Re-Print: Developing and then Confirming a Hypothesis Based on a Chronology of Several Clinical Trials: A Bayesian Application to Pirfenidone Mortality Results | Author : Zhengning Lin | Abstract | Full Text | Abstract :Designing a study for independent confirmation of a treatment effect is sometimes not practical due to required large sample size. Post hoc pooling of studies including those for learning purposes is subject to selection bias and therefore generally not suitable for confirmation of a treatment effect. We propose a Bayesian approach which calibrates the role of prior information from historical studies for learning and confirming purposes. The amount of prior information to be combined with current study data for the purpose of hypothesis confirmation depends on the overall strength of prior information for hypothesis generation. The method is illustrated in the analysis of mortality data for the pirfenidone NDA.
The Bayesian analysis provides a formal method to calibrate the role of information from historical evidence in the overall interpretation of results from both historical and concurrent clinical studies. The increased efficiency of using all available data is especially important in drug development for rare diseases with serious consequences, where limited patient source prohibits large trials, and unmet medical needs demand rapid access to treatment options. |
| Highlights on some different Wild Mushrooms Xeromphalina, Cookeina, Gyromitra, Xylaria, Phellodon, Marasmius and Parasola, Description and Ecology | Author : Waill A. Elkhateeb | Abstract | Full Text | Abstract :This review provides detailed morphological descriptions of some wild mushrooms of the genus Xeromphalina, Cookeina, Gyromitra, Xylaria, Phellodon, Marasmius and Parasola, including common species for each genus. |
| Coronavirus Variants of Concern: An Insight | Author : Prabir K. Mandal | Abstract | Full Text | Abstract :The new coronavirus, SARS-CoV-2, which causes the disease COVID-19, has had a serious worldwide impact on human health. The virus was virtually unknown at the beginning of 2020. Since then, intense research efforts have resulted in sequencing the coronavirus genome, identifying the structures of its proteins, and creating a wide range of tools to search for effective vaccines and therapies. Also, there’s a chance that the COVID-19 contraction rate could get higher than the COVID-19 vaccination rate. In other words, the virus continues to spread while very little people actually get vaccinated. This only makes the job of scientists even harder. In order to stop the spread of COVID-19, citizens must get vaccinated more frequently than citizens are contracting COVID-19. The coronavirus attacks and kills healthy cells, causing detrimental damage to the respiratory system and immune system. It was then discovered that COVID-19 can be terribly fatal for those with already fragile immune systems and preexisting health conditions.
Back in March, when COVID-19 was clearly becoming a critical threat to many countries around the world, the evidence indicated that the virus spreads from person to person through small respiratory droplets produced when people cough or sneeze, or even breathe. Surfaces can serve as an intermediary for the virus when looking for a host. Instead of contracting the virus directly from a person, it is possible to receive the virus from touching an object that an infected person sneezed on. It has been discovered that the virus can last up to three 3 days on a surface. Proceeding to rub one’s eyes, mouth, or nose after such contact is also a mode of transmission. |
| Novel Therapeutic Trends in Pneumonia: Antibiotics and Mesenchymal Stem Cells | Author : Li Zhong | Abstract | Full Text | Abstract :Pneumonia remains a major cause of morbidity and mortality. With the significant global health burden that pneumonia poses, it is essential to improve therapeutic and management strategies. The increasing emergence of antibiotic-resistant bacterial strains limits options for effective antibiotic use. New antibiotics for the treatment of pneumonia may address deficits in current antimicrobial drugs, with an ability to cover both typical, atypical, and resistant pathogens. Several of these newer drugs also have structural characteristics that allow for a decreased propensity for the development of bacterial resistance. The potential use of stem cell therapies in place of corticosteroid treatments may also offer an improvement in patient outcomes. Human mesenchymal stem cell treatments have shown efficacy and safety in treating COVID-19 induced pneumonia. Combined treatment with both stem cells and antibiotics in pneumonia in a rabbit model has also shown significantly increased efficacy in comparison to antibiotic treatment alone. This presents yet another possible route for a novel strategy in treating pneumonia, though additional future studies are necessary before clinical implementation. While pneumonia remains a major disease of concern, having newer approved antibiotics as well as novel therapies such as stem cell treatments in the pipeline offers clinicians more options in effectively treating pneumonia. |
| The case number 506 of Mostyn Embrey Syndrome: Imaging Studies and Ethics of Naming Syndromes | Author : Aamir Jalal Al Mosawi | Abstract | Full Text | Abstract :Background: Mostyn Embrey syndrome is a rare disorder associated with unilateral renal agenesis and malformations of the female reproductive tract. Delayed diagnosis is associated with serious diagnostic difficulties that may lead to inappropriate management including harmful surgery. The aim of this paper is to present imaging studies of case number 506 of the syndrome which was the first case of this rare syndrome in Iraq, and was originally reported in 2016. Ethics of naming syndromes relevant to this syndrome is discussed.
Patients and methods: An 18-year-old female presented with acute abdominal pain and poor urine output associated with retention of urine; about three years after the onset of menses. The pain was radiating to the back and pelvis. Her menstrual cycles started at the age of fifteen, and were lasting seven days. Cycles were associated with normal flow. The first physician the patient consulted considered the diagnosis of uterine tumor and the need for hysterectomy, but the family of the patient consultedanother physician. Vaginal exam was performed and showed bulging left vaginal wall. The diagnosis of hematocolpos was made. A clotted blood was drained by trans- vaginal approach.
Results: It was difficult to identify the two separate uteri and two separate cervices and to make a diagnosis of didelphys uterus on hysterosalpingography. Abdominal MRI showed left renal agenesis, and two uterine bodies, cervices, and vaginas with normal myometrium and endometrium (uterine didelphys), and normal ovaries.
Conclusions: It is recommended that pediatricians, and pediatric nephrologists need to be aware of this syndrome to avoid unexpected presentations which may lead to delayed diagnosis and sometimes to inappropriate management. The imaging modalities that can be used to diagnose Mostyn Embrey syndrome include ultrasonography, hysterosal pingography and MRI. In this case, hysterosal pingography was not of much help. Ultrasound is affordable, non-invasive, widely available imaging modality that contributes to the accurate diagnosis of Mostyn Embrey syndrome. However, there can be difficulties in visualizing the vaginal septum on ultrasound which best shown on MRI. MRI can facilitate early diagnosis and thus help in the prevention of further complications. Syndromes in medicine are often named after the physician or group of physicians that discovered them or initially provided the full clinical picture or the best description of the syndrome. Unfortunately, Mostyn Embrey syndromes has been attributed unfairly and inappropriately to physicians other that those first described them in almost all previous papers. |
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