Setting up pharmacovigilance based on available endTB Project data for bedaquiline

SETTING: Active pharmacovigilance (PV) is recommended for TB programmes, notably for multidrug-resistant TB (MDR-TB) patients treated with new drugs. Launched with the support of UNITAID in April 2015, endTB (Expand New Drug markets for TB) facilitated treatment with bedaquiline (BDQ) and/or delamanid of >2600 patients in 17 countries, and contributed to the creation of a central PV unit (PVU).OBJECTIVE: To explain the endTB PVU process by describing the serious adverse events (SAEs) experienced by patients who received BDQ-containing regimens.DESIGN: The overall PV strategy was in line with the ‘advanced´ WHO active TB drug safety monitoring and management (aDSM) system. All adverse events (AEs) of clinical significance were followed up; the PVU focused on signal detection from SAEs.RESULTS and CONCLUSION: Between 1 April 2015 and 31 March 2019, the PVU received and assessed 626 SAEs experienced by 417 BDQ patients. A board of MDR-TB/PV experts reviewed unexpected and possibly drug-related SAEs to detect safety signals. The experts communicated on clusters of risks factors, notably polypharmacy and off-label drug use, encouraging a patient-centred approach of care. Organising advanced PV in routine care is possible but demanding. It is reasonable to expect local/national programmes to focus on clinical management, and to limit reporting to aDSM systems to key data, such as the SAEs.

An Unusual Cause of Sudden Cardiac Death

Sarcoidosis is a chronic granulomatous disease with multi-systemic involvement and with varied forms of presentation. The diagnosis can often be a challenge particularly due to the non-specific nature of the disease. It is often silent and may require no active treatment except during flares. We present the case of a middle age lady with pulmonary sarcoidosis who had sudden death from cardiac affectation without prior cardiac symptoms. We concluded that active cardiac assessment is a prudent step in patients presenting with sarcoidosis regardless of the organ of affectation at presentation or diagnosis.

Modification of Initial Highly Active Antiretroviral Therapy (HAART) Regimen in Paediatric HIV Patients

BACKGROUND

Treatment options among Human Immunodeficiency Virus (HIV)-infected children are limited as only a few Highly Active Antiretroviral Therapy (HAART) are approved worldwide for paediatric use. Among children, frequent changes in HAART regimen can rapidly exhaust treatment options, and information addressing this issue is scarce.

OBJECTIVE

The aim of the study was to determine factors associated with the modification of initial HAART regimen modification among HIV-infected children.

METHOD

A retrospective study was performed among HIV-infected children aged 18 and below, that received HAART for at least six months in a tertiary hospital in Malaysia. Factors associated with modification of initial HAART regimen were investigated.

RESULTS

Out of 99 patients, 71.1% (n=71) required initial HAART regime modification. The most common reason for HAART modification was treatment failure (n=39, 54.9%). Other reasons included drug toxicity (n=14, 19.7%), change to fixed-dose products (n=11, 15.5%), product discontinuation (n=4, 5.6%) and intolerable taste (n=3, 4.2%). The overall mean time retention on initial HAART before regimen modification was 3.32 year ± 2.24 years (95% CI, 2.79-3.85). Patient's adherence was the only factor associated with initial regimen modification in this study. Participants with poor adherence showed a five-fold risk of having their initial HAART regimen modified compared to those with good adherence (adjusted OR [95% CI], 5.250 [1.614 - 17.076], p = 0.006).

CONCLUSION

Poor adherence was significantly associated with initial regimen modification, intervention to improve patient's adherence is necessary to prevent multiple regimen modification among HIV-infected children.

Development and in-vitro Evaluation of Once Daily Tablet Dosage Form of Loxoprofen Sodium

Purpose: To formulate and characterize once daily controlled release tablet of loxoprofen sodium.Methods: Eudragit RS-100, hydroxylpropyl methylcellulose (HPMC) and pectin were used as release retarding polymers. All the formulations were prepared by direct compression method. Various precompression studies were carried out to determine Hausner’s ratio, Carr’s index, angle of repose, bulk density and tapped density Differential scanning calorimetry (DSC) studies and also post-compression studies to evaluate hardness, friability, weight variation, drug content, in-vitro drug release were conducted on the tablets. The drug release data were subjected to kinetic models, including zero order, first order, Hixon Crowell, Higuchi and Korsmeyer-Peppas.Results: Compressibility index (7.6 ± 1.32 - 12.5 ± 1.43%), Hausner’s ratio (1.08 ± 0.04 - 1.14 ± 0.03), angle of repose (27.78 ± 0.47 - 30.49 ± 0.46°), hardness (6.25 ± 0.27 - 7.21±0.21 kg/cm2), friability (0.14 ± 0.06 - 0.28 ± 0.0 %), weight variation (249.5 ± 2.09 - 251.35 ± 2.41 mg) and drug content  (97.30 ± 0.28 - 103.70 ± 0.31 %) were within generally accepted limits for the pre-and post-compression formulations, respectively. The tablets having the maximum amount of among the three polymers tested as matrix materials, HPMC, represented by F3 tablets, exerted better sustained release properties after 12 h. Release pattern was more of Fickian diffusion followed by Higuchi mechanism.Conclusion: The release of the loxoprofen sodium was optimized up to 12 h.Keywords: Loxoprofen, Sustained release, hydroxypropyl methylcelluose, Pectin, Eudragit, Matrix tablets

Select critically ill patients at risk of augmented renal clearance: experience in a Malaysian intensive care unit

Augmented renal clearance (ARC) refers to increased solute elimination by the kidneys. ARC has considerable implications for altered drug concentrations. The aims of this study were to describe the prevalence of ARC in a select cohort of patients admitted to a Malaysian intensive care unit (ICU) and to compare measured and calculated creatinine clearances in this group. Patients with an expected ICU stay of <24 hours plus an admission serum creatinine concentration <120 µmol/l, were enrolled from May to July 2013. Twenty-four hour urinary collections and serum creatinine concentrations were used to measure creatinine clearance. A total of 49 patients were included, with a median age of 34 years. Most study participants were male and admitted after trauma. Thirty-nine percent were found to have ARC. These patients were more commonly admitted in emergency (P=0.03), although no other covariants were identified as predicting ARC, likely due to the inclusion criteria and the study being under-powered. Significant imprecision was demonstrated when comparing calculated Cockcroft-Gault creatinine clearance (Crcl) and measured Crcl. Bias was larger in ARC patients, with Cockcroft-Gault Crcl being significantly lower than measured Crcl (P <0.01) and demonstrating poor correlation (rs=-0.04). In conclusion, critically ill patients with 'normal' serum creatinine concentrations have varied Crcl. Many are at risk of ARC, which may necessitate individualised drug dosing. Furthermore, significant bias and imprecision between calculated and measured Crcl exists, suggesting clinicians should carefully consider which method they employ in assessing renal function.

Isolation and characterization of a heat-induced gene, hcit2, encoding a novel 16.5 kDa protein: expression coincides with heat-induced tolerance to chilling stress

Heat treatment of tomato fruits induces tolerance to chilling injury. We have previously shown that specific heat-shock proteins (HSPs) are expressed in heated tomato fruits after cold storage. To search for heat-induced genes that are expressed at low temperatures, a cDNA library prepared from pre-heated chilled tomato fruits was differentially screened. A novel cDNA clone, hcit2, encoding a protein of ca. 16.5 kDa, was isolated. The predicted protein contains three putative trans-membrane hydrophobic sequences, suggesting that the protein is membrane-localized. The expression of hcit2 in fruits was induced by high temperature, but not by other stresses such as low temperature, drought or anaerobic conditions, and not during fruit ripening. A high level of hcit2 transcript was found in heated fruits after 2 weeks at 2 degrees C. High temperatures also induced hcit2 expression in tomato leaves, flowers and stems. The HCIT2 protein may be involved in the acquisition of tolerance to chilling injury.

Serum erythrocyte and leukocyte adenosine deaminase activities in patients with vivax malaria in Turkey

Adenosine deaminase (ADA) activities in serum samples, erythrocytes, leukocytes and plasma hemoglobin concentrations were investigated in 50 patients with vivax malaria and compared with control group. ADA activity was determined by Bertholet reaction. Student's t-test and correlation analyses methods were used for statistical analyses. Serum ADA activity in patients with vivax malaria 49.20 +/- 29.02 IU/I, in control 21.15 +/- 8.04 IU/I (p = 0.005), erythrocyte ADA activity in patients 2.91 +/- 1.23 U/gr Hb, in control 1.65 +/- 0.59 U/gr (p = 0.001), leukocyte specific ADA activity in patients 26.23 +/- 20.21 U/mg protein, in control 25.84 +/- 9.19 U/gr Hb were determined (P > 0.05). Plasma hemoglobin concentration in patients 29.25 +/- 28.10 ml/dl, in control 9.80 +/- 13.14 mg/dl were also determined. There is no significant correlation among mentioned parameters. Erythrocyte purine salvage pathway is accelerated by Plasmodium to provide preformed purine source which can not be synthesized by Plasmodium to provide preformed purine source which can correlation between plasma hemoglobin concentration and serum ADA activity suggests that increased serum ADA activity may develop secondarily to the disease independently from the hemolyses. No higher ADA activity level than expected value of leukocytes may reflect immunosuppression of leukocytes.

Covalently immobilized DNA plate for luminometric DNA-DNA hybridization to identify viridans streptococci in under 2 hours

Single-stranded chromosomal DNA was covalently bound to a microdilution plate and used for quantitative DNA-DNA hybridization. After 30 min, hybridized DNA was quantitatively detected by alkaline phosphatase and a chemiluminescent substrate. This method was successfully used for the rapid identification of viridans streptococci.

Three new species of the genus Peptostreptococcus isolated from humans: Peptostreptococcus vaginalis sp. nov., Peptostreptococcus lacrimalis sp. nov., and Peptostreptococcus lactolyticus sp. nov

We describe three new species of the genus Peptostreptococcus which were isolated from human specimens and were tentatively identified as Peptostreptococcus prevotii. These three organisms were not homologous with previously described type strains of the genus Peptostreptococcus. A total of 12 strains that were identified biochemically as P. prevotii were divided into five independent DNA similarity groups; 10 of these strains were divided into three similarity groups which exhibited significant phenotypic differences from previously described species. Therefore, we propose the following new species: Peptostreptococcus vaginalis for group 1 strains, Peptostreptococcus lacrimalis for group 2 strains, and Peptostreptococcus lactolyticus for group 3 strains. The type strain of P. vaginalis is strain GIFU 12669 (= JCM 8138), the type strain of P. lacrimalis is strain GIFU 7667 (= JCM 8139), and the type strain of P. lactolyticus is strain GIFU 8586 (= JCM 8140).