No effect of albumin infusion on the prevention of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt

Hepatic encephalopathy (HE) is a major problem in patients submitted to TIPS. Previous studies identified low albumin as a factor associated to post-TIPS HE. In cirrhotics with diuretic-induced HE and hypovolemia, albumin infusion reduced plasma ammonia and improved HE. Our aim was to evaluate if the incidence of overt HE (grade II or more according to WH) and the modifications of venous blood ammonia and psychometric tests during the first month after TIPS can be prevented by albumin infusion. Twenty-three patients consecutively submitted to TIPS were enrolled and treated with 1 g/Kg BW of albumin for the first 2 days after TIPS followed by 0,5 g/Kg BW at day 4th and 7th and then once a week for 3 weeks. Forty-five patients included in a previous RCT (Riggio et al. 2010) followed with the same protocol and submitted to no pharmacological treatment for the prevention of HE, were used as historical controls. No differences in the incidence of overt HE were observed between the group of patients treated with albumin and historical controls during the first month (34 vs 31 %) or during the follow-up (39 vs 48 %). Two patients in the albumin group and three in historical controls needed the reduction of the stent diameter for persistent HE. Venous blood ammonia levels and psychometric tests were also similarly modified in the two groups. Survival was also similar. Albumin infusion has not a role in the prevention of post-TIPS HE

Effect of vitamins A, E, C and omega-3 fatty acids supplementation on the level of catalase and superoxide dismutase activities in streptozotocin-induced diabetic rats

Background: Since free radicals and antioxidant enzymes may play an important role in the development of diabetes, the present study was designed to assess the effect of supplementation with vitamins A, E and C and �-3 fatty acids on catalase and superoxide dismutase activity in streptozotocin (STZ)-induced diabetic rats. Methods: A total of 64 male Wistar rats weighing 250 g were divided into four groups as normal control, diabetic control, diabetic supplemented with vitamin A, E and C and diabetic supplemented with �-3 fatty acids. After four weeks the rats were anesthetized and catalase (CAT) and superoxide dismutase (SOD) activities were investigated in blood samples, liver and heart homogenates. Results: In diabetic rats, the activity levels of heart SOD (p < 0.001) and heart and liver CAT (p < 0.001) were significantly lower than in normal control rats. Supplementation with vitamins A, E and C significantly increased heart CAT (p = 0.05). No significant change was observed in diabetic rats supplemented with �-3 fatty acids. Conclusion: Supplementation with vitamins A, E and C and �-3 fatty acids was found to increase heart CAT activity in diabetic rats and they can be valuable candidates in the treatment of the complications of diabetes

Improving Hypertensive Therapy Outcomes Among African Americans

The effects of nonadherence to prescribed blood pressure medication adversely impacts African Americans (AA) in comparison to their European American counterparts. The associated health consequences of uncontrolled hypertension include heart failure, stroke, and renal dysfunction. And the treatment of the complications negatively impacts quality of life and contributes to increased health care costs. To address the problem at 1 clinic, a quality improvement (QI) project was developed by the clinic nursing staff, but the project had never been evaluated. The project included blood pressure measurements assessed among AA patients before and after implementation of a 4-item Morisky Medication-Taking Adherence Scale (MMAS) and education by the nurses. The purpose of this project was to evaluate whether the use of the MMAS and education improved blood pressure control in the AA hypertensive patients. This QI evaluation project was guided by Johnson\u27s medication adherence model and the Kolkaba comfort theory. Deidentified results of 3 months of patient blood pressures taken before and 3 months after the QI project was implemented were obtained from the site for statistical analysis. A paired sample t test was used to determine if a difference in blood pressure existed between the 2 groups, before and after implementation (n = 33) of the teaching and the MMAS. Results indicated a statistically significant (p \u3c .05) decrease in blood pressures after implementation of the QI project. The findings of this project may positively influence social change by improving adherence to blood pressure medication and thereby improving healthcare outcomes for AA patients

Access, perceived quality and uptake of antenatal services in urban communities of Osun state, Southwest Nigeria

Quality antenatal care (ANC) is one of the key interventions to improve intrapartum care uptakes and to reduce the menace of maternal deaths globally. Yet, ANC coverage has remained low in many developing countries like Nigeria. It becomes imperative to contextually understand factors associated with ANC uptake in Nigeria. The study assessed level of utilization, perceived quality, level of satisfaction and determinants of ANC utilization among women of reproductive age-group in Oshogbo, South-west Nigeria. Cross-sectional study design was employed and cluster sampling method was used to recruit 420 consenting respondents. Data were collected using pretested interviewer-administered, semi-structured questionnaire. Both descriptive and inferential statistics were done at p&lt;0.05. The mean (±SD) age of the respondents was 30.84±6.0 years. Almost three-quarters (73.9%) of the respondents had at least 4 ANC visits. Main reasons for non-ANC usage were high cost of care, long waiting time at the clinic, long distance to the clinic and unsatisfactory service quality. Only 59.9% of respondents were satisfied with services received while 63.1% of them rated the service quality as excellent. Main determinants of ANC uptake were respondents’ age (AOR=2.35;95%CI=1.34-5.89), level of education (AOR=0.56;95% CI= 0.42-0.71), socio-economic status (AOR=5.22; 95%CI=2.02-6.65) and monthly family income (AOR=0.89; 95%CI=0.02-0.90). Although the rate of ANC use was high in the study setting, the proportion of women who were satisfied with service quality was sub-optimal. There is need for implementation of multi-pronged intervention to make ANC services more available, accessible, affordable and acceptable to the Nigerian women. (Afr J Reprod Health 2022; 26[12]: 78-89). Les soins prénatals (CPN) de qualité sont l'une des interventions clés pour améliorer le recours aux soins intra-partum et réduire la menace de décès maternels dans le monde. Pourtant, la couverture des soins prénatals est restée faible dans de nombreux pays en développement comme le Nigeria. Il devient impératif de comprendre contextuellement les facteurs associés à l'utilisation des soins prénatals au Nigéria. L'étude a évalué le niveau d'utilisation, la qualité perçue, le niveau de satisfaction et les déterminants de l'utilisation des soins prénatals chez les femmes en âge de procréer à Oshogbo, dans le sud-ouest du Nigeria. Une conception d'étude transversale a été utilisée et une méthode d'échantillonnage en grappes a été utilisée pour recruter 420 répondants consentants. Les données ont été recueillies à l'aide d'un questionnaire prétesté et semi-structuré administré par un intervieweur. Les statistiques descriptives et inférentielles ont été réalisées à p&lt;0,05. L'âge moyen (± ET) des répondants était de 30,84 ± 6,0 ans. Près des trois quarts (73,9%) des répondants ont eu au moins 4 consultations prénatales. Les principales raisons de la non-utilisation des soins prénatals étaient le coût élevé des soins, les longs temps d'attente à la clinique, la distance jusqu'à la clinique et la qualité de service insatisfaisante. Seulement 59,9% des répondants étaient satisfaits des services reçus tandis que 63,1% d'entre eux ont qualifié la qualité du service d'excellente. Les principaux déterminants du recours aux soins prénatals étaient l'âge des répondants (OR=2,35 ; IC à 95 % = 1,34-5,89), le niveau d'éducation (OR=0,56 ; IC à 95 % = 0,42-0,71), le statut socio-économique (OR=5,22 ; 95 %IC=2.02-6.65) et le revenu familial mensuel (AOR=0.89 ; 95%IC=0.02-0.90). Bien que le taux d'utilisation des soins prénatals soit élevé dans le cadre de l'étude, la proportion de femmes satisfaites de la qualité des services était sous-optimale. Il est nécessaire de mettre en oeuvre une intervention à plusieurs volets pour rendre les services de soins prénatals plus disponibles, accessibles, abordables et acceptables pour les femmes nigérianes. (Afr J Reprod Health 2022; 26[12]: 78-89)

مقايسه اثر مپريدين و متادون در درمان لرز پس از بيهوشی

لرز پس از بيهوشی عمومی به دليل، افزايش مصرف اکسيژن تا 600 % ، ايجاد کشيدگی در محل برش جراحی، افزايش فشار داخل چشم و مغز، نياز به توجه و درمان دارد. استفاده از گرم کردن سطحی پوست و دارو در درمان لرز پس از عمل مطرح می‌باشند. مپريدين يک داروی مؤثر در درمان لرز است اما در برخی بيماران از جمله مصرف‌کنندگان MAO- I (Mono Amino oxidase inhibitor) دارای ممنوعيت مصرف است. لذا در اين مطالعه سعی شده است تا با مقايسه اثر دارويی مپريدين با متادون در درمان لرز بعد از بيهوشی، جايگزين مناسبی برای مپريدين در مواقعی که مصرف آن ممنوع است پيدا کنيم. در اين مطالعه که بصورت کارآزمايی بالينی صورت گرفت، 50 بيمار به روش غيراحتمالی آسان انتخاب و با راندوميزاسيون در 2 گروه متادون و مپريدين قرار داده شدند. در گروه مپريدين 25 ميلی‌گرم دارو به ازای 70 کيلوگرم وزن بيمار بصورت داخل وريدی و در گروه متادون 5/2 ميلی‌گرم به ازای 70 کيلوگرم وزن بدن بصورت رقيق شده داخل وريدی استفاده شد و اثرات آنها در درمان لرز بعد از بيهوشی عمومی در ريکاوری بررسی گرديد. ميانگين سنی در گروه مپريدين 76/33 سال و در گروه متادون 4/34 سال بود. ميانگين دمای اگزيلاری در گروه مپريدين 1/36 و در گروه متادون 08/36 بود که تفاوت معنی‌داری نداشت (05/0 P> ). در گروه مپريدين در 84% موارد بهبودی لرز تا 150 ثانيه پس از تزريق ديده شد و در گروه متادون در 64% موارد بهبود لرز طی اين مدت مشاهده گرديد که با هم تفاوت معنی‌دار آماری نداشتند. (05/0 P> ). در گروه مپريدين اغلب بيماران در 30 ثانيه اول، لرز آنها بهبود يافت و در گروه متادون اين اثر در 60 ثانيه اول پس از مصرف دارو ديده شد. اختلاف بهبودی در اين 2 گروه از نظر آماری معنی‌دار نبود (05/0 P> ). با توجه به نتايج بدست آمده می‌توان در موارد ممنوعيت مصرف مپريدين از متادون جهت درمان لرز پس از بيهوشی عمومی استفاده کرد

Historical Perspectives in the Development of Antiviral Agents Against Poxviruses

The poxvirus vaccinia virus (VV) served as the model virus for which the first antivirals, the thiosemicarbazones, were identified. This dates back to 1950; and, although there is at present no single antiviral drug specifically licensed for the chemotherapy or -prophylaxis of poxvirus infections, numerous candidate compounds have been described over the past 50 years. These compounds include interferon and inducers thereof (i.e., polyacrylic acid), 5-substituted 2’-deoxyuridines (i.e., idoxuridine), IMP dehydrogenase inhibitors, S-adenosylhomocysteine hydrolase inhibitors, acyclic nucleoside phosphonates (such as cidofovir) and alkoxyalkyl prodrugs thereof (such as CMX001), viral egress inhibitors (such as tecovirimat), and cellular kinase inhibitors (such as imatinib)

Treatment of psychological morbidity secondary to benign prostatic hyperplasia: a comparative study

Background: Authors tend to compare the medical treatment of benign prostatic hyperplasia with the surgical option regarding lower urinary tract symptoms (LUTS) and related psychological morbidity.Methods: A retrospective study of (1614) patients who were managed by either transurethral resection of prostate (TURP) or medical treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) over a period of 5 years between (Sep. 2013 and Sep. 2018) carried out in Prince Hussein Urology Center at Jordanian Royal Medical Services. Patients were classified into two groups, group1 (807 patients) who get a medical option and group 2 (807 patients who underwent TURPs. A comparison between both groups according to the effect of minimizing the psychological morbidities was done over a period of 1-year follow-up after reviewing the patient’s medical records.Results: Ages of the patients for group1 and 2 were (47-68 years), (49-73 years), respectively. There were significant differences at the level of depression, anxiety and psychiatric morbidity pre-treatment between both groups p-value 0.05, but significant differences in the level of improvement after treatment between both groups and in group 2 were found, p-value <0.05.Conclusions: The severity of LUTS and psychological morbidity have a positive relationship and were higher in the pretreatment surgical group, but the effect of TURP was superior to the medical group in the management of this morbidity and its causative (LUTS)

Prescribing patterns in patients with chronic liver and kidney disease in a tertiary care hospital

Background: Liver diseases are major cause of mortality and morbidity worldwide. It is the 12th leading cause of death liver diseases can be classified as acute if the onset of symptom does not exceed six months or chronic if symptoms persist beyond this period. According to the recently available World Health Organization. The aim of study is to facilitate rational use of medicines. Methods: This study is a prospective, observational, single center study which include patients aged ≥18 years, diagnosis of liver diseases with or without co-morbidities and is conducted at out-patient of Medicine department, Rajindra Medical College and Hospital, Patiala. Results: In this study, total of 97 prescriptions of patients with liver disease were analyzed. Out of 97 patients, the majority of patients were male. In ALD, males were 32 (78%) whereas female were 9 (22%) while in CLD males were 47 (84%) and females were 9 (16%).While observing the LFT profile of patients with ALD common tests were observed which includes total bilirubin (1.82±2.42), SGOT (96.81±117.49) and SGPT (94.78±142.94) and in patients with CLD common tests were observed which includes total bilirubin (2.50±3.63), SGOT (67.50±43.04), SGPT (47.10±33.12), blood urea (46.92±24.14) and alkaline phosphatase (147.02±63.14). Conclusions: The study interprets the prescribing pattern of drugs used in patients with ALD and CLD and observed that vitamins and minerals and antibiotics were the most prescribed in order to avoid further complications followed by hepatoprotective agents, antiulcer drugs, antihypertensives and laxatives.

Estimating the costs for the treatment of abortion complications in two public referral hospitals: a cross-sectional study in Ouagadougou, Burkina Faso.

BACKGROUND: Treatment costs of induced abortion complications can consume a substantial amount of hospital resources. This use of hospitals scarce resources to treat induced abortion complications may affect hospitals' capacities to deliver other health care services. In spite of the importance of studying the burden of the treatment of induced abortion complications, few studies have been conducted to document the costs of treating abortion complications in Burkina Faso. Our objective was to estimate the costs of six abortion complications including incomplete abortion, hemorrhage, shock, infection/sepsis, cervix or vagina laceration, and uterus perforation treated in two public referral hospital facilities in Ouagadougou and the cost saving of providing safe abortion care services. METHODS: The distribution of abortion-related complications was assessed through a review of postabortion care-registers combined with interviews with key informants in maternity wards and in hospital facilities. Two structured questionnaires were used for data collection following the perspective of the hospital. The first questionnaire collected information on the units and the unit costs of drugs and medical supplies used in the treatment of each complication. The second questionnaire gathered information on salaries and overhead expenses. All data were entered in a spreadsheet designed for studying abortion, and analyses were performed on Excel 2007. RESULTS: Across six types of abortion complications, the mean cost per patient was USD45.86. The total cost to these two public referral hospital facilities for treating the complications of abortion was USD22,472.53 in 2010 equivalent to USD24,466.21 in 2015. Provision of safe abortion care services to women who suffered from complications of unsafe induced abortion and who received care in these public hospitals would only have cost USD2,694, giving potential savings of more than USD19,778.53 in that year. CONCLUSIONS: The treatment of the complications of abortion consumes a significant proportion (up to USD22,472.53) of the two public hospitals resources in Burkina Faso. Safe abortion care services may represent a cost beneficial alternative, as it may have saved USD19,778.53 in 2010