Cerebral Oximetry Monitoring in Extremely Preterm Infants

BACKGROUND

The use of cerebral oximetry monitoring in the care of extremely preterm infants is increasing. However, evidence that its use improves clinical outcomes is lacking.

METHODS

In this randomized, phase 3 trial conducted at 70 sites in 17 countries, we assigned extremely preterm infants (gestational age, <28 weeks), within 6 hours after birth, to receive treatment guided by cerebral oximetry monitoring for the first 72 hours after birth or to receive usual care. The primary outcome was a composite of death or severe brain injury on cerebral ultrasonography at 36 weeks' postmenstrual age. Serious adverse events that were assessed were death, severe brain injury, bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, and late-onset sepsis.

RESULTS

A total of 1601 infants underwent randomization and 1579 (98.6%) were evaluated for the primary outcome. At 36 weeks' postmenstrual age, death or severe brain injury had occurred in 272 of 772 infants (35.2%) in the cerebral oximetry group, as compared with 274 of 807 infants (34.0%) in the usual-care group (relative risk with cerebral oximetry, 1.03; 95% confidence interval, 0.90 to 1.18; P = 0.64). The incidence of serious adverse events did not differ between the two groups.

CONCLUSIONS

In extremely preterm infants, treatment guided by cerebral oximetry monitoring for the first 72 hours after birth was not associated with a lower incidence of death or severe brain injury at 36 weeks' postmenstrual age than usual care. (Funded by the Elsass Foundation and others; SafeBoosC-III ClinicalTrials.gov number, NCT03770741.).

Misdiagnosis trends in patients with hereditary angioedema from the real-world clinical setting

BACKGROUND

Hereditary angioedema due to C1 inhibitor deficiency (C1-INH-HAE) causes swelling in the skin and upper airways and pain in the abdomen because of mucosal swelling. C1-INH-HAE is frequently misdiagnosed, leading to delays in diagnosis, inadequate treatment, and unnecessary procedures.

OBJECTIVE

To evaluate the history of misdiagnosis in patients participating in the Icatibant Outcome Survey (IOS).

METHODS

The IOS is an observational study in which safety and effectiveness of icatibant have been evaluated since 2009. As part of the IOS, patients record any misdiagnoses received before being diagnosed as having C1-INH-HAE.

RESULTS

In January 2016, a total of 418 of 633 IOS patients with C1-INH-HAE type I or II had provided misdiagnosis data. Of these, 185 of 418 (44.3%) received 1 or more prior misdiagnoses. The most common misdiagnoses were allergic angioedema (103 of 185) and appendicitis (50 of 185). A variety of other misdiagnoses were reported, including a substantial number of gastrointestinal disorders (excluding appendicitis). Misdiagnosis rates were similar between males (41.1%) and females (46.5%) and between C1-INH-HAE type I (43.7%) and type II (51.6%). Patients with family members diagnosed as having C1-INH-HAE were significantly less likely to be misdiagnosed than patients without a family history (140 of 366 [41.7%] vs 38 of 58 [65.5%], respectively; P = .001). Patients with a prior misdiagnosis had longer median delay to C1-INH-HAE diagnosis (13.3 years) than patients without (1.7 years; P < .001).

CONCLUSION

From this large database, approximately 50% of patients with C1-INH-HAE type I or II have previously had their conditions misdiagnosed, most commonly as allergic angioedema or appendicitis. Misdiagnosis results in marked delays in receiving the correct diagnosis, during which time patients cannot access effective, lifesaving treatment.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT01034969.

Repeat treatment with icatibant for multiple hereditary angioedema attacks: FAST-2 open-label study

BACKGROUND

The For Angioedema Subcutaneous Treatment (FAST)-2, a phase III, double-blind, randomized, multicenter, placebo-controlled study (ClinicalTrials.gov identifier: NCT00500656), established the efficacy and safety of single injections of icatibant, a bradykinin B₂ receptor antagonist, in the treatment of hereditary angioedema (HAE) attacks. Here, we evaluate the efficacy and safety of repeated treatment with icatibant in adult patients experiencing HAE attacks during the FAST-2 open-label extension (OLE) phase.

METHODS

Patients completing the controlled phase were eligible to participate in the OLE phase and receive open-label icatibant (30 mg subcutaneously) for the treatment of cutaneous, abdominal, and/or laryngeal HAE attack(s) severe enough to warrant treatment. Time to onset of symptom relief was calculated for each attack. Descriptive analyses (median, 95% CIs) were performed for all attacks; post hoc analyses were conducted in patients with at least five icatibant-treated attacks throughout the FAST-2 OLE phase. Safety was also monitored.

RESULTS

Fifty-four patients received icatibant for 374 attacks (176 cutaneous, 168 abdominal, and 30 laryngeal). For cutaneous and/or abdominal attacks (attacks 2-5), the median times to onset of symptom relief ranged between 2.0 and 2.5 h. For all laryngeal attacks, the median times to regression (start of improvement) of symptoms ranged between 0.3 and 4.0 h. Post hoc analyses showed that the overall median time to onset of symptom relief was 2.0 h. Overall, 89.8% of attacks resolved with a single icatibant injection. No drug-related serious adverse events were reported.

CONCLUSIONS

These findings have demonstrated the efficacy and safety of repeated icatibant treatment for HAE attacks.

Antioxidant activity of Arbutus unedo leaves

The ethanol and methanol extracts of Arbutus unedo leaves were screened for antioxidant activity. The antioxidant activity was determined by an improved assay based on the decolorization of the radical monocation of [2,2'-azinobis-(3-ethylbenzothiazoline-6-sulfonic acid)] (ABTS). The ethanol and methanol extract of A. unedo leaves displayed potent antioxidant activity.

Comparison of different gutta-percha root filling techniques: Thermafil, Quick-fill, System B, and lateral condensation

OBJECTIVES

In this in vitro study, the core (gutta-percha or gutta-percha and carrier)/sealer ratio and the sealing ability were calculated for 4 different gutta-percha techniques: Thermafil, JS Quick-Fill, System B, and lateral condensation.

STUDY DESIGN

One hundred single-rooted teeth were instrumented and obturated. Forty of the teeth were embedded in resin and sectioned horizontally at 1, 2,3, and 4 mm from the anatomic apex. Photographs were taken of each section, and the total area of the canal filled with core material or sealer was calculated. Sixty of the teeth were kept in wet storage for 90 days, after which the teeth were immersed in 2% methylene blue for 48 hours. The length of dye penetration was measured.

RESULTS

Roots obturated with Thermafil and JS Quick-Fill contained significantly more core material than did those obturated with System B or with lateral condensation. The lateral condensation technique had the lowest core/sealer ratio (P < .05). Roots using Thermafil and Quick-Fill showed significantly less dye leakage than did the lateral condensation technique.

CONCLUSIONS

Through use of these techniques in vitro, Thermafil and JS Quick-Fill with carrier and System B were found to be superior to the lateral condensation technique in terms of core/sealer ratio. Thermafil and Quick-Fill were superior to lateral condensation in terms of dye leakage.

Ultrasonic frequencies calculated for the q[100] mode in the first-order, tricritical and the second-order phase transitions of NH4Cl

This study correlates the volume changes to the ultrasonic frequencies of the q[100] mode of NH4Cl for the first-order, tricritical and the second-order phase transitions in this crystal. Using these correlations we were able to calculate the ultrasonic frequencies of this mode at the pressures of 0, 0.6 and 1.1 kbar (first-order), 1.6 kbar (tricritical) and 2.15 kbar (second-order) by means of the volume change data from the literature. Our calculated frequencies are in good agreement with the observed data for the phase region below the critical temperature T(C) for the first-order, tricritical and the second-order phase transitions in NH4Cl. Above T(C) our calculated frequencies do not agree satisfactorily for the q[100] mode and it is incapable of explaining the observed behaviour of NH4Cl. Our method of calculating the ultrasonic frequencies is presented.

A comparative study of the area of the canal space obturated by thermoplasticized gutta-percha techniques

Two thermoplasticized gutta-percha techniques were evaluated for the percentage area of canal obturated by gutta-percha and compared with the lateral condensation of gutta-percha technique. All obturation systems were used in conjunction with Grossman's sealer. Single rooted teeth were obturated by either injected thermoplasticized gutta-percha (Ultrafil), thermoplasticized gutta-percha with metal carrier (Thermafil) or lateral condensation of gutta-percha. There were ten specimens in each group. The teeth were embedded in resin, sectioned at 1.5 mm, 3 mm and 4.5 mm from the root apex and examined with a stereomicroscope. Specimens filled by Ultrafil and Thermafil contained a significantly higher percentage of gutta-percha than specimens filled by the lateral condensation technique at every level. However no difference was found between Ultrafil and Thermafil. Three lateral condensation specimens showed voids at the 1.5 mm section; no voids were detected in specimens filled by Ultrafil or Thermafil at any level.