Effect of Music Tempo on Pattern Reversal Visual Evoked Potential in Young Adults-Multisensory Stochastic Resonance: A Pilot Study

Stochastic resonance (SR) is a phenomenon in which an intermediate level of noise enhances the response of a weak input signal. This phenomenon is experimentally used for rehabilitation and treatment of visuomotor disorders associated with low amplitude and higher latency P100 VEPs. We presupposed that shortly it will be possible to develop and design new devices that enable multisensory SR in the audio-visual modality for human sensorimotor enhancement and rehabilitation purposes. This study was newer in which the auditory noise was used in the form of song of different tempos and their amplitude and latency of P100 PRVEP (pattern reversal visual evoked potential) was compared. Whether the different tempos song may affects the PRVEP. This study was conducted on 57 healthy volunteers in AIIMS Bhopal. The subjects were placed in front of a computer displaying a checkerboard 8x8 size. Electrodes were pasted on their scalp. The average latencies and amplitudes of the PRVEP were recorded at resting, then with the stimulus of acoustic noise in the form of low and high tempo song. The PRVEP were recorded for each event. We found that low- and high-tempo songs do not affect the latency component of PRVEP, while it significantly affects amplitude. Music therapy can help with vision rehabilitation, especially in patients with low amplitude PRVEP. A more significant number of samples for further study in this field in multisensory SR with visual evoked potentials (VEP) are necessary. We can also conclude that a sound-free environment is essential during VEP recording.

Suicide Trends during the COVID-19 pandemic and the International COVID-19 Suicide Prevention Research Collaboration

Introduction

There was and still is much speculation about the COVID-19 pandemic impact on suicide rates. We aimed to assess the effect of the COVID-19 pandemic on suicide rates around the world.

Methods

We sourced real-time suicide data from countries or countries areas through a systematic internet search (official websites of Ministries of health, police agencies, and government-run statistics agencies or equivalents), recourse to our networks (e.g. ICSPRC) and the published literature (a living systematic review). We used an interrupted time-series analysis to model the trend in monthly suicides before COVID-19 in each country or country area, comparing the expected number of suicides derived from the model with the observed number of suicides in the early months of the pandemic (from April 1 to July 31, 2020, in the primary analysis). We have now updated this work to cover the first 15 months of the pandemic and stratified analyses by age and sex and method. We will present findings from the new updated data (35 countries) at the conference.

Results

Initially we sourced data from 21 countries (16 high-income and five upper-middle-income countries). Rate ratios (RRs) and 95% CIs based on the observed versus expected numbers of suicides showed no evidence of a significant increase in risk of suicide since the pandemic began in any country or area. There was statistical evidence of a decrease in suicide compared with the expected number in 12 countries or areas.

Conclusions

This was the first study to examine suicides occurring in the context of the COVID-19 pandemic in multiple countries. Early on high-income and upper-middle-income countries, suicide numbers remained largely unchanged or declined compared with the expected levels based on the pre-pandemic period. We need to remain vigilant and be poised to respond as the longer-term mental health and economic effects of the pandemic unfold. We will present updated findings with more recent data.

Subjective and Objective Assessment of Effect of Allergic Rhinitis on Voice in Indian Patients

To perform a subjective and objective assessment of vocal complaints in patients of allergic rhinitis (AR) using voice handicap index and video-stroboscopy respectively and find the association of their parameters with severity of the disease. Cross-sectional-observational study design. Outpatient department of Otorhinolaryngology of a tertiary centre. Seventy-five adult patients diagnosed with AR and classified according to 'Allergic Rhinitis and its Impact on Asthma' guidelines were compared with same number of normal subjects as controls, with the same age and sex, to ensure uniformity. Both the groups were asked to fill a self-answered questionnaire called Voice Handicap Index (VHI) and underwent laryngeal examination with Video-Stroboscopy (VS). The mean VHI score of the AR group (29.45 ± 32.11) was significantly higher (p < 0.05) than that of controls (12.07 ± 16.62). VS parameters including amplitude, supraglottic activity, vocal edge and phase closure also showed significant difference between cases and controls (p < 0.05). VHI scores increased, but the VS findings did not change significantly with the severity of the disease. AR patients show subjective and objective derangements of voice quality. VHI scores show increase, while VS parameters do not change with the severity of AR.

Computational insights of phytochemical-driven disruption of RNA-dependent RNA polymerase-mediated replication of coronavirus: a strategic treatment plan against coronavirus disease 2019

The current pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has raised global health concerns. RNA-dependent RNA polymerase (RdRp) is the prime component of viral replication/proliferation machinery and is considered to be a potential drug target against SARS-CoV-2. The present study investigated the anti-RdRp activity of phytochemicals against SARS-CoV-2 infection. Virtual ligand screening was carried out to determine the potent compounds against RdRp. Molecular docking and an MD Simulation study were employed to evaluate the spatial affinity of selected phytochemicals for the active sites of RdRp. Structural stability of target compounds was determined using root mean square deviation computational analysis and drug-like abilities were investigated using ADMET. Bond distances between ligand and receptor were marked to predict the strength of interaction. Aloe, azadirachtin, columbin, cirsilineol, nimbiol, nimbocinol and sage exhibited the highest binding affinities and interacted with active sites of RdRp, surpassing the ability of chloroquine, lamivudine, favipiravir and remdesivir to target the same. All the natural metabolites exhibited stable conformation during MD Simulation of 101 ns at 310 K. Kinetic, potential and electrostatic energy were observed to be least in the case of natural metabolites in comparison with synthetic analogues. Deviations and fluctuations were observed to be structurally least in target phytochemicals. Physiochemical and biological properties of these compounds further validated their drug-like properties. Non-bonded distance was found to be short enough to form hydrogen bonding or hydrophobic interactions, which revealed that these target compounds can strongly bind with RdRp. The study found potential phytochemicals to disrupt the replication domain of SARS-CoV-2 by hindering RdRp. We therefore anticipate that the current findings could be considered as valuable for the development of an efficient preventive/therapeutic expedient against COVID-19.

Elemental formula associated hypophosphataemic rickets

OBJECTIVES

Hypophosphataemic rickets (HR) is usually secondary to renal phosphate wasting but may occur secondary to reduced intake or absorption of phosphate. We describe a series of cases of HR associated with the use of Neocate^®, an amino-acid based formula (AAF).

METHODS

A retrospective review of cases with HR associated with AAF use presenting to centres across the United Kingdom.

RESULTS

10 cases were identified, over a 9 month period, all associated with Neocate^® use. The age at presentation was 5 months to 3 years. The majority (8/10) were born prematurely. Gastro oesophageal reflux disease (6/10) was the most frequent indication for AAF use. Radiologically apparent rickets was observed after a median of 8 months (range 3-15 months) of exclusive Neocate^® feed. The majority (7/10) were diagnosed on the basis of incidental findings on radiographs: rickets (6/10) or fracture with osteopenia (5/10). All patients had typical biochemical features of HR with low serum phosphate, high alkaline phosphatase, normal serum calcium and 25 hydroxyvitamin D. However, in all cases the tubular reabsorption of phosphate (TRP) was ≥96%. Phosphate supplementation resulted in normalisation of serum phosphate within 1-16 weeks, and levels remained normal only after Neocate^® cessation. In patients with sufficient follow up duration (4/10), normalisation of phosphate and radiological healing of rickets was noted after 6 months (range: 6-8 months) following discontinuation of Neocate^®.

CONCLUSION

The presence of a normal TRP and resolution of hypophosphataemia and rickets following discontinuation of Neocate^® indicates this is a reversible cause likely mediated by poor phosphate absorption. Close biochemical surveillance is recommended for children on Neocate^®, especially in those with gastrointestinal co-morbidities, with consideration of a change in feed or phosphate supplementation in affected children.

The effect of increased chewing strokes on the DeMeester score

Saliva is known to be protective for esophageal mucosa. Increased chewing strokes result in a quantitative and qualitative enhancement of saliva. Reduction in the amount of saliva produced results in an increased incidence of gastroesophageal reflux disease (GERD), which can be objectively measured by the DeMeester score. The impact of increased chewing strokes on the DeMeester score remains largely unknown, thus this study aimed to find out their impact on the value of the DeMeester score and its individual components.The effect of increased chewing strokes on the DeMeester score was investigated in 12 subjects (5 male and 7 female) who were diagnosed with GERD. All subjects underwent a 48-hour pH monitoring using the Bravo® pH capsule. All the patients chewed their food 20 times more on Day 2 as compared to Day 1. The data were analyzed for change in the DeMeester score and its individual components in 2 days.In patients with GERD (DeMeester score > 14.72 on Day 1), the number of long refluxes (>5 minutes) on Day 2 (mean = 3.2, SD = 2.3) was significantly lower than on Day 1 (mean = 6.4, SD = 2.7); Z = -2.032, p = 0.04. Though, the DeMeester score and its other individual parameters decreased on Day 2, they were not statistically significant.In patients with GERD, increased chewing strokes lead to a decrease in the number of long reflux episodes. Though there is a decrease in the DeMeester score and its other individual components, larger randomized controlled studies are required to reach statistical significance.

Utilizing PBPK Modeling to Evaluate the Potential of a Significant Drug-Drug Interaction Between Clopidogrel and Dasabuvir: A Scientific Perspective

Dasabuvir, a component of VIEKIRA PAK, is a substrate of CYP2C8 enzymes. Prescribing information for VIEKIRA PAK contraindicates gemfibrozil, a strong CYP2C8 inhibitor, because coadministration significantly increases dasabuvir exposures, which may increase the risk of QT prolongation. Clopidogrel may increase dasabuvir exposures primarily due to CYP2C8 inhibition by clopidogrel-acyl-β-D-glucuronide. This commentary outlines the US Food and Drug Administration (FDA) interdisciplinary review team's scientific perspective to address the potential for a significant drug-drug interaction (DDI) between clopidogrel and VIEKIRA PAK.

Invasive floating macrophytes reduce greenhouse gas emissions from a small tropical lake

Floating macrophytes, including water hyacinth (Eichhornia crassipes), are dominant invasive organisms in tropical aquatic systems, and they may play an important role in modifying the gas exchange between water and the atmosphere. However, these systems are underrepresented in global datasets of greenhouse gas (GHG) emissions. This study investigated the carbon (C) turnover and GHG emissions from a small (0.6 km²) water-harvesting lake in South India and analysed the effect of floating macrophytes on these emissions. We measured carbon dioxide (CO₂) and methane (CH₄) emissions with gas chambers in the field as well as water C mineralization rates and physicochemical variables in both the open water and in water within stands of water hyacinths. The CO₂ and CH₄ emissions from areas covered by water hyacinths were reduced by 57% compared with that of open water. However, the C mineralization rates were not significantly different in the water between the two areas. We conclude that the increased invasion of water hyacinths and other floating macrophytes has the potential to change GHG emissions, a process that might be relevant in regional C budgets.

Association of CYP2C19, CYP3A5 and GPIIb/IIIa gene polymorphisms with Aspirin and Clopidogrel Resistance in a cohort of Indian patients with Coronary Artery Disease

INTRODUCTION

Dual antiplatelet therapy with clopidogrel and aspirin is the current standard of care in the management of patients with coronary artery disease (CAD) and acute coronary syndrome (ACS). The variability in response to these antiplatelet agents may be due to the underlying genetic diversity. This study was designed to determine the resistance to aspirin and clopidogrel in Indian patients and to look for correlation, if any, with selected polymorphisms.

METHODS

Platelet function testing by light transmission aggregometry was performed on 72 patients with CAD/ACS who were stable on dual antiplatelet therapy (clopidogrel 75 mg OD and aspirin 150 mg OD) along with 72 controls. Aspirin resistance was considered as mean platelet aggregation ≥ 70% with 10 μm ADP and ≥ 20% with 0.75 mm arachidonic acid. Clopidogrel resistance was defined as <10% decrease from the baseline in platelet aggregation in response to ADP 10 μm and semi-response as <30% decrease from the baseline. Polymorphisms CYP2C19*2, *3, CYP3A5*3 and PLA1/A2 were genotyped.

RESULTS

We found 51.4% patients with inadequate response to clopidogrel (1.4% resistant and 50% semi-responders) and 5.5% patients semi-responders to aspirin, none being completely resistant. The genotype and allele frequencies of CYP2C19*2 and PLA1/A2 gene polymorphisms were significantly different between clopidogrel semi-responders and responders. Carriers of CYP2C19*2 and CYP3A5*3 showed diminished inhibition of platelet aggregation. No significant correlation was found between coronary events, type of coronary intervention with clopidogrel nonresponsiveness.

CONCLUSION

Unlike aspirin, a high proportion of partial responders to clopidogrel were identified. In an interim analysis on 72 Indian patients, a significant association was found between CYP2C19*2 and PLA1/A2 in clopidogrel semi-responders.

Establishing RHD zygosity in India: a step into the future of foetal and neonatal haemolytic disease prevention

BACKGROUND

Determination of RHD zygosity is important for the prevention of haemolytic disease of foetus and neonate. There is no data from India regarding the prevalence of RHD genotypes.

OBJECTIVES

We conducted this study to investigate RHD zygosity in phenotypically RhD positive (RhD+) Indians. We have also investigated the utility and concordance of two different genotyping techniques.

METHODS

Hundred serologically RhD+ Indians were genotyped at the RHD gene using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and polymerase chain reaction-sequence-specific primer (PCR-SSP) techniques.

RESULTS

Of the 100 RhD+ individuals, 26 (25%) were D heterozygous by both methods and 74 (71·2%) were D homozygous. There was no discordance in the results from the two techniques.

CONCLUSION

At least 25% of RhD+ Indians are heterozygous at the RHD gene. Both the genotyping techniques were equally robust and their complete concordance indicates RHD deletion as the main mechanism underlying RhD negativity in Indians.

Vitiligo at Injection Site of PEG-IFN-α 2a in Two Patients with Chronic Hepatitis C: Case Report and Literature Review

A 72-year-old female and a 57-year-old male with chronic hepatitis C were treated with a combination therapy of pegylated interferon (PEG-IFN)-α 2a (180 μg s.c. once a week) and ribavirin (1,000 mg orally daily). This resulted in the destruction of melanocytes at the injection site in both patients. In the male patient, the depigmentation progressed to the surrounding skin area. The dermatologist concurred with vitiligo as the diagnosis in both patients. Injection and surrounding site vitiligo associated with PEG-IFN-α 2b treatment for hepatitis C was noticed in previous case studies. For the first time, the case reports below highlight the same immunological adverse event secondary to PEG IFN-α 2a/ribavirin combination therapy and explain, in part, the complex interaction between host immune response and viral genotype. In addition, we systematically review drug-induced vitiligo and autoimmune diseases associated with the depigmentation disorder.

Status of HFE mutation in thalassemia syndromes in north India

Hereditary hemochromatosis is an autosomal recessive and most commonly inherited single gene disorder among Caucasians, with a prevalence of 5 per 1,000 and a carrier frequency of 1 in 10. Two point mutations were described and are referred as C282Y and H63D. In the present study, we have analyzed 729 north Indian samples for C282Y and H63D mutations. Of these, no allele of the C282Y mutation was seen, while 3 homozygous and 43 heterozygous for the H63D mutation were seen in the patients of thalassemia group. However, 47 cases were found heterozygous for the H63D mutation among the normal groups (11.16%).

Etiology and outcome of childhood and adolescent diabetes mellitus in North India

The etiology of childhood onset diabetes mellitus (DM) varies between regions and races, and its long-term outcome is affected by social and economic factors. There are scant data on the etiology of childhood DM and outcome of multidisciplinary team management from developing countries. We retrospectively analyzed case records of 160 predominantly middle socio-economic group patients with onset of DM < or =18 years of age for etiology and features at presentation. In addition, we prospectively studied acute and chronic complications and metabolic control in a subset of 67 patients. Type 1 DM comprised 81%, type 2 DM 8%, and fibrocalculous pancreatic DM 9% of patients. Mean HbA1c was 8.0+/-1.5%. Retinopathy was present in 22% and nephropathy in 18% of those with DM duration > or =5 years (mean age 21.2+/-6.8 years, mean duration 10.2+/-4.6 years). The frequency of ketoacidosis and severe hypoglycemia was 5.0 and 3.3 episodes per 100 patient years. Mortality was 7% over 823 person years of follow up. We conclude that fairly good metabolic control is achievable in a middle socio-economic population in India, with the assistance of a diabetes education program. The frequency of microvascular complications is comparable to that in the literature. However, mortality remains unacceptably high.

Age effects on the pharmacokinetics of tityustoxin from Tityus serrulatus scorpion venom in rats

The pharmacokinetics of scorpion venom and its toxins has been investigated in experimental models using adult animals, although, severe scorpion accidents are associated more frequently with children. We compared the effect of age on the pharmacokinetics of tityustoxin, one of the most active principles of Tityus serrulatus venom, in young male/female rats (21-22 days old, N=5-8) and in adult male rats (150-160 days old, N=5-8). Tityustoxin (6 microg) labeled with 99mTechnetium was administered subcutaneously to young and adult rats. The plasma concentration vs time data were subjected to non-compartmental pharmacokinetic analysis to obtain estimates of various pharmacokinetic parameters such as total body clearance (CL/F), distribution volume (Vd/F), area under the curve (AUC), and mean residence time. The data were analyzed with and without considering body weight. The data without correction for body weight showed a higher Cmax (62.30 +/- 7.07 vs 12.71 +/- 2.11 ng/ml, P<0.05) and AUC (296.49 +/- 21.09 vs 55.96 +/- 5.41 ng h(-1) ml(-1), P<0.05) and lower Tmax (0.64 +/- 0.19 vs 2.44 +/- 0.49 h, P<0.05) in young rats. Furthermore, Vd/F (0.15 vs 0.42 l/kg) and CL/F (0.02 +/- 0.001 vs 0.11 +/- 0.01 l h(-1) kg(-1), P<0.05) were lower in young rats. However, when the data were reanalyzed taking body weight into consideration, the Cmax (40.43 +/- 3.25 vs 78.21 +/- 11.23 ng kg(-1) ml(-1), P<0.05) and AUC (182.27 +/- 11.74 vs 344.62 +/- 32.11 ng h(-1) ml(-1), P<0.05) were lower in young rats. The clearance (0.03 +/- 0.002 vs 0.02 +/- 0.002 l h(-1) kg(-1), P<0.05) and Vd/F (0.210 vs 0.067 l/kg) were higher in young rats. The raw data (not adjusted for body weight) strongly suggest that age plays a pivotal role in the disposition of tityustoxin. Furthermore, our results also indicate that the differences in the severity of symptoms observed in children and adults after scorpion envenomation can be explained in part by differences in the pharmacokinetics of the toxin.

Population pharmacokinetics and pharmacodynamics of ciclesonide

Ciclesonide is a novel glucocorticoid that is converted into ciclesonide--active principle (CIC-AP) in the lung. The study objectives were to identify a structural model for population pharmacokinetic (PK) analysis of CIC-AP using nonlinear mixed-effects modeling, assess the influence of select covariates on PK and/or pharmacodynamic (PD) parameters, and investigate the effects of CIC-AP on endogenous cortisol. Pooled concentration data from nine phase I studies (dose: 400-3600 micrograms) involving healthy and asthmatic patients were included in the PK analysis. There were 151 subjects (3300 observations) for the CIC-AP population PK analysis. Various models examined inter- and intrasubject variability for the PK parameters. Population estimates of the PK parameters of clearance and volume of distribution were 396 L/h (64.8% co-efficient of variation [CV]) and 1190 L (41.2% CV), respectively. Pharmacodynamic population estimates included maximum cortisol release rate, 3140 ng/h (5.4% CV). The EC50 of CIC-AP was 0.88 ng/mL. Ciclesonide is a safe corticosteroid that causes negligible cortisol suppression. The disposition and effect of CIC-AP can be described using mixed-effect modeling. The estimated EC50 is similar to mean Cmax from an 800-micrograms dose, further suggesting CIC-AP has little effect on cortisol suppression.

Midazolam sedation in mechanically ventilated newborns: a double blind randomized placebo controlled trial

OBJECTIVE

To determine efficacy of midazolam as a sedative in mechanically ventilated newborns.

DESIGN

Double blind randomized placebo controlled trial.

SETTING

Neonatal Unit of Tertiary Hospital.

OUTCOME

Sedation over 48 h of observation.

METHODS

Neonates with birth weight less than 2000 g who were mechanically ventilated within 7 days of life were randomly assigned to midazolam and placebo group. Midazolam and placebo were administered as bolus (0.2 mg/kg) followed by continuous infusion (0.06 mg/kg/h). Both groups received morphine infusion (10 microg/kg/h). Sedation score was noted at 6 hourly intervals for 48 hours. Hemodynamic variables, ventilatory variables, complications and side effects of treatments were also recorded.

RESULTS

Thirty-three neonates were enrolled (17 in midazolam, 16 in placebo group). The groups were comparable for birth weights and gestation. The midazolam group had significantly better sedation from 18-24 hours after enrollment compared to placebo group. At 48 h there were no significant differences in proportion of infants with adequate sedation between midazolam and placebo group. The two groups were comparable with respect to heart rate, perfusion, ventilatory indices and blood gas parameters. None of the infants were noted to have hypotension on loading with midazolam or placebo. Seizures were noted in 2 neonates in placebo group 24 hours after enrollment (insignificant statistically).

CONCLUSION

Sedation provided by continuous infusion of midazolam and morphine appears to be comparable to morphine alone in newborn babies on mechanical ventilation, with no significant adverse effects. The course of mechanical ventilation is not influenced by use of midazolam.