Effect of mutation and vaccination on spread, severity, and mortality of COVID-19 disease

Coronavirus disease 2019 (COVID-19) has had different waves within the same country. The spread rate and severity showed different properties within the COVID-19 different waves. The present work aims to compare the spread and the severity of the different waves using the available data of confirmed COVID-19 cases and death cases. Real-data sets collected from the Johns Hopkins University Center for Systems Science were used to perform a comparative study between COVID-19 different waves in 12 countries with the highest total performed tests for severe acute respiratory syndrome coronavirus 2 detection in the world (Italy, Brazil, Japan, Germany, Spain, India, USA, UAE, Poland, Colombia, Turkey, and Switzerland). The total number of confirmed cases and death cases in different waves of COVID-19 were compared to that of the previous one for equivalent periods. The total number of death cases in each wave was presented as a percentage of the total number of confirmed cases for the same periods. In all the selected 12 countries, Wave 2 had a much higher number of confirmed cases than that in Wave 1. However, the death cases increase was not comparable with that of the confirmed cases to the extent that some countries had lower death cases than in Wave 1, UAE, and Spain. The death cases as a percentage of the total number of confirmed cases in Wave 1 were much higher than that in Wave 2. Some countries have had Waves 3 and 4. Waves 3 and 4 have had lower confirmed cases than Wave 2, however, the death cases were variable in different countries. The death cases in Waves 3 and 4 were similar to or higher than Wave 2 in most countries. Wave 2 of COVID-19 had a much higher spread rate but much lower severity resulting in a lower death rate in Wave 2 compared with that of the first wave. Waves 3 and 4 have had lower confirmed cases than Wave 2; that could be due to the presence of appropriate treatment and vaccination. However, that was not reflected in the death cases, which were similar to or higher than Wave 2 in most countries. Further studies are needed to explain these findings

Postoperative complications after pancreatoduodenectomy for malignancy: results from the Recurrence After Whipple’s (RAW) study

Background Pancreatoduodenectomy (PD) is associated with significant postoperative morbidity. Surgeons should have a sound understanding of the potential complications for consenting and benchmarking purposes. Furthermore, preoperative identification of high-risk patients can guide patient selection and potentially allow for targeted prehabilitation and/or individualized treatment regimens. Using a large multicentre cohort, this study aimed to calculate the incidence of all PD complications and identify risk factors. Method Data were extracted from the Recurrence After Whipple’s (RAW) study, a retrospective cohort study of PD outcomes (29 centres from 8 countries, 2012–2015). The incidence and severity of all complications was recorded and potential risk factors for morbidity, major morbidity (Clavien–Dindo grade > IIIa), postoperative pancreatic fistula (POPF), post-pancreatectomy haemorrhage (PPH) and 90-day mortality were investigated. Results Among the 1348 included patients, overall morbidity, major morbidity, POPF, PPH and perioperative death affected 53 per cent (n = 720), 17 per cent (n = 228), 8 per cent (n = 108), 6 per cent (n = 84) and 4 per cent (n = 53), respectively. Following multivariable tests, a high BMI (P = 0.007), an ASA grade > II (P II patients were at increased risk of major morbidity (P < 0.0001), and a raised BMI correlated with a greater risk of POPF (P = 0.001). Conclusion In this multicentre study of PD outcomes, an ASA grade > II was a risk factor for major morbidity and a high BMI was a risk factor for POPF. Patients who are preoperatively identified to be high risk may benefit from targeted prehabilitation or individualized treatment regimens

Efficacy and toxicity of once versus twice daily regimens of amikacin in febrile neutropenic pediatric cancer patients

Purpose: To compare the pharmacokinetic profile, clinical efficacy and toxicity of once-daily dosing of amikacin compared to twice-daily dosing among pediatric cancer patients with fever and neutropenia. Methods: 134 pediatric patients with hematological malignancies were randomly assigned to receive 15 mg/kg/day amikacin intravenously, either once or twice-daily dosing. For pharmacokinetics, two blood samples were obtained from each patient, the first sample was taken after 1 h from the beginning of infusion and the second sample was taken after 3 h from the first sample. Treatment success was considered when the patient improved without a change in the assigned antibiotic regimen or mortality from infection. Nephrotoxicity was assessed by following the increase in serum creatinine level. Results: Pharmacokinetic data revealed superiority in once-daily dosing where maximum concentration Cmax, area under the concentration time curve in 24 h AUC24 and elimination half-life t1/2 were a significantly higher while minimum concentration Cmin, elimination rate constant Ke and clearance CL were significantly lower in once-daily dosing compared to the twice-daily dosing. Clinical response achieved in 76.8% in once-daily group compared to 69.2% in twice-daily group. Nephrotoxicity was recorded in two patients in once-daily group and six patients in the twice-daily group. After stratifying our patients according to age, a significant increase was observed in the volume of distribution V and CL in pediatrics with age ⩽five compared to >five years. Cmax and AUC24 were significantly lower in the age group of ⩽five years. Conclusions: Clinical efficacy and nephrotoxicity were slightly improved in once-daily dosing compared to twice-daily dosing

Extracellular biosynthesis of silver nanoparticles using Rhizopus stolonifer

Synthesis of silver nanoparticles (AgNPs) has become a necessary field of applied science. Biological method for synthesis of AgNPs by Rhizopus stolonifer aqueous mycelial extract was used. The AgNPs were identified by UV–visible spectrometry, X-ray diffraction (XRD), transmission electron microscopy (TEM) and Fourier transform infrared spectrometry (FT-IR). The presence of surface plasmon band around 420 nm indicates AgNPs formation. The characteristic of the AgNPs within the face-centered cubic (fcc) structure are indicated by the peaks of the X-ray diffraction (XRD) pattern corresponding to (111), (200) and (220) planes. Spherical, mono-dispersed and stable AgNPs with diameter around 9.47 nm were prepared and affirmed by high-resolution transmission electron microscopy (HR-TEM). Fourier Transform Infrared (FTIR) shows peaks at 1426 and 1684 cm−1 that affirm the presence of coat covering protein the AgNPs which is known as capping proteins. Parameter optimization showed the smallest size of AgNPs (2.86 ± 0.3 nm) was obtained with 10−2 M AgNO3 at 40 °C. The present study provides the proof that the molecules within aqueous mycelial extract of R. stolonifer facilitate synthesis of AgNPs and highlight on value-added from R. stolonifer for cost effectiveness. Also, eco-friendly medical and nanotechnology-based industries could also be provided. Size of prepared AgNPs could be controlled by temperature and AgNO3 concentration. Further studies are required to study effect of more parameters on size and morphology of AgNPs as this will help in the control of large scale production of biogenic AgNPs

Hydrophobic natural deep eutectic-solvent bar microextraction combined with HPLC-DAD for determination of urinary 1-hydroxypyrene of smokers

1-hydroxypyrene (1-OHP) is a metabolite of pyrene, which is a type of polycyclic aromatic hydrocarbons (PAHs) found in tobacco smoke and preferred use as a biomarker to determine exposure to PAHs from smoking. This paper reports a new and simple microextraction technique for 1-hydroxypyrene (1-OHP) determination in smokers' urines using hydrophobic natural deep eutectic solvent (HNDES) in developing solvent bar microextraction (SBME) and high performance liquid chromatography-diode array detection (HPLC-DAD). Terpenoids based-HNDES using various ratios of (thymol/menthol) were synthesized and investigated as extraction solvents. The variables affecting HNDE-SBME steps were optimized by response surface methodology (RSM) based on central composite design (CCD). Under the optimum conditions, the calibration graph of spiked urine samples was linear in the range of 0.3–25.0 μg L−1 1-OHP with a correlation coefficient of 0.999. Additionally, the detection limit, quantitation limit, and extraction recovery were found to be 0.06 μg L−1, 0.22 μg L−1, and ≥100%, respectively. In comparison with referenced methods and based on the satisfactory results of applications, the proposed method can be considered as a potential method for the detection of urinary 1-OHP for health risk assessment of PAHs exposures

Olanzapine for the Prevention of Chemotherapy-Induced Nausea and Vomiting: A Comparative Study From Sudan

Purpose: Chemotherapy-induced nausea and vomiting (CINV) is a distressing adverse effect. Neurokinin-1 receptor antagonist (NK1RA)–containing regimens are the standard regimens for CINV prophylaxis in patients with cancer receiving highly or moderately emetogenic chemotherapy (HEC or MEC). NK1RA agents are expensive and were not registered in Sudan. Recently, regimens containing olanzapine, the available and affordable medication in Sudan, were introduced as another option. This study aimed to compare the efficacy of an olanzapine-containing regimen with the antiemetic regimen that was currently used in our institute for CINV prophylaxis in HEC/MEC settings. Patients and Methods: The study prospectively compared an olanzapine-containing regimen (acute phase: olanzapine, ondansetron, dexamethasone; delayed phase: olanzapine, ondansetron) with an ondansetron/dexamethasone regimen (acute phase: ondansetron, dexamethasone; delayed phase: ondansetron) in adult patients with cancer receiving HEC or MEC. The study outcomes were complete response (CR; no emesis and no rescue medications) and nausea control (no nausea), which were assessed in the acute (0 to 24 hours), delayed (24 to 120 hours), and overall (0 to 120 hours) phases. Results: The study included 131 patients (olanzapine-containing: 50 patients; ondansetron/dexamethasone: 81 patients). CR and nausea control were higher in the olanzapine-containing than in the ondansetron/dexamethasone regimen (CR: acute phase, 86% v 71.6%; P = .086; delayed phase, 72% v 30.9%; P < .001; overall phase, 66% v 25.9%; P < .001; nausea control: acute phase, 86% v 74.1%; P = .127; delayed phase, 76% v 34.6%; P < .001; overall phase, 72% v 29.6%; P < .001). The major toxicity of olanzapine was grade 1 and 2 sedation or drowsiness (25 patients). Conclusion: An olanzapine-containing regimen has better efficacy for prevention of CINV in the HEC/MEC setting. Oncologists working in a limited-resource setting should be familiar with olanzapine-containing regimens, because NK1RA agents are not affordable and not easily available