Advanced HIV Infection in Treatment Naïve Individuals: Effectiveness and Persistence of Recommended Three-Drug Regimens

Background Approximately 20% of newly diagnosed people with HIV (PWH) in the U.S. have advanced HIV infection, yet literature on current antiretroviral therapy (ART) options is limited. Discontinuation/modification and effectiveness of common regimens were compared among ART-naïve people with advanced HIV infection (CD4 cell count <200 cells/μL). Methods ART-naïve adults with advanced HIV infection initiating bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) or a boosted darunavir (bDRV)-, dolutegravir (DTG)- or elvitegravir/cobicistat (EVG/c)-based three-drug regimen between 1JAN2018 and 31JUL2019 in the OPERA cohort were included. The association between regimen and discontinuation or viral suppression (<50 or <200 copies/mL) was assessed using Cox proportional hazards models with inverse probability of treatment weights. Results Overall, 961 PWH were included (416 B/F/TAF, 106 bDRV, 271 DTG, 168 EVG/c); 70% achieved a CD4 cell count ≥200 cells/μL over a 16 months median follow-up. All regimens were associated with a statistically higher likelihood of discontinuation than B/F/TAF (bDRV aHR: 2.65 [95% CI: 1.75, 4.02], DTG: 2.42 [1.75, 3.35], EVG/c: 3.52 [95% CI: 2.44, 5.07]). Compared to B/F/TAF, bDRV initiators were statistically less likely to suppress to <50 copies/mL (0.72 [0.52, 0.99]) and <200 copies/mL (0.55 [0.43, 0.70]); no statistically significant difference was detected with DTG or EVG/c. Conclusions Among people with advanced HIV infection, those initiating B/F/TAF were less likely to discontinue/modify their regimen than those on any other regimen, and more likely to achieve viral suppression compared to those on bDRV but not compared to those on other integrase inhibitors.

Comparative Diagnostic Accuracy of Mean and Lowest Cycle Threshold Levels in Xpert MTB/RIF Assay and Molecular Epidemiology of Missing Probes In Rifampicin Resistant Tubercular Cases From A Tertiary Care Hospital

Background: The comparative diagnostic accuracy of mean and lowest Ct values needs to be evaluated for the assessment of mycobacterial burden in tubercular cases. Mutation in any codon of 81 base-pair core regions prevents the hybridization of one or more of five overlapping Probes A-Ein Xpert MTB/RIF assay indicated by “missing probe. Molecular epidemiology of missing probes may prove useful in tracing the source of infection and selection of a more suitable drug regimen for treatment. Methods: This study included 65 rifampicin resistant cases and an equal number of rifampicin sensitive cases detected by Xpert MTB/RIF assay. Only samples tested positive for tubercular bacilli were included. The information regarding the tubercular load, Ct values of five probes targeting the rpoB gene, lowest Ct value among the five probes, missing probe in rifampicin resistant cases and time taken for the entire cycle were recorded in each case. Results: Lowest Ct is a stronger indicator of tubercular load than the mean Ct value. E probe was found to be missing in majority (64.6%) of the cases, followed by A (6.2%), B and D (4.6%), C (1.5%) probes. In 7.6% cases, more than one probe was missing. None of the probe was missing in 10.6% of rifampicin resistant cases. Conclusions: Lowest Ct value was found to be a better tool than mean Ct value for the determination of mycobacterium burden. Molecular epidemiology of missing probes could be useful in the development of new probes for the detection of rifampicin resistance.

Importance of Medication Reconciliation as a Strategy for Health Literacy

Health literacy depends on communication skills of health professionals. Assertiveness, clarity, and positivity (ACP) are a communication model/technique very useful to improve the patient-health professional relationship, adherence to treatment, health literacy, and quality of life. This model can be used in medication reconciliation (MR) – the identification of the most precise list of medication that a patient has been taking and should take, which requires a multidisciplinary participation and a better communication between health professionals and between them and the patient. When the guidance from healthcare professionals is clear and effective, patients and caregivers are more compliant to the recommended drug regimen, resulting in better health outcomes.

Sustained HIV viral suppression with dolutegravir, tenofovir, and emtricitabine as initial therapy despite high-level transmitted multi-class resistance

Multi-class high-level transmitted HIV drug resistance is uncommon, and the selection of the optimal initial antiretroviral drug regimen may be challenging. We report a case of extensive transmitted multi-class resistance successfully treated with dolutegravir, tenofovir, and emtricitabine even though the baseline genotype demonstrated full susceptibility to only one drug class, the integrase strand transfer inhibitors. Our case highlights both the high resistance barrier of dolutegravir and the residual antiviral activity of nucleoside reverse transcriptase inhibitors despite extensive resistance on genotype.

Study on Role of In-patient Pharmacist in Prescribed Drug Handling, Mixing, Infusing and Spillage Handling of Chemotherapeutic Drug-Cisplatin in a Tertiary Hospital Pharmacy

The in-patient pharmacist in a cancer hospital plays a major role in patient care especially in patient taking chemotherapy and other narrow indexed drugs as a part of cancer treatment. The pharmacist works as one of the members of cancer treatment team along with physician, oncologist, nurse and other medical professionals. An oncology pharmacist has major role in chemotherapeutic drug handling, mixing, infusing and spillage handling in a disciplined manner. In order to get hands on training about ‘‘oncology-pharmacy’’, it is a mandatory novel pharmaceutical department where a hospital pharmacist who works in oncology will have to get training in handling of chemotherapeutic drugs. The pharmacists who are interested in cancer care will involve in various facets cancer care; from chemotherapeutic drug regimen preparation, mixing of dosage regimen, infusing and finally spillage handling. Hence, it is a mandatory criterion for a graduate pharmacist to get hands on training in specialty Centre to take the responsibility as oncology in-patient pharmacist. The inpatient pharmacist can also be a clinical investigator for various clinical trials involving chemotherapeutic medication usage in patients with cancer. Current study shows that an inpatient pharmacist can play a major role in handling, mixing, infusing and spillage handling of chemotherapeutic drugs in a cancer care centre. The pharmacists are also responsible for reducing drug waste, dealing with drug shortages and reducing exposure to hazardous cytotoxic drugs. The current study suggests that the pharmacist in a cancer care hospital should specially be trained for the handling of chemotherapeutic drugs, mixing and infusion, spillage handling and wastage handling in order to provide accurate treatment for patient and to avoid untoward damage to the person who is handling.

Application of Wavelet in Quantitative Evaluation of Gait Events of Parkinson’s Disease

Motivation. In Parkinson’s disease, disturbances in gait initiation are of particular interest as they affect postural adjustments and movement disorders which may lead to falling. This falling down may be dangerous and at times life threatening, thus becoming a major concern for the patient and the clinician. These gait abnormalities are due to dependencies of movement on the motor system. Paroxysmal dyskinesia (commonly termed as freezing of gait) is one of the extreme cases of motor blocks. Since the last two decades, automated methods for monitoring motor activities, their data analysis, and algorithm techniques have been subjects of research for Parkinson’s disease (PD). This research will be of help to clinicians in prescribing a drug regimen. Problem Statement. Development of a system based on an algorithm for automatic detection of the freezing of gait (FOG) and other postural adjustments, with the help of wearable sensor’s data and to provide a quantitative approach for assessing the intensity of PD by analyzing frequency components associated with different motor movements and gait. Methodology. This paper presents a novel wavelet energy distribution approach to distinguish between walking, standing, and FOG. Data from the acceleration sensor is taken as input. After preprocessing, discrete wavelet transform (DWT) is applied on the data which shows its entire frequency spectrum. In the next step, energy is computed for the decomposed level of interest. Results. Systems detected FOG and other gait postures and showed time-frequency range by examining differentiated decomposed signals by DWT. Energy distribution and PSD graph proved the accuracy of the system. Validation is done by the LOSO method which shows 90% accuracy for the proposed method. Conclusion. Observations of the clinical trials validate the proposed technique. In comparison to the previous techniques reported in literature, it is seen that the proposed method shows improvement in time and frequency resolution as well as processing time.

Case Report on Mild Anemia and Gastritis due to Zidovudine, Lamivudine and Nevirapine (ZLN) Regimen

AIDS is a deadly syndrome in which Highly Active Anti-retroviral therapy is used to reduce the viral load. However these anti-retroviral drugs are supposed to cause several adverse drug reaction. There are several studies that report anemia with Zidovudine and gastrointestinal symptoms with Lamivudine. In this report, We present a case of a 38 year old female patient suffering from HIV infection who is suspected to drug induced anemia and gastritis due to Zidovudine, Lamivudine and Nevirapine combination (ZLN) regimen. The relationship between the administered drug regimen and the suspected ADR’s was found using causality assessment. Severity, predictability and probability was also found for the suspected ADR’s. We need to monitor the HIV patients who are under ZLN regimen for their blood haemoglobin and gastrointestinal symptoms.

The efficacy of bedaquiline versus kanamycin in multi-drug resistant tuberculosis: A systematic scoping review

Background: Drug-resistant tuberculosis (DR-TB) has become a serious cause of concern both on a global scale and in South Africa. It is associated with a lower successful treatment rate, thus creating a hurdle in achieving good treatment outcomes for patients.Aim: The aim of this study was to compare the efficacy of the drug kanamycin, an injectable aminoglycoside, to bedaquiline, a newer oral drug used to treat DR-TB.Methods: PubMed and Google Scholar, both of which are online databases, were extensively searched using the necessary keywords so that studies that were relevant to the scoping review were retrieved. A data-charting list was developed to extract the needed data for this scoping review.Results: The main findings of the scoping review showed that bedaquiline was highly efficacious in the treatment of DR-TB, and that it was a valuable addition in the treatment of DR-TB. The findings of the study also showed that kanamycin does not have good efficacy against DR-TB. and its use extends the treatment of DR˗TB.Conclusion: It stands to reason that bedaquiline replaces kanamycin in the DR-TB drug regimen as it was shown to be more efficacious and patients experienced better treatment outcomes in a shorter period of time. There were also fewer adverse effects associated with bedaquiline as compared to kanamycin.Contribution: Bedaquiline-based DR-TB therapy is more efficacious than aminoglycoside-based regimens which include kanamycin.

Factors Increasing Noncompliance of Psychiatric Patients Undergoing for Psychotropic Therapy

Introduction: The positive result of the treatment regimen mainly depends on the adherence of the patients towards the instruction given by the physician and termed as the noncompliance or incomplete adherence to treatment. Methods: The present study aimed to descriptively analyze and identify the reasons that increasing the incomplete adherence for psychotropic therapy based on information retrieved from the patient and their relatives in Institute of Mental Hospital (IMH), Chennai.90 participants were interrogated using a structured questioner by purposive-sampling procedure after receiving their informed consent. Results: The present study showed the involvement of different factors such as pre – mature stopping the drug regimen (28.8%), buying lesser quantity of the drugs than prescribed by physicians (24.4%), and irregular drug consuming (23.3%). The present study importance of creating the awareness regarding the optimal follow- ups and emphasized the advices regarding the changing the mental health service regimes. The patients and relatives should be given the psychological based awareness for reducing the noncompliance on the psychotropic regimes.

Osteosarcoma: A review

Osteosarcoma (OS) is a type of cancer with onset in late childhood and peak at early adolescence. OS is a typically is chemo sensitive cancer. The treatment modalities include neo-adjuvant and adjuvant therapies with definitive surgery. Permutations and combinations of chemotherapeutics agents have been used. However, in many clinical trial high dose methotrexate has been used as main drug with cisplatin and doxorubicin (MAP). In recent years, case studies have cited addition of fourth drug to the three drug regimen gives a detail of drug regimen being used over past years and discusses the successful treatment.