Critical appraisal of laropiprant and extended-release niacin combination in the management of mixed dyslipidemias and primary hypercholesterolemia

Niacin is a B-complex vitamin which has been used for decades for the management of mixed dyslipidemias and primary hypercholesterolemia. It decreases the risk of cardiovascular events either when used as a monotherapy or in combination with other lipid lowering medications. However, a major limitation to its use is niacin-induced flushing occurring even with the extended-release formulations. Laropiprant, a selective prostaglandin-2 receptor inhibitor, specifically targets the cascade of events causing the flushing. It has been recently used in combination with extended-release niacin. This article will review the early experience with this combination with focus on efficacy, safety, tolerability and current place in therapy. Early data are promising and suggest that more patients in clinical practice will benefit from niacin combined with laropiprant. Ongoing clinical trials will provide a better insight on the long-term safety of the drug and its efficacy for reducing cardiovascular events

Prostatic diseases: is it toxic or genetic? Study of TNF alpha gene polymorphism and cigarette smoking in cases of prostate cancer and benign prostatic hyperplasia

Inflammation has been implicated as an etiological factor, in several human cancers. Allelic variants of the genes involved in inflammatory pathways are logical candidates as genetic determinants of prostate cancer risk. Besides genetic factors, environmental factors such as smoking are an important risk factor for prostate cancer. This study aimed to investigate whether 308 G/A single nucleotide polymorphism of tumor necrosis factor-α (TNF-α) gene promoter region was associated with outcomes of prostate cancer and to analyze the gene environment interaction between 308 G/A TNF polymorphism and cigarette smoking. A total of 282 patients with prostate cancer (143 smokers, 139 non smoker) and 212 patients with benign prostatic hyperplasia (105 smokers, 107 non smokers) along with 115 healthy control were enrolled in the study. Urinary Cotinine and serum TNF and PSA levels were measured using ELISA technique. TNF genotyping was performed using PCR-RFLP technique. Prostate cancer was significantly associated with TNF G/G genotype and this is accompanied by elevated plasma TNF, PSA and urinary Cotinine. Cancer smokers showed a high frequency of TNF-α 308 G allele compared with other patient groups associated with increased TNF levels. Results of this study support the hypothesis that polymorphism in proinflammatory genes may be important in prostate cancer development and the sequence variants in these inflammatory genes may interact with environmental modifiers such as cigarette smoking to increase prostate cancer risk

Antioxidant and cardioprotective activity of Stachys schimperi Vatke against doxorubicin-induced cardiotoxicity

AbstractCardiotoxicity is one of the major side effects of anthracycline antibiotics. Most studies implicated increased oxidative stress as the major determinant of doxorubicin (DOX) cardiotoxicity. The aim of the current investigation was to study the possible cardioprotective effect of Stachys schimperi Vatke (family Lamiaceae) on DOX-induced cardiotoxicity in rats based on biochemical and histopathological parameters. The phenolic profile of the methanol extract was determined qualitatively by HPLC. Isoscutellarein 7-O-[2″-O-(6″′-acetyl)-β-d-allopyranosyl]-β-d-glucopyranoside (compound 1) was isolated and identified from EB fraction as a major constituent for the first time from this Stachys species. The methanolic extract and the combined EtOAc and n-butanol fractions (EB) as well as compound 1 showed prominent free radical scavenging activity when assessed by the DPPH method. The methanolic extract showed moderate protection against DOX-induced alteration in cardiac oxidative stress markers; GSH and MDA, and cardiac serum markers; CK-MB and LDH activities. Additionally, histopathological study denoted mild protection against DOX-induced cardiotoxicity.It was concluded that Stachys schimperi Vatke methanolic extract protected against DOX-induced cardiotoxicity, at least in part, by virtue of its antioxidant activity

Post-transplant anemia in pediatric patients and its impact on patient and graft survival: single center experience

Introduction: Post-transplantation anemia (PTA)occurs frequently, with prevalence rates between 20and 60% depending on the criteria used for defininganemia.Aim of the work: We aimed to assess the prevalenceof anemia after 6 months of transplantation inpediatric renal transplant patients under differentprotocols of immunosuppression, and to determinethe impact of anemia upon long-term patient andgraft survival.Patients and methods: Based on the data of 108renal transplants performed in our center, patientswere categorized after 6 months according to theirhemoglobin (Hb) levels into two groups. The firstgroup with Hb more than 11gm/dl (group I, 29cases) and the second group with Hb lessthan11gm/dl (group II, 79cases). We compared thetwo groups regarding post transplant complications(rejection episodes, hypertension, diabetes mellitus,infections, hepatic dysfunction, and patient andgraft survival.Results: we found no significant difference betweenthe two groups regarding rejection episodes.However, the percentage of cases with chronicallograft nephropathy was significantly higher in the anemic group. The survivors with functioning graftswere significantly higher in cases with normal Hb.Moreover, living cases with graft failure weresignificantly higher in anemic group. Graft survivalrate was better in the non anemic group. However,no difference in patient survival was detected. Also,we found no difference between the two groupsregarding post-transplant complications.Conclusions: From this study, we can conclude thatthe prevalence of post-transplant anemia is highpediatric renal transplant patients especially thosereceiving CNI and MMF, and it was associated withpoorer graft outcome but no effect on patientsurvival

Detection of multidrug-resistant bacteria in the occupied Palestinian territory: a cross-sectional study

Background Antimicrobial resistance is a worldwide threat to public health. WHO has created several resolutions and strategies on this subject at the World Health Assembly. In May, 2015, WHO published a global action plan to mitigate antimicrobial resistance, including tracking and global surveillance focusing on improving awareness and understanding of this issue. The aim of this study was to screen for carbapenem-resistant bacteria in the occupied Palestinian Territory, to investigate the mechanisms behind the resistance, and to assess the scope of this difficulty in the area. Methods During 6 weeks in 2012, we collected all available Gram-negative isolates taken from inpatients and outpatients in hospital laboratories at Al-Shifa Hospital and five additional hospitals in the West Bank to screen for carbapenem resistance. Resistant isolates were identified with MALDI-TOF, mapped for their resistance pattern, and

Seroprevalence and risk factors associated with Newcastle disease in backyard chickens in West Kordofan State, Sudan

Background and Aim: Newcastle disease (ND), a major constraint to poultry production worldwide, is a highly contagious disease of many species of domestic, exotic, and wild birds caused by ND virus (NDV). Epidemiological studies are lacking regarding ND in village chickens, including the traditional and intensive production systems used in Sudan. However, it is necessary to develop appropriate strategies to control the disease. Therefore, this study aimed to estimate the flock- and bird-level seroprevalence of NDV in backyard chickens in West Kordofan State, Sudan, and to identify the risk factors associated with ND in the study area. Materials and Methods: The seroprevalence of the circulating NDV and bird-level risk factors associated with ND was determined in backyard chickens from March to October 2017, in six villages (Alnowara, Alleait, Geibaish, Baiad, Sougoh, and Alnuhoud) in the Geibaish and Elnuhoud localities of West Kordofan State. Results: Using the hemagglutination-inhibition test, the bird- and flock-level seroprevalences of antibodies to NDV were estimated as 20.6% (78/378) and 45% (18/40), respectively. Bird-level NDV seropositivity in backyard chickens was significantly associated with the reason for raising chickens, type of housing, contact with neighboring poultry, contact with wild birds, and chicken mortality caused by infectious diseases (p ≤ 0.05). Conclusion: This study indicated that NDV is circulating in backyard chickens and may act as a potential source of infection for other birds and thus persistence of ND among local traditionally managed chickens in the areas of West Kordofan State. Risk factors contributing to ND occurrence are important for designing appropriate prevention and control strategies

Safety of Transcatheter Aortic Valve Replacement in Patients with Aortic Aneurysm: A Propensity-Matched Analysis

Introduction There is a paucity of data regarding the outcomes of transcatheter aortic valve replacement (TAVR) among patients with thoracic or abdominal aortic aneurysms (AA). Using the Nationwide Inpatient Sample (NIS) database, we explored the safety of TAVR among patients with a diagnosis of AA. Methods We queried the National Inpatient Sample database (2012–2017) for hospitalized patients undergoing TAVR, using ICD-9 and ICD-10 codes for endovascular TAVR. Reports show that \u3e 95% of endovascular TAVR in the US is via transfemoral access, so our population are mostly patients undergoing transfemoral TAVR. Using propensity score matching, we compared the trends and outcomes of TAVR procedures among patients with versus without AA. Results From a total sample of 29,517 individuals who had TAVR procedures between January 2012 and December 2017, 910 had a diagnosis of AA. In 774 matched-pair analysis, all-cause in-hospital mortality was similar in patients with and without AA OR 0.63 [(95% CI 0.28–1.43), p = 0.20]. The median length of stay was higher in patients with AA: 4 days (IQR 2.0–7.0) versus 3 days (IQR 2.0–6.0) p = 0.01. Risk of AKI [OR 1.01 (0.73–1.39), p = 0.87], heart block requiring pacemaker placement [OR 1.17 (0.81–1.69), p = 0.40], aortic dissection [OR 2.38 (0.41–13.75), p = 0.25], acute limb ischemia [OR 0.46 (0.18–1.16), p = 0.09], vascular complications [OR 0.80 (0.34–1.89), p = 0.53], post-op bleeding [OR 1.12 (0.81–1.57), p = 0.42], blood transfusion [OR 1.20 (0.84–1.70), p = 0.26], and stroke [OR 0.58 (0.24–1.39), p = 0.25] were similar in those with and without AA. Conclusions Data from a large nationwide database demonstrated that patients with AA undergoing TAVR are associated with similar in-hospital outcomes compared with patients without AA. Key Summary Points Patients with a diagnosis aortic aneurysm (thoracic or abdominal) undergoing transcatheter aortic valve replacement (TAVR) have same risk of periprocedural complications as those without a diagnosis of aortic aneurysms (AA). Patients with a diagnosis of aortic aneurysm had a longer length of hospital stay. Further studies are needed to determine how specific features of aortic aneurysm such as size, shape, thrombus burden, or calcifications affect the safety of TAVR

Validity of procalcitonin as diagnostic biomarker for infective endocarditis

Background: Infective endocarditis (IE) is still a fatal infection with high morbidity and mortality. Successful patient outcomes depend on prompt diagnosis and effective therapy. Blood cultures are usually time consuming and sometimes echocardiography is falsely negative. Thus, a straightforward blood test may assist early diagnosis of IE. Multiple studies have revealed that procalcitonin (PCT) was highly associated with bacteremia - the main diagnostic criteria for endocarditis - in patients with fever. Objectives: We aimed to assess the diagnostic significance of procalcitonin concentration in suspected patients of IE. Patients and methods: Twenty-two patients admitted to Assiut University Heart Hospital with a suspicion of IE were enrolled in a prospective study. Based on clinical, microbiological, and echocardiographic findings, Modified duke criteria were applied to the cases to confirm their diagnosis as definite, possible, or rejected IE cases before testing for procalcitonin was done. The study also included fifteen healthy volunteers for comparison with IE patients. Results: Procalcitonin was significantly higher (P-value <0.05) in patients diagnosed as definite and possible IE than with healthy volunteers. The area under the ROC curve was 0.705. At cutoff value of 0.425 ng/ml, the procalcitonin test's sensitivity, specificity, negative predictive value, and positive predictive values were 47.6%, 93.3%, 56%, and 90.9%, respectively. Conclusion: This study implies that procalcitonin may be a valuable supplementary diagnostic marker in IE diagnosis. A threshold value of 0.425 ng/ml should be used for ruling out endocarditis in routine clinical practice and the diagnosis of IE can be strongly excluded below this value

Equity in healthcare: status, barriers, and challenges

Global health provides a challenge for primary care and general practice which will become increasingly important in the future as the prevalence of multimorbidity increases. There is increasing likelihood of survival from acute illnesses and increase an in the elderly population. This literature review focuses on the health inequities, the role of family medicine and the factors that are essential in overcoming these inequalities. Health disparities refer to gaps in the quality of health and delivery of health care across racial, ethnic, gender and socioeconomic groups. The health disparities vary among different countries and the factors that lead to these disparities differ across the world. Family medicine plays a crucial role in bridging this gap and is an essential backbone of the society in developing nations as well as the wealthier nations in providing equity in health care to all people. There are many factors leading to inequity in health care. Family medicine should be recognized as a specialty across the world, as family medicine with its person centered care can bring about a global change in health care. This issue has to be taken up more seriously by the institutions like the WHO, UN and also individual governments along with the political parties to create uniformity in health care. In the current setting of the global economic and financial crisis, a truly global solution is needed. The WHO has come up with various strategies to solve the issue of financial crises and ensuring equity in health globally. This will ensure equal health care to all people especially the underprivileged in developing countries who do not have access to better healthcare due to lack of resources. This factor is a major contributor to the premature death of individuals at all stages of life from new born to the elderly and includes infant mortality and mortality due to chronic diseases. This is important in creating uniformity in health care across the world but has to be considered at a global level to have an impact

Betaine and nano-emulsified vegetable oil supplementation for improving carcass and meat quality characteristics of broiler chickens under heat stress conditions

IntroductionThis research aimed to examine the effects of water-added betaine (BET) and/or nano-emulsified vegetable oil (MAGO) on carcass and meat quality characteristics of broilers raised under thermoneutral (TN) and heat stress (HS) conditions.MethodsOn day 21, 640 birds (Ross 308) were randomly assigned to one of two thermal conditions (thermoneutral 22 ± 1°C and heat stress 32 ± 1°C) each containing four treatment groups: Control, BET, MAGO, and a mixture of both (BETMAGO) in a 2 × 4 factorial arrangement (eight groups). Each group has eight replicates, with ten birds each. The birds' carcass and meat quality characteristics were evaluated at 35 days.Results and discussionThe dressing percentage, breast, leg, wing, heart, initial pH, color change, cooking loss (CL), water-holding capacity (WHC), shear force (SF), and texture profile with exception of springiness significantly affected by the treatments. The results showed that HS had negative effects on carcass weight and relative weights of the breast, spleen, and heart. Moreover, HS increased dressing percentage, wing, initial pH, final core temperature, initial lightness, WHC, and hardness. Significant differences in interactions between treatments and temperature were observed in the spleen, WHC, and SF.ConclusionWater supplemented with BET effectively improved carcass dressing percentage, breast weight, and meat quality in terms of water-holding capacity and tenderness under HS conditions. More studies on the use of BET and/or MAGO at different levels were recommended