Interchangeability and Comparative Effectiveness between Micronized and Non-micronized Products of Glibenclamide Tablets

Background: During the last few years there was wide debate about the interchangeability and effectiveness between circulated products containing Glibenclamide in the market.Objectives: This study aimed to compare the effectiveness of this product “non-micronized” to the originator’s product of Glibenclamide tablets “of micronized” sulfonylurea.Methods: 12 volunteers received a dose of 5mg of Glibenclamide (from test and standard products) under fasting conditions in two separate sessions using randomized crossover design. Blood glucose level for the volunteers was monitored to avoid the development of hypoglycemia. Plasma samples were collected over 24 hours and analyzed using HPLC.Results: The maximum concentration Cmax for the test and reference products were 2.508 ± 0.104 and 3.526 ± 0.118 (ìg/ml) respectively and the area under the curve AUC0-[ were 3.511 ± 0.153 4.572 ± 0.202 (ìg.h/ml) for these products respectively, with a difference of about 24% between the test and reference products in its AUC.Conclusions: The results indicate that the test product is not bioequivalent to reference product. The difference in formulation between micronized product and non-micronized product of Glibenclamide tablets has impact on clinical outcomes.Key words:sulfonylurea,Blood glucose,hypoglycemia

Poor specificity of National Early Warning Score (NEWS) in spinal cord injuries (SCI) population: a retrospective cohort study

Study design: Retrospective chart audit. Objectives: The National Early Warning Score (NEWS) is based on seven physiological parameters which can be altered in some individuals with spinal cord injuries (SCI). The aim was to start the development of adapted NEWS suitable for SCI population. The objective was to determine the SBP NEWS specificity based on neurological level of injury (NLI) and completeness of injury. Setting: Tertiary centre in the UK. Methods: Adult patients admitted for the first time to the National Spinal Injuries Centre between 1st January 2015 and 31st December 2016 were included if they were > 6 months post-injury. Data were extracted retrospectively including the last ten consecutive BP and heart rate readings before discharge. Data were analysed based on different AIS grades, completeness of injury and NLI. Results: 191 patients were admitted in 2015 and 2016 and 142 patients were included in the primary analysis. The mean SBP ranged between 92 and 151 mmHg. Patients with the NLI of T6 and above (≥ T6) motor complete lesions had a significantly lower SBP than motor incomplete lesions. The specificity of the SBP NEWS was 35.3% in ≥ T6 motor complete individuals versus 80.3 % in ≥ T6 motor incomplete individuals. Conclusion: The baseline BP is significantly lower in the ≥ T6 motor complete SCI individuals (> 6 months post-injury) resulting in a very low specificity of 35.3 % to SBP NEWS which could lead to mismatch between clinical deterioration and NEWS resulting in lack of timely clinical response

Policy transfer and part 2 of the Housing Act (Wales) 2014

Part 2 of the Housing Act (Wales) 2014and its implementation has been keenly observed by governments outside of Wales, as they continue to search for policy solutions to help address the homelessness crisis.This paper examines the extent to whichthere has been policy transfer from Wales to other national contexts and thepotential for such transfer to occur in the future.It is identified that some transfer has already taken place within the UK and there is thepotentialforfuture policy transferboth within the UK and internationally. Adaptation to each of the new contexts is necessary to underpin successful transferof provisions of the Act, however, outside of the UK this will need to be more extensive and includethe introduction of a right tohousing

Cancer management in Sudan: Current status and future perspectives

Introduction: Sudan is one of the developing countries that face a great challenge with cancer management. About 5700 cases had been seen during year 2007 in Radiation and Isotope Center- Khartoum (RICK) and Institute of Nuclear medicine, Molecular biology, and Oncology (INMO) Wadmedani which are the only cancer centers in Sudan.Purpose: Aim of this work is to highlight the difficulties of cancer management in Sudan and to propose possible solutions.Methods: This paper evaluates the current situation of cancer management in Sudan through reviewing of data available in cancer centers and reports from the Sudan national bureau of statistic. Suggestions are also made for cancer control plan in Sudan having the current situation in mind and guided by the published international data on cancer control.Results: The preliminary analysis of the available data reveals that Sudan has very limited resources available to deal with cancer and the service provided is not evenly distributed.Conclusion: Establishment of new centers is extremely needed with special attention to good distribution of services. To achieve such a goal training of more staff and upgrading of the existing centers is mandatory to manage all types of cancer. Cancer registry is the right way to plan for cancer control in Sudan.Keywords: Nuclear medicine, radiation, oncologis

Detection of serum prostate specific antigen in lactating, pregnant, and advanced breast cancer Sudanese Women.

Introduction: Although prostate-specific antigen (PSA) is the most valuable tumor marker for the diagnosis and management of prostate carcinoma, it is widely accepted that PSA is not prostate specific.Objectives: The aim of this study is to address the possibility of using the PSA as marker for the sex assignment in different categories and relevance of this test in women problems.Method: We have evaluated the measurement of serum total PSA for differentiation between Sudanese women with advanced breast cancer (n= 10), and those are lactating (n=10), pregnant (n=10) compared with 20 healthy women as control group. Serum total PSA (TPSA) was measured using immuno-radiometric assay (IRMA).Results: In this study the mean age was significantly higher advanced breast cancer groups compared with lactating group (

Breastfeeding in the community—how can partners/fathers help? A systematic review

Support from partners/fathers and families can play a significant role in a mother’s decision to initiate, continue or cease breastfeeding postnatally. This study systematically reviewed published studies to determine the impact of specific types of partner support on breastfeeding initiation, duration and exclusivity. We used the 2015 Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines for the review. Seven computerized bibliographic databases (Embase, ProQuest Central, Scopus, PsycINFO, Web of Science, MEDLINE/PubMed and CINAHL) were searched. Of a total of 695 articles retrieved from the databases, seven studies met the inclusion criteria and reported on breastfeeding initiation, duration and exclusivity. Four of the seven studies found that partner support in the form of verbal encouragement to new mothers increased breastfeeding duration and exclusivity. Other types of partner supportive actions that led to improved breastfeeding behavior included sensitivity of the partner to the nursing mother’s needs, assistance in preventing and managing breastfeeding difficulties, and helping with household and child care duties. This review showed that specific supportive actions of partners/fathers in the community positively improved breastfeeding practices. To maximise the impact of breastfeeding policies and interventions among new mothers, breastfeeding programmes should consider the involvement of partners/fathers and their specific roles

Surgical techniques in radiation induced temporal lobe necrosis in nasopharyngeal carcinoma patients

Background Radiation induced brain injury ranges from acute reversible edema to late, irreversible radiation necrosis. Radiation induced temporal lobe necrosis is associated with permanent neurological deficits and occasionally progresses to death. Objective We present our experience with surgery on radiation induced temporal lobe necrosis (RTLN) in nasopharyngeal carcinoma (NPC) patients with special consideration of clinical presentation, surgical technique, and outcomes. Method This retrospective study includes 12 patients with RTLN treated by the senior author between January 2010 and December 2014. Patients initially sought medical treatment due to headache; other symptoms were hearing loss, visual deterioration, seizure, hemiparesis, vertigo, memory loss and agnosia. A temporal approach through a linear incision was performed for all cases. RTLN was found in one side in 7 patients, and bilaterally in 5. 4 patients underwent resection of necrotic tissue bilaterally and 8 patients on one side. Results No death occurred in this series of cases. There were no post-operative complications, except 1 patient who developed aseptic meningitis. All 12 patients were free from headache. No seizure occurred in patients with preoperative epilepsy. Other symptoms such as hemiparesis and vertigo improved in all patients. Memory loss, agnosia and hearing loss did not change post-operatively in all cases. The follow-up MR images demonstrated no recurrence of necrotic lesions in all 12 patients. Conclusion Neurosurgical intervention through a temporal approach with linear incision is warranted in patients with radiation induced temporal lobe necrosis with significant symptoms and signs of increased intracranial pressure, minimum space occupying effect on imaging, or neurological deterioration despite conservative management

Banking sector profitability, before, during and after Global Financial Crisis: Evidence from a developing economy

This study grants empirical support to the fact that profitability of the Pakistani banking sector was reduced during 2008-2009 and among other factors this reduction was accredited to the global financial crisis and resulting increased investments portfolio in total assets. We have used panel data of all Pakistani scheduled banks during 2005-2012. We proved theoretically and empirically that fixed effects model is appropriate for this study. Second stage analysis confirms the above results and shows that the profitability of Pakistani banking sector was higher in pre and post crisis years than in financial crisis period. Profitability was relatively lower in the after crisis years then in before crisis years because of the residual effects of the global financial crisis. In third stage analysis we found that private and foreign banks were more affected by financial crisis than public sector, specialized and Islamic banks. Our results are robust to alternate measures of profitability. In context of developing countries this study will help bank managers and the regulators to stay better prepared to face any financial crisis in future.&nbsp