Pharmacokinetic characterization of favipiravir in patients with COVID-19

This prospective observational study describes the pharmacokinetic characteristics of favipiravir in adult patients hospitalized for mild to moderate COVID-19 with a positive RT-PCR test. Favipiravir was administered for 5 days, with a loading dose of 3200 mg and a maintenance dose of 1200 mg/day. Serial blood samples were collected on Day-2 and Day-4 of the therapy. Laboratory findings of the patients (n=21) and in-hospital mortality were recorded. Favipiravir concentrations exhibited substantial variability and a significant decrease during the treatment of COVID-19. The median favipiravir trough concentration (C_0-trough ) on Day-2 was 21.26 (IQR, 8.37-30.78) μg/mL whereas it decreased significantly to 1.61 (IQR, 0.00-6.41) μg/mL on Day-4, the area under the concentration versus time curve decreased by 68.5%. Day-2-C_0-trough of female patients was higher than male patients. Our findings indicate that favipiravir concentrations show significant variability during the treatment of COVID-19 and therapeutic drug monitoring may be necessary to maintain targeted concentrations.

The effectiveness of BD Vacutainer® Plus Urinalysis Preservative Tubes in preservation of urine for chemical strip analysis and particle counting

Introduction

The aim of this study was to evaluate the stability of urine collected in preservative tubes for chemistry strip analyses and particle counting to determine whether the transport of urine samples with all of their constituents is possible.

Materials and methods

275 pathologic urine specimens were included. Each urine sample was evaluated after 4, 8, 12, 24, and 48 hours of storage in BD Vacutainer® Plus Urinalysis Preservative (BD UAP) tubes and compared with refrigeration at 4 °C. All analyses were peformed on H-800 and FUS-200 automatic modular urine analyzers (Dirui Industry, Changchun, China). The kappa coefficients (κ), false positive (FP) and false negative (FN) rates were evaluated. κ > 0.8 was accepted as good agreement.

Results

Haemoglobin (Hb), leucocyte esterase (LE), and protein (Pro) analyses should be performed within 4 hours, whereas glucose (Glc) was stable until the end of 48 hours in both storage conditions. Nitrite (Nit) was well preserved in BD UAP tubes for 24 hours but was stable only up to 8 hours at 4 °C. Bilirubin (Bil) had very high FN rates even at 4 hours in both conditions. The particle counting showed high FN rates for white blood cells (WBC) and red blood cells (RBC), whereas squamous epithelial cells (EC) were stable up to 8 hours in both conditions.

Conclusions

Preanalytical requirements for both urine chemical strip analyses and particle counting in a unique sample were not met in either condition. Thus, the transfer of urine samples for centralization of urinalysis is not yet feasible.

A new surgical approach for the management of severe postpartum hemorrhage due to uterine atony: preliminary results in 27 cases

PURPOSE OF INVESTIGATION

To demonstrate a new suturing technique that effectively reduces severe postpartum hemorrhage secondary to uterine atony.

MATERIALS AND METHODS

The study consisted of 27 patients with persistent postpartum bleeding due to uterine atony which was unresponsive to medical treatment. The patients were treated with ∞ compression sutures that passed through entire uterine wall on which the placenta was located and were knotted within uterine cavity. Demographic properties, complications, operative results are demonstrated.

RESULTS

Uterine bleeding was controlled in 26 of 27 cases (%96.3). Total abdominal hysterectomy was performed in only one patient who had persistent incision site bleeding and disseminated intravascular coagulation.

CONCLUSION

Uterine atony is an emergency and early intervention is necessary. As indicated by the preliminary results, the new technique effectively stopped bleeding in 96.3% of cases; no other techniques were carried out additionally. The technique is promising with properties as easy applicability, safety, and absence of major complications. A larger study is needed for further comparison of operative results.

The combined use of MODFLOW and precipitation-runoff modeling to simulate groundwater flow in a diffuse-pollution prone watershed

A numerical modeling case study of groundwater flow in a diffuse pollution prone area is presented. The study area is located within the metropolitan borders of the city of Izmir, Turkey. This groundwater flow model was unconventional in the application since the groundwater recharge parameter in the model was estimated using a lumped, transient water-budget based precipitation-runoff model that was executed independent of the groundwater flow model. The recharge rate obtained from the calibrated precipitation-runoff model was used as input to the groundwater flow model, which was eventually calibrated to measured water table elevations. Overall, the flow model results were consistent with field observations and model statistics were satisfactory. Water budget results of the model revealed that groundwater recharge comprised about 20% of the total water input for the entire study area. Recharge was the second largest component in the budget after leakage from streams into the subsurface. It was concluded that the modeling results can be further used as input for contaminant transport modeling studies in order to evaluate the vulnerability of water resources of the study area to diffuse pollution.

The effect of icodextrin and glucose-containing solutions on insulin resistance in CAPD patients

PURPOSE

Peritoneal dialysis patients have particular risks with respect to their lipid status and hyperinsulinemia. The aim of this study was to investigate the relation between insulin resistance and the type of the peritoneal dialysis solution.

MATERIALS

41 randomly selected non-diabetic patient cohort who were already under treatment with continuous ambulatory peritoneal dialysis (CAPD) and 10 healthy controls participated in the study. 24 of the 41 patients were using 3 standard 1.36% glucose solutions during the day and 1 hypertonic solution with 2.27% glucose dwell during the night (glucose group: mean age 45.54 +/- 16.67 years and median CAPD duration 16.5 months). The remaining 17 patients were using 3 standard 1.36% glucose solutions during the day and 1 icodextrin dwell during the night for 8-10 hours (icodextrin group: mean age 47.47 +/- 13.15 years, median duration of icodextrin use 6 months (range 2-20 months), and median CAPD duration 30 months). Insulin resistance (IR) was calculated according to the homeostasis model assesment (HOMA) formula: HOMA-IR = fasting glucose (mmol/l) x fasting insulin (microU/1/22.5. The HOMA cutoff point for diagnosis of insulin resistance was established with receiver-operating characteristic (ROC) curves. The patients were called HOMA-IR(+) if their HOMA scores were higher than cutoff value.

RESULTS

There were no significant differences between age, BMI, triglyceride, total and high-density lipoprotein (HDL) cholesterol, iron and ferritin, alanine aminotransferase, fibrinogen, intact parathyroid hormone, magnesium, hemoglobin and hematocrit levels of the 2 groups. The mean glucose levels of the groups were not different but fasting insulin levels and HOMA scores of the icodextrin group were significantly lower than the glucose group (10.15 +/- 6.87 vs. 18.11 +/- 13.15, p = 0.028, and 2.28 +/- 1.67 vs. 4.26 +/- 3.27, p = 0.027, respectively). The ratio of patients with low HOMA scores (cutoff = 2.511) were significantly higher in the icodextrin group than in the glucose group (71% vs 38%, p = 0.037). Other than fasting insulin and glucose levels, significantly positive correlation was found between HOMA score and BMI in both groups. With regression analysis, we found that the main parameters effecting HOMA score were BMI (p = 0.008) and triglyceride (p = 0.029) in the glucose group, but no parameters were found to affect HOMA score in icodextrin group.

CONCLUSION

These results suggest that insulin resistance is reduced in peritoneal dialysis patients using icodextrin-based dialysis fluid instead of glucose-based dialysis fluid.