Evaluation of one-year effectiveness of clobazam as an add-on therapy to anticonvulsant monotherapy in participants with epilepsy having uncontrolled seizure episodes: An Indian experience

OBJECTIVES

To prospectively study the effectiveness and safety of clobazam as an add-on therapy in patients with epilepsy whose seizures are not adequately controlled with antiseizure medicine (ASM) monotherapy.

METHODS

We conducted a prospective, observational study at 28 neurology outpatient clinics in India from June 2017 to October 2019. Consecutive patients with epilepsy (older than 3 years) with inadequate seizure control with ASM monotherapy were initiated on clobazam. Patients were followed up at 1, 3, 6, 9, and 12 months. Seizure control and adverse events were assessed through personal interviews and seizure diaries.

RESULTS

Out of 475 eligible patients, data of 429 patients (men: 65.5%) were evaluated (46 excluded due to protocol deviations). The median age was 25 (range, 3-80 years) years and the median duration of epilepsy was 3 (0.1-30) years. The majority of patients had focal epilepsy (55.0%) and genetic generalized epilepsy (40.1%). The one-year follow-up was completed by 380 (88.5%) patients. At one-year follow-up, 317 (83.4%; N = 380) patients in the study remained seizure free. These 317 patients who were seizure free at 12 months comprised 73.9% of the evaluable population (N = 429). In 98.8% of patients, the primary reason for adding clobazam was inadequate control of seizures with treatment. During one-year follow-up, a total of 113 (22.6%) patients experienced at least one adverse event which included 103 (20.6%) patients who experienced 386 episodes of seizures.

CONCLUSION

The study provides preliminary evidence that clobazam is effective and well-tolerated as add-on therapy for a period of one year among patients with epilepsy inadequately stabilized with monotherapy.

TRIAL REGISTRATION NUMBER

CTRI/2017/12/010906.

Insights from a Pan India Sero-Epidemiological survey (Phenome-India Cohort) for SARS-CoV2

To understand the spread of SARS-CoV2, in August and September 2020, the Council of Scientific and Industrial Research (India) conducted a serosurvey across its constituent laboratories and centers across India. Of 10,427 volunteers, 1058 (10.14%) tested positive for SARS-CoV2 anti-nucleocapsid (anti-NC) antibodies, 95% of which had surrogate neutralization activity. Three-fourth of these recalled no symptoms. Repeat serology tests at 3 (n = 607) and 6 (n = 175) months showed stable anti-NC antibodies but declining neutralization activity. Local seropositivity was higher in densely populated cities and was inversely correlated with a 30-day change in regional test positivity rates (TPRs). Regional seropositivity above 10% was associated with declining TPR. Personal factors associated with higher odds of seropositivity were high-exposure work (odds ratio, 95% confidence interval, p value: 2.23, 1.92-2.59, <0.0001), use of public transport (1.79, 1.43-2.24, <0.0001), not smoking (1.52, 1.16-1.99, 0.0257), non-vegetarian diet (1.67, 1.41-1.99, <0.0001), and B blood group (1.36, 1.15-1.61, 0.001).

Seasonal variations in serum levels of thyroid hormones and their relation with seminal quality and libido in buffalo bulls

Blood samples from 15 Murrah buffalo bulls, (10- to 15- years-old) were collected during the summer, monsoon and winter seasons. The serum samples were analysed for thyroxine (T4) and triiodothyronine (T3) by RIA. Semen samples from these bulls were evaluated for various attributes. Sexual behaviour of these bulls was also recorded during the different seasons and was expressed as reaction time and refusal response. T4, T3, (T4 + T3) level and T4:T3 ratio did not reveal significant difference between seasons. Similarly, seminal characteristics did not exhibit any seasonal variation except for the percentage of live spermatozoa. However, the refusal response (no interest in mounting and ejaculating) was highest during summer months. T4 was significantly correlated to T(3) (r=0.53). Overall, T4 showed a positive correlation with seminal volume and initial motility while T3 exhibited a positive correlation with total sperm concentration and percentage of live spermatozoa. T3 was negatively correlated with refusal response only during the monsoon season. Correlation with other seminal and behavioural characteristics were not significant. The results indicated that although the sexual interest of buffalo bulls is reduced during the summer, the bulls can produce semen throughout the year under appropriate feeding and management conditions.

Serum thyroid hormone levels in male buffalo calves as related to age and sexual development

A total of 155 male buffalo calves were classified into 17 groups according to chronological age. The body weight was recorded on a balance or computed. Sera samples were analysed for thyroxine (T(4)) and triiodothyronine (T(3)) by radioimmunoassay. Highest concentration of thyroid hormones (T(4), 87.6+/-17.6; T(3), 3.1+/-0.07 ng/ml) were seen during the first week after birth followed by a gradual decline until two months of age. Later, the mean T(4) and T(3) levels fluctuated between 30 and 40 ng/ml and at around 1.0 ng/ml, respectively, except for a mild peak at 12 to 15 months of age. T4:T3 ratio did not vary significantly among various age groups. Both T4 and T3 were negatively correlated with age.

Circulating concentrations of thyroid hormones in pregnant camels (Camelus dromedarius )

Blood samples from 16 female camels were collected at monthly intervals commencing from 60 d post. breeding until the last month of gestation. Two camels failed to conceive and two had unnoticed abortions. The average gestation period was 398+/-13 and 372+/-11 in camels bearing male and female fetus, respectively, with an overall mean of 383+/-9 d. Sera were analyzed for thyroxine (T(4)) and triiodothyronine (T(3)) by radioimmunoassay. Mean T(4) and T(3) concentrations varied from 76 to 116 ng/ml and 0.73 to 1.32 ng/ml, respectively, during various stages of gestation. In general, the T(4) and T(3) levels were higher during early pregnancy, with lowest values in the tenth month. T(4):T(3) ratio showed minor, nonsignificant fluctuations. Age of dam of sex of fetus had no effect on hormone levels. Similarly, hormone levels were not affected by failure of conception or by abortion.

Enzymatic mechanism and biochemistry for cyanide degradation: a review

Cyanides are fast-acting poisons, can be lethal if exposed in excess. In spite of fact, cyanides are discharged as effluents in large scale from industries every year. Certain bacteria, fungi, algae and plants produce cyanides. It has been observed that microbes and plant systems can degrade cyanides to less toxic compounds. There are many enzymes, which are produced by microorganisms that utilize cyanides as substrate to make alanine, glutamic acid, alfa-amino-butyric acid, beta-cyanoalanine, etc. Present paper deals with different enzymes, their mechanisms and corresponding pathways with respect to the known biochemistry of enzyme and feasibility for the use in treatment of cyanides containing industrial effluents.

Japanese Encephalitis : Is Routine Immunization Required?

Japanese encephalitis is the leading cause of viral encephalitis in Asia. In endemic areas annual incidence ranges from 10-100 per 100000 population. Case fatality averages 30% and a high percentage of the survivors are left with permanent neuropshychiatric sequelae. There is no effective drug treatment for this disease. In recent decades, Japanese encephalitis virus has caused epidemics in previously unaffected countries like India, Myanmar, Nepal, Sri Lanka, Thailand and Viet Nam. No effective environmental control is known. Although socioeconomic improvement and changes in agricultural practices are likely to reduce viral transmission, large-scale vaccination of affected populations with an effective and affordable vaccine appears logical at least in the short term. The impact of large-scale Japanese Encephalitis vaccination is documented in some regions of China and systematic vaccination has contributed to significant decline in incidence in Japan, Republic of Korea and Thailand.

Effect of long-term dehydration on serum constituents in extreme climatic conditions in camel (Camelus dromedarius)

Eight healthy female adult camels were used to study the effect of long term dehydration on serum constituents in extreme climatic conditions viz. cold and hot. The dehydration phases were of 24 days in cold and 13 days in hot conditions. The changes in sodium, potassium, calcium and phosphorus were non significant (P > 0.05) while in chloride, glucose, total proteins, urea, bilirubin, cholesterol and creatinine were significant (P < or = 0.05) during dehydration phase. The mean values of all the constituents tended to return to normal as the rehydration phase advanced. Changes in sodium and potassium in dehydrated camels reflected that they were able to maintain the salt balance.

The adsorption of nucleotides and polynucleotides on montmorillonite clay

The binding of adenine derivatives to Na(+)-montmorillonite increases in the order 5'AMP, 3'-AMP, 5'ADP < adenosine < purine, adenine. With the exception of cytosine, cytosine derivatives bind less strongly than the corresponding adenine derivatives in the order 5'-CMP < cytidine < cytosine. There is little difference in the binding of uracil derivatives and these compounds bind less strongly than the corresponding adenine analogs. It is concluded that the adenine ring in adenine derivatives is protonated by the acidic montmorillonite surface and binding is a consequence of the electrostatic interaction between the protonated base and the negative charges on the surface of the montmorillonite. Different binding trends were observed with Cu(2+)-montmorillonite with AMP binding more strongly than adenosine and UMP binding more strongly than uridine. It is concluded that ligation to the Cu2+ is a major force in the binding of nucleotides to Cu(2+)-montmorillonite and are not readily washed from the clay. Factors contributing to the binding are discussed. Watson-Crick hydrogen bonding of 5'-AMP to poly(U) and 5'GMP to poly(C) was observed when the homopolymers are bound to the surface of the clay. No association of 5'-UMP to poly(U) bound to clay was detected. The possible role of montmorillonite clays in the prebiotic formation of RNA is discussed.

Photochemical reactions in interstellar grains photolysis of CO, NH3, and H2O

A simulation of the organic layer accreted onto interstellar dust particles was prepared by slow deposition of a CO:NH2:H2O gas mixture on an Al block at 10 K, with concomitant irradiation with vacuum UV. The residues were analyzed by GC-MS, HPLC, and near IR; a reaction pathway leading from NH3 to complex alcohol, fatty acid, and amide products in 27 stages is postulated. The astronomical relevance and significance of the observations are discussed.

Preoperative sonographic diagnosis of acute appendicitis caused by Ascaris lumbricoides

Acute appendicitis caused by Ascaris lumbricoides is an uncommon variant of a common disease. We describe a case in which sonography was used for preoperative diagnosis of ascaris appendicitis.

Quantitative analysis of HBY 097 and its metabolites in human serum and urine by HPLC

Two HPLC methods were developed: one for the quantitation of HBY 097 reverse transcriptase inhibitor and its metabolites M2 and M3 in human serum, and one for the quantitation of metabolite M5 in urine. The HPLC procedure for the quantitation of HBY 097 and its metabolites M2 and M3 in human serum involved protein precipitation with acetonitrile followed by automated on-line trace enrichment. The HPLC procedure for the analysis of metabolite M5 in urine involved enzymatic hydrolysis of urine with beta-glucuronidase to convert metabolite M5 (glucuronide of M3) to M3. Reverse phase chromatographic separation with gradient elution. UV detection at 335 nm, and internal standard were used to quantitate analytes in both procedures. The lower quantitation limits were 25 ng ml-1 for HBY 097 and metabolites M2 and M3 in serum, and 0.5 microgram ml-1 for the metabolite M5 in urine measured as metabolite M3 after hydrolysis. The HBY 097 and metabolite M3 concentrations were specific but metabolite M2 was semi-specific because the two diastereomers of M2 were not resolved by the present chromatographic procedure. Both procedures were applied to the quantitation of HBY 097 and its metabolites in serum and urine of HIV positive patients who were enrolled in a clinical study of drug safety and pharmacokinetics.

Modified Levinson's test in rapid diagnosis of tuberculous meningitis

Modified Levinson's precipitation test was done in 64 cases of TBM, 54 cases of TBM with inconsistent CSF finding, and 32 cases of pyogenic meningitis. The test was positive in 93.7% cases of TBM (sensitivity, 93.7%), 85.5% cases of TBM with doubtful diagnosis and in 9.4% cases of pyogenic meningitis (specificity 90.6%) compared to 79.7%, 72.2% and 18.8% in original Levinson's test, respectively. With CSF examination only 66% cases of TBM could be diagnosed while with modified Levinson's test and CSF analysis 89% cases could be diagnosed (p < 0.001). So modified Levinson's test for diagnosis of TBM is better than Levinson's test (p < 0.05) with an added advantage of time saving.

High-performance liquid chromatographic methods for the determination of sulfonamides in tissue, milk and eggs

In the last decade, significant research has been done to improve the existing high-performance liquid chromatographic (HPLC) methods and also towards developing simple, reliable and sensitive HPLC methods for sulfonamides in meat, milk and eggs. The replacement of solvent extraction with solid-phase extraction or matrix solid-phase dispersion techniques is a step forward. Significant improvements in sensitivity have been achieved. This review concentrates on HPLC methods for the determination of sulfonamides in foods of animal origin published after 1980. The existing methods are critically evaluated and suggestions for future research are made.

Surgical manifestations of ascariasis in childhood

Amongst 50 patients with surgical complications of Ascaris lumbricoides 35 patients (70%) were treated conservatively and 15 patients (30%) required surgical intervention which included squeezing of worms to distal colon, resection and anastomosis of ileum, appendicectomy and peritoneal lavage. Intestinal perforation was observed in 3 cases. Two patients (4%) died because of postoperative complications. Those presenting with subacute intestinal obstruction had no mortality or morbidity. Although a large number of roundworms were seen in the jejunum, the obstruction was generally observed in the distal ileum.

A new procedure for the isomerization of vitamin D and its metabolites

A new procedure for the isomerization of vitamin D and its metabolites is described. Vitamin D or its metabolites are dissolved in 100 microliters methanol and 10 M HC1 in 2-butanol is used as the reagent for isomerization. The isomerization reaction is carried out at 5 degrees C for 2-3 min which gives quantitative yields of isotachysterols down to 10 ng level without use of any carrier.

Comparative antifilarial efficacy of the N-oxides of diethylcarbamazine and two of its analogues

The N-oxides of 1-diethyl carbamoyl-4-methyl piperazine (DEC), 3-ethyl-8-methyl, 1,3,8-triazabicyclo (4,4,0) decan-2-one (centperazine) and 1-methyl-4-(pyrrolidin-1-yl-carbonyl) piperazine (CDRI Comp. 72/70) have been evaluated against Limotosoides carinii infection in cotton rats to establish whether conversion of the three antifilarials into N-oxides would lead to exertion of better antifilarial activity. Of the three N-oxides, N-oxide of DEC showed significantly more suppressive effect on circulating microfilariae in comparison to its parent compound. However, adult worms were unaffected. It was observed that basicity of the N-CH3 group did not play major role in exertion of activity of DEC and related compounds. Nevertheless, two other N-oxides were inactive.

Liquid chromatographic determination of vitamin D in infant formula

A method is described for the determination of vitamins D2 + D3 in milk- and soy-based infant formula. Vitamins D2 and D3 are extracted from the saponified sample and converted to isotachysterols with acidified butanol. Reverse-phase liquid chromatography (LC) is used to remove interferences, and total vitamin D is quantitated using normal-phase LC. Recoveries of spiked samples averaged 97.6% for milk-based infant formula, and 98.8% for soy-based infant formula. This method quantitates vitamin D2 + D3 in infant formulas containing as low as 40 IU/qt when prepared according to label direction.

Simultaneous determination of D- and L-malic acids in apple juice by gas chromatography

A gas chromatographic (GC) method was developed for the simultaneous determination of D- and L-malic acids in apple juice. D-Malic-(R)-(-)-2-butyl ester and L-malic-(R)-(-)-2-butyl ester are prepared with (R)-(-)-2-butanol. These diastereomers are separated and quantitated by gas chromatography on a Carbowax 20M (30 m x 0.25 mm) fused silica capillary column. This procedure does not involve any extraction or cleanup step.

Liquid chromatographic determination of vitamin D in fortified milk

A method for the determination of vitamins D2 + D3 in fortified milk is described. Vitamins D2 and D3 are extracted from the saponified sample and converted to isotachysterols with antimony trichloride. The isotachysterols are quantitated using liquid chromatography with ultraviolet detection at 301 nm, which is the absorption maximum. At this wavelength other materials present in the sample do not interfere with the analysis of isotachysterols and therefore a cleanup step is avoided. Recoveries of vitamin D added to skim milk were 98.1% (SD 5.3), 96.7% (SD 3.3), and 96.0% (SD 5.1) for samples fortified with 200, 400, and 600 IU/quart, respectively. For whole milk, recoveries were 102.0% (SD 6.5) and 97.1% (SD 3.5) in samples fortified with vitamin D equivalent to 200 and 400 IU/quart, respectively. The detection limit for vitamin D is 40 IU/quart.

Seasonal variation in serum levels of steroid hormones and their relation with seminal quality and libido in buffalo bulls

Blood samples from 15 breeding male Murrah buffaloes were collected during the winter, summer and monsoon seasons. Seminal characteristics and sexual behaviour were also studied. Serum samples were analysed for testosterone, progesterone and estradiol-17beta levels by radioimmunoassay. The studies showed significantly lower values for testosterone during winter (0.53 +/- 0.06 ng/ml) than during summer (1.22 +/- 0.19 ng/ml) and monsoon (1.06 +/- 0.12 ng/ml). The progesterone level was lowest during monsoon (84 +/- 9 pg/ml), intermediate during winter (115 +/- 14 pg/ml) and highest during summer (224 +/- 24 pg/ml). The mean level of estradiol-17beta was almost double (9 +/- 0.7 pg/ml) during monsoon as compared to winter (5 +/- 0.1 pg/ml). The correlations between hormone levels, seminal characteristics and sexual behaviour were of low magnitude.

Changes in profiles of serum sex steroids of male buffaloes from birth to maturity

Age-related changes in testosterone, progesterone and estradiol 17-beta were determined by radioimmunoassay (RIA) in the serum of 155 male buffalo calves of varying ages. The calves were classified into 17 age groups. The mean weight of calves increased from 33.6+/-9.6 kg at one week of age to 531+/-41.4 kg at 42 months. The testosterone levels were less than 100 pg/ml from birth until 15 months of age, followed by peak concentrations of 422+/-79 pg/ml at 24 to 30 months and 793+/-193 pg/ml at 42 to 48 months (corresponding to puberty and maturity, respectively). The progesterone levels were higher in newly born calves and mature bulls. Otherwise, the levels continued to be low throughout the period of growth and development. Estradiol 17-beta was significantly higher in postnatal calves up to two months of age. The testosterone revealed a positive correlation with weight and age while E2 17-beta showed a negative correlation with age. These results do not support a direct role of peripheral progesterone and estradiol 17-beta in the onset of puberty and sexual maturity of buffalo bulls.

A twenty-four hour temporal variation in peripheral levels of testosterone and thyroid hormones in male buffaloes

Hourly serum samples from four adult Murrah buffalo bulls of 5 to 6 years of age were analysed for testosterone, thyroxine and triiodothyronine by radioimmunoassay during a period of 24 hours. All four bulls exhibited three episodic peaks for testosterone with some variation in the time, duration and peak concentration of the hormone. The average testosterone concentration varied from 0.30 to 3.50 ng/ml of serum. Thyroxine levels varied from 20 to 40 ng/ml of serum among the four bulls. One clear-cut peak was observed between 2 and 5 a.m. in three of the four bulls. One animal showed a characteristic peak at 10 p.m. Triiodothyronine levels ranged from 1 to 2 ng/ml of serum and followed a similar trend as that of thyroxine except for an additional small peak between 6 and 9 p.m.

Relationship of serum guanase levels with economic characters in Zebu purebred and temperate x Zebu crossbred dairy cattle

Serum guanase levels of Indian Zebu (Hariana) cattle and its crosses with different exotic levels of temperate breeds of dairy cattle were estimated in 527 animals, and their associations with economic characters were determined. The overall mean value of serum guanase level was 13.46 +/- 0.45 IU/ml of serum. An inverse relationship between the concentration of the enzyme and the frequency of cattle falling within a definite range was observed, as over 75% of the animals possessed 1 to 20 IU/ml of serum guanase. An analysis of variance revealed significant differences (P less than 0.01) in enzyme levels among different genetic groups under study. Hariana (Zebu) purebreds had significantly higher enzyme levels (19.60 +/- 1.85) than any of the crossbred groups, whose enzyme levels ranged from 8.99 +/- 1.41 in Red Dane F1 half-breds to 14.30 +/- 1.11 in Brown Swiss F1 half-breds. The correlation and regression coefficients were significantly positive for reproductive traits such as age at first service and age at first calving, and significantly negative for production traits such as lactation yield and lactation length. These results suggest that selection of dairy cattle based on low serum guanase levels might result in correlated improvements in dairy cattle productivity.

Intrathecal antitetanus serum (horse) with steroid in the treatment of neonatal tetanus

107 patients with neonatal tetanus were studied and the value of intrathecal antitetanus serum with steroid was noted. The mortality rate in a control group (68%) was significantly higher than that of the test group (37%). Furthermore, a delay in antitetanus serum administration was found to have a strong positive linear correlation with the mortality rate. In fact, the mortality rate for neonates who were given antitetanus serum 24 hours after the onset of convulsions was found to be as high as for the control group. This suggests that intrathecal antitetanus serum is ineffective unless it is administered within 24 hours of the onset of convulsions. There was no significant difference in mortality rate whether a dose of 100 units or one of 50 units antitetanus serum was given intrathecally. The mean duration in hospital for survivals of the test group (7.4 days) was significantly shorter than that for survivals of the control group (10.4 days). No complication of intrathecal antitetanus serum was observed during the study.