Optimizing Disclosure of HIV Status to a Diverse Population of HIV-Positive Youth at an Urban Pediatric HIV Clinic

PurposeThe purpose of the study was to increase the proportion of youth living with HIV (YLWH) aged ≥11 years who undergo developmentally appropriate disclosure about their HIV status.MethodsA quality improvement project was initiated at an urban pediatric HIV clinic between July 2018 and March 2020. The primary outcome measure was the proportion of YLWH aged ≥11 years who were disclosed to about their HIV status. The proportion of undisclosed YLWH who had documented nondisclosure status was also assessed as a process measure. Plan-Do-Study-Act (PDSA) cycles for change included monthly clinic staff check-ins to discuss new disclosures, quarterly team meetings to discuss strategies to improve disclosure, and modifying a clinic note template to prompt providers to document disclosure status. Annotated run charts were used to analyze the data.ResultsBefore the first PDSA cycle, 26/46 (57%) of the target population of YLWH aged ≥11 years had their HIV status disclosed to them, and none of the undisclosed youth had disclosure status documented in their medical record. After 20 months and six PDSA cycles, the proportion of YLWH aged ≥11 years disclosed to about their HIV status increased to 80% and the proportion of undisclosed YLWH with documentation of their disclosure status increased to 100%.ConclusionsSeveral interventions integrated throughout the pediatric HIV care process were associated with an increase in the proportion of YLWH with developmentally appropriate HIV disclosure and documentation of disclosure status, an important psychosocial aspect of care in these individuals.     

Ductal stent endocarditis resulting in a large aortic pseudoaneurysm

An infant with ductal dependent pulmonary blood flow who underwent neonatal ductal stenting and, 4 months later, developed ductal stent endocarditis due to Streptococcus gallolyticus subsp. pasteurianus was described. The infection was associated with a moderate aortic pseudoaneurysm and the patient was treated with antibiotics as well as surgical aortic pseudoaneurysm repair. This novel and unusual complication of ductal stent placement warrants reporting.     

Follicular carcinoma of thyroid following successful liver transplantation – A report

Dantuluri S, Urs A, Karthik SV. Follicular carcinoma of thyroid following successful liver transplantation – A report. Abstract: Follicular carcinoma of the thyroid is a relatively rare malignancy in childhood even in paediatric solid organ transplant recipients. The risk of developing de novo malignancies after liver transplantation is higher compared to the general population. We report an 18‐yr‐old girl who had successfully undergone liver transplantation five yr earlier for neonatal sclerosing cholangitis complicated by the development of dysplastic nodules. Baseline immunosuppression was with tacrolimus and prednisolone. Mycophenolate mofetil was later added in view of steroid‐resistant episodes of graft rejection. She subsequently suffered from marked obesity and essential hypertension needing antihypertensive medication. Five yr after liver transplantation, she presented with a right‐sided thyroid swelling that was rapidly progressive with no associated lymphadenopathy and normal systemic examination. Ultrasound of her neck revealed a solid lesion in the right lobe of the thyroid gland with ill‐defined margins, and a diagnostic right thyroid lobectomy confirmed the diagnosis of follicular carcinoma with focal capsular and vascular invasion. She underwent total thyroidectomy and currently remains well on thyroxine supplements. Our report highlights the need for high level of suspicion and prompt investigation into any abnormal lesion in the long‐term follow‐up of solid organ transplant recipients.     

Paclitaxel-loaded PLGA nanoparticles surface modified with transferrin and Pluronic®P85, an in vitro cell line and in vivo biodistribution studies on rat model

The development of multidrug resistance (due to drug efflux by P-glycoproteins) is a major drawback with the use of paclitaxel (PTX) in the treatment of cancer. The rationale behind this study is to prepare PTX nanoparticles (NPs) for the reversal of multidrug resistance based on the fact that PTX loaded into NPs is not recognized by P-glycoproteins and hence is not effluxed out of the cell. Also, the intracellular penetration of the NPs could be enhanced by anchoring transferrin (Tf) on the PTX-PLGA-NPs. PTX-loaded PLGA NPs (PTX-PLGA-NPs), Pluronic^®P85-coated PLGA NPs (P85-PTX-PLGA-NPs), and Tf-anchored PLGA NPs (Tf-PTX-PLGA-NPs) were prepared and evaluted for cytotoxicity and intracellular uptake using C6 rat glioma cell line. A significant increase in cytotoxicity was observed in the order of Tf-PTX-PLGA-NPs > P85-PTX-PLGA-NPs > PTX-PLGA-NPs in comparison to drug solution. In vivo biodistribution on male Sprague–Dawley rats bearing C6 glioma (subcutaneous) showed higher tumor PTX concentrations in animals administered with PTX-NPs compared to drug solution.     

Role of α-relaxation on crystallization of amorphous celecoxib above T(g) probed by dielectric spectroscopy

In the present study, the role of α-relaxation toward isothermal crystallization of amorphous celecoxib was studied using dielectric spectroscopy (DES). The dielectric response of the α-relaxation was measured as a function of frequency (10?1 to 10? Hz), isothermally at every 4 K interval in the range of 303.15 to 443.15 K. The dielectric loss spectrum at each temperature was analyzed using the Havriliak Negami (HN) equation to extract the characteristic relaxation time, τ(HN). Two Vogel-Fulcher-Tammann (VFT) functions were required for representing the temperature dependence of τ(HN) across the temperature range of study. The VFT fit parameters obtained from the two regions varied drastically pointing toward the underlying differences in the dynamics of relaxation above and below the crossover. Later, in situ isothermal crystallization experiments were performed at 363.15, 368.15, 373.15, and 378.15 K. The conversion rate, obtained from the normalized dielectric strength, was modeled using the Avrami model, which indicated the possibility of different crystallization mechanism at higher crystallization temperatures. HN shape parameters, α(HN) and product of α(HN) and β(HN), were analyzed during the course of crystallization to understand the dynamics of amorphous phase when crystallites were being evolved. HN shape parameters indicated α-like motions were affected, whereas β-like remained unaffected by the crystallization temperature. Characteristic crystallization time, τ(cr), obtained from Avrami fits, showed Arrhenius type of temperature dependence (R2 = 0.999). A plot between log τ(cr) and log τ(HN) show a linear regression with R2 of 0.997 indicating the direct correlation between these two phenomena. However, the coupling coefficient was found to be varying within the temperature range of study, indicating tendency of crystallization to be more diffusion controlled at higher crystallization temperatures. With different crystalline solid phase crystallizing at higher crystallization temperature, complemented with direct correlation between log τ(cr) and log τ(HN), Avrami modeling of crystallization and HN shape parameter analysis, the role of α-relaxation in the crystallization of amorphous celecoxib at T > T(g) is emphasized.     

Radial Tunnel Syndrome

PurposeRadial tunnel syndrome is defined as a compressive neuropathy of the posterior interosseus nerve. It is differentiated from posterior interosseus nerve compression by symptom profile. The purpose of this article is to review past and current literature on the topic and determine if there are any emerging treatment options for this condition.Recent FindingsTraditionally, conservative management of Radial Tunnel syndrome has been relatively unsuccessful. As a result, patients afflicted by this neuropathy require operative intervention. Effectiveness of surgical decompression is variable and can range from 67 to 92% but currently remains the standard treatment. However, there are some conservative treatment options that have been recently reported that show promising results. Such treatments include dry needling of the affected area and ultrasound guided corticosteroid injections to hydro dissect around the posterior interosseus nerve at sites of compression.SummaryRadial tunnel syndrome is an uncommon and unique peripheral neuropathy. It involves the posterior interosseus nerve however it can be differentiated from PIN syndrome based on the symptom profile. There are various compressive etiologies that can cause a patient to become symptomatic; therefore it is important to critically assess the patient and their symptoms and use appropriate imaging to determine the cause and appropriate treatment. Typically, conservative treatments are attempted first. Traditionally, conservative therapy is unsuccessful and operative decompression is necessary. However, current literature highlights various new nonsurgical options that suggest some promise and could be alternatives to surgical decompression.     

Raman spectroscopy using plasmonic and carbon-based nanoparticles for cancer detection,diagnosis, and treatment guidance. Part 2: Treatment

Raman spectroscopy and surface-enhanced raman scattering (SERS) have the potential to improve the detection and monitoring of various diseases, particularly cancer, with or without the support of multifunctional active nanosystems. This review is focused on the recent advances that have made Raman a major tool for treatment guidance for surgical tumor resection or for analytical monitoring of various therapies, such as photodynamic therapy, photothermal therapy, and drug delivery. The potential of Raman spectroscopy and nanosytems to further improve cancer treatments is also discussed.     

Investigation of atypical dissolution behavior of an encapsulated amorphous solid dispersion

Poor dissolution performance is one of the challenges encountered in dosage form design of amorphous solid dispersions (ASDs). This study was aimed to investigate the effect of solid-liquid interactions of an encapsulated ASD on drug release. Drug release profiles of a molecularly interacting amorphous celecoxib solid dispersion (ACSD) comprising of amorphous celecoxib (A-CLB), polyvinylpyrrolidone (PVP), and meglumine (7:2:1, w/w) were compared with crystalline CLB (C-CLB), in powder and capsule form. Although, ACSD powder displayed 28- to 50-fold higher dissolution efficiency at 60 min (DE(60)), the DE(60) in the encapsulated state were drastically reduced due to the formation of a nondispersible plug. The accompanied physical and compositional changes were investigated using X-ray powder diffraction, differential scanning calorimetry, scanning electron microscopy, and chromatographic techniques. ACSD displayed optimal wettability, sustained A-CLB-PVP interactions, and suppressed phase transformations in aqueous media. Furthermore, Fourier transform infrared and texture analysis revealed role of intermolecular interactions of the solid dispersion, which (i) altered PVP's functionality and (ii) promoted interparticle cohesivity via water-mediated hydrogen bonds, resulting in solid mass agglomeration. Parallel evaluation of A-CLB, physical mixture of ACSD components, and C-CLB solid dispersion supported the above inferences. On the basis of these findings, rationalized formulation approaches for ASD-based drug products are discussed.     

Raman spectroscopy using plasmonic and carbon-based nanoparticles for cancer detection,diagnosis, and treatment guidance.Part 1: Diagnosis

Optical techniques, including Raman, photothermal and photoacoustic microscopy and spectroscopy, have been intensively explored for the sensitive and accurate detection of various diseases. Rapid advances in lasers, photodetectors, and nanotechnology have led to the development of Raman spectroscopy, particularly surface-enhanced Raman scattering (SERS), as a promising imaging modality that can help diagnose many diseases. This review focuses on the major recent advances in Raman spectroscopy and SERS-enhancing contrast nanoagents, as well as their potential to transition from a proof-of-concept approach to a cancer detection tool in vitro and in vivo.     

Barrier coated drug layered particles for enhanced performance of amorphous solid dispersion dosage form

Amorphous solid dispersions (ASDs) may entail tailor-made dosage form design to exploit their solubility advantage. Surface phenomena dominated the performance of amorphous celecoxib solid dispersion (ACSD) comprising of amorphous celecoxib (A-CLB), polyvinylpyrrolidone, and meglumine (7:2:1, w/w). ACSD cohesive interfacial interactions hindered its capsule dosage form dissolution (Puri V, Dhantuluri AK, Bansal AK 2011. J Pharm Sci 100:2460-2468). Furthermore, ACSD underwent significant devitrification under environmental stress. In the present study, enthalpy relaxation studies revealed its free surface to contribute to molecular mobility. Based on all these observations, barrier coated amorphous CLB solid dispersion layered particles (ADLP) were developed by Wurster process, using microcrystalline cellulose as substrate and polyvinyl alcohol (PVA), inulin, and polyvinyl acetate phthalate (PVAP) as coating excipients. Capsule formulations of barrier coated-ADLP could achieve rapid dispersibility and high drug release. Evaluation under varying temperature and RH conditions suggested the crystallization inhibitory efficiency in order of inulin < PVA ≈ PVAP; however, under only temperature treatment, crystallization inhibition increased with increase in T(g) of the coating material. Simulated studies using DSC evidenced drug-polymer mixing at the interface as a potential mechanism for surface stabilization. In conclusion, surface modification yielded a fast dispersing robust high drug load ASD based dosage form.