Although air pollution has become a significant global environmental problem posing many negative impacts on human health and society, there has been a little known about how people think and respond to it, especially in developing and emerging countries. This article presents a dataset on how the suburbanites perceived and reacted with air pollution in Vietnam, an emerging country in Southeast Asia. A stratified random sampling technique and a face-to-face interview method were employed to survey 302 inhabitants living within Hanoi suburban, during November and December 2019. The constructed data contains three groups of information: (1) perspectives on air quality, causes, and impacts of polluted air, (2) respondent's preventative measures to air pollution, and suggested solutions to improve air quality, and (3) demographic information of interviewees. The dataset could be useful for many scholars who want to conduct a further in-depth study and or environmentalists, policymakers who want to keep society informed about the air pollution-related progression, which could help design a desirable policy for mitigating and or controlling air pollution in Vietnam and beyond.
Background: Ustekinumab is a monoclonal antibody that inhibits interleukins 12 and 23. It is approved for treatment of Crohn’s disease (CD) in adults; however, there is a paucity of data regarding its use in pediatric CD. We describe our experience using ustekinumab in anti-TNF refractory CD pediatric patients. Methods: We performed a retrospective chart review on pediatric patients with CD who were started on ustekinumab from January 2016 to November 2018. We collected patient’s clinical history, previous treatment history, surgeries related to CD, disease severity, as measured by abbrPCDAI, and endoscopic severity as recorded by SES-CD before and after ustekinumab. Results: We identified 10 patients with CD who were started on ustekinumab due to non-response to currently approved agents. Seven patients needed augmented maintenance dosing every 4-6 weeks to achieve clinical response or remission. Six of these seven patients had therapeutic drug monitoring during the course of treatment, with five patients showing subtherapeutic drug levels of <4.5 μg/mL while on standard maintenance dosing every 8 weeks, and four patients showing therapeutic drug levels of >4.5 μg/mL on augmented dosing interval. The remaining three patients were on standard maintenance dosing for the duration of treatment. Conclusion: In this retrospective chart review, 7 out of 10 patients with anti-TNF refractory pediatric-onset CD required augmented maintenance doses of ustekinumab to achieve clinical response or remission. A prospective study is needed to define appropriate ustekinumab dosing and interval in management of pediatric CD.
INTRODUCTION: Adalimumab is a fully-humanized anti-tumor necrosis factor antibody FDA approved in 2014 for the treatment of pediatric patients between 6 and 17 years of age with moderately to severely active Crohn's disease. Across all indications, the most commonly reported adverse event was injection site reaction. Citrate free adalimumab was specifically designed to reduce injection pain by removing the citrate acid monohydrate from the formula, using less volume and a smaller needle. The study supporting decreased perception of pain was conducted in adult rheumatological disease patients. The perception of pain in children is very complex and involves psychological, physiological, behavioral and developmental factors. Complications associated with sub-optimally controlled disease is more detrimental for children because the impact on their growth potential. For those patients on dose intensification with adalimumab, the implications of compliance is even more important and the experience with injection site reaction is even more impactful. METHODS: Patients with pediatric inflammatory bowel disease were asked to rate their injection site pain comparing the original adalimumab formulation verses the citrate free adalimumab formulation. We collected patient’s specific inflammatory bowel disease type, gender, and age. We evaluated changes in pain between the original formulation verses the citrate free adalimumab using a pediatric visual analog scale (VAS) pain scale. RESULTS: The pain score deviated significantly from normal distribution by both Shapiro-Wilk and Kolmogorov Smirnov tests (P < 0.05). Therefore, Wilcoxon Signed Rank test was used to test the difference in pain score between the two types of injection medication. The median pain score was 7.5 in the original formulation injection group and 1 in the citrate free formulation injection group. The median pain reduction was 6 scales when switching from original formulation to citrate free injection. Wilcoxon Signed Rank test showed significant difference in pain score between the two types of the injections (P < 0.0001). CONCLUSION: The citrate free adalimumab formulation is associated with statistically significant less injection site pain which provided an overall improved experience for pediatric IBD patients and their families. Alleviating the burden of treatment may improve the quality of adherence for pediatric patients and positively influence treatment outcomes for patients with IBD.
During the fasted-refed transition, hepatic glycogen repletion from glucose can occur by the direct and indirect pathway. In the indirect pathway, glucose is first metabolized to 3-carbon intermediates that then are converted in the liver to glucose 6-phosphate via the gluconeogenic pathway before conversion to glycogen. The present study evaluated whether skeletal muscle is a major source of 3-carbon intermediates (i.e., lactate, pyruvate, and alanine) during refeeding of 1-day fasted rats. Arteriovenous differences for lactate, pyruvate, and alanine across the anesthetized rat hindlimbs were used to evaluate muscle metabolism in the fed, fasted, and refed state. In the fasted state, liver glycogen was depleted, and muscle released 3-carbon intermediates. One hour after refeeding, hepatic glycogen was 30% repleted, and blood lactate, pyruvate, and alanine increased. Despite this, the release of alanine by muscle diminished at this time and lactate was removed. At 4 h after refeeding, 3-carbon intermediates were all released by hindlimb tissue but in an amount not greater than in the fasted state. Overall, these results suggest that skeletal muscle in the rat is not a major source of 3-carbon precursors for early postprandial hepatic glycogen repletion via the indirect pathway, nor is the rise in 3-carbon intermediates in blood during refeeding caused by their increased output by muscle.
Zusammenfassung Einleitung Akute COPD-Exazerbationen (AECOPD) im Rahmen einer pneumologischen Rehabilitation (PR) sind häufige und gefährliche Komplikationen. Neben Einschränkungen der Lebensqualität führen sie zu einem Unterbrechung der PR und gefährden den PR-Erfolg. Eine Abhängigkeit zwischen dem Krankheitsstatus und einem erhöhten Risiko für eine AECOPD ist beschrieben. Dabei stellt sich die Frage, ob der Charlson Comorbidity Index (CCI) oder die Cumulative Illness Rating Scale (CIRS) dafür geeignet sind, besonders exazerbationsgefährdete COPD-Patienten in der PR im Vorfeld zu detektieren. Patienten und Methoden In einer retrospektiven Untersuchung wurden die Daten von COPD-Patienten, welche im Jahr 2018 eine PR erhielten, analysiert. Primärer Endpunkt der Untersuchung war die Punktzahl im CCI. Alle Daten wurden dem Klinikinformationssystem Phönix entnommen und COPD-Exazerbationen erfasst. Die laut Fallzahlplanung benötigten 44 Patienten wurden zufällig (mittels Zufallsliste für jede Gruppe) aus diesem Datenpool rekrutiert: 22 Patienten mit und 22 ohne Exazerbation während der PR. CCI und CIRS wurden für die eingeschlossenen Fälle für beide Gruppen bestimmt. Die Auswertung des primären Endpunktes (CCI) erfolgte durch den Gruppenvergleich der arithmetischen Mittel und der Signifikanzprüfung (Welch-Tests). Weitere statistische Lage- und Streuungsmaße wurden ergänzt (Median, Quartile, Standardabweichung).Zusätzlich wurde mittels Receiver Operating Characteristic (ROC)-Analyse sowohl für den CCI als auch für den CIRS ein optimaler Cutpoint zur Diskriminierung in AECOPD- und Nicht-AECOPD-Patienten gesucht. Ergebnisse 244 COPD-Patienten erhielten eine stationäre PR von durchschnittlich 21 Tagen, wovon 59 (24 %) während der PR eine behandlungspflichtige AECOPD erlitten. Die ausgewählten 22 Patienten mit einer AECOPD hatten einen mittleren CCI von 6,77 (SD: 1,97) und die 22 Patienten ohne AECOPD von 4,32 (SD: 1,17). Die Differenz von –2,45 war zu einem Signifikanzniveau von 5 % statistisch signifikant (p < 0,001; 95 %-KI: [–3,45 ; –1,46]). Die ROC-Analyse zeigte einen optimalen Cutpoint für den CCI bei 6 mit einer Sensitivität zur Feststellung einer AECOPD von 81,8 % und einer Spezifität von 86.,4 % mit einem Wert der AUC (area under the curve) von 0,87. Der optimale Cutpoint für den CIRS war 19 mit einer Sensitivität von 50 %, einer Spezifität von 77,2 % und einer AUC von 0,65. Schlussfolgerung COPD-Patienten mit einer akuten Exazerbation während der pneumologischen Rehabilitation haben einen höheren CCI. Mithilfe des CCI lässt sich mit einer hohen Sensitivität und Spezifität das Risiko einer AECOPD von COPD-Patienten im Rahmen eines stationären PR-Programms einschätzen.
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