128 research outputs found

    Population pharmacokinetics of benznidazole in adult patients with Chagas disease

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    AIM: To build a population pharmacokinetic (PopPK) model to characterize benznidazole (BNZ) pharmacokinetics in adults with chronic Chagas disease. METHODS: Prospective, open-label, single-center clinical trial(EudraCT:2011-002900-34;CINEBENZclinicaltrials.govnumber:NCT01755403), approved by the local ethics committee. Patients received 2.5mg/kg/12h (Abarax(R), Elea Laboratory, Argentina) for 60 days. Plasma BZN samples were taken at several times along the study and analyzed by HPLC-UV. The PopPK analysis was done with NONMEMv.7.3. Demographic and biological data were tested as covariates. Intraindividual, interoccasion and residual variability were modeled. Internal and external validations were completed to assess the robustness of the model. Later on, simulations were performed to generate the BNZ concentration-time course profile for different dosage regimens. RESULTS: A total of 358 plasma BZN concentrations from 39 patients were included in the analysis. A one-compartment-PK-model characterized by clearance(CL/F) and apparent volume of distribution(V/F) with first order absorption(Ka) and elimination, adequately described the data (CL/F:1.73 L/h; V/F:89.6 L; Ka:1.15 h-1). No covariates were found to be significant for CL/F and V/F. Internal and external validation of the final model showed adequate results. Data from simulations revealed that a dose of 2.5mg/kg/12h might lead to overexposure in the most of the patients. A lower dose (2.5mg/kg/24h) was able to achieve trough BNZ plasma concentrations within the accepted therapeutic range of 3-6 mg/L. CONCLUSION: A population PK model for BNZ in adults with chronic Chagas disease has been developed. Dosing simulations showed that a BNZ dose of 2.5 mg/kg/24h would adequately keep BNZ trough plasma concentrations within the recommended target range concentrations for the majority of patients

    What to expect and when: benznidazole toxicity in chronic Chagas' disease treatment

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    Background: Benznidazole is one of the two most effective antiparasitic drugs for Chagas' disease treatment. However, knowledge about its toxicity profile is mostly based on post-marketing observational studies. Objectives: Our study combines data from two prospective clinical trials designed to assess the safety of the drug newly produced by ELEA Laboratories (Abarax(R)). Methods: Eligible participants were selected using a consecutive sampling strategy in the CINEBENZ and BIOMARCHA studies between 2013 and 2016 (EUDRACT 2011-002900-34 and 2012-002645-38, respectively, and clinicaltrials.gov NCT01755403 and NCT01755377, respectively). Enrolled subjects received treatment with 5 mg/kg/day benznidazole orally in two divided doses for 8 weeks and were followed up fortnightly. Results: We observed 305 adverse reactions in 85 of 99 participants (85.9%). Each patient had a median of three adverse reactions, 89.5% were mild and the median duration was 12 days. Most adverse reactions appeared in the first month of treatment except arthritis and peripheral neuropathy. Twenty-six patients did not complete treatment: 2 were withdrawn, 1 for ectopic pregnancy and 1 for epilepsy relapse due to cysticercosis; 2 were lost to follow-up; and 22 were owing to adverse reactions, two of them severe. We observed some unexpected adverse reactions that have not been described previously, such as psychiatric symptoms, erectile dysfunction, menstrual cycle alterations and lung infiltration. Conclusions: There is a very high frequency of adverse reactions to benznidazole. Most adverse reactions are mild, but the treatment burden is significant and unexpected reactions are not rare. Severe reactions are uncommon, but they can be life-threatening. Further studies are necessary to optimize treatment

    Learning to Teach About Ideas and Evidence in Science : The Student Teacher as Change Agent

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    A collaborative curriculum development project was set up to address the lack of good examples of teaching about ideas and evidence and the nature of science encountered by student teachers training to teach in the age range 11-16 in schools in England. Student and teacher-mentor pairs devised, taught and evaluated novel lessons and approaches. The project design required increasing levels of critique through cycles of teaching, evaluation and revision of lessons. Data were gathered from interviews and students' reports to assess the impact of the project on student teachers and to what extent any influences survived when they gained their first teaching posts. A significant outcome was the perception of teaching shifting from the delivery of standard lessons in prescribed ways to endeavours demanding creativity and decision-making. Although school-based factors limited newly qualified teachers' chances to use new lessons and approaches and therefore act as change-agents in schools, the ability to critique curriculum materials and the recognition of the need to create space for professional dialogue were durable gains

    Temperature dependence of planktonic metabolism in the subtropical North Atlantic Ocean

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    The temperature dependence of planktonic metabolism in the subtropical North Atlantic Ocean was assessed on the basis of measurements of gross primary production (GPP), community respiration (CR) and net community production (NCP), as well as experimental assessments of the response of CR to temperature manipulations. Metabolic rates were measured at 68 stations along three consecutive longitudinal transects completed during the Malaspina 2010 Expedition, in three different seasons. Temperature gradients were observed in depth and at basin and seasonal scale. The results showed seasonal variability in the metabolic rates, the highest rates being observed during the spring transect. The overall mean integrated GPP / CR ratio was 1.39 ± 0.27 decreasing from winter to summer, and the NCP for the subtropical North Atlantic Ocean during the cruises exhibits net autotrophy (NCP > 0) in about two-thirds (66%) of the total sampled communities. Also, we reported the activation energies describing the temperature dependence of planktonic community metabolism, which was generally higher for CR than for GPP in the subtropical North Atlantic Ocean, as the metabolic theory of ecology predicts. Furthermore, we made a comparison of activation energies describing the responses to in situ temperature in the field (EaCR = 1.64 ± 0.36 eV) and those derived experimentally by temperature manipulations (EaCR = 1.45 ± 0.6 eV), which showed great consistency

    International Analysis of Electronic Health Records of Children and Youth Hospitalized With COVID-19 Infection in 6 Countries

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    Question What are international trends in hospitalizations for children and youth with SARS-CoV-2, and what are the epidemiological and clinical features of these patients? Findings This cohort study of 671 children and youth found discrete surges in hospitalizations with variable trends and timing across countries. Common complications included cardiac arrhythmias and viral pneumonia, and laboratory findings included elevations in markers of inflammation and abnormalities of coagulation; few children and youth were treated with medications directed specifically at SARS-CoV-2. Meaning These findings suggest large-scale informatics-based approaches used to incorporate electronic health record data across health care systems can provide an efficient source of information to monitor disease activity and define epidemiological and clinical features of pediatric patients hospitalized with SARS-CoV-2 infections

    Pro-apoptotic and antiproliferative activity of human KCNRG, a putative tumor suppressor in 13q14 region

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    Deletion of 13q14.3 and a candidate gene KCNRG (potassium channel regulating gene) is the most frequent chromosomal abnormality in B-cell chronic lymphocytic leukemia and is a common finding in multiple myeloma (MM). KCNRG protein may interfere with the normal assembly of the K+ channel proteins causing the suppression of Kv currents. We aimed to examine possible role of KCNRG haploinsufficiency in chronic lymphocytic leukemia (CLL) and MM cells. We performed detailed genomic analysis of the KCNRG locus; studied effects of the stable overexpression of KCNRG isoforms in RPMI-8226, HL-60, and LnCaP cells; and evaluated relative expression of its transcripts in various human lymphomas. Three MM cell lines and 35 CLL PBL samples were screened for KCNRG mutations. KCNRG exerts growth suppressive and pro-apoptotic effects in HL-60, LnCaP, and RPMI-8226 cells. Direct sequencing of KCNRG exons revealed point mutation delT in RPMI-8226 cell line. Levels of major isoform of KCNRG mRNA are lower in DLBL lymphomas compared to normal PBL samples, while levels of its minor mRNA are decreased across the broad range of the lymphoma types. The haploinsufficiency of KCNRG might be relevant to the progression of CLL and MM at least in a subset of patients

    The allometry of the smallest: superlinear scaling of microbial metabolic rates in the Atlantic Ocean

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    Prokaryotic planktonic organisms are small in size but largely relevant in marine biogeochemical cycles. Due to their reduced size range (0.2 to 1 mu m in diameter), the effects of cell size on their metabolism have been hardly considered and are usually not examined in field studies. Here, we show the results of size-fractionated experiments of marine microbial respiration rate along a latitudinal transect in the Atlantic Ocean. The scaling exponents obtained from the power relationship between respiration rate and size were significantly higher than one. This superlinearity was ubiquitous across the latitudinal transect but its value was not universal revealing a strong albeit heterogeneous effect of cell size on microbial metabolism. Our results suggest that the latitudinal differences observed are the combined result of changes in cell size and composition between functional groups within prokaryotes. Communities where the largest size fraction was dominated by prokaryotic cyanobacteria, especially Prochlorococcus, have lower allometric exponents. We hypothesize that these larger, more complex prokaryotes fall close to the evolutionary transition between prokaryotes and protists, in a range where surface area starts to constrain metabolism and, hence, are expected to follow a scaling closer to linearity.Versión del editor8,951
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