Oman’s treated chronic kidney failure population in years 1980 to 2015: an epidemiology research

Background and aim: Epidemiological studies on incidence, prevalence, and other epidemiological variables of Oman’s treated kidney failure population have been limited, and questionable as to their use of rigorous research methods. The main aim of this study was to identify the epidemiological variables of treated patients with advanced kidney disease in Oman, the status of publishing on the studied population, and describing the dialysis sub-population characteristics in the northern region of Oman. Methods: First, a secondary data analysis was performed using data from the Oman's renal replacement therapy (RRT) register (1980-2015). The studied epidemiological variables included: incidence, prevalence, death figures, causes of death and treatment costs of the Oman’s treated kidney failure population, especially dialysis sub-population. The publications on chronic kidney failure population of Oman were explored at this stage. Secondly, a multi-centre, cross-sectional study (i.e. survey research) was conducted covering the dialysis sub-population of the northern region of Oman. The basic aim of the survey was to assist in developing the first description of the main characteristics (e.g. demography, primary diagnoses, and co-morbidities) of dialysis-treated patients with advanced kidney disease living the northern region of Oman. A convenience sample (n = 341) of participants were recruited from four renal dialysis centres (RDCs). Those who met the pre-specified study inclusion criteria were surveyed using a researcher-administered survey during October and November 2014. SomeFrom December 2014 to December 2015, there were some additional data was gathered (e.g. death figures) from December 2014 to December 2015. Results: The first RRT care that started in Oman was peritoneal dialysis (PD) in April 1980, while the well-structured PD programme started in 1992 and was boosted in 2007. In 1983, the first dialysis center was opened with seven machines for haemodialysis, serving 35 patients. By the end of 2015, the Ministry of Health (MOH) had 18 RDCs serving 1,439 patients on dialysis per annum for Oman’s population. The analysis of the RRT register's data showed that the mean prevalence for all years (1983-2015) was 724.9 dialysis patients per year. The mean incidence for the same years was 203.7 kidney failure patients per year. The mean death rate calculated for all years (1983-2015) was 58 deaths per year. The recorded causes of death were cardiovascular diseases, and infection. Over the years, it was described that death due to infections and cardiovascular diseases were increasing among the RRT population and particularly within dialysis cohort. The cost of the dialysis sessions increased dramatically from 2,246,627 OMR (~ 4.5 million GBP) in 1998 to 9,543,572 OMR (~20 million GBP) in 2015, which is a 325% increase. Among the databases searched, there were 44 articles, which either focused on, or mentioned Oman’s chronic kidney failure population. Most of these articles focused on kidney transplantation and were of limited and questionable methodologies. In the multi-centre cross-sectional study, the northern region of Oman was divided into two subdivisions. The average age of this population was 51.7 ± 15.8 (mean ± SD) with no statistical evidence of difference between the subdivisions of the northern region of Oman (P = 0.177). There were more males (n = 187 = 54.8%) than females (n = 154 = 45.2%), with no significant difference between subdivisions (P = 0.598). It was described that the divorce frequency was low in this population (n = 22 = 6.4%), with no significant difference between subdivisions (P = 0.49), but unemployment was high (n = 292 = 85.9%), showing no significant difference between subdivisions (P = 0.537). Nearly half of this population were illiterate (n = 164 = 48.1%), with more illiterate females (n = 103= 66.9%) compared to males (n = 61= 32.6%), and no significant difference between subdivisions (P = 0.174). Nearly half of the participants had been on dialysis for five years at the time of data collection (n = 165 = 48.4%). The most common co-morbidities reported by these participants were hypertension and diabetes combined (n = 156 = 32.4%). The main reported causes of death shown by the data gathered were cardiovascular diseases (n = 41 = 41.5%) and infection (n = 10 = 10.2%). More than half of the participants were hoping to have kidney transplantations as soon as possible (n = 173 = 50.7%). Conclusion: This study is a comprehensive description of the Oman’s RRT epidemiology. The data showed a significant increase in the incidence and prevalence of treated chronic kidney failure in Oman. It showed the increase in the cost of dialysis in Oman for the past 17 years (1998-2015), which is in line with the recent publications from Oman (Al-Alawi et al., 2017; Al-Ismaili et al., 2016) and is in line with global findings. This research’s results have contributed to providing a deeper understanding of the Oman’s treated chronic kidney failure population. It appears that there is a heavy burden borne by the country, the health sector and the patients on dialysis because of the complex nature of life-long treatment. Oman’s publications on this health problem were limited. Therefore, it is necessary to conduct additional research with rigorous methods to obtain a complete picture of this health problem in Oman

Current trends in drug metabolism and pharmacokinetics.

Pharmacokinetics (PK) is the study of the absorption, distribution, metabolism, and excretion (ADME) processes of a drug. Understanding PK properties is essential for drug development and precision medication. In this review we provided an overview of recent research on PK with focus on the following aspects: (1) an update on drug-metabolizing enzymes and transporters in the determination of PK, as well as advances in xenobiotic receptors and noncoding RNAs (ncRNAs) in the modulation of PK, providing new understanding of the transcriptional and posttranscriptional regulatory mechanisms that result in inter-individual variations in pharmacotherapy; (2) current status and trends in assessing drug-drug interactions, especially interactions between drugs and herbs, between drugs and therapeutic biologics, and microbiota-mediated interactions; (3) advances in understanding the effects of diseases on PK, particularly changes in metabolizing enzymes and transporters with disease progression; (4) trends in mathematical modeling including physiologically-based PK modeling and novel animal models such as CRISPR/Cas9-based animal models for DMPK studies; (5) emerging non-classical xenobiotic metabolic pathways and the involvement of novel metabolic enzymes, especially non-P450s. Existing challenges and perspectives on future directions are discussed, and may stimulate the development of new research models, technologies, and strategies towards the development of better drugs and improved clinical practice

An evaluation of contracting out government services in a privatisation context in the Sultanate of Oman

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

al Idarah, wa al Tahlil al Mali

374 hal.; 24 c

THE EFFECT OF A SINGLE OR MULTIPLE DOSES OF GRAPEFRUIT JUICE ON SOME PHARMACOKINETIC AND PHARMACODYNAMIC EFFECTS OF PARACETAMOL IN MICE

Grapefruit juice (GFJ), a commonly consumed dietary substance, has been shown to alter the disposition of several commonly used drugs. The available data on the effects of GFJ on the paracetamol pharmacokinetics and pharmacodynamics are at variance. The aim of this study was to evaluate the effect of a single or multiple dose of GFJ on some pharmacokinetics and pharmacodynamics aspects of orally given paracetamol (400 mg/Kg). Male mice were randomly divided into three equal groups: mice in the first group were given paracetamol; the second group was given a single oral dose (10 mL/Kg) of GFJ one hour prior to paracetamol administration; the third group was administered multiple oral doses of GFJ (10 mL/Kg) for five consecutive days, and on the last day it was treated with paracetamol. Blood samples were collected 10, 20, 30, and 40 min, and 1, 2, 4, 6 and 8 h after paracetamol administration for subsequent pharmacokinetic analysis. Some mice in the same three groups were also tested for their reactions to thermal (hotplate) and chemical (acetic acid induced – abdominal constriction) nociceptive stimuli. GFJ increased the plasma concentration and area under the plasma concentration curve of paracetamol, to a greater extent after a single dose than multiple doses. It also increased the reaction time in the hotplate test, and reduced abdominal constrictions. GFJ administration increased the plasma concentration and the analgesic effect of paracetamol in mice. The possible implications of these changes in humans and their clinical relevance need to be further investigated

A rapid and sensitive microscale HPLC method for the determination of indomethacin in plasma of premature neonates with patent ductus arteriousus

Indomethacin (IND) is the drug of choice for the closure of a patent ductus arteriosus (PDA) in neonates. This paper describes a simple, sensitive, accurate and precise microscale HPLC method suitable for the analysis of IND in plasma of premature neonates. Samples were prepared by plasma protein precipitation with acetonitrile containing the methyl ester of IND as the internal standard (IS). Chromatography was performed on a Hypersil C-18 column. The mobile phase of methanol, water and orthophosphoric acid (70:29.5:0.5, v/v, respectively), was delivered at 1.5 mL/min and monitored at 270 nm. IND and the IS were eluted at 2.9 and 4.3 min, respectively. Calibrations were linear (r > 0.999) from 25 to 2500 mu g/L. The inter- and intra-day assay imprecision was less than 4.3% at 400-2000 mu g/L, and less than 22.1% at 35 mu g/L. Inaccuracy ranged from -6.0% to +1.0% from 35 to 2000 mu g/L. The absolute recovery of IND over this range was 93.0-113.3%. The IS was stable for at least 36 h when added to plasma at ambient temperature. This method is suitable for pharmacokinetic studies of IND and has potential for monitoring therapy in infants with PDA when a target therapeutic range for IND has been validated. (c) 2005 Elsevier B.V. All rights reserved

Use of routine data for determination of the population pharmacokinetics and enteral biovailability of phenytoin in neonates and infants with seizures

Objective: To investigate the population pharmacokinetics and the enteral bioavailability of phenytoin in neonates and infants with seizures. Methods: Data (5 mg kg-1 day-1) from 83 patients were obtained retrospectively from the medical records following written ethical approval. A one-compartment model was fitted to the data using NONMEM with FOCE-interaction. Between-subject variability (BSV) and interoccasion variability (IOV) were modelled exponentially together with a log transform-both-sides exponential residual unexplained variance (RUV) model. Covariates in nested models were screened for significance (X2, 1, 0.01). Model validity was determined by bootstrapping with replacement (N=500 samples) from the dataset. Results: The parameters of final pharmacokinetic were: Clearance (L h-1) = 0.826.(current Weight [kg]/70)0.75.(1+0.0692.(Postnatal age [days]-11)); Volume of distribution (L) = 74.2.(current Weight [kg]/70); Enteral bioavailability = 0.76; Absorption rate constant (h-1) = 0.167. BSV for clearance and volume of distribution were 74.2% and 65.6%, respectively. The IOV in clearance was 54.4%. The RUV was 51.1%. Final model parameters deviated from mean bootstrap estimates b

Impact of medication reconciliation and review and counselling, on adverse drug events and healthcare resource use

Background Adverse drug events from preventable medication errors can result in patient morbidity and mortality, and in cost to the healthcare system. Medication reconciliation can improve communication and reduce medication errors at transitions in care. Objective Evaluate the impact of medication reconciliation and counselling intervention delivered by a pharmacist for medical patients on clinical outcomes 30 days after discharge. Setting Sultan Qaboos University Hospital, Muscat, Oman. Methods A randomized controlled study comparing standard care with an intervention delivered by a pharmacist and comprising medication reconciliation on admission and discharge, a medication review, a bedside medication counselling, and a take-home medication list. Medication discrepancies during hospitalization were identified and reconciled. Clinical outcomes were evaluated by reviewing electronic health records and telephone interviews. Main outcome measures Rates of preventable adverse drug events as primary outcome and healthcare resource utilization as secondary outcome at 30 days post discharge. Results A total of 587 patients were recruited (56 ± 17 years, 57% female); 286 randomized to intervention; 301 in the standard care group. In intervention arm, 74 (26%) patients had at least one discrepancy on admission and 100 (35%) on discharge. Rates of preventable adverse drug events were significantly lower in intervention arm compared to standard care arm (9.1 vs. 16%, p = 0.009). No significant difference was found in healthcare resource use. Conclusion The implementation of an intervention comprising medication reconciliation and counselling by a pharmacist has significantly reduced the rate of preventable ADEs 30 days post discharge, compared to the standard care. The effect of the intervention on healthcare resource use was insignificant. Pharmacists should be included in decentralized, patient-centred roles. The findings should be interpreted in the context of the study's limitations