Effectiveness of GenoType MTBDRsl in excluding TB drug resistance in a clinical trial

OBJECTIVES: To assess the performance of the GenoType MTBDRsl v1, a line-probe assay (LPA), to exclude baseline resistance to fluoroquinolones (FQs) and second-line injectables (SLIs) in the Standard Treatment Regimen of Anti-tuberculosis Drugs for Patients With MDR-TB 1 (STREAM 1) trial.METHODS: Direct sputum MTBDRsl results in the site laboratories were compared to indirect phenotypic drug susceptibility testing (pDST) results in the central laboratory, with DNA sequencing as a reference standard.RESULTS: Of 413 multidrug-resistant TB (MDR-TB) patients tested using MTBDRsl and pDST, 389 (94.2%) were FQ-susceptible and 7 (1.7%) FQ-resistant, while 17 (4.1%) had an inconclusive MTBDRsl result. For SLI, 372 (90.1%) were susceptible, 5 (1.2%) resistant and 36 (8.7%) inconclusive. There were 9 (2.3%) FQ discordant pDST/MTBDRsl results, of which 3 revealed a mutation and 5 (1.3%) SLI discordant pDST/MTBDRsl results, none of which were mutants on sequencing. Among the 17 FQ- and SLI MTBDRsl-inconclusive samples, sequencing showed 1 FQ- and zero SLI-resistant results, similar to frequencies among the conclusive MTBDRsl. The majority of inconclusive MTBDRsl results were associated with low bacillary load samples (acid-fast bacilli smear-negative or scantily positive) compared to conclusive results (P < 0.001).CONCLUSION: MTBDRsl can facilitate the rapid exclusion of FQ and SLI resistances for enrolment in clinical trials.

Extensive Ossification of the Achilles Tendon with and without Acute Fracture: A Scoping Review

Extensive Ossification of the Achilles Tendon (EOAT) is an uncommon condition characterized by the presence of heterotopic ossification within the substance of the Achilles Tendon and is distinct from other tendinopathies associated with tendon mineralization. The purpose of this scoping review of the literature on EOAT is to describe the pathogenesis, patient population, presentation, management, and outcomes of this rare condition. Fifty-four articles were included in the scoping review after screening and selection. According to the literature, EOAT often presents with pain and swelling around the Achilles Tendon and is frequently associated with acute trauma. EOAT is more common in men, and although the exact mechanisms of the pathology are not fully understood, EOAT may demonstrate specific molecular signaling patterns. The lack of knowledge regarding the molecular mechanism may be a significant hindrance to the management of the condition. Even though a standard treatment regimen for EOAT does not exist, conservative management for six months in patients without complications is recommended. Those who have an acute fracture of the ossification should be managed more aggressively and will often require surgical repair with autograft, although there is no standardized procedure at this time. Clinicians should be aware of the typical presentation, risk factors, and management options of patients with EOAT. Additionally, they should be cautious when selecting treatment strategies and conduct a thorough evaluation of long-term outcomes with various treatment modalities, which this review provides. Most important, this review highlights the need for further research to determine the best course of clinical treatment of EOAT injuries, in order to establish a standard treatment regimen.

Dynamics of the clinical state of patients with peri-implantitis under conditions of complex application of physiotherapy technologies

The article presents the results of the treatment of inflammatory complications in patients with orthopedic constructions on dental implants using the course complex application of low-intensity infrared laser therapy and low-frequency electrostatic therapy. It has been shown that under the influence of a complex of physiotherapeutic factors, a more pronounced inverse dynamics of the clinical manifestations of peri-implantitis is observed in comparison with the standard treatment regimen, which has a positive effect on the indicators of the secondary stability of the implants themselves. The mechanisms of realization of the therapeutic efficiency of a low-intensity laser and a low-frequency electrostatic field are considered from the medical and biological point of view. The analysis of the study allows concluding that the course complex application of physiotherapeutic technologies in the treatment of post-prosthetic inflammatory complications during dental implantation is highly effective. The addition of the standard treatment regimen with the combined use of a low-frequency electrostatic field and laser therapy has a positive effect on the regression of the clinical manifestations of peri-implantitis and on the index indicators of the patients’ dental status. The increase in therapeutic efficiency observed when using a low-frequency electrostatic field in combination with an infrared laser of the complex is realized due to the potentiating type of interaction of physical factors, which is based on various points of application and the mechanisms of their corrective activity.

Recent Advances in Glioma Therapy: Combining Vascular Normalization and Immune Checkpoint Blockade

Glioblastoma (GBM) accounts for more than 50% of all primary malignancies of the brain. Current standard treatment regimen for GBM includes maximal surgical resection followed by radiation and adjuvant chemotherapy. However, due to the heterogeneity of the tumor cells, tumor recurrence is often inevitable. The prognosis of patients with glioma is, thus, dismal. Glioma is a highly angiogenic tumor yet immunologically cold. As such, evolving studies have focused on designing strategies that specifically target the tyrosine kinase receptors of angiokines and encourage immune infiltration. Recent promising results from immunotherapies on other cancer types have prompted further investigations of this therapy in GBM. In this article, we reviewed the pathological angiogenesis and immune reactivity in glioma, as well as its target for drug development, and we discussed future directions in glioma therapy.

Adherence with the standard treatment regimen for the treatment of COVID-19 patients in Bangabandhu Sheikh Mujib Medical University

The present study was conducted to evaluate the adherence to standard treatment regimen in Bangabandhu Sheikh Mujib Medical University (BSMMU) for the treatment of corona virus disease 19 (COVID-19) patients. The study assessed the awareness of prescribers, adherence to treatment guidelines and reasons for non-adherence. A questionnaire survey was conducted followed by a retrospective and prospective medical review and in-depth interview. The study revealed that 79.9% of key prescribers are aware of treatment guidelines. Adherence was 28.4% in moderate cases and 53.3% in severe cases and difference was highly statistically significant (p<0.001). Adherence in moderate cases was highest in patients with hypertension (43.3%) and lowest in bronchial asthma (16.6%). Adherence in severe cases was highest with diabetes (80%) and lowest in bronchial asthma (20 %). In COVID-19 patients, the adherence was highest with International Guideline (96%), followed by institutional Guideline (74.6%) and National Guideline (23.5%). There is significant variation in extent of adherence in different age group of patients, co-morbidities and categories of guidelines. BSMMU J 2021; 14 (COVID -19 Supplement): 13-18

Study of the effect of Baricitinib on the Course of COVID-19

The aim of the study was to determine the effect of the inhibitor of janus kinase – baricitinib ("Olumiant") on the course of COVID-19. This drug baricitinib is able to suppress the systemic inflammatory response, which is one of the common causes of death in COVID-19, is an urgent problem of the study. The study was carried out in the Regional Specialized Budget Infectious Diseases Hospital of Stavropol (Russian Federation, Stavropol Region). In a multivariate analysis, it was shown that the use of baricitinib was associated with a decrease in the frequency of the primary endpoint of death/need for invasive lung ventilation. The use of baricitinib was quite safe, but in some patients there was an increase in the level of transaminases. No cases of hypercoagulation have been reported while taking baricitinib. It was found that patients with a normal BMI are more sensitive to therapy than those who are overweight.75% of patients in the first group had a temperature above 38.0oC. However, against the background of taking the standard treatment regimen and baricitinib, it was noted that the temperature stabilized during the day and did not rise again. Against the background of taking baricitinib, the elimination of the phenomena of respiratory failure and the refusal of an oxygen mask occurred 3.1 times more often than without baricitinib. The authors concluded that the use of baricitinib can be considered as an additional therapy for moderate forms of pneumonia in patients over 65 years or in patients with concomitant chronic diseases in order to suppress the reactions of systemic inflammation and the development of serious respiratory and other system lesions caused by COVID-19.

Prehospital clopidogrel use and STEMI management: a review

Clopidogrel is an anticoagulant commonly used in the prehospital environment for the management of ST-elevation myocardial infarction (STEMI). Some ambulance services have incorporated this into their treatment regimens; however, others hold a variety of alternative pharmacological interventions. This study examines and determine the pharmacological efficacy and safety of clopidogrel in the management of patients with STEMI and assess whether ambulance services should use the drug as part of standard practice. A literature review was conducted to identify articles relating to the administration of clopidogrel in the prehospital setting. Fourteen peer-reviewed journal articles and eight clinical practice guidelines from international ambulance services were included in this review. According to this review, clopidogrel has been deemed safe, effective and practical for widespread use in the prehospital environment for the management of STEMI. However, some disagreement has arisen over whether clopidogrel is a more favourable anticoagulant than ticagrelor and prasugrel. Anticoagulants such as clopidogrel should be strongly considered as a standard treatment regimen in the prehospital management of STEMI across international jurisdictions.

Disseminated Mycobacterium simiae and Mycobacterium avium infection causing an immune reconstitution inflammatory syndrome in a female patient with HIV infection

This case study discusses the management of a disseminated Mycobacterium simiae and Mycobacterium avium infection causing an immune reconstitution inflammatory syndrome in a 52-year-old woman with HIV infection. Disseminated M. avium infections have extensively been described in HIV patients; however, reports of infections with M. simiae are rare. Treatment of M. simiae infections is challenging due to its high rates of natural drug resistances, and thus far, no standard treatment regimen exists.

Appropriateness of oral clopidogrel for prehospital STEMI management

Introduction: Clopidogrel is an anticoagulant commonly used in the prehospital environment for the management of ST-elevation myocardial infarction (STEMI). Some ambulance services have incorporated this into their treatment regimens; however, others hold a variety of alternative pharmacological interventions. Aims: The purpose of this study is to examine and determine the pharmacological efficacy and safety of clopidogrel in the management of patients with STEMI and assess whether ambulance services should use the drug as part of standard practice. Methods: A literature review was conducted to identify articles relating to the administration of clopidogrel in the prehospital setting. Fourteen peer-reviewed journal articles and eight clinical practice guidelines from international ambulance services were included in this review. Results: According to this literature review, clopidogrel has been deemed safe, effective and practical for widespread use in the prehospital environment for the management of STEMI. However, some disagreement has arisen over whether clopidogrel is a more favourable anticoagulant than ticagrelor and prasugrel. Conclusion: Anticoagulants such as clopidogrel should be strongly considered as a standard treatment regimen in the prehospital management of STEMI across international jurisdictions.

Ectoine in the Treatment of Irritations and Inflammations of the Eye Surface

The ocular surface is facing various unspecific stress factors resulting in irritation and inflammation of the epithelia, causing discomfort to the patients. Ectoine is a bacteria-derived extremolyte with the ability to protect proteins and biological membranes from damage caused by extreme environmental conditions like heat, UV-light, high osmolarity, or dryness. Evidence from preclinical and clinical studies attest its effectiveness in treating several epithelium-associated inflammatory diseases, including the eye surface. In this review, we analysed 16 recent clinical trials investigating ectoine eye drops in patients with allergic conjunctivitis or with other unspecific ocular inflammations caused by e.g. ophthalmic surgery. Findings from these studies were reviewed in context with other published work on ectoine. In summary, patients with irritations and unspecific inflammations of the ocular surface have been treated successfully with ectoine-containing eye drops. In these patients, significant improvement was observed in ocular symptoms of allergic rhinoconjunctivitis, postoperative secondary dry eye syndrome, or ocular reepithelisation after surgery. Using ectoine as an add-on therapy to antihistamines, in allergy patients accelerated symptom relief by days, and its use as an add-on to antibiotics resulted in faster wound closure. Ectoine is a natural substance with an excellent tolerability and safety profile thus representing a helpful alternative for patients with inflammatory irritation of the ocular surface, who wish to avoid local reactions and side effects associated with pharmacological therapies or wish to increase the efficacy of standard treatment regimen.