Individuality and Community: The Perspective of Classical Indian and African Philosophies

Ph.DDOCTOR OF PHILOSOPH

Perception and Use of Herbal Medicines Among Clients Visiting Selected Community Pharmacies in Ibadan, Nigeria

Globally, there is an increasing trend in the use of herbal medicines. Despite, the benefit of its use, herbal medicines are not completely harmless. This study aims to evaluate the perception and use of herbal medicines among clients who visited selected community pharmacies in Ibadan metropolis, Nigeria. A cross-sectional survey was carried out among clients who patronized the selected community pharmacies, using a self-administered questionnaire. Demographic information, as well as perception and use of herbal medicines were evaluated. Data were summarized with descriptive statistics while K-W test was used for ranked variables at P<0.05. The response rate was 90.7 %. Malaria 113 (58.9 %) was cited as the most common illness treated with herbal medicines. A total of 232 (76.8 %) had score 50.0 % indicating “good” perception on the use of herbal medicine. The level of education of the clients significantly influenced some of their perception towards herbal medicine. This include statement such as herbs can cure all diseases (K-W p=0.011), combination of the conventional drugs and herbs have no side effects (K-W p=0.002), and that side effect of synthetic drugs can be minimized with combination with herbs (K-W p=0.044). Most of the respondents had good perception about herbal medicine use. However, it was notable that the level of education significantly influenced the perception about the use of herbal medicines of some respondents. Public sensitization programme, and health education about the safety of herbal medicines, may be a useful means of improving the use of herbal medicine and reduce potential health risk

Dual Claim and the Exhaustion of Local Remedies Rule in International Law

Notwithstanding the anomaly of the procedural requirement that local remedies available in the respondent state must be exhausted before there can be diplomatic intervention on behalf of a national, there can be no doubt that the rule serves some very useful purposes and has become generally accepted. This is demonstrated by the significant role the rule now plays in the resolution of issues before the European Commission of Human Rights. Because the rule is often discussed in the context of a complaint of denial of justice, considerable difficulties may be encountered in determining when the rule should be complied with. This difficulty is particularly manifest when an unlawful act injures both the state and its national simultaneously. When the state takes diplomatic action or institutes judicial proceedings under these circumstances, various tests have been used or proposed for determining whether the requirements of the exhaustion of local remedies rule must be fulfilled. In the Interhandel Case the International Court of Justice decided that the applicability of the rule depended on whether the private or the public interest is preponderant in the claim; if the former, local remedies must be exhausted, and if the latter, the rule will not be applied. Other suggested tests that have been considered include making the applicability of the rule depend on the subject matter of the dispute or whether the alleged wrongful act causes an immediate injury to the state

Ablation of Complex Fractionated Atrial Electrograms for Atrial Fibrillation Rhythm Control: A Systematic Review and Meta-analysis.

BACKGROUND: Pulmonary vein isolation (PVI) has become an increasingly important therapy in the management of atrial fibrillation (AF), however, the best procedural techniques to ensure success have not been determined. We assessed the incremental benefit of complex fractionated atrial electrograms (CFAEs) ablation for AF rhythm control. METHODS: PubMed, Embase, CENTRAL, and Clinicaltrials.gov databases were searched up until May 7, 2015. Included were randomized controlled trials that compared PVI with PVI and CFAEs ablation (PVI+) with a minimum of 3 months\u27 follow-up. Statistical analysis was performed with Review Manager version 5.3 (Cochrane Collaboration, Oxford, United Kingdom). Categorical and continuous outcomes were reported as summary risk differences and mean differences (MDs), respectively. P \u3c 0.05 was considered statistically significant for all analyses. RESULTS: Ten randomized controlled trials randomized patients to PVI+ (n = 635) and PVI (n = 427) with follow-up ranging from 3 to 23 months. There was no significant difference in freedom from atrial tachyarrhythmias without antiarrhythmic agents after a single ablation between PVI+ and PVI (313 of 635 vs 230 of 427; risk difference, 0.01 [95% confidence interval (CI)-0.08 to 0.10]; P = 0.78; I(2) = 52%). Findings were not different for any prespecified subgroup analyses, including paroxysmal vs nonparoxysmal AF, automated vs manual detection of CFAEs, and left atrial vs biatrial ablation. PVI+ led to significantly increased procedure time (MD, 49.81 minutes [95% CI 42.86-56.76]; P \u3c 0.001), fluoroscopy time (MD, 11.55 minutes [95% CI 8.02-15.07]; P \u3c 0.001), and radiofrequency energy application time (MD, 19.16 minutes [95% CI 6.61-31.70]; P = 0.003) compared with PVI. CONCLUSIONS: Ablation of CFAEs in addition to PVI did not increase freedom from atrial tachyarrhythmias but procedural times were increased

Pharmacist-led Care in Collaboration with a Cardiovascular Team to Improve the Management of Atherosclerotic Heart Disease Risk in Hospitalized Patients

Background: Cardiovascular disease (CVD) is the leading cause of death worldwide, with approximately 17.5 million people dying yearly. Of which, about 85% are due to heart attack and stroke. In high-risk patients, lipid-lowering, blood pressure-lowering, and smoking cessation interventions have shown to lower primary and secondary risk, while antiplatelet therapy can reduce secondary risk of CVD events. Literature shows that appropriate prescribing and management of cardiovascular (CV) risk factors remains suboptimal, despite the established benefits. Pharmacists are essential pharmacotherapy experts in improving quality of care through medication optimization. A significant body of literature has proven the benefits of pharmacists within a multidisciplinary team in various disease states. This study aims to evaluate the impact of pharmacist-led care by identifying and managing atherosclerotic cardiovascular disease (ASCVD) risk in hospitalized patients with coronary artery disease (CAD). Methods: This is a single-center bi-phasic electronic health record review conducted at a community hospital over a 4-month period. Adult, non-pregnant, hospitalized patients diagnosed with acute coronary syndrome (ACS) during current hospitalization or those undergoing elective cardiac catheterization were included. Patients were excluded if they had type II myocardial infarction or if discharged within 12 hours of cardiac catheterization procedure. The primary outcomes include the proportion of patients who had medication therapy optimized through an established clinical care pathway, and the total number as well as type of pharmacy interventions made and accepted. Secondary outcomes include hospital length of stay and 30-day hospital re-admission. Results: In progress. Conclusion: The results will be discussed. Clinical Implications: This study will provide valuable insight regarding the role of a pharmacist in the implementation of clinical care pathways to identify opportunities for the management of ASCVD risk in hospitalized patients after an ACS event and/or elective cardiac catheterization

Impact of new-onset versus pre-existing atrial fibrillation on outcomes after transcatheter aortic valve replacement/implantation

Patients with aortic stenosis who undergo transcatheter aortic valve replacement/transcatheter aortic valve implantation (TAVR/TAVI) experience a high incidence of pre-existing atrial fibrillation (pre-AF) and new-onset atrial fibrillation (NOAF) post-operatively. This systematic review and meta-analysis aimed to update current evidence concerning the incidence of 30-day mortality, stroke, acute kidney injury (AKI), length of stay (LOS), and early/late bleeding in patients with NOAF or pre-AF who undergo TAVR/TAVI. PubMed, Google Scholar, JSTOR, Cochrane Library, and Web of Science were searched for studies published between January 2012 and December 2020 reporting the association between NOAF/pre-AF and clinical complications after TAVR/TAVI. A total of 15 studies including 158,220 adult patients with TAVI/TAVR and NOAF or pre-AF were identified. Compared to patients in sinus rhythm, patients who developed NOAF had a higher risk of 30-day mortality, AKI, early bleeding events, extended LOS, and stroke after TAVR/TAVI (odds ratio [OR]: 3.18 [95% confidence interval [CI] 1.58, 6.40]) (OR: 3.83 [95% CI 1.18, 12.42]) (OR: 1.70 [95% CI 1.05, 2.74]) (OR: 13.96 [95% CI, 6.41, 30.40]) (OR: 2.51 [95% CI 1.59, 3.97], respectively). Compared to patients in sinus rhythm, patients with pre-AF had a higher risk of AKI and early bleeding episodes after TAVR/TAVI (OR: 2.43 [95% CI 1.10, 5.35]) (OR: 17.41 [95% CI 6.49, 46.68], respectively). Atrial fibrillation is associated with a higher risk of all primary and secondary outcomes. Specifically, NOAF but not pre-AF is associated with a higher risk of 30-day mortality, stroke, and extended LOS after TAVR/TAVI