Adolescent pregnancy: An important issue for paediatricians and primary care providers-A position paper from the European academy of paediatrics.

Adolescent pregnancy and childbearing, remain a widespread health-related problem with potential short and long-term consequences. Comprehensive social, economic, environmental, structural, and cultural factors heavily impact on adolescents' sexual and reproductive health and early pregnancy. Health professionals can play a pivotal role in the prevention of unplanned pregnancy. Improved access to family planning, sexuality education in schools, community-based interventions, and policies contribute greatly to reduce the risk of adolescent pregnancy and the adoption of respectful and responsible sexual behaviour. Additionally, health care professionals can support pregnant adolescents in making decisions under these circumstances and provide adequate health care. This review highlights actions that can guide healthcare professionals in empowering young adolescents to become more aware and capable of making informed decisions about their sexual life, health, and future

Determinants of insulin-related knowledge among healthcare providers at a county referral hospital in Kenya

Background: Insulin is a high alert medication with potential to cause hypoglycaemia if used incorrectly. Inadequate healthcare provider knowledge regarding insulin contributes to errors in its use that may cause patient harm. Objective: To identify the determinants of healthcare provider knowledge regarding insulin use in type 2 diabetes. Methodology: A cross-sectional study was conducted at Thika Level V Hospital in March 2015. A 20-item questionnaire was used to assess insulin knowledge in pharmaceutical, nursing and medical staff working in the outpatient department and the medical wards. The outcomes of interest were the scores on types, prescribing, administration and monitoring of insulin. Descriptive and regression data analyses were performed using IBM SPSS Statistics Version 20. Results: The participants’ mean (±SD) age was 32.6±10.2 years. The mean (±SD) duration of clinical practice was 8.3±9.03 years. Nurses formed the largest (36, 40%) cadre in the study. Determinants of the overall score in the insulin knowledge test were professional cadre (p<0.0001), in-patient care (p=0.044) and reading of journals (p=0.005). Insulin pharmacology scores were correlated with younger age (21-30 years, (p=0.02), clinical experience of <5 years, (p=0.013), use of information from drug representatives (p=0.023) and being a pharmacist intern or medical officer (p=0.002). Good prescribing scores were found among the medical officers, consultants and the clinical pharmacist (p=0.035). Conclusion: Several factors account for the differences in insulin-related knowledge among the healthcare providers evaluated in this study. Interventions are required to address these variations and equip the health workers with knowledge on all areas related to insulin use. Such interventions should include development of a curriculum on certified diabetes education, improved access to journals, collaboration with pharmaceutical companies in provision of drug-related information, continuing medical education and staff duty rotation to ensure that the healthcare providers gain experience in in-patient diabetes care. Keywords: diabetes, healthcare provider, insulin-related knowledg

Linking a dermal permeation and an inhalation model to a simple pharmacokinetic model to study airborne exposure to di(n-butyl) phthalate

Six males clad only in shorts were exposed to high levels of airborne di(n-butyl) phthalate (DnBP) and diethyl phthalate (DEP) in chamber experiments conducted in 2014. In two 6 h sessions, the subjects were exposed only dermally while breathing clean air from a hood, and both dermally and via inhalation when exposed without a hood. Full urine samples were taken before, during, and for 48 h after leaving the chamber and measured for key DnBP and DEP metabolites. The data clearly demonstrated high levels of DnBP and DEP metabolite excretions while in the chamber and during the first 24 h once leaving the chamber under both conditions. The data for DnBP were used in a modeling exercise linking dose models for inhalation and transdermal permeation with a simple pharmacokinetic model that predicted timing and mass of metabolite excretions. These models were developed and calibrated independent of these experiments. Tests included modeling of the “hood-on” (transdermal penetration only), “hood-off” (both inhalation and transdermal) scenarios, and a derived “inhalation-only” scenario. Results showed that the linked model tended to duplicate the pattern of excretion with regard to timing of peaks, decline of concentrations over time, and the ratio of DnBP metabolites. However, the transdermal model tended to overpredict penetration of DnBP such that predictions of metabolite excretions were between 1.1 and 4.5 times higher than the cumulative excretion of DnBP metabolites over the 54 h of the simulation. A similar overprediction was not seen for the “inhalation-only” simulations. Possible explanations and model refinements for these overpredictions are discussed. In a demonstration of the linked model designed to characterize general population exposures to typical airborne indoor concentrations of DnBP in the United States, it was estimated that up to one-quarter of total exposures could be due to inhalation and dermal uptake

Let-7b Inhibits Human Cancer Phenotype by Targeting Cytochrome P450 Epoxygenase 2J2

BACKGROUND: MicroRNAs (miRNAs) are small, noncoding RNA molecules of 20 to 22 nucleotides that regulate gene expression by binding to their 3' untranslated region (3'UTR). Increasing data implicate altered miRNA participation in the progress of cancer. We previously reported that CYP2J2 epoxygenase promotes human cancer phenotypes. But whether and how CYP2J2 is regulated by miRNA is not understood. METHODS AND RESULTS: Using bioinformatics analysis, we found potential target sites for miRNA let-7b in 3'UTR of human CYP2J2. Luciferase and western blot assays revealed that CYP2J2 was regulated by let-7b. In addition, let-7b decreased the enzymatic activity of endogenous CYP2J2. Furthermore, let-7b may diminish cell proliferation and promote cell apoptosis of tumor cells via posttranscriptional repression of CYP2J2. Tumor xenografts were induced in nude mice by subcutaneous injection of MDA-MB-435 cells. The let-7b expression vector, pSilencer-let-7b, was injected through tail vein every 3 weeks. Let-7b significantly inhibited the tumor phenotype by targeting CYP2J2. Moreover, quantitative real-time polymerase chain reaction and western blotting were used to determine the expression levels of let-7b and CYP2J2 protein from 18 matched lung squamous cell cancer and adjacent normal lung tissues; the expression level of CYP2J2 was inversely proportional to that of let-7b. CONCLUSIONS: Our results demonstrated that the decreased expression of let-7b could lead to the high expression of CYP2J2 protein in cancerous tissues. These findings suggest that miRNA let-7b reduces CYP2J2 expression, which may contribute to inhibiting tumor phenotypes

Cytochrome P450-derived eicosanoids: the neglected pathway in cancer

Endogenously produced lipid autacoids are locally acting small molecule mediators that play a central role in the regulation of inflammation and tissue homeostasis. A well-studied group of autacoids are the products of arachidonic acid metabolism, among which the prostaglandins and leukotrienes are the best known. They are generated by two pathways controlled by the enzyme systems cyclooxygenase and lipoxygenase, respectively. However, arachidonic acid is also substrate for a third enzymatic pathway, the cytochrome P450 (CYP) system. This third eicosanoid pathway consists of two main branches: ω-hydroxylases convert arachidonic acid to hydroxyeicosatetraenoic acids (HETEs) and epoxygenases convert it to epoxyeicosatrienoic acids (EETs). This third CYP pathway was originally studied in conjunction with inflammatory and cardiovascular disease. Arachidonic acid and its metabolites have recently stimulated great interest in cancer biology; but, unlike prostaglandins and leukotrienes the link between cytochome P450 metabolites and cancer has received little attention. In this review, the emerging role in cancer of cytochrome P450 metabolites, notably 20-HETE and EETs, are discussed

Evaluation of aortic valve in valve sparing root replacement: Reimplantation versus noncoronary sinus replacement

Background: Valve sparing aortic root replacement (VSRR) had been popularized in the last decades because preservation of the native valve allows for better hemodynamics, better left ventricular performance, lesser risk of endocarditis and avoidance of lifelong anticoagulation. Two basic types of VSRR techniques are used: reimplantation of the aortic valve (Tirone David) and remodeling of the aortic root(Yacoub). We compared the David reimplantation technique versus one or two sinus replacement in repair of aortic root aneurysm or dissection associated with aortic regurge. Patients & Methods: Fifty patients were divided into two groups: Group I (25 patients) undergone David reimplantation technique, Group II (25 patients) undergone supracoronary with one or two sinus replacement. Results: There were two deaths (8%) within 30 days in each group. Postoperative significant regurge in Group I occurred in 1 case (4.3%) and in 2 cases (8.6%) in Group II with no significant difference. Cross clamp time was significantly shorter in Group II; 137 ± 37.0 min versus 177 ± 33.0 min in Group I. Significant bleeding occurred in 7 cases (28%) in Group I which was significantly higher than Group II; 1 case (4%). Conclusion: Replacement of one or two sinuses is not inferior to reimplantation technique regarding early survival and correction of aortic regurge. Noncoronary sinus replacement provided better results than reimplantation technique regarding postoperative bleeding and cross clamp time

Additive effect of drospirenone/17-beta-estradiol in hypertensive postmenopausal women receiving enalapril

Aldosterone has been implicated in the pathogenesis of progressive cardiovascular disease. Drospirenone (DRSP) is a novel progestin with aldosterone receptor antagonist activity developed for hormone replacement therapy (HRT) as DRSP/17beta-estradiol (DRSP/ E2). We investigated the additive effect of DRSP/E2 versus placebo on 24-h ambulatory blood pressure (BP) in postmenopausal women with hypertension treated with enalapril maleate (ENA). This was a double-blind, randomized, two-parallel group trial. Twenty-four nonsmoking postmenopausal women receiving 10 mg of ENA twice a day before study were randomized to DRSP/E2 + ENA (n = 12) or placebo (P) + ENA (n = 12) for 14 days. Twenty-four-hour ambulatory BP, plasma renin activity, and serum aldosterone were determined at baseline and on day 14. Compared to placebo, 24-h mean [SD] BP in the DRSP/E2 + ENA group decreased significantly from baseline (139/80 mm Hg), systolic (-9 [51 mm Hg, P = .014) and diastolic (-5 [4] mm Hg, P = .007). Essentially no change from baseline (139/83 mm Hg) in systolic or diastolic 24-h ambulatory BP were observed in the P + ENA group. Aldosterone (mean [SD]) increased from baseline by 2.6 [4.5] ng/dL in the DRSP/E2 + ENA group, and decreased by 0.3 [5.5] ng/dL in the P + ENA group (P = .08) consistent with an antimineralocorticoid effect. Our results suggest a significant additive BP-lowering effect of DRSP/E2 on both systolic and diastolic BP in hypertensive postmenopausal women receiving ENA, consistent with an antimineralocorticoid effect. DRSP/E2, a HRT with antimineralocorticoid effects, could offer a novel potential mechanism for reducing cardiovascular end points in postmenopausal women