Foreign Body Aspiration Presenting as Pneumothorax in a Child.

A typical presentation of a foreign body aspiration (FBA) in a child includes witnessed choking, respiratory distress, cyanosis, coughing, wheezing, diminished breath sounds, and/or altered mental status. Following an extensive literature review, we found pneumothorax occurring secondary to FBA is a rare occurrence and should elicit prompt treatment. This 17-month-old female was admitted for respiratory syncytial virus (RSV) bronchiolitis and developed a subsequent pneumothorax during her hospital stay, consequent to aspiration of a cashew fragment two weeks before presentation. In light of the National Institute of Allergy and Infectious Diseases (NIAID)-sponsored expert panel\u27s addended guidelines, published and endorsed by the American Academy of Pediatrics (AAP) in 2017, we highlight a potential complication of increasing encouragement of peanut consumption in children as young as four months

Evaluation of the effect of the herpes zoster vaccination programme 3 years after its introduction in England: a population-based study

Background: In 2013, a herpes zoster vaccination programme was introduced in England for adults aged 70 years with a phased catch-up programme for those aged 71–79 years. We aimed to evaluate the effect of the first 3 years of the vaccination programme on incidence of herpes zoster and postherpetic neuralgia in this population. Methods: In this population-based study, we extracted data from the Royal College of General Practitioners sentinel primary care network on consultations with patients aged 60–89 years for herpes zoster and postherpetic neuralgia occurring between Oct 1, 2005, and Sept 30, 2016, obtaining data from 164 practices. We identified individual data on herpes zoster vaccinations administered and consultations for herpes zoster and postherpetic neuralgia, and aggregated these data to estimate vaccine coverage and incidence of herpes zoster and postherpetic neuralgia consultations. We defined age cohorts to identify participants targeted in each year of the programme, and as part of the routine or catch-up programme. We modelled incidence according to age, region, gender, time period, and vaccine eligibility using multivariable Poisson regression with an offset for person-years. Findings: Our analysis included 3·36 million person-years of data, corresponding to an average of 310 001 patients aged 60–89 years who were registered at an RCGP practice each year. By Aug 31, 2016, uptake of the vaccine varied between 58% for the recently targeted cohorts and 72% for the first routine cohort. Across the first 3 years of vaccination for the three routine cohorts, incidence of herpes zoster fell by 35% (incidence rate ratio 0·65 [95% 0·60–0·72]) and of postherpetic neuralgia fell by 50% (0·50 [0·38–0·67]). The equivalent reduction for the four catch-up cohorts was 33% for herpes zoster (incidence rate ratio 0·67 [0·61–0·74]) and 38% for postherpetic neuralgia (0·62 [0·50–0·79]). These reductions are consistent with a vaccine effectiveness of about 62% against herpes zoster and 70–88% against postherpetic neuralgia. Interpretation: The herpes zoster vaccination programme in England has had a population impact equivalent to about 17 000 fewer episodes of herpes zoster and 3300 fewer episodes of postherpetic neuralgia among 5·5 million eligible individuals in the first 3 years of the programme. Communication of the public health impact of this programme will be important to reverse the recent trend of declining vaccine coverage. Funding: Public Health England

The statistical fragility of the management options for reverse shoulder arthroplasty: a systematic review of randomized control trial with fragility analysis

Reverse shoulder arthroplasty (RSA) is used in the treatment of traumatic and arthritic pathologies, with expanding clinical indications and as a result there has been an increase in clinical research on the topic. The purpose of this study was to examine the statistical fragility of randomized control trials (RCTs) reporting outcomes from RSA. A systematic search was undertaken to find RCTs investigating RSA. The Fragility Index (FI) was calculated using Fisher’s exact test, by sequentially altering the number of events until there was a reversal of significance. The Fragility Quotient (FQ) was calculated by dividing the FI by the trial population. Each trial was assigned an overall FI and FQ calculated as the median result of its reported findings. Overall, 19 RCTs warranted inclusion in the review, representing 1146 patients, of which 41.2% were male, with a mean age of 74.2 ± 4.3 years and mean follow-up of 22.1 ± 9.9 months. The median RCT population was 59, with a median of 9 patients lost to follow-up. The median FI was 4.5, and median FQ was 0.083, indicating more patients did not complete the trial than the number of outcomes which would have to change to reverse the finding of significance. This review found that the RCT evidence for RSA management may be vulnerable to statistical fragility, with a handful of events required to reverse a finding of significance

Characterization of tablet film coatings using a laser-induced breakdown spectroscopic technique

Laser-induced breakdown spectroscopy (LIBS) was evaluated as an early phase process analytical technology (PAT) tool for the rapid characterization of pharmaceutical tablet coatings. Measurement of coating thickness, uniformity, and photodegradation-predictive potential of the technique were evaluated. Model formulation tablets were coated with varying amounts (2%–4% wt/wt) of red and yellow Opadry II, and a pulsed laser was used to sample at multiple sites across the tablet face. LIBS was able to successfully detect the emissions of Fe and Ti in the coated samples, and a proportional increase in signal with coating thickness was observed. Batch-to-batch variability in the coating procedure was also easily monitored by LIBS. The coating thickness was non-uniform across the tablet surface with higher thickness at the edges, likely due to the concave shape of the tablet. Film coating levels and color of the film had been subjected to photostability studies according to the International Conference on Harmonisation (ICH) guideline to determine effectiveness of the film coats. LIBS measurements of coating thickness provided a good correlation (R2>0.99) to photodegradation as measured by high-performance liquid chromatography (HPLC). Last, the concentration of Fe in the coating was varied and monitored by LIBS. Increasing photostability was observed with increasing levels of ferric oxide, providing a new understanding of the photoprotection mechanism in the coated formulation. Determination of levels of ferric oxide and coating thickness by LIBS demonstrated its utility as a good PAT tool for the determination of photoprotection of the drug, thereby enabling facile optimization of the coating process

Intranasal Oxytocin in Children and Adolescents with Autism Spectrum Disorder

BackgroundExperimental studies and small clinical trials have suggested that treatment with intranasal oxytocin may reduce social impairment in persons with autism spectrum disorder. Oxytocin has been administered in clinical practice to many children with autism spectrum disorder.MethodsWe conducted a 24-week, placebo-controlled phase 2 trial of intranasal oxytocin therapy in children and adolescents 3 to 17 years of age with autism spectrum disorder. Participants were randomly assigned in a 1:1 ratio, with stratification according to age and verbal fluency, to receive oxytocin or placebo, administered intranasally, with a total target dose of 48 international units daily. The primary outcome was the least-squares mean change from baseline on the Aberrant Behavior Checklist modified Social Withdrawal subscale (ABC-mSW), which includes 13 items (scores range from 0 to 39, with higher scores indicating less social interaction). Secondary outcomes included two additional measures of social function and an abbreviated measure of IQ.ResultsOf the 355 children and adolescents who underwent screening, 290 were enrolled. A total of 146 participants were assigned to the oxytocin group and 144 to the placebo group; 139 and 138 participants, respectively, completed both the baseline and at least one postbaseline ABC-mSW assessments and were included in the modified intention-to-treat analyses. The least-squares mean change from baseline in the ABC-mSW score (primary outcome) was -3.7 in the oxytocin group and -3.5 in the placebo group (least-squares mean difference, -0.2; 95% confidence interval, -1.5 to 1.0; P = 0.61). Secondary outcomes generally did not differ between the trial groups. The incidence and severity of adverse events were similar in the two groups.ConclusionsThis placebo-controlled trial of intranasal oxytocin therapy in children and adolescents with autism spectrum disorder showed no significant between-group differences in the least-squares mean change from baseline on measures of social or cognitive functioning over a period of 24 weeks. (Funded by the National Institute of Child Health and Human Development; SOARS-B ClinicalTrials.gov number, NCT01944046.)

The role of astrocytes in parkinson\u27s disease

2014 Springer International Publishing Switzerland. All rights reserved. Unlike other disorders, astrocytes in regions undergoing neurodegeneration in patients with Parkinson\u27s disease do not become reactive. Instead gray matter protoplasmic astrocytes accumulate α-synuclein, withdraw their processes from damaged neurons, and show altered expression of constituent proteins, including PINK-1, parkin, and DJ-1 (gene products associated with recessive Parkinson\u27s disease). These and other gene products are normally up-regulated in astrocytes by disease states. Combined, these data suggest that protoplasmic astrocytes lose their protective function in patients with Parkinson\u27s disease, leaving neurons vulnerable to perturbations and insults they would normally be protected from. Recent work also shows that astrocytes are able to take up and metabolize L-DOPA, the drug of choice for standard therapy for Parkinson\u27s disease. It is therefore possible that ongoing astrocytic dysfunction may compromise the efficacy of L-DOPA therapy. These unique astrocytic responses to the disease process and current main therapy support the concept that astrocytes play a critical, under-recognized role in the initiation, progression, and treatment response of patients with Parkinson\u27s disease

Optical biosensors in drug discovery

Optical biosensors that exploit surface plasmon resonance, waveguides and resonant mirrors have been used widely over the past decade to analyse biomolecular interactions. These sensors allow the determination of the affinity and kinetics of a wide variety of molecular interactions in real time, without the need for a molecular tag or label. Advances in instrumentation and experimental design have led to the increasing application of optical biosensors in many areas of drug discovery, including target identification, ligand fishing, assay development, lead selection, early ADME and manufacturing quality control. This article reviews important advances in optical-biosensor instrumentation and applications, and also highlights some exciting developments, such as highly multiplexed optical-biosensor arrays