Patient Factors Associaed With Adherence And Change In Cardiac Risk Factors Among Cardiac Rehabilitation Patients In Qatar

Background: cardiovascular disease is the number one killer in Qatar. Cardiac rehabilitation (CR) is a cost-effective model of care shown to reduce cardiovascular morbidity and mortality by 20%. However, it is vastly underutilized with low enrollment and adherence rates. This study aimed to (a) examine the association between number of sessions attended and change in cardiac risk factors after completion of CR program, and (b) investigate factors associated with adherence Methods: This is a retrospective cohort study, consisted of 714 cardiac patients, aged ≥18 years, referred to a cardiac rehabilitation program in Qatar. A simple linear regression analysis (unadjusted model) was used to assess the association between the mean change in each of the following risk factors: cholestrol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and body mass index (BMI and number of sessions attended. Then, we adjusted for clinical and sociodemographic factors that affect the outcome variable via multiple linear regression analyses. Logistic regression model was used to assess factors associated with adherence. Additionally, a paired sample t-test was used to identify mean change in cardiac risk factors pre-post CR and link this change to clinical significant cut off values in the literature. An independent sample t-test was used to identify change between groups (adherence vs. no adherence). Result: The mean age of the population was 52.7±10.1 years (mean ± SD). Patients referred to CR program were mostly males (n= 641, 89.8%) and non-Qatari (n= 596, 83.5%), almost one fourth were smokers (n=185, 25.91%), and one fifth (n=128, 18.8%) were diagnosed with severe depression. The main positive predictor for adherence was AACVPR moderate risk [OR=12.71, 95%CI= 7.81-20.68] and high-risk level [OR=10, 95%CI= 6.44-17.44]. PCI [OR=0.39, 95%CI= 0.17-0.89] and musculoskeletal disease [OR=0.17, 95%CI= 0.03-0.95] were negatively associated with adherence. We found clinically significant improvements among adherents to CR; 10% reduction in total cholesterol level and 15% reduction in low-density lipoproteins. Conclusion: This study provides new insights in Qatar setting into the factors that lead patients to adhere to their CR sessions. These patient-level variables associated with adherence represent opportunities for program directors in identifying patients who are less likely to adhere to the program; therefore, develope effective interventions to target these patients and consequently improve their health status

The Use of Glycomacropeptide in Dietary Management of Phenylketonuria

Dietary therapy is the most common therapy applied in treatment of Phenylketonuria (PKU) with restriction of intake of most natural proteins that are rich in Phenylalanine (Phe). Recently, it has been claimed that caseinoglycomacropeptide (GMP), derived of whey, may be used to replace the amino acid formulae (AAF). The Aim of Work. To study the feasibility of use of GMP for partial replacement of artificial formula in treatment of children with PKU. Methods. Ten patients with PKU were included in the study. They received the recommended daily allowances of protein in the form of AAF or a combination of AAF and GMP. The percent of intake of GMP in phases 1 and 2 was 50% and zero%, respectively. Results. The median and interquartiles of phenyl alanine Phe levels phase were not significantly different in phases I and II, 376 (167–551) μmol/L versus 490 (289–597) μmol/L, respectively. Phenylalanine/tyrosine ratio, amino acids, and other laboratory data showed no significant difference between the two phases. Conclusion. GMP may be used to replace 50% of the protein intake to improve the nutritive value and palatability of diet and to provide a more satisfactory diet. No toxicity or side effects were reported in patients on that regimen

Fibroblast growth factor-23 is a strong predictor of insulin resistance among chronic kidney disease patients

Insulin resistance (IR) is very common among chronic kidney disease (CKD) patients. Disturbance in mineral and bone metabolism (MBD) seems to play a role in the pathogenesis of insulin resistance. Fibroblast growth factor-23 (FGF23) is evolving as the most important link between MBD and many pathologic sequences of CKD. The aim was to evaluate IR in pre-dialysis CKD patients looking for a possible association to mineral metabolism among CKD patients. A total of 100 stage 3–5 CKD patients were selected beside 20 normal control subjects. Homeostatic model assessment of insulin resistance (HOMA-IR) was used to assess IR in selected cases. Both groups were compared for fasting blood glucose (FBG), fasting blood insulin (FBI), HOMA-IR, estimated glomerular filtration rate (eGFR), serum calcium (Ca), phosphorus (P), 25 hydroxy vitamin D (25 OH vit D), parathormone (PTH), and uric acid (UA). Correlation study between HOMA_IR and different studied parameters was performed. HOMA-IR is significantly higher in CKD (8.87 ± 3.48 vs. 3.97 ± 0.34 in CKD vs. control, respectively, p < .001). In addition CKD patients have significantly higher FGF23 (235 ± 22.96 vs. 139 ± 12.3 pg/mL, p < .001), PTH (76.9 ± 15.27 vs. 47.9 ± 2.52 pg/mL, p < .001), P (4.3 ± 0.67 vs. 3.6 ± 0.23 mg/dL, p < .001), and UA (5 ± 1.22 vs. 4.85 ± 0.48 mg/dL, p < .001) and significantly lower Ca (8.2 ± 0.3 vs. 8.9 ± 0.33 mg/dL, p < .001), and 25 (OH) vit D (17 ± 5.63 vs. 37 ± 3.43 ng/mL, p < .001). Stepwise linear regression analysis revealed that BMI, GFR, Ca, P, and FGF23 were the only significant predictors of HOMA IR. Increased IR in CKD is a consequence of the uremic status and is intimately associated with disturbed phosphate metabolism and FGF23. Further studies are needed to look for an underlying mechanism

Outcome of orthotopic sigmoid versus ileal neobladder reconstruction

Introduction: Radical cystectomy with orthotopic urinary diversion is considered the gold standard for treatment of muscular invasive bladder cancer or high-risk nonmuscular invasive bladder cancer. The choice of orthotopic neobladder reconstruction depends on the clinical outcomes of it and should be planned with the patients, especially the risk of incontinence. Methods: this study included 52 Egyptian patients underwent radical cystectomy and orthotopic neobladder reconstruction with sigmoid (25 patients) and ileal (27 patients) segments. Postoperative clinical outcomes between the sigmoid and ileal neobladder groups were compared. Results: In the present study, 12 intraoperative complications (6 in each group) and 19 postoperative complications (17 in sigmoid and 15 in ileal group) occurred; however, there was no significant difference in the incidence of intraoperative and postoperative complications between both groups. There were no significant differences in the continence status and spontaneous voiding between both groups. There were no significant differences in maximal flow rate and voided volume between both groups. Night voiding frequency in the ileal neobladder patients was significantly smaller than sigmoid neobladder patients. Free flowery showed a significant difference of voiding time and volume in favor of sigmoid neobladder group. Maximum urethral pressure and urethral closing pressure were significantly higher in ileal neobladder group. Conclusions: Both types of neobladder reconstruction resulted in comparatively satisfactory outcomes; however, the voiding function in sigmoid neobladder group appeared to be more favorable than that in ileal neobladder group

Serum 25-hydroxyvitamin D level is negatively associated with serum phosphorus level among stage 3a-5 chronic kidney disease patients

Background: Serum 25-hydroxyvitamin D (25(OH)D) negatively correlates with serum phosphorus level of stage 3a-5 chronic kidney disease (CKD) patients. So far, no explanation has been provided for this negative association. Objective: To confirm this negative association and determine if this relationship is mediated through other known co-morbid factors. Cases and methods: One hundred (57 male and 43 female) pre-dialysis stage 3a-5 CKD patients were selected. Estimated glomerular filtration rate (eGFR), serum calcium (Ca), phosphorus (P), 25(OH)D, parathyroid hormone (PTH), and intact fibroblast growth factor-23 (FGF23) were assessed. A correlation analysis between serum 25(OH)D and the different parameters studied was performed. Multivariate linear regression analysis was carried out to determine predictors of 25(OH)D. Results: The negative association between serum 25(OH)D and serum P was confirmed in univariate and multivariate correlation analysis. On the other hand, we failed to detect a significant association between 25(OH)D and serum FGF23. Serum P is the most important independent predictor of 25(OH)D in these patients (partial R2 = 0.15, p < 0.0001). Conclusion: Serum P is likely to have a direct negative impact on serum 25(OH)D. Further studies are needed to determine the underlying mechanism. Resumen: Antecedentes: La 25-hidroxivitamina D (25[OH]D) sérica se correlaciona negativamente con el nivel de fósforo sérico en pacientes con enfermedad renal crónica (ERC) en estadio 3a-5. Hasta la fecha, no se dispone de ninguna explicación sobre esta asociación negativa. Objetivo: Confirmar la asociación negativa y averiguar si esta relación está mediada por otros factores de comorbilidad conocidos. Casos y métodos: Se seleccionaron 100 pacientes (57 varones y 43 mujeres) con ERC en estadio 3a-5 prediálisis. Se evaluaron la tasa de filtración glomerular estimada (TFRe), el calcio sérico (Ca), el fósforo (P), la 25(OH)D, la hormona paratiroidea (HPT) y el factor de crecimiento de fibroblastos 23 intacto (FGF23). Se realizó un análisis de correlación entre la 25(OH)D sérica y los distintos parámetros estudiados. Se llevó a cabo un análisis de regresión lineal multivariable para determinar los factores pronósticos de 25(OH)D. Resultados: Se confirmó la asociación negativa entre la 25(OH)D sérica y el P sérico en análisis de correlación univariable y multivariable. Por otro lado, no detectamos ninguna asociación significativa entre la 25(OH)D y el FGF23 sérico. El P sérico es el factor predictivo independiente más importante de la 25(OH)D en estos pacientes (R2 parcial = 0,15; p < 0,0001). Conclusión: Es probable que el P sérico tenga un impacto negativo directo sobre la 25(OH)D sérica. Es necesario realizar más estudios para averiguar el mecanismo subyacente. Keywords: 25-Hydroxyvitamin D, CKD-MBD, Phosphorus, FGF23, Parathyroid hormone, Palabras clave: 25-Hidroxivitamina D, ERC-TMO, Fósforo, FGF23, Hormona paratiroide

Formulation and pharmacokinetics of multi-layered matrix tablets: Biphasic delivery of diclofenac

The rapid availability of the drug at the site of action followed by maintaining its effect for a long period of time is of great clinical importance. Thus, the purpose of the present study was to prepare and evaluate multi-layered matrix tablets of diclofenac using Eudragit RL/RS blend to achieve both immediate and sustained therapeutic effects. Diclofenac potassium (25 mg) was incorporated in an outer immediate release layer to provide immediate pain relief whereas diclofenac sodium (75 mg) was incorporated in the inner core to provide extended drug release. Wet granulation was employed to prepare the inner core of the tablets that were further layered with an immediate release drug layer in the perforated pan coater. The in-vitro and in-vivo performance of the developed formulation was compared with the marketed products Voltaren® SR 75 mg and Cataflam® 25 mg. The in-vitro drug release of the prepared formulation showed similarity (f2 = 66.19) to the marketed product. The pharmacokinetic study showed no significant difference (p > 0.05) in AUC0-24 and Cmax between the test and reference formulations. The AUC0-24 values were 105.36 ± 83.3 and 92.87 ± 55.53 μg h/ml whereas the Cmax values were 11.25 ± 6.87 and 12.97 ± 8.45 μg/ml, for the test and reference, respectively. The multi-layered tablets were proved to be bioequivalent with the commercially available tablets and were in agreement with the observed in-vitro drug release results. Stable physical characteristics and drug release profiles were observed in both long term and accelerated conditions stability studies