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Postoperative delirium is a common and serious complication affecting older surgical patients, often leading to prolonged hospital stays, increased need for long-term care, and a higher likelihood of cognitive decline and dementia. Despite its prevalence, identifying patients at risk of developing postoperative delirium remains a significant challenge. Prof. Yuan Shen, from Shanghai Mental Health Center, with her team may have found a solution to this issue.

The study, recently published in General Psychiatry, involved 169 patients aged 65 and older who were scheduled for elective surgeries such as hip or knee replacements, or kidney and prostate surgeries at Shanghai 10th People’s Hospital. As part of their preoperative assessment, participants underwent an eye imaging test called optical coherence tomography (OCT) to measure the thickness of the macular layer of the retina. The incidence and severity of postoperative delirium were assessed using the Confusion Assessment Method (CAM) algorithm and CAM-Severity (CAM-S) on the first three days following surgery.

Of the 169 participants, 40 (24%) developed postoperative delirium. These patients had a significantly thicker macular layer in their right eye compared to those who did not experience delirium (mean thickness of 283.35 µm vs. 273.84 µm). The study also found that a thicker preoperative macular layer in the right eye was associated with a 1.593 higher odds of developing postoperative delirium and a greater severity of the condition. Interestingly, the study found no such association in the left eye. The reasons for such asymmetry are not currently well understood.

However, the study has several limitations, including the small sample size and lacks of examination of potential confounding factors. “Further large-scale validation studies with larger samples are needed to confirm these results,” Prof. Yuan Shen noted.

As the population ages, the incidence of postoperative delirium is likely to increase, making the need for effective screening tools more urgent. By leveraging retinal imaging, macular thickness may serve as a non-invasive biomarker to identify individuals vulnerable to developing postoperative delirium after anesthesia and surgery.

Reference:

Zhongyong Shi, Xin Ma, Tianyi Tang, Meijuan Wang, Hailin Zheng, Yupeng Chen, Jingxiao Hu, Ariel Mueller, Timothy T Houle, Edward R Marcantonio, Zhongcong Xie, Yuan Shen – Association between retinal layer thickness and postoperative delirium in older patients: General Psychiatry 2025;38:e101740.

The Xpert MTB/Ultra molecular diagnostic test for stool samples, until now recommended only for children, could be established as an additional test for diagnosing tuberculosis in adults living with HIV. This is the main conclusion of the Stool4TB Alliance study, led by the Barcelona Institute for Global Health (ISGlobal), an institution supported by the ”la Caixa” Foundation, in collaboration with the Manhiça Health Research Centre (CISM), the Research Center Borstel, the Makerere University, the Baylor College of Medicine Children’s Foundation – Eswatini, and The Amsterdam Institute for Global Health and Development. The results, published in The Lancet Microbe, could represent a paradigm shift in the diagnosis of the disease in this population.

Tuberculosis (TB), caused by the bacterium Mycobacterium tuberculosis, was responsible for 1.25 million deaths in 2023, 13% of which were among people living with HIV. Currently, the main diagnostic strategy for tuberculosis focuses on sputum samples, which are obtained by deep coughing and expectoration of secretions produced in the lungs. So far, the WHO has recommended molecular sputum tests for people living with HIV, in addition to urine antigen detection (TB-LAM). However, access to these diagnostics remains limited in many settings, and they are not effective for all people living with HIV. In fact, people with HIV often struggle to produce sputum; more than half of those in advanced stages of the disease are unable to do so. In addition, the concentration of bacteria in the sputum is often so low that it is undetectable.

To address this problem, researchers from the EDCTP-funded Stool4TB project proposed using a molecular test (called Xpert MTB/RIF Ultra), currently used on respiratory samples, on stool samples. This test is already recommended for children because they have difficulty producing sputum. The research was conducted between December 2021 and August 2024 in medical centres in three African countries -Eswatini, Mozambique, and Uganda-, and recruited 677 patients over 15 years old with HIV and suspected TB. Participants provided sputum, urine, stool, and blood samples.

The challenge of diagnosing TB in vulnerable populations

“People living with HIV are at higher risk of developing pulmonary tuberculosis, but diagnosis in these cases is particularly challenging due to the low sensitivity of conventional tests,” explains George William Kasule, a PhD student at ISGlobal and the University of Barcelona, and the first author of the study. “The variety of samples obtained in this study allowed us to compare the sensitivity and specificity of the Stool Ultra test with a microbiological reference standard consisting of three WHO-recommended tests: TB-LAM in urine, liquid culture, and Xpert Ultra from sputum,” he adds.

A more sensitive test in advanced stages of HIV

The results showed that the stool test had a sensitivity of 23.7% and a specificity of 94.0%, compared with the reference standard. In patients with CD4 counts below 200 cells/μl, sensitivity increased to 45.5%. CD4 lymphocytes are immune system cells that are affected by HIV infection, so people with CD4 counts below 200 are more likely to develop serious opportunistic infections such as tuberculosis.

“The results of our study support the use of the Stool Ultra test as a complementary tool for diagnosing tuberculosis in people living with HIV, especially in those with advanced AIDS, where the risk of tuberculosis is higher,” says Alberto L. García-Basteiro, a researcher at ISGlobal and head of the Vaccine and Immune Response to Infections Unit at Hospital Clínic de Barcelona.

The Stool Ultra test identified additional cases that were not detected by TB-LAM, Ultra in sputum or bacterial culture. “In these patients, the sensitivity of standard tests is much lower than in the HIV-negative population. However, in patients with advanced AIDS, our results show that stool molecular detection is no less effective than sputum testing. Most importantly, it can confirm the disease in many cases where respiratory tests are negative. This demonstrates the potential of this sample, perhaps counterintuitively, for diagnosing tuberculosis in people with HIV, especially when respiratory samples are not available,” concludes García-Basteiro.

Reference:

Kasule, G., Hermans, S., Acacio, S., et al, Performance of stool Xpert MTB/RIF Ultra for detection of Mycobacterium tuberculosis among adult people living with HIV: a prospective multicentre diagnostic study. Lancet Microbe (2025). https://doi.org/10.1016/j.lanmic.2025.101085

The U.S. Food and Drug Administration has approved Dupixent (dupilumab) for the treatment of adults and adolescents with chronic spontaneous urticaria.

Researchers at Umeå University, Sweden, have discovered a previously unknown type of connective tissue cells that surround cancer cells in pancreatic tumors. The newly discovered cells counteract tumor development and may therefore be a target for research into new treatments for pancreatic cancer, which is one of the deadliest forms of cancer. The work is published in the journal Cancer Research.

Mumbai: Global pharma major, Lupin Limited, has received approval from the United States Food and Drug Administration (U.S. FDA) for its
Abbreviated New Drug Application for Tolvaptan Tablets, 15 mg, 30 mg, 45 mg, 60 mg, and 90 mg.

Tolvaptan is indicated to slow kidney function decline in adults at risk of rapidly progressing autosomal dominant polycystic kidney disease (ADPKD).

Tolvaptan Tablets are bioequivalent to Jynarque Tablets, 15 mg, 30 mg, 45 mg, 60 mg, and 90 mg, of
Otsuka Pharmaceutical Company, Ltd.

As per the release, Lupin is the exclusive first-to-file for this product and is eligible
for 180 days of generic drug exclusivity.

This product will be manufactured at Lupin’s Nagpur facility in
India and will be launched soon. 

Read also: Lupin Launches Ajaduo M Forte, a Triple Fixed-Dose Combination of Empagliflozin, Linagliptin, and Metformin Extended Release (ER)

“We are very pleased to have obtained approval for generic Tolvaptan from the U.S. FDA. This marks
a significant entry into the nephrology segment and demonstrates our commitment to addressing
the unmet needs of patients globally,” said Vinita Gupta, CEO, Lupin.

Tolvaptan Tablets (RLD Jynarque) had an estimated annual sale of USD 1,467 million in the U.S. (fiscal
year ended December 31, 2024).

Read also: BRESER Study Demonstrates Real-World Efficacy and Safety of Lupin’s Ranibizumab Biosimilar (Ranieyes)

Lupin Limited is a global pharmaceutical leader headquartered in Mumbai, India, with products distributed in over 100
markets. Lupin specializes in pharmaceutical products, including branded and generic formulations, complex generics,
biotechnology products, and active pharmaceutical ingredients. The company has a strong position in India and the U.S. across multiple therapy areas, including respiratory,
cardiovascular, anti-diabetic, anti-infective, gastrointestinal, central nervous system, and women’s health. Lupin has 15
state-of-the-art manufacturing sites and 7 research centers globally.