A case report of ofloxacin induced fixed drug eruptions and hypersensitivity reaction

Ofloxacin is the most commonly used first generation fluoroquinolones. Its activity against gram negative organisms lie between Norfloxacin and Ciprofloxacin. It is used for treating infections like UTI, gastroenteritis etc. It is generally well tolerated, gastric upset is the most common adverse effect. However very few cases of Fixed Drug Eruptions have been reported. Here we report a case of a 16year old female patient who developed redness and rashes all over body along with nausea, vomiting, dizziness, palpitations, blurring of vision, headache and loss of consciousness after receiving Tab ofloxacin 200mg for gastroenteritis. Signs and symptoms subsided within 24 hrs after the drug was stopped and supportive treatment like IV fluids along with dexamethasone was given. Ofloxacin was strongly suspected as the causal drug for the hypersensitivity reaction as the subject had a history of allergic reaction to the same in the past. Early detection of cutaneous lesions and immediate withdrawal of the offending drug can prevent progression of such reactions to their severe variants as well as morbidity and mortality

Characterization of cenospheres from Malaysian coal generated power plants: Jimah, Kapar and Manjung

Cenosphere is a component of fly ash (FA) and has been used as part of sustainable material in wastewater treatment, automotive, ceramic, and construction industries due to its properties. This research presents the first study on characterization of cenospheres from Malaysian power plants namely Jimah, Kapar and Manjung. The characterization was conducted via X-ray fluorescence (XRF), particle size analyzer (PSA), X-ray diffraction (XRD), and scanning electron microscopy (SEM). The XRF analysis consisted of oxides elements ranged from 14.70 to 22.63% (aluminum oxide, Al2 O3 ), 3.78 to 13.44% (calcium oxide, CaO), 34.73 to 57.67% (silicon dioxide, SiO2 ), 0.42 to 1.07% (sulphur trioxide, SO3 ), 9.09 to 24.92% (iron oxide, Fe2 O3 ), 3.62 to 3.67% (potassium oxide, K2 O), 1.76 to 4.24% (titanium oxide, TiO2 ) and 0.16 to 0.93% (magnesium oxide, MgO). The classifications of cementitious materials by American Standard of Testing Materials were Class F (Jimah, Kapar) and Class C (Manjung). The classification represents the quality and capability of cementitious materials as cement replacement material, additive, and filler in concrete mix. The sizes of cenospheres were Kapar > Jimah > Manjung. The sizes of cenosphere were found to be larger than FA (Jimah: 2.720-49.21 µm, Kapar: 5.069-98.29 µm, Manjung: 1.084-3.986 µm). Cenospheres contained quarts (Jimah, Kapar, Manjung: 26°) and silicates (Kapar, Manjung: 45°). Ferrospheres, cenospheres, aluminosilicate-spheres, plerospheres and carbon fragments were observed. The cenosphere from Manjung showed high quality as cement replacement material, additive, and filler with 13.44% of CaO

Global, regional, and national burden of colorectal cancer and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Funding: F Carvalho and E Fernandes acknowledge support from Fundação para a Ciência e a Tecnologia, I.P. (FCT), in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of the Research Unit on Applied Molecular Biosciences UCIBIO and the project LA/P/0140/2020 of the Associate Laboratory Institute for Health and Bioeconomy i4HB; FCT/MCTES through the project UIDB/50006/2020. J Conde acknowledges the European Research Council Starting Grant (ERC-StG-2019-848325). V M Costa acknowledges the grant SFRH/BHD/110001/2015, received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006.proofepub_ahead_of_prin

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance.

Investment in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing in Africa over the past year has led to a major increase in the number of sequences that have been generated and used to track the pandemic on the continent, a number that now exceeds 100,000 genomes. Our results show an increase in the number of African countries that are able to sequence domestically and highlight that local sequencing enables faster turnaround times and more-regular routine surveillance. Despite limitations of low testing proportions, findings from this genomic surveillance study underscore the heterogeneous nature of the pandemic and illuminate the distinct dispersal dynamics of variants of concern-particularly Alpha, Beta, Delta, and Omicron-on the continent. Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve while the continent faces many emerging and reemerging infectious disease threats. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Electrophysiological study of the ulnar palmar cutaneous nerve in normal individuals

Introduction The electrophysiological assessment of the ulnar palmar cutaneous nerve (UPCN) is clinically essential to assess the integrity of this nerve in some clinical situations that involve compression or injury of this nerve. Aim This study proposed to assess the electrophysiological antidromic technique of the UPCN and to obtain normal reference values for the electrophysiological parameters of this nerve. Settings and design It is a single-center public hospital-based electromyography laboratory. It is a cross-sectional study of consecutive apparently healthy volunteers. Patients and methods The study included 70 apparently healthy volunteers. Antidromic sensory nerve conduction study of the UPCN was carried out. Statistical analysis Quantitative data were analyzed using Student’s t-test and paired t-test. Correlation was tested using the Pearson correlation test. Results The present study included 119 hands of 70 healthy individuals [36 (51.43%) women]. Their mean age was 41.91±13.21 years. The UPCN was elicited in 116 (97.48%) hands. The estimated reference values (mean±2 standard deviations) for the UPCN sensory nerve action potential were determined for onset latency (≤2.1 ms), peak latency (≤2.8 ms), conduction velocity (≥46.4 m/s), amplitude (≥6.9 µV), and interside sensory nerve action potential amplitude ratio (≥0.50). Conclusion This study provided a feasible electrophysiological antidromic technique and normal reference values for sensory conduction study of the UPCN

Electrophysiological study of Martin–Gruber anastomosis in a sample of Egyptians

Introduction Martin–Gruber anastomosis (MGA) is one of the most common anomalous innervations present in the body. Missing these anomalous innervations may easily be mistaken for technical pitfalls or even for actual pathology. Aim The aim of the current study was to determine the presence and the frequency of MGA by electrophysiological examination in a sample of Egyptian subjects. Subjects and methods It is a cross-sectional study of consecutive apparently healthy volunteers. The study included 200 forearms from 100 apparently healthy Egyptian volunteers in a single-center public-hospital-based electromyography laboratory. Electrophysiological studies in the form of motor conduction study for the median and ulnar nerves were performed by recording the hypothenar, first dorsal inerosseous, and thenar muscles. Qualitative data were analyzed using Pearson’s Chi-square test and Fisher’s exact test. Results The present study included 69 (69%) women. MGA was found in 39 (19.5%) forearms of 26 (26%) subjects electrophysiologically. There was no statistical significant difference between the occurrence of MGA in men versus women (P=0.127). The most common form was MGA to the first dorsal interosseous muscle. It was present in 30 (15%) forearms of 24 (24%) subjects. MGA to thenar muscles was present in 13 (6.5%) forearms of 12 (12%) subjects. MGA to the abductor digiti minimi muscle was present in five (2.5%) forearms of five (5%) subjects. Conclusion Martin–Gruber anastomosis is present in Egyptians. The frequency of occurrence of MGA in a sample of Egyptian subjects was found to be 26% in electrophysiological examination