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Background: Hizentra® (IGSC 20 %) is a 20 % liquid IgG product approved for subcutaneous administration in adults and children 2 years of age and older who have primary immunodeficiency disease (PIDD). There is limited information about the use of IGSC 20 % in very young children including those less than 5 years of age. Methods: A retrospective chart review involved 88 PIDD infants and children less than 5 years of age who received Hizentra®. Results: The mean age at the start of Hizentra® was 34 months (range 2 to 59 months). IGSC 20 % was administered weekly to 86 infants (two additional infants received twice weekly and three times weekly infusions, respectively) and included an average of 63 infusions (range 6-182) for an observation period up to 45.5 months. Infusion by manual delivery occurred in 15 patients. The mean dose was 674 mg/kg/4 weeks. The mean IgG level was 942 mg/dL while on IGSC 20 %, compared to a mean trough IgG level of 794 mg/dL ( p < 0.0001) during intravenous or subcutaneous IgG administration prior to IGSC 20 %. Average infusion time was 47 (range 5-120) minutes, and the median number of infusion sites was 2 (range 1-4). Local reactions were mostly mild and observed in 36/88 (41 %) children. No serious adverse events were reported. A significant increase in weight percentile (7 % ± 19.2, p = 0.0012) among subjects was observed during IGSC 20 % administration. The rate of serious bacterial infections was 0.067 per patient-year while receiving IGSC 20 %, similar to previously reported efficacy studies. Conclusions: Hizentra® is effective in preventing infections, and is well tolerated in children less than age 5 years. [ABSTRACT FROM AUTHOR]

A novel series of hitherto unknown 3-(4-aryl-5 H-indeno[1,2- b]pyridin-2-yl)coumarin derivatives 3a- r have been synthesized by the reaction of 3-coumarinyl methyl pyridinium salts 1a-c with appropriate 2-arylidene-1-indanones 2a- f under Krohnke's reaction condition so as to investigate their in vitro antimicrobial activity. Structures of the target compounds 3a- r were characterized by their spectral and elemental analyses. Among the series, compound 3l displayed an encouraging antibacterial activity profile as compared to the reference drug ampicillin against tested bacterial strains. Graphical Abstract: [Figure not available: see fulltext.] [ABSTRACT FROM AUTHOR]

The ability of hyperaccumulator oilcake manure as compared to chelates was investigated by growingCalendula officinalisL for phytoremediation of cadmium and lead contaminated alluvial soil. The combinatorial treatment T6[2.5 g kg−1oilcake manure + 5 mmol kg−1EDDS] caused maximum cadmium accumulation in root, shoot and flower up to 5.46, 4.74 and 1.37 mg kg−1and lead accumulation up to 16.11, 13.44 and 3.17 mg kg−1, respectively at Naini dump site, Allahabad (S3). The treatment showed maximum remediation efficiency for Cd (RR = 0.676%) and Pb (RR = 0.202%) at Mumfordganj contaminated site (S2). However, the above parameters were also observed at par with the treatment T5[2.5 g kg−1oilcake manure +2 g kg−1humic acid]. Applied EDDS altered chlorophyll–a, chlorophyll–b, and carotene contents of plants while application of oilcake manure enhanced their contents in plant by 3.73–8.65%, 5.81–17.65%, and 7.04–17.19%, respectively. The authors conclude that Calendula officinalis L has potential to be safely grown in moderately Cd and Pb-contaminated soils and application of hyperaccumulator oilcake manure boosts the photosynthetic pigments of the plant, leading to enhanced clean-up of the cadmium and lead-contaminated soils. Hence, the hyperaccumulator oilcake manure should be preferred over chelates for sustainable phytoremediation through soil-plant rhizospheric process. [ABSTRACT FROM AUTHOR]

The article describes a case of scurvy in a 9-year-old African American male. The patient had a history of autism and nonverbal communication. He presented with refusal to bear weight and a draining mouth sore. Topics discussed include the symptoms of vitamin C deficiency, how it develops in children, and the suggested treatment for scurvy.

Background: Computed tomography (CT) and magnetic resonance (MR) enterography are now widely used to diagnose and monitor Crohn's disease. Aim: We sought to assess the use of enterography for management of inflammatory bowel disease (IBD) in our medical center. Methods: We performed a retrospective review of all patients diagnosed with IBD who underwent MR or CT enterography from November 1, 2010 to October 25, 2012 at our institution. We assessed disease complications identified by enterography, agreement between disease activity determined by endoscopy and enterography, association between inflammatory markers and enterography-determined disease activity and recommended changes in medical and surgical management following enterography. Results: A total of 311 enterography studies (291 MR and 20 CT enterographies) were performed on 270 patients, including 258 (83.0 %) on patients with presumed Crohn's disease and 53 (17.0 %) with presumed ulcerative colitis. Active small bowel (SB) disease was noted in 73/311 (23.5 %) studies. Complications including strictures, perianal fistulas, abscesses and SB fistulas were noted in 108/311 (34.7 %) studies. Endoscopic and enterography defined active disease had an agreement of κ = 0.36 in the ileum ( n = 179). A total of 142/311 (45.7 %) enterographies were associated with recommended medication changes within 90 days while surgery or endoscopic dilation of stricture was recommended following 41/311 (13.2 %) enterographies. Enterography resulted in a change in diagnosis from ulcerative colitis to Crohn's in 5/311 (1.6 %) studies. Conclusion: Enterography reveals active disease and complications not evident on endoscopy and should be considered in the initial diagnosis, assessment of disease activity, and monitoring of therapy in patients with IBD. [ABSTRACT FROM AUTHOR]

A novel class of substituted pyridyl coumarin derivatives has been synthesized starting from 3-acetyl coumarin and chromone-3-carbaldehyde via one pot reaction and fully characterized by spectral and elemental analysis. All these derivatives 3a-l were screened in vitro for antimicrobial activity against a representative panel of pathogenic strains. Compounds demonstrated good to excellent antibacterial activity, while some compounds exhibited equipotent antifungal activity as compared to that of first line standard drug. As a part of investigation of new antitubercular agents, in vitro screening of synthesized compounds against Mycobacterium tuberculosis HRv has been done. Among the designed molecules, three compounds showed relatively better activity. From the entire study, it has been revealed that compounds appear to be better antimicrobials but relatively poor antituberculars. [ABSTRACT FROM AUTHOR]

The CO2 Laser is one of the most widely used medical lasers globally delivering an intense beam of Infrared light with 10,600 nm wavelength. Thirteen clinical cases of dogs with warts/small tumours (<3 cm) were subjected to CO2 Laser ablation. Operation was performed under general anesthesia and full-thickness skin was excised using CO2 Laser with 0.4mm ceramic tip and settings of 10W continuous wave mode. Surgical blood loss was estimated and post-operative complications, surgical outcome and post-operative clinical appearance were recorded after 15 to 30 days. In the present study, for warts and tumors power of 12W to 15W was optimum. The average blood loss during surgery was -1 ml. In all cases, the cosmetic appearance of scar was good without any post-operative complications. [ABSTRACT FROM AUTHOR]

Nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) frequently coexist due to shared risk factors. Their rising prevalence parallels the growing epidemic of obesity and insulin resistance (IR). In patients with T2DM and biopsy-proven NAFLD, a significantly higher prevalence of nonalcoholic steatohepatitis (NASH) (63-87%), any fibrosis (22-60%), and advanced fibrosis (4-9%) is noted. Possible risk factors for more advanced liver disease include concomitant metabolic syndrome with three or more components, visceral obesity, older age, increased duration of diabetes, and family history of diabetes. Liver biopsy is strongly suggested in these patients. Cardiovascular disease (CVD) and malignancy are the leading causes of death in this population, but a growing body of evidence shows liver-related mortality as an important cause of death, including an increased rate of hepatocellular carcinoma (HCC) in diabetes. The presence of NAFLD in T2DM is also associated with increased overall mortality. We aim with this review to summarize the results from studies investigating NAFLD in T2DM and to outline the factors that predict more advanced liver histology as well as the impact of these hepatic changes on CVD, overall and liver-related mortality. [ABSTRACT FROM AUTHOR]

Photodynamic therapy (PDT) is based on the synergism of a photosensitive drug (a photosensitizer) and visible light to destroy target cells (e.g., malignant, premalignant, or bacterial cells). The aim of this study was to investigate the response of normal rat tongue mucosa to PDT following the topical application of hematoporphyrin derivative (Photogem®), Photodithazine®, methylene blue (MB), and poly(lactic- co-glycolic acid) (PLGA) nanoparticles loaded with MB. One hundred and thirty three rats were randomly divided in various groups: the PDT groups were treated with the photosensitizers for 10 min followed by exposure to red light. Those in control groups received neither photosensitizer nor light, and they were subjected to light exposure alone or to photosensitizer alone. Fluorescent signals were obtained from tongue tissue immediately after the topical application of photosensitizers and 24 h following PDT. Histological changes were evaluated at baseline and at 1, 3, 7, and 15 days post-PDT treatment. Fluorescence was detected immediately after the application of the photosensitizers, but not 24 h following PDT. Histology revealed intact mucosa in all experimental groups at all evaluation time points. The results suggest that there is a therapeutic window where PDT with Photogem®, Photodithazine®, MB, and MB-loaded PLGA nanoparticles could safely target oral pathogenic bacteria without damaging normal oral tissue. [ABSTRACT FROM AUTHOR]

Background. Ectopic fat deposition in the pancreas and its relationship with hepatic steatosis and insulin resistance have not been compared between patients with nonalcoholic fatty liver disease (NAFLD) and healthy controls. Aim. Using a novel magnetic resonance imaging (MRI) based biomarker, the proton-density-fat-fraction (MRI-PDFF), we compared pancreatic fat content in patients with biopsy-proven NAFLD to healthy controls and determined whether it is associated with insulin resistance and liver fat content. Methods. This nested case-control studywas derived fromtwo prospective studies including 43 patientswith biopsy-proven NAFLD and 49 healthy controls who underwent biochemical testing and MRI. Results. Compared to healthy controls, patients with NAFLD had significantly higher pancreatic MRI-PDFF (3.6% versus 8.5%, P value <0.001), and these results remained consistent in multivariable-adjusted models including age, sex, body mass index, and diabetes (P value =0.03).We found a strong correlation between hepatic and pancreatic MRI-PDFF (Spearman correlation, P = 0.57, P value <0.001). Participants with increased insulin resistance determined by homeostatic-model-of-insulin-resistance (HOMA-IR) greater than 2.5 had higher pancreatic (7.3% versus 4.5%, P value =0.015) and liver (13.5% versus 4.0%, P value <0.001) MRI-PDFF. Conclusion. Patients with NAFLD have greater pancreatic fat than normal controls. Insulin resistance is associated with liver and pancreatic fat accumulation. [ABSTRACT FROM AUTHOR]

In an attempt to find a new class of antimicrobial agents, a series of fused chromenone derivatives containing pyridine and quinoline moieties were prepared via the reaction of 4-chloro-2-oxo- 2H-chromene-3-carbaldehydes with cyclopentanone or cyclohexanone or α-tetralone in the presence of ammonium acetate in refluxing glacial acetic acid. The target molecules were also synthesized using interchange component strategy. These compounds were screened for their antibacterial activity against Gram-positive bacteria ( Staphylococcus aureus and Streptococcus pyogenes), Gram-negative bacteria ( Pseudomonas phaseolicola and Pseudomonas fluorescens), and antifungal activity against Fusarium oxysporum and Aspergillus niger. The compounds exhibited good to moderate antibacterial and antifungal properties against tested microorganisms. Structures of the newly synthesized compounds were established by elemental analysis and spectral data. Graphical abstract: [InlineMediaObject not available: see fulltext.] [ABSTRACT FROM AUTHOR]

Abstract: Introduction: The objective of this study was to evaluate the antimicrobial effects of photodynamic therapy (PDT) on infected human teeth ex vivo. Methods: Fifty-two freshly extracted teeth with pulpal necrosis and associated periradicular radiolucencies were obtained from 34 subjects. Twenty-six teeth with 49 canals received chemomechanical debridement (CMD) with 6% NaOCl, and 26 teeth with 52 canals received CMD plus PDT. For PDT, root canal systems were incubated with methylene blue (MB) at concentration of 50 μg/mL for 5 minutes, followed by exposure to red light at 665 nm with an energy fluence of 30 J/cm2. The contents of root canals were sampled by flushing the canals at baseline and after CMD alone or CMD+PDT and were serially diluted and cultured on blood agar. Survival fractions were calculated by counting colony-forming units (CFUs). Partial characterization of root canal species at baseline and after CMD alone or CMD+PDT was performed by using DNA probes to a panel of 39 endodontic species in the checkerboard assay. Results: The Mantel-Haenszel χ2 test for treatment effects demonstrated the better performance of CMD+PDT over CMD (P = .026). CMD+PDT significantly reduced the frequency of positive canals relative to CMD alone (P = .0003). After CMD+PDT, 45 of 52 canals (86.5%) had no CFUs as compared with 24 of 49 canals (49%) treated with CMD (canal flush samples). The CFU reductions were similar when teeth or canals were treated as independent entities. Post-treatment detection levels for all species were markedly lower for canals treated by CMD+PDT than they were for those treated by CMD alone. Bacterial species within dentinal tubules were detected in 17 of 22 (77.3%) and 15 of 29 (51.7%) canals in the CMD and CMD+PDT groups, respectively (P = .034). Conclusions: Data indicate that PDT significantly reduces residual bacteria within the root canal system, and that PDT, if further enhanced by technical improvements, holds substantial promise as an adjunct to CMD. [Copyright &y& Elsevier]

More than 2 million Americans use cocaine each month (National Survey on Drug Use and Health, Department of Health and Human Services: Substance Abuse and Mental Health Services Administration (SAMHSA) & Office of Applied Studies (OAS), Rockville, MD ). Starting in early 2003, South American cocaine cartels began to add levamisole, a pharmaceutical agent, to bulk cocaine prior to shipment to the USA (Valentino and Fuentecilla ). A dramatic increase in the prevalence of levamisole in cocaine was noted in early 2008. By October, 30% of cocaine bricks analyzed by the United States Drug Enforcement Administration contained levamisole (Casale et al. ). Exposure to levamisole can cause agranulocytosis (Amery and Bruynseels ). We report the first confirmed case of agranulocytosis associated with consumption of levamisole-contaminated cocaine in the USA. A previously healthy adult male presented to the emergency department with 5 days of mouth pain. He admitted to chronic active ethanol and crack cocaine abuse. Laboratory studies revealed severe neutropenia, with an absolute neutrophil count of 19 cells/mm3 (normal = 1,500–8,000 cells/mm3). A urine screen for drugs of abuse was positive for cocaine metabolites and opiates. Evaluation of a peripheral blood smear showed leukopenia with severe absolute neutropenia. A bone marrow biopsy revealed recently injured bone marrow showing early recovery. While in the hospital, the patient had little spontaneous bone marrow recovery. He received granulocyte colony-stimulating factor with improvement in peripheral white blood cell counts. The residue in the patient’s crack pipe contained 10% levamisole. Subsequently, levamisole was detected in the patient’s urine. Levamisole-associated agranulocytosis should be considered in the diagnosis of patients who present with neutropenia and a history or evidence of cocaine use. [ABSTRACT FROM AUTHOR]

Live pentavalent human–bovine reassortant rotavirus vaccine is recommended in the United States for routine immunization of infants. We describe three infants, two with failure to thrive, who had dehydration and diarrhea within 1 month after their first or second rotavirus immunization and subsequently received a diagnosis of severe combined immunodeficiency. Rotavirus was detected, by means of reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assay, in stool specimens obtained from all three infants, and gene-sequence analysis revealed the presence of vaccine rotavirus. These infections raise concerns regarding the safety of rotavirus vaccine in severely immunocompromised patients. [ABSTRACT FROM AUTHOR]

Some 4-aryl-2,6-di(coumarin-3-yl)pyridines 3a-r are synthesized by the reaction of 3-coumarinoyl methyl pyridinium salts 1a-c with appropriate 1-[2H-1-benzopyran-2-on-3-yl]-3-aryl-prop-2-en-1-ones 2a-f in the presence of ammonium acetate and acetic acid under the Kröhnke reaction conditions. All the synthesized compounds are screened for antimicrobial activity. [ABSTRACT FROM AUTHOR]

Various 3-(1-aryl-9,10-dihydro-4-azaphenanthren-9-yl)coumarins 3a-o were synthesized by reacting various 3-coumarinoyl methyl pyridinium salts 1a-c with appropriate 2-benzylidene-1-tetralone 2a-e in the presence of ammonium acetate and acetic acid under the Kröhnke's reaction condition. The structures of all the synthesized compounds were established on the basis of elemental and spectral analysis. [ABSTRACT FROM AUTHOR]

This paper focuses on the role of an information centre/library in the uplift of rural people in various areas such as education, health, agriculture and employment, It also emphasizes on the use of Information Communication Technology (ICT) at the bottom of the pyramid to enable the rural citizenry to access the resources available at the Rural Information Centre (RIC). It also examines how the RIC can help the government, Non Government Organizations (NGOs) and Self Help Groups (SHGs) to alleviate poverty, eradicate illiteracy and generate awareness about health, self-employment, the right to information and the benefits of e-governance for sustainable development at the bottom of the pyramid. [ABSTRACT FROM AUTHOR]

Biliptysis is an important clinical feature to recognize as it is associated with bronchobiliary fistula, a rare entity. Bronchobiliary fistulas have been diagnosed with planarcholescintigraphy. However, cholescintigraphy with single-photon emission computed tomography (SPECT) can better spatially localize a bronchobiliary fistula as compared to planar cholescintigraphy alone, and is useful for preoperative planning if surgical treatment is required. Here, we present the case of a 23-year-old male who developed a bronchobiliary fistula in the setting of posttraumatic and postsurgical infection, which was diagnosed and localized by cholescintigraphy with SPECT. [ABSTRACT FROM AUTHOR]

Patient: Male, 34-year-old Final Diagnosis: Gastric sarcoidosis Symptoms: Abdominal pain * nausea * vomiting * weight loss Medication: -- Clinical Procedure: -- Specialty: Gastroenterology and Hepatology * General and Internal Medicine Objective: Rare disease Background: Sarcoidosis is an inflammatory condition with multisystem involvement of unknown etiology that is characterized by noncaseating granulomas. Gastrointestinal (GI) involvement of sarcoidosis is not commonly seen in patients with extrapulmonary disease but can result in luminal narrowing, ulceration, and, less commonly, bleeding and obstruction. Patients that present with symptomatic gastric sarcoidosis are extremely rare. Definitive diagnosis can be challenging due to the need for endoscopic biopsy, which may not be performed if the diagnosis is not considered. Biopsy may be falsely negative due to the patchy mucosal involvement of this disease. Case Report: This case describes a 38-year-old mixed-race man who presented to the Emergency Department with GI symptoms including nausea, vomiting, and abdominal pain, which persisted after being recently discharged from an outside hospital. The patient had a known history of multisystem sarcoid including pulmonary and neurosarcoidosis, and was maintained on immunosuppressive therapy. The patient underwent upper endoscopy with biopsy confirming a new diagnosis of gastric sarcoidosis. Conclusions: There is an important role for early endoscopy in the diagnosis of patients with symptomatic gastric sarcoidosis to facilitate early treatment initiation and escalation or titration of immunosuppressive therapy, especially in patients with a known history of sarcoidosis with extrapulmonary involvement. The described endoscopic appearance of gastric sarcoidosis is variable in the published literature; endoscopic biopsy is therefore essential to diagnosing this disease. This type of disease progression should be considered in all sarcoid patients with persistent GI symptoms that do not resolve with conservative management, including those who are already on established immunosuppressive therapy. [ABSTRACT FROM AUTHOR]

Facilitated subcutaneous immunoglobulin (fSCIG) 10% is an immunoglobulin replacement therapy that utilizes recombinant human hyaluronidase (rHuPH20) to enhance immunoglobulin dispersion and absorption, allowing for longer treatment intervals similar to intravenous immunoglobulin (up to once monthly). fSCIG 10% is indicated in the USA for treating adults and children aged ≥ 2 years with primary immunodeficiency diseases (PIDs). This prospective, non-interventional, open-label, multicenter, post-authorization safety study (NCT02593188) was conducted in the USA from November 2015 to October 2021 to assess the long-term safety of fSCIG 10% in routine clinical practice. Patients with PIDs aged ≥ 16 years who were prescribed and/or had started fSCIG 10% treatment were enrolled. In total, 253 patients were enrolled and included (full analysis set). Participants received fSCIG 10% treatment for a median (interquartile range) of 10.0 (3.5–11.8) months, with the majority of infusions administered every 4 weeks (54.4% [1197/2201 infusions]) and at home (62.6% [1395/2230 infusions]). Overall, 98.5% of infusions were administered without rate reduction, interruption, or discontinuation due to adverse events (AEs). Treatment-related, non-serious AEs were experienced by 52 patients (20.6%, 284 events). Two patients (0.8%) each experienced one treatment-related serious AE (aseptic meningitis and deep vein thrombosis). Development of antibodies against rHuPH20 was uncommon; 14/196 patients (7.1%) tested positive for binding antibodies (titer ≥ 1:160) with no neutralizing antibodies detected. There was no relationship between anti-rHuPH20 antibody positivity and the occurrence of treatment-related serious or non-serious AEs. Long-term, repeated self-administration of fSCIG 10% was well tolerated in US clinical practice by patients with PIDs. [ABSTRACT FROM AUTHOR]

The crystal structure of the title compound is determined by single crystal X-ray structure analysis. The crystals are monoclinic, space group P21/c, a = 13.607(3) Å, b = 13.352(3) Å, c = 9.700(2) Å, β = 92.085(3)°, Z = 4, and R = 0.0543 for 3111 observed reflections. The dihedral angle between the coumarin nucleus and pyridine ring is 1.41(3)°, confirming the perfect planarity of the pyrido coumarin moiety. Ring D deviates significantly from planarity. The observed conformation for ring D is a half chair (ΔC2(C5–C6) = 6.26). The supramolecular aggregation in the title compound is extremely simple and involves just one intermolecular hydrogen bond. Molecules are also reinforced by π–π stacking interactions involving pyrido coumarin moiety of the molecule. [ABSTRACT FROM AUTHOR]