may be relevant to other countries with similar obesity management service models. Implementation of these recommendations should facilitate data pooling for clinical audits and research collaborations across clinics seeking to improve the quality of specialist obesity care.