Screening of Extended Family Members of Thalassemia Major Children as a Thalassemia Preventive Strategy

BACKGROUND: Thalassemia is considered as the most common single gene disorder worldwide. Preventive measures include identification of thalassemia carriers (traits) through screening, genetic counselling and prenatal diagnosis to reduce the incidence. This study aims at estimating the prevalence of carrier status detection among the extended family members of children having thalassemia major so as to use it as a screening prevention strategy with appropriate counselling. METHODS: This cross-sectional study was conducted in thalassemia unit of Pediatric Department of a tertiary care teaching hospital over a period of 18 months. Blood samples were collected from 117 extended family members (EFM) of 23 children with thalassemia major to carry out investigations such as Complete Blood Counts (CBC), Naked Eye Single Tube Red Cell Osmotic Fragility Test (NESTROFT), Reticulocyte count, High Performance Liquid Chromatography(HPLC) and serum ferritin. Reports were analysed to find out the prevalence of carriers. RESULTS: Among 117 EFM, 62 (52.9%) were males while 55(47.1%) were females. Mean age distribution in this study was 16.49 years (8.5). Prevalence of thalassemia trait (carrier) was 35%. NESTROFT test was positive in 57(48.7%) participants. The binary logistic regression found only positive NESTROFT test as a predictor (adjusted OR=0.022, P=0.001) of having raised HbA2 (HbA2≥3.5 %). CONCLUSION: Screening of thalassemia carrier by targeting extended family members of thalassemia major children could yield more carrier cases and targeted counselling could help effectively in decreasing the number of children born with thalassemia major. This strategy could be included in future plan of national prevention programme for thalassemia

Analytical Study of a Case Series of Vancomycin Associated Adverse Drug Reactions in Paediatric Population at a Tertiary Care Hospital: A Brief Report

Background: Red man syndrome (RMS) is frequently reported from pediatric ward in patients receiving vancomycin, at the medical store of SGH, Pune. Though common in pediatric patients, not all patients receiving vancomycin developed Red man syndrome. Hence, this study was done to analyse the demographic, pathophysiological, and pharmacological aspects of the subject who experience adverse drug reactions with vancomycin and to determine if this predisposition is associated with any of these factors. Methods: All adverse drug reactions (ADR) to injection vancomycin in the pediatric ward that were reported from April 2018 - January 2022 were included. Controls were a similar number of randomly selected pediatric cases from the same ward who had received Intravenous vancomycin during the same period but did not experience the adverse drug reactions Results: The mean age was 29.91 ± 34.87 months in subjects who experienced ADR and 57.37 ± 41.58 months, in non-ADR group (p=0.0286). 37.4% were infants, 29.69% toddlers in ADR Group. Seventy four percent of patients who manifested with ADR were below age of 3 compared to barely 38% in controls (p=0.03). 66.6% were malnourished in the ADR group compared to 27.6% in controls (p=0.007). There was no association between the ADR and ethnicity, religion, gender, diagnosis, co-morbidities, co-administered drugs, or administered dose of vancomycin among the children. There was no apparent seasonal variation in occurrence of the ADR.Conclusion: RMS is more common in paediatric population than adults and is usually uneventful. Around 75% of the reactions occur within first 4 days of start of Vancomycin and usually occurs within 30 min of the preceding dose. Younger age groups (infants) and malnourishment were the two factors significantly associated with occurrence of RMS. We may also consider using lower than conventional doses and much slower infusions in such at-risk population

On-surface Synthesis of Edge-Extended Zigzag Graphene Nanoribbons.

Graphene nanoribbons (GNRs) have gained significant attention in nanoelectronics due to their potential for precise tuning of electronic properties through variations in edge structure and ribbon width. However, the synthesis of GNRs with highly sought-after zigzag edges (ZGNRs), critical for spintronics and quantum information technologies, remains challenging. In this study, we present a design motif for synthesizing a novel class of GNRs termed edge-extended ZGNRs. This motif enables the controlled incorporation of edge extensions along the zigzag edges at regular intervals. We successfully demonstrate the synthesis of a specific GNR instance-a 3-zigzag-rows-wide ZGNR-with bisanthene units fused to the zigzag edges on alternating sides of the ribbon axis. The resulting edge-extended 3-ZGNR is comprehensively characterized for its chemical structure and electronic properties using scanning probe techniques, complemented by density functional theory calculations. The design motif showcased here opens up new possibilities for synthesizing a diverse range of edge-extended ZGNRs, expanding the structural landscape of GNRs and facilitating the exploration of their structure-dependent electronic properties. This article is protected by copyright. All rights reserved

On-surface polyarylene synthesis by cycloaromatization of isopropyl substituents

Immobilization of organic molecules on metal surfaces and their coupling via thermally induced C–C bond formation is an important technique in organic and polymer synthesis. Using this approach, insoluble and reactive carbon nanostructures can be synthesized and the reactions monitored in situ using scanning probe microscopy methods. The diversity of conceivable products, however, is limited by the number and variety of known on-surface reactions. Here, we introduce the on-surface synthesis of polyarylenes by intermolecular oxidative coupling of isopropyl substituents of arenes. This [3+3] dimerization reaction forms a new phenylene ring and can be regarded as a formal cycloaromatization. The synthetic value of this reaction is proved by the synthesis of polyarylenes and co-polyarylenes, which we demonstrate by synthesizing poly(2,7-pyrenylene-1,4-phenylene). Scanning tunnelling microscopy and non-contact atomic force microscopy studies, complemented by density functional theory calculations, offer mechanistic insight into the on-surface cycloaromatization reaction

Pharmacokinetics of first-line drugs in children with tuberculosis using WHO-recommended weight band doses and formulations

Background: Dispersible paediatric fixed dose combination (FDCs) tablets delivering higher doses of first-line antituberculosis drugs in WHO-recommended weight-bands were introduced in 2015. We report the first pharmacokinetic data for these FDCs in Zambian and South African children in the treatment-shortening SHINE trial. // Methods: Children weighing 4.0-7.9 kg, 8.0-11.9 kg, 12.0-15.9 kg and 16.0-24.9 kg had 1, 2, 3 and 4 tablets daily (rifampicin/isoniazid/pyrazinamide 75/50/150 mg, with or without 100 mg ethambutol, or rifampicin/isoniazid 75/50 mg), respectively. Children 25.0-36.9 kg received doses recommended for adults <37kg (300, 150, 800, 550 mg daily for rifampicin, isoniazid, pyrazinamide, ethambutol). Pharmacokinetics were evaluated after at least 2 weeks of treatment. // Results: Of 77 children evaluated, median (IQR) age was 3.7 (1.4-6.6) years, 40 (52%) were male and 20 (26%) HIV-positive. AUC24 for rifampicin, isoniazid, pyrazinamide and ethambutol were 32.5 (20.1-45.1), 16.7 (9.2 - 25.9), 317 (263 - 399) and 9.5 (7.5 – 11.5) mg.h/L, respectively, and lower in children compared to adults for rifampicin in 4.0-7.9 kg, 8-11.9kg and ≥25kg weight-bands, isoniazid in 4.0-7.9kg and ≥25kg, and ethambutol in all five weight-bands. Pyrazinamide exposures were similar to adults. // Conclusions: Recommended weight-band based FDC doses result in lower drug exposures in children in lower weight-bands and in those ≥25kg (on adult doses). Further adjustments to current doses are needed to match current target exposures in adults. The use of ethambutol at the current WHO-recommended doses requires further evaluation

Shorter treatment for minimal tuberculosis (TB) in children (SHINE): A study protocol for a randomised controlled trial

BACKGROUND: Tuberculosis (TB) in children is frequently paucibacillary and non-severe forms of pulmonary TB are common. Evidence for tuberculosis treatment in children is largely extrapolated from adult studies. Trials in adults with smear-negative tuberculosis suggest that treatment can be effectively shortened from 6 to 4 months. New paediatric, fixed-dose combination anti-tuberculosis treatments have recently been introduced in many countries, making the implementation of World Health Organisation (WHO)-revised dosing recommendations feasible. The safety and efficacy of these higher drug doses has not been systematically assessed in large studies in children, and the pharmacokinetics across children representing the range of weights and ages should be confirmed. METHODS/DESIGN: SHINE is a multicentre, open-label, parallel-group, non-inferiority, randomised controlled, two-arm trial comparing a 4-month vs the standard 6-month regimen using revised WHO paediatric anti-tuberculosis drug doses. We aim to recruit 1200 African and Indian children aged below 16 years with non-severe TB, with or without HIV infection. The primary efficacy and safety endpoints are TB disease-free survival 72 weeks post randomisation and grade 3 or 4 adverse events. Nested pharmacokinetic studies will evaluate anti-tuberculosis drug concentrations, providing model-based predictions for optimal dosing, and measure antiretroviral exposures in order to describe the drug-drug interactions in a subset of HIV-infected children. Socioeconomic analyses will evaluate the cost-effectiveness of the intervention and social science studies will further explore the acceptability and palatability of these new paediatric drug formulations. DISCUSSION: Although recent trials of TB treatment-shortening in adults with sputum-positivity have not been successful, the question has never been addressed in children, who have mainly paucibacillary, non-severe smear-negative disease. SHINE should inform whether treatment-shortening of drug-susceptible TB in children, regardless of HIV status, is efficacious and safe. The trial will also fill existing gaps in knowledge on dosing and acceptability of new anti-tuberculosis formulations and commonly used HIV drugs in settings with a high burden of TB. A positive result from this trial could simplify and shorten treatment, improve adherence and be cost-saving for many children with TB. Recruitment to the SHINE trial begun in July 2016; results are expected in 2020

Challenges in conducting trials for pediatric tuberculous meningitis: lessons from the field

SETTING: TBM-KIDS is a phase I/II trial enrolling children with tuberculous meningitis (TBM) in three tertiary referral centers in India and Malawi. OBJECTIVE: To describe the challenges encountered in conducting the first randomized clinical trial of antimicrobial agents in pediatric TBM. DESIGN: The sources of the data were primarily monthly trial reports, non-enrollment case report forms, study diaries and registers maintained for recruitment, experiences shared by key team members during regular study calls and comments from site review visits. We reviewed, broadly categorized, and describe in detail the challenges encountered by study teams in trial implementation. RESULTS: Over 17 months, 3371 children with clinical presentations consistent with meningoencephalitis or undergoing lumbar puncture were assessed for eligibility; 21 (<1%) met enrollment criteria. We encountered challenges related to diagnosis, management of sick children, large catchment areas, adverse event attribution, concomitant medications, infrastructure requirements, expensive pediatric formulations with short expiry, and detection of treatment response in a highly variable disease across the age continuum. Training and adaptation of tools for neurocognitive and neurologic function assessment were necessary. Special care was undertaken to explain study participation to distraught caregivers and manage children longitudinally. CONCLUSION: Interventional trials in pediatric TBM are challenging but are critically important for improving the treatment of a disease that disables children physically, cognitively and emotionally. Sharing these challenges may help to address them more effectively as a TB research community and to advance treatments for this at-risk population

Isoniazid hair concentrations in children with tuberculosis: a proof of concept study

Assessing treatment adherence and quantifying tuberculosis drug exposure among children is challenging. We undertook a “proof of concept” study to assess the drug concentrations of isoniazid in hair as a therapeutic drug monitoring tool. Children <12 years of age initiated on thrice-weekly treatment including isoniazid (10 mg/kg) for newly diagnosed tuberculosis were enrolled. Isoniazid concentrations in hair were measured using liquid chromatography-tandem mass spectrometry at 1, 2, 4 and 6 months after tuberculosis treatment initiation. We found that isoniazid hair concentrations in all children on thrice weekly isoniazid were detectable and displayed variability across a dynamic range