An extensive clinical development program (comprising two phase 2 and five phase 3 trials) has demonstrated the efficacy and safety of ceftazidime-avibactam in the treatment of adults with ...complicated intra-abdominal infection (cIAI), complicated urinary tract infection (cUTI), and hospital-acquired pneumonia (HAP), including ventilator-associated pneumonia (VAP). During the phase 3 clinical program, updated population pharmacokinetic (PK) modeling and Monte Carlo simulations using clinical PK data supported modified ceftazidime-avibactam dosage adjustments for patients with moderate or severe renal impairment (comprising a 50% increase in total daily dose compared with the original dosage adjustments) to reduce the risk of subtherapeutic drug exposures in the event of rapidly improving renal function. The modified dosage adjustments were included in the ceftazidime-avibactam labeling information at the time of initial approval and were subsequently evaluated in the final phase 3 trial (in patients with HAP, including VAP), providing supportive data for the approved U.S. and European ceftazidime-avibactam dosage regimens across renal function categories. This review describes the analyses supporting the ceftazidime-avibactam dosage adjustments for renal impairment and discusses the wider implications and benefits of using modeling and simulation to support dosage regimen optimization based on emerging clinical evidence.
•The effect of simple virus enrichment methods were tested on a metagenomics dataset.•Centrifugation, filtration or nuclease-treatment was evaluated.•A multi-step enrichment method increased the ...proportion of virus sequences.•This evaluation guides researchers in their choice of enrichment methodology.
The discovery of new or divergent viruses using metagenomics and high-throughput sequencing has become more commonplace. The preparation of a sample is known to have an effect on the representation of virus sequences within the metagenomic dataset yet comparatively little attention has been given to this. Physical enrichment techniques are often applied to samples to increase the number of viral sequences and therefore enhance the probability of detection. With the exception of virus ecology studies, there is a paucity of information available to researchers on the type of sample preparation required for a viral metagenomic study that seeks to identify an aetiological virus in an animal or human diagnostic sample. A review of published virus discovery studies revealed the most commonly used enrichment methods, that were usually quick and simple to implement, namely low-speed centrifugation, filtration, nuclease-treatment (or combinations of these) which have been routinely used but often without justification. These were applied to a simple and well-characterised artificial sample composed of bacterial and human cells, as well as DNA (adenovirus) and RNA viruses (influenza A and human enterovirus), being either non-enveloped capsid or enveloped viruses. The effect of the enrichment method was assessed by both quantitative real-time PCR and metagenomic analysis that incorporated an amplification step. Reductions in the absolute quantities of bacteria and human cells were observed for each method as determined by qPCR, but the relative abundance of viral sequences in the metagenomic dataset remained largely unchanged. A 3-step method of centrifugation, filtration and nuclease-treatment showed the greatest increase in the proportion of viral sequences. This study provides a starting point for the selection of a purification method in future virus discovery studies, and highlights the need for more data to validate the effect of enrichment methods on different sample types, amplification, bioinformatics approaches and sequencing platforms. This study also highlights the potential risks that may attend selection of a virus enrichment method without any consideration for the sample type being investigated.
•A highly sensitive (97 %) RSV real time PCR A/B duplex assay has been developed.•It detects only RSV A/B and not other respiratory pathogens (100 % specificity).•The limit of detection for RSV A/B ...was 200/800 RSV RNA copies per 20 μl respectively.•This assay targets the L polymerase gene, unlike other published methods.•Human RNaseP detection was also successfully added to the assay as a sample control.
Respiratory syncytial virus (RSV) is a common cause of acute respiratory disease worldwide, especially in young children. The World Health Organization (WHO) has initiated an RSV Surveillance Pilot program that aims to perform worldwide RSV surveillance, requiring the development of reliable and rapid molecular methods to detect and identify RSV. A duplex real-time RT-PCR assay developed for simultaneous detection of both A and B subtypes of RSV was included as part of this program. This duplex assay targeted a conserved region of the RSV polymerase gene and was validated for analytical sensitivity, specificity, reproducibility and clinical performance with a wide range of respiratory specimens. The assay was highly specific for RSV and did not react with non-RSV respiratory pathogens, including the SARS-CoV-2 virus.
Purpose
Craniopharyngiomas can be aggressive leading to significant complications and morbidity. It is not clear whether there are any predictive factors for incidence or outcomes. Our aim was ...therefore to record the incidence, presentation, characteristics and progression of paediatric craniopharyngiomas in the West of Scotland.
Method
Retrospective case note review for children diagnosed with paediatric craniopharyngiomas at the Royal Hospital for Children Glasgow, from 1995 to 2021 was conducted. All analyses were conducted using GraphPad Prism 9.4.0.
Results
Of 21 patients diagnosed with craniopharyngiomas, the most common presenting symptoms were headaches (17/21, 81%); visual impairment (13/21, 62%); vomiting (9/21, 43%) and growth failure (7/21, 33%). Seventeen (81%) patients underwent hydrocephalus and/or resection surgery within 3 months of diagnosis, usually within the first 2 weeks (13/21, 62%). Subtotal resection surgeries were performed in 71% of patients, and median time between subsequent resection surgeries for tumour recurrence was 4 years (0,11). BMI SDS increased at 5 year follow-up (p = 0.021) with 43% being obese (BMI > + 2SD). More patients acquired hypopituitarism post-operatively (14/16, 88%) compared to pre-operatively (4/15, 27%). A greater incidence of craniopharyngiomas were reported in more affluent areas (10/21, 48%) (SIMD score 8–10) compared to more deprived areas (6/10, 29%) (SIMD score 1–3). Five patients (24%) died with a median time between diagnosis and death of 9 years (6,13).
Conclusion
Over 25 years the management of craniopharyngioma has changed substantially. Co-morbidities such as obesity are difficult to manage post-operatively and mortality risk can be up to 25% according to our cohort.
BACKGROUND: Enteroviruses are a common cause of human disease and are associated with a wide range of clinical manifestations. Enterovirus 68 is rarely detected yet was reported in many countries in ...2010. Here enterovirus 68 was identified for the first time in New Zealand in 2010 and was detected in a further fourteen specimens over a six month period. OBJECTIVES: To genetically characterise enterovirus 68 specimens identified in New Zealand in 2010. STUDY DESIGN: The genome sequence of a New Zealand representative enterovirus 68 isolate was obtained. Ten clinical specimens were analysed by sequencing the VP1 region of the enterovirus 68 genome. RESULTS: Based on sequence analysis of the VP1 region and the full genome of one representative isolate, the New Zealand enterovirus 68 isolates clustered with contemporary enterovirus 68 viruses and do not show any clear distinguishing genetic diversity when compared to other strains. All fifteen specimens showed high similarity with enterovirus 68 by VP1 sequencing. The majority of New Zealand patients suffered from bronchiolitis, were less than two years of age and were of Pacific Island or Maori descent. CONCLUSIONS: We document the rare occurrence of an enterovirus 68 cluster in New Zealand in 2010. These viruses shared similarity with other clusters of enterovirus 68 that occurred globally in 2010. A greater awareness in enterovirus 68 infection may help detect this virus with increased frequency and enable us to better understand the role this strain plays in disease and the reasons behind this global emergence in 2010.
The synthesis of the new m‐terphenyl‐substituted cyclopentadienyl ligand precursor 1‐cyclopentadiene‐2,6‐bis(2,4,6‐trimethylphenyl)benzene (TerMesCpH) is described. The synthesis proceeds through the ...reaction of TerMesLi with cobaltocenium iodide, followed by oxidation of the intermediate cobalt(I) species to give the corresponding cyclopentadiene as a mixture of isomers. The preparation and spectroscopic properties of the alkali‐metal salts (Li–Cs) is described, as well as structural information obtained by X‐ray diffraction studies for the lithium, potassium, and cesium analogues. Crystallographic data demonstrate the ability of these new ligands to act as monoanionic chelates by forming metal complexes with Cp–M–Ar bonding environments.
Slick LiKCs: A bulky m‐terphenyl ligand has been combined with the ubiquitous cyclopentadienyl ligand to form a unique ligand that is capable of chelation to a metal through the cyclopentadienyl and o‐aryl fragments. Alkali‐metal complexes of this ligand formed linear (Li) and cyclic (K) tetramers and a cyclic hexamer (Cs) in the solid state.
Treatment of complicated urinary tract infections and complicated intra-abdominal infections is increasingly difficult due to the rising prevalence of multidrug-resistant Gram-negative bacteria. ...Ceftazidime-avibactam is a combination of the established third-generation cephalosporin ceftazidime with avibactam, a novel non-β-lactam β-lactamase inhibitor, which restores the activity of ceftazidime against many β-lactamase-producing Gram-negative bacteria, including extended-spectrum β-lactamases and Klebsiella pneumoniae carbapenemases. Clinical and nonclinical studies supporting the safety and efficacy of ceftazidime-avibactam include microbiological surveillance studies of clinically relevant pathogens, in vivo animal models of infection, pharmacokinetic/pharmacodynamic target attainment analyses, Phase I clinical pharmacology studies, and Phase II/III studies in the treatment of complicated intra-abdominal infections and complicated urinary tract infections, including patients with ceftazidime-nonsusceptible Gram-negative infections.
Hospital-acquired and ventilator-associated pneumonia (HAP/VAP; nosocomial pneumonia) due to Gram-negative pathogens are associated with significant morbidity and mortality; treatment options for ...multidrug-resistant infections are limited. The pivotal phase III REPROVE trial evaluated the efficacy of ceftazidime-avibactam (CAZ-AVI) vs meropenem in the treatment of patients with HAP/VAP. Study results for prespecified analyses per US Food and Drug Administration-recommended trial end points are reported here.
Hospitalized adults with HAP/VAP proven or suspected to be caused by a Gram-negative pathogen were randomized 1:1 to receive CAZ-AVI or meropenem for 7 to 14 days. The primary outcome was 28-day all-cause mortality in the intent-to-treat (ITT) population. Secondary outcomes included clinical cure at test of cure (TOC) in the ITT and microbiological ITT (micro-ITT) populations, and safety and tolerability throughout the study.
hundred seventy randomized patients received treatment and were included in the ITT population (CAZ-AVI, n = 436; meropenem, n = 434). CAZ-AVI was noninferior to meropenem for the primary end point (28-day all-cause mortality; ITT) based on the prespecified 10% noninferiority margin (CAZ-AVI, 9.6%; meropenem, 8.3%; difference, 1.5%; 95% confidence interval CI, -2.4% to 5.3%) and for the clinical cure end point in the ITT population based on a prespecified -10% noninferiority margin (CAZ-AVI, 67.2%; meropenem, 69.1%; difference, -1.9%; 95% CI, -8.1% to 4.3%). Clinical cure rates at TOC for patients infected with CAZ-nonsusceptible pathogens were similar (CAZ-AVI, 75.5%; meropenem, 71.2%; micro-ITT). Safety data were consistent with established safety profiles for both agents.
CAZ-AVI provides an important new treatment option for HAP/VAP due to Gram-negative pathogens, including CAZ-nonsusceptible strains.
A series of mono- and bis-ethynyl phosphonium salts have been prepared via reaction of bromoacetylenes, Ph–C≡C–Br or Br–C≡C–C
6
H
4
–C≡C–Br, with various phosphines. Some of the derivatives reported ...are previously known, (Ph–C≡C–PPh
3
Br, Ph–C≡C–PMe
3
Br, Ph–C≡C–PBu
3
Br, and Ph
3
P–C≡C–C
6
H
4
–C≡C–PPh
3
Br
2
), however typically these are missing complete spectroscopic characterization and many have been prepared using much more complicated methods. The derivative Ph–C≡C–PPh
3
Br is capable of inhibiting the growth of tumour cells and has been shown crystallographically to have a significant interaction with the heat shock proteins (HSP70 or DnaK). Thus, solid state structures for all seven phosphonium salts prepared have been reported as they may be of interest to others in this field. Sterically encumbered phosphines such as Mes
3
P did not react with Ph–C≡C–Br; however, (2,4,6-MeO–C
6
H
2
)
3
P was found to slowly react at moderate temperature to give the expected alkynyl phosphonium salt. However, at higher temperatures, the alkynyl phosphonium undergoes an intramolecular cyclization to form a phosphonium analogue of a 1,4-oxazine. Finally, electronic structure calculations reveal the positive charge on the acetylenic β-carbon, a result of a significant contribution of other canonical structures. The flexibility of the P–C≡C bond has been investigated showing a low-energy barrier (<5 kcal/mol) for bending up to 40° from the optimized angle in the model Ph–C≡C–PMe
3
+
cation. This ease of bending may be of significance in the development of other alkynyl phosphonium tumour cell growth inhibitors.
Notes how, in 2010, the Enterovirus 74 (EV74) viral infection was identified in New Zealand in a 2 year old child with a further three cases identified in children within six months - the first ...report of EV74 in New Zealand. Describes the near complete genome sequence of four EV74 isolates from New Zealand, including the first complete EV74 genome sequenced from a patient with acute flaccid paralysis. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.
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