The use of dexamethasone in animals: implication for fertility, pregnancy and extrapolation of the animal data to humans

Exposure to dexamethasone causes numerous changes in various biological systems including the reproductive system and this has huge implication on fertility and pregnancy. Maternal dexamethasone administration promotes foetal lung maturation and thermoregulation in premature foetuses. This indication makes dexamethasone a drug of choice in maternal and neonatal human and veterinary health care. In addition, dexamethasone is widely used in human and veterinary medicine as potent anti-inflammatory, immunosuppressive and analgesic drug in all age categories. Although the safety profile of short term dexamethasone treatment has been established, there has been growing concern about the long term effects of dexamethasone therapy and its implication on fertility and pregnancy in animals and humans. Most of the indications or uses in humans are extrapolated from animal data. This necessitates the need to provide review updates of current literature on dexamethasone use in humans and animals as there are many intrinsic differences between humans and animals. The review provides an overview of dexamethasone uses, its merits and demerits on animal pregnancy and fertility and implication on extrapolation of the animal data to humans. The review is based on a comprehensive literature search of relevant materials between 1969 and 2016 as well as authors’ personal manuscript/abstract files and citations of known references and discussed according to the multidisciplinary clinical experience of the authors. Although low-dose dexamethasone treatment has been used in veterinary and human clinics for many years and produced no severe effect on vital functions, repetitive high dose or long-term therapy may be associated with more serious sequelae on fertility and pregnancy. While no animal truly recapitulates human pregnancy and fertility, it is recommended that results from animal data be subjected to rigorous preclinical pharmacokinetic scaling processes to justify possible extrapolation to humans.Keywords: Animals, Dexamethasone, Fertility, Humans, Pregnanc

An Election Energy Threshold Based Multi-Hop Routing Protocol in a Grid-Clustered Wireless Sensor Network

Owing to the limited energy of sensor nodes (SNs) in a wireless sensor network (WSN), it is important to reduce and balance the energy consumption of the SNs in order to extend the WSN lifetime. Clustering mechanism is a highly efficient and effective mechanism for minimizing the amount of energy that SNs consume during the transmission of data packets. In this paper, an election energy threshold based multi-hop routing protocol (mEEMRP) is presented. In order to minimize energy consumption, this routing protocol uses grid clustering, where the network field is divided into grid clusters. SNs in each grid cluster select a cluster head (CH) based on a weight factor that takes the node location, node’s residual energy (RE) as well as the node’s distance from the base station into consideration. An energy efficient multi-hop routing algorithm is adopted during the transmission of data packets from the cluster heads (CHs) to the base station (BS). This multi-hop routing algorithm uses an election energy threshold value, T­nhCH that takes into consideration the RE of CHs as well as the distance between CHs. Simulation results show a 1.77% and 10.65% improvement in terms of network lifetime for two network field scenarios over Energy Efficient Multi-hop Routing Protocol (EEMRP)

Osjetljivost bakterija Escherichia coli i Staphylococcus aureus izdvojenih iz pilića u Maiduguri (Nigerija) prema betalaktamskim antibioticima

Escherichia coli and Staphylococcus aureus species though opportunist pathogens, are becoming a global clinical problem in both human and veterinary medicine. This study was designed to determine the antibiotic susceptibility patterns of β-lactamase-producing E. coli serotypes and S. aureus strains isolated from chickens in the Maiduguri Arid zone, Nigeria. Various tissue samples from apparently healthy and diseased chickens were collected and examined for the presence of E. coli and S. aureus. Isolates were identified by relevant biochemical tests. β-lactamase-producing strains of the isolates were determined by the chromogenic cephalosporin method, using nitrocefin-impregnated sticks and cephalosporin (nitrocefin) solution. The antibiotics susceptibility patterns of the isolates were determined for ten antibiotics (ampicillin, chloramphenicol, cephalexin, ciprofloxacin, lincomycin, doxycycline, tetracycline, tylosin, tylosin tartrate and penicillin) by the micro-broth dilution method. E. coli was isolated in 805 and S. aureus in 660 of 1300 tissue samples examined; from which 89 (11.1%) and 58 (8.8%) were β-lactamase-positive isolates respectively. Out of 540 E. coli isolates serotyped, 57 (10.6%) serogroups were identified from which 17 (29.8%) were serogroups O1, 5 (8.8%) were O2, and 2 (3.5%), 9 (15.8%), 6 (10.5%) and 18 (31.6%) were serogroups O26, O78, O86 and O141 respectively, whilst, 483 (89.4%) isolates were not typable with the available sera. Serogroups O141, O1 and O78 were more frequently isolated and serogroups O1 and O78 were more prevalent in sick chickens than in healthy chickens. E. coli exhibited high resistance to ampicillin, chloramphenicol, tetracycline, lincomycin, penicillin and tylosin with MIC values >8.0 μg/mL, as did S. aureus to all the antibiotics tested with MIC values >8.0 μg/mL. In conclusion, the study has demonstrated the presence of E. coli serotypes and S. aureus in various tissues of chickens and their antibiotic susceptibility patterns, clearly demonstrating multiple drug resistance.Premda uvjetno patogene vrste Escherichia coli i Staphylococcus aureus predstavljaju globalni klinički problem u humanoj i veterinarskoj medicini. Ovo istraživanje provedeno je sa svrhom određivanja osjetljivosti prema antibioticima serovarova E. coli i izolata S. aureus izdvojenih iz pilića u sušnom području Maiduguri u Nigeriji. Različiti uzorci tkiva od naizgled zdravih te od bolesnih pilića bili su pretraženi na prisutnost bakterija E. coli i S. aureus. Izolati su bili identificirani različitim biokemijskim testovima. Sojevi što su proizvodili β-laktamazu bili su identificirani kromogen cefalosporinskom metodom uz uporabu nitrocefinom impregniranih stikova i otopine cefalosporina (nitrocefina). Osjetljivost spomenutih bakterija bila je određivana mikrodilucijskom metodom na 10 antibiotika (ampicilin, kloramfenikol, cefaleksin, ciprofloksacin, linkomicin, doksiciklin, tetraciklin, tilozin, tilozin tartarat i penicilin). E. coli je bila izdvojena iz 805, a S. aureus iz 660 od 1300 pretraženih uzoraka tkiva od čega je 89 (11,1%) izolata E. coli i 58 (8,8%) izolata S. aureus bilo pozitivno na β-laktamazu. Od 540 serološki tipiziranih izolata E. coli identificirano je bilo 57 (10,6%) seroloških skupina od čega je 17 (29,8%) pripadalo serološkoj skupini O1, 5 (8,8%) serološkoj skupini O2, 2 (3,5%) skupini O26, 9 (15,8%) skupini O78, 6 (10,5%) skupini O86 i 18 (31,6%) serološkoj skupini O141, dok se 483 (89,4%) izolata nisu mogla tipizirati raspoloživim antiserumima. Najčešće su bile izdvojene serološke skupine O141, O1 i O78 s time da su serološke skupine O1 i O78 prevladavale u bolesnih pilića. E. coli je bila vrlo otporna na ampicilin, kloramfenikol, tetraciklin, linkomicin, penicilin i tilozin s vrijednostima minimalne inhibitorne koncentracije >8,0 μg/mL. I S. aureus je bio otporan prema svim pretraživanim antibioticima s minimalnim inhibitornim vrijednostima >8,0 μg/mL. U istraživanju je dokazana prisutnost serovarova E. coli i vrste S. aureus u različitim tkivima pilića te njihova osjetljivost na antibiotike s jasno dokazanom multiplom rezistencijom

Dexamethasone uses in humans and animals: public health and socio-economic implications

The importance of dexamethasone is demonstrated by its wide uses in human and veterinary medical practice. Unfortunately, dexamethasone use is prone to abuse. Health authorities have emphasized the importance of increasing knowledge of benefits and potential harmful effects of synthetic glucocorticoids use as a guide to responsible and judicious use of the pharmaceutical. This review provides an overview of the uses of dexamethasone and its consequences on public health visa vie socio–economy. Methodology: Source of Data: The review is based on literature searches using PubMed and MeSH and authors' personal manuscript/abstract files and citations of known references. Study selection: The selection of articles reflects the authors' opinion as to originality and importance in the context of the review. The review included human and some aspects of animal study. Data extraction: The electronic searches were scrutinized and full manuscripts of all quotes considered relevant to the study were obtained. All the articles whose abstracts were not available were excluded. Results: Dexamethasone is still one of the most prescribed medicines in human and veterinary medical practice despite over 4-decades of use and its attendant negative consequences. Recently non-medical uses of the drug are also on the increase which greatly contributed to the problems. Conclusion: Dexamethasone use has consequences on public health visa vie socio-economy. Its indispensability is not unconnected with its broad spectrum pharmacological actions and cost effectiveness. Due to rampant abuses and the attendant adverse effects of dexamethasone, it is recommended that the drug be enlisted as controlled drug

Limited emergence of resistance to integrase strand transfer inhibitors (INSTIs) in ART-experienced participants failing dolutegravir-based antiretroviral therapy: a cross-sectional analysis of a Northeast Nigerian cohort

Background Due to the high prevalence of resistance to NNRTI-based ART since 2018, consolidated recommendations from the WHO have indicated dolutegravir as the preferred drug of choice for HIV treatment globally. There is a paucity of resistance outcome data from HIV-1 non-B subtypes circulating across West Africa. Aims We characterized the mutational profiles of persons living with HIV from a cross-sectional cohort in North-East Nigeria failing a dolutegravir-based ART regimen. Methods WGS of plasma samples collected from 61 HIV-1-infected participants following virological failure of dolutegravir-based ART were sequenced using the Illumina platform. Sequencing was successfully completed for samples from 55 participants. Following quality control, 33 full genomes were analysed from participants with a median age of 40 years and median time on ART of 9 years. HIV-1 subtyping was performed using SNAPPy. Results Most participants had mutational profiles reflective of exposure to previous first- and second-line ART regimens comprised NRTIs and NNRTIs. More than half of participants had one or more drug resistance-associated mutations (DRMs) affecting susceptibility to NRTIs (17/33; 52%) and NNRTIs (24/33; 73%). Almost a quarter of participants (8/33; 24.4%) had one or more DRMs affecting tenofovir susceptibility. Only one participant, infected with HIV-1 subtype G, had evidence of DRMs affecting dolutegravir susceptibility—this was characterized by the T66A, G118R, E138K and R263K mutations. Conclusions This study found a low prevalence of resistance to dolutegravir; the data are therefore supportive of the continual rollout of dolutegravir as the primary first-line regimen for ART-naive participants and the preferred switch to second-line ART across the region. However, population-level, longer-term data collection on dolutegravir outcomes are required to further guide implementation and policy action across the region

Medication adherence among diabetic and hypertensive patients in Al-Qassim region of Saudi Arabia

Non-adherence to medication is often an unrecognized risk factor that contributes to failure of the therapeutic plan. The purpose of the study was to identify factors related to high, medium and low medication adherence among adult Saudi patients with hypertension and diabetes mellitus. This study is designed as a descriptive cross sectional survey and was conducted in three tertiary care hospitals of Al-Qassim province of Saudi Arabia. The data was collected using the 8-item Morisky Medication Adherence Scale (MMAS-8) and analyzed by SPSS. Three levels of adherence were considered based on the following scores: 0 to <6 (low); 6 to <8 (medium); 8 (high). Of the 396 patients interviewed, 52% reported low adherence to prescribed medication. Multinomial logistic regression analysis was conducted. Gender, age, literacy level, duration of illness and type of chronic disease were negatively associated with medication adherence. The study shows very high proportion of low and medium adherence on long term medication, which may be responsible for the failure of achieving therapeutic outcome. Further investigation is required to evaluate the applicability of MMAS-8 as a tool of measuring medication adherence among Saudi patients with chronic diseases. Adherence enhancing strategies should also be evaluated in separate patients group

A participatory action research approach to strengthening health managers’ capacity at district level in Eastern Uganda

BACKGROUND: Many approaches to improving health managers’ capacity in poor countries, particularly those pursued by external agencies, employ non-participatory approaches and often seek to circumvent (rather than strengthen) weak public management structures. This limits opportunities for strengthening local health managers’ capacity, improving resource utilisation and enhancing service delivery. This study explored the contribution of a participatory action research approach to strengthening health managers’ capacity in Eastern Uganda. METHODS: This was a qualitative study that used open-ended key informant interviews, combined with review of meeting minutes and observations to collect data. Both inductive and deductive thematic analysis was undertaken. The Competing Values Framework of organisational management functions guided the deductive process of analysis and the interpretation of the findings. The framework builds on four earlier models of management and regards them as complementary rather than conflicting, and identifies four managers’ capacities (collaborate, create, compete and control) by categorising them along two axes, one contrasting flexibility versus control and the other internal versus external organisational focus. RESULTS: The findings indicate that the participatory action research approach enhanced health managers’ capacity to collaborate with others, be creative, attain goals and review progress. The enablers included expanded interaction spaces, encouragement of flexibility, empowerment of local managers, and the promotion of reflection and accountability. Tension and conflict across different management functions was apparent; for example, while there was a need to collaborate, maintaining control over processes was also needed. These tensions meant that managers needed to learn to simultaneously draw upon and use different capacities as reflected by the Competing Values Framework in order to maximise their effectiveness. CONCLUSIONS: Improved health manager capacity is essential if sustained improvements in health outcomes in lowincome countries are to be attained. The expansion of interaction spaces, encouragement of flexibility, empowerment of local managers, and the promotion of reflection and accountability were the key means by which participatory action research strengthened health managers’ capacity. The participatory approach to implementation therefore created opportunities to strengthen health managers’ capacity

Research priorities to reduce the impact of COVID-19 in low- and middle-income countries

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Comparative analysis of co-processed starches prepared by three different methods

Co-processing is currently of interest in the generation of high-functionality excipients for tablet formulation. In the present study, comparative analysis of the powder and tableting properties of three co-processed starches prepared by three different methods was carried out. The co-processed excipients consisting of maize starch (90%), acacia gum (7.5%) and colloidal silicon dioxide (2.5%) were prepared by co-dispersion (SAS-CD), co-fusion (SAS-CF) and co-granulation (SAS-CG). Powder properties of each co-processed excipient were characterized by measuring particle size, flow indices, particle density, dilution potential and lubricant sensitivity ratio. Heckel and Walker models were used to evaluate the compaction behaviour of the three co-processed starches. Tablets were produced with paracetamol as the model drug by direct compression on an eccentric Tablet Press fitted with 12 mm flat-faced punches and compressed at 216 MPa. The tablets were stored at room temperature for 24 h prior to evaluation. The results revealed that co-granulated co-processed excipient (SAS-CG) gave relatively better properties in terms of flow, compressibility, dilution potential, deformation, disintegration, crushing strength and friability. This study has shown that the method of co-processing influences the powder and tableting properties of the co-processed excipient