Clinical Safety and Tolerability of A2NTX, a Novel Low Molecular Weight Neurotoxin Derived From Botulinum Toxin Subtype A2, in Comparison with Subtype A1 Toxins

All the available botulinum type A neurotoxins for clinical uses are of A1 subtype. We developed a subtype A2 low molecular weight (150kD) neurotoxin (A2NTX), with less spread and faster entry into the motor nerve terminal than A1 in vitro and in vivo. Preliminary clinical studies showed its efficacy superior to A1 toxins. We conducted an open study exploring its safety and tolerability profile in comparison with A1LL (onabotulinumtoxinA) and low molecular weight (150kD) A1 neurotoxin (A1NTX). Those who had been using A1LL (n=90; 50-360 mouse LD50 units) or A1NTX (n=30; 50-580 units) were switched to A2NTX (n=120; 25-600 units) from 2010 till 2018 (number of sessions ~ 27, cumulative doses ~11,640 units per patient). Adverse events for A2NTX included weakness (n=1, ascribed to alcoholic polyneuropathy), dysphagia (1), local weakness (4), spread to other muscles (1), whereas those for A1LL or A1NTX comprised weakness (n=2, A1NTX), dysphagia (8), ptosis (6), local weakness (7) and spread to other muscles (15). After injections, 89 out of 120 patients preferred A2NTX to A1 for the successive sessions. The present study demonstrated that A2NTX had the clinical safety up to the dose of 500 units, and was well tolerated compared to A1 toxins.

Efficacy of topical dorzolamide 2% in diabetic cystoid macular edema

AIM: To study the effect of topical dorzolamide 2% on macular thickness reduction in diabetic cystoid macular edema (CME). METHODS: This was a prospective, non-randomized, open study including eyes with diabetic macular edema (DME). All eyes received topical dorzolamide 2% three times daily for one month. Changes in best-corrected visual acuity (BCVA), and central macular thickness (CMT) by optical coherence tomography) were evaluated at 1wk, 1, and 3mo post-treatment. RESULTS: Ninety-three eyes (84 patients) were included. Mean±SD (logMAR) BCVA improved significantly from 1.08±0.26 pretreatment to 0.66±0.24 at 1mo and 0.87±0.26 at 3mo post-treatment (P<0.001 both). The mean±SD CMT was significantly reduced from 535.27±97.4 μm at baseline to 357.43±125.8 μm at 1mo and 376.23±114.5 μm at 3mo post-treatment (P<0.001 both). No significant ocular or systemic side effects were recorded. CONCLUSION: Topical dorzolamide 2% results in significant improvement of mean BCVA and reduction of mean CMT at 3mo post-treatment. It can be used as an effective, affordable, and safe therapy for treatment of non-refractory diabetic CME.

The Еffectiveness of Stabilometrical Training in the Complex of Rehabilitation Measures in Elderly and Senile Patients with Arterial Hypertension

The treatment and rehabilitation of elderly patients with hypertension is often hampered by their existing geriatric syndromes of senileasthenia and the risk of falls. Stabilometric balance training will allow to maintain the level of physical functioning and supporting theautonomy of this category of patients. Aim. To assess the possibilities of using stabilometric training with biofeedback to correct the risk of falls in patients aged 63 and olderwith arterial hypertension. Material and methods. On the basis of the geriatric department of the Regional Budgetary Institution of Health «Ivanovo ClinicalHospital named after Kuvaevi» conducted an open study involving 95 patients aged 63 to 92 years with arterial hypertension andfalling syndrome, diagnosed according to the results of the physical activity tests brief battery. Balance indicators were obtained whenexamining patients on a stabilometric complex concurrently with a five-day training «Restoring balance». Results. According to the stabilometrical data of all patients with hypertension and the risk of falling, a typical symptom complex ofthe main stance instability was revealed. After the training, improvement in quantitative indicators and in the balance function wererecorded in 70% of patients. Conclusion. The inclusion of stabilometrical training in the treatment and rehabilitation complex of hypertensive patients with senileasthenia syndromes and the risk of falling improves balance indicators in elderly and senile people.

A CLINICAL RANDOMIZED OPEN STUDY ON THE MANAGEMENT OF SANDHIGATAVATA W.S.R. TO OSTEOARTHRITIS BY PATOLA (TRICOSANTHUS DIOCA) KSHIR BASTI

Osteoarthritis is the leading causes of arthritis in adult population. The word “Osteoarthritis” correlate as “Sandhigatavata” which is describe under ‘Vatvyadhi” in Ayurveda. Osteoarthritis (OA) may be perhaps the oldest of all known diseases. In this present era there is no definite cure for OA. Ayurvedic manage-ment of SandhigataVata, include BahyaSnehan (external oliation), Swedana (fomentation), Abhyantara TiktaSnehapana (ingestion of medicated ghee), Basti (medicated enema) treatment and GugguluPray-oga(drug containing comiferamukul). Aim: To assess the efficacy of ‘Patola (Tricosanthusdioca) Kshir Basti’ in the patients of ‘Sandhigatavata’. To study the efficacy of ‘Guduchi (Tinusporacordifolia) Kshir Basti’ in the patients of ‘Sandhigatavata’. Materials and Methods: In the present study 60 patients of Sandhigatavata were studied. These patients were classified randomly into two groups termed as Trial Group and Control Group. Diagnosis of Sandhigatavata was done on the basis of classical signs and symp-toms mentioned in Ayurvedic text, as well as the diagnostic criteria for osteoarthritis of knee Result: Signif-icant results (P< 0.05) were found in all the cardinal symptoms – Pain (Sandhiruja), Swelling (Shotha), tenderness, crepitus and pain on extension and flexion. Haematological findings showed significant result in sr. calcium, Haemoglobin percentage and ESR (Erythrocyte sedimentation rate) changes. Conclusion: At 5% level tabulated Chi Square suggested that both of the groups are same.

A study of clinical profile of pneumonia in Shivamogga institute of medical science attached hospital with special reference to curb scoring

Background: Our study was done to study in detail the clinical profile of cases admitted with pneumonia to Mc Ganna hospital, SIMS, Shivamogga. Aim of the study were to study in detail the clinical profile of pneumonia and to know the morbidity and mortality associated with pneumonia by comparing with CURB score.Methods: Ours is a clinical, prospective, observational and open study. The study subjects were pneumonia patients admitted to Shivamogga institute of medical sciences attached McGann hospital, Shivamogga with signs and symptoms suggestive of pneumonia. After obtaining a detailed history and clinical examination the patients were subjected to relevant investigations. The complete data was collected in specially designed case recording form and transferred into a master chart which is then subjected to statistical analysis.Results: We studied 100 cases of pneumonia, out of which 12 patients presented with confusion, 30 patients presented with raised blood urea nitrogen, 28 patients with raised respiratory rate, and 30 patients with hypotension. CURB score of 0 was observed in 54 patients, score 1 in 16 patients, score 2 in 8 patients and score 3 in 22 patients. Prognosis was good in patients aged less than 50 years and those without any comorbidities. Fever was the most common symptom of presentation.Conclusions: Our study had highlighted the fact that CURB scoring is helpful in triaging pneumonia patients but it is not a good predictor of mortality in pneumonia patients.