Knowledge and attitude of primary care doctors towards management of postmenopausal symptoms

AbstractBackgroundAccording to the current recommendations, women with post-menopausal symptoms should be managed. Knowledge and perception of primary care physicians towards management of postmenopausal symptoms are deficient.AimThe aim of the present study was to explore knowledge and attitude of primary care doctors towards management of postmenopausal symptoms.MethodsThis study is a cross-sectional survey that was conducted from October to December 2010 in the five health regions in Kuwait. Two centers were selected randomly from each health region. All physicians who were currently working in the selected centers were asked to participate in the study. Out of 209 physicians, 142 agreed to participate and completed a self-administered questionnaire.ResultsThe study revealed that 82.4% of physicians had moderate knowledge about treatment options for postmenopausal symptoms, 88.0% discussed postmenopausal symptoms with their patients, and 45.1% of them either described or referred their patients for hormonal replacement therapy (HRT). The correct answers regarding 10 statements related to the Women Health Initiative finding were ranging from 2.8% to 78.9% which indicated low level of knowledge. Regarding the effectiveness of hormonal replacement therapy in postmenopausal women, the majority of the physicians agreed correctly that HRT is effective in prevention of osteoporosis (87.3%), treatment of vasomotor symptoms (83.7%), and treatment of vulvo-vaginal symptoms (82.4%). There was a variation among physicians opinion about the effectiveness of certain treatment options for managing hot flushes in postmenopausal women.ConclusionThe results suggest that there is a lack of primary care physicians knowledge and confidence in recognizing signs and symptoms of menopause and in identifying and prescribing appropriate management

Awareness of hypertension guidelines among family physicians in primary health care

AbstractBackgroundOnly 14% of patients on treatment achieve the recommended blood pressure target. Guidelines aim to assist clinicians in the management of patients with hypertension.ObjectivesThe primary purpose of the study was to survey family physicians(FPs) in Kuwait about their awareness, and to understand better their reasons for not implementing specific guidance within the WHO/ISH guidelines.MethodsThis study is a cross-sectional survey that was carried out in the five health regions of Kuwait. All PHC physicians who were currently working as FPs were asked to participate in the study. Data were collected using a structured questionnaire of clinically oriented questions formulated on the basis of the 1999 World Health Organization/International Society of Hypertension (WHO/ISH), as standard reference.ResultsThe study revealed that 49.1% and 42.1% of FPs were very familiar or somewhat familiar with the guidelines respectively, 92.1% were in agreement, and 79.8% indicated that they always or usually follow these guidelines when treating patients. Regarding the correct choice of the guideline statements, only 8.8% of the FPs choose correctly less than ten of the 20 statements, 64% choose 10 to less than 15, and only 27.2% choose ⩾15 statements. When asked about perceived patient barriers to blood pressure control, 84.0% of the respondents ranked overcrowded clinics as important or most important barrier to blood pressure control while, 87.4% considered lack of patient knowledge as important or most important barrier. Non availability of the drugs in the clinic was considered by 88.4% of the physicians, and poor adherence to antihypertensive drugs by 90.1%.ConclusionThere is a need to establish nationwide educational and quality monitoring programs to facilitate the correct implementation of hypertension guidelines in PHC clinical practices in Kuwait

Potent hepatoprotective activity of common rattan (Calamus rotang L.) leaf extract and its molecular mechanism

Abstract Background Calamus rotang L. (CR) is an Indian shrub. The leaves and other organs of the plant are traditionally used in India for treatment of various diseases. The in vitro antioxidant property of the leaves extract was previously established. Thus, the current study aimed to evaluate the antioxidant and hepatoprotective effects of CR ethyl acetate extract at a dose of 350 mg/kg on CCl4 induced hepatotoxic rats through different mechanisms. Methods Histopathological examination of the treated rats’ group in comparison with positive and negative controls were performed. Quantitative measuring of the proinflammatory cytokines (TNF α), inflammatory regulators (Arginase, PPAR α) and the antiapoptotic protein Bcl-2 in comparison with positive and negative control groups was achieved using immunohistochemical examination. HPLC profiling of the polyphenol contents and molecular docking of the identified compounds against BH3 proapoptotic protein were correspondingly studied to evaluate the potential antiapoptotic property. Results The CR extract greatly protects the liver tissue through the suppression of TNF α, arginase and PPAR α induced by CCl4 as well as its enhancement of the antiapoptotic Bcl-2 protein. Fourteen polyphenols of different classes were identified in CR extract and tested via molecular docking for their potential antiapoptotic activities against BH3 protein. Naringin, rutin, 7-hydroxy flavone, and ellagic acid compounds exhibit the highest affinity and potential inhibition of pro-apoptotic protein BH3 via molecular docking study. Conclusions The ethyl acetate fraction of the leaves of C. rotang is rich in polyphenols that exhibited potent hepatoprotective effect on CCl4 induced hepatotoxic rats through its antioxidant, anti-inflammatory, anti-steatosis and antiapoptotic properties

Correlation between severity of pulmonary embolism and obstructive sleep apnea using computed tomography pulmonary artery obstruction index and right ventricular to left ventricular diameter ratio as severity indices

Abstract Background Recent studies have shown a bidirectional association between pulmonary embolism (PE) and obstructive sleep apnea (OSA), and due to their morbidity and mortality, this contributes significantly to the global health-care burden, so this study aims to assess the relationship between PE and OSA severity using the obstruction index of the pulmonary artery and the ratio of right ventricular to left ventricular (RV/LV) diameter as severity indices. Results The study comprised 138 patients with a high clinical suspicion of PE that was verified by computed tomography pulmonary angiography. In addition to calculating the RV/LV diameter ratio and pulmonary artery obstruction index (PAOI), the pulmonary embolism severity index was also calculated, and the Epworth Sleepiness Scale and polysomnography (PSG) were used to assess all patients for OSA. Finally, three groups of patients ( 50%) were created based on the PAOI. Age, gender, neck, and waist circumference showed no significant difference between the three groups, but there were significant correlations between higher PAOI and increased BMI, provoked PE, increased rate of thrombolysis, increase in the recurrence of venous thrombosis, a longer length of hospital stay, and a higher ratio of RV/LV diameter (p value was  40%, and the ratio of RV/LV diameter > 1 being found to be predictors of severe sleep apnea. Conclusions We deduced from this study that there is a substantial relationship between the severity of PE and the severity of OSA, as patients with higher obstruction of the pulmonary artery had severe OSA, and both the obstruction index of the pulmonary artery > 40% and the ratio of RV/LV diameter > 1 were considered significant predictors for the severity of OSA among the acute PE patients

Characterisation of the metabolites of an antibacterial endophyte <i>Botryodiplodia theobromae</i> Pat. of <i>Dracaena draco</i> L. by LC–MS/MS

<div><p><i>Botryodiplodia theobromae</i> Pat. belongs to the endophytic fungi that live within the tissues of medicinal plants and produce bioactive natural products. The endophyte was isolated from the leaves of <i>Dracaena draco</i> L. The LC–MS-based metabolite fingerprinting of the ethyl acetate extract of <i>B. theobromae</i> with antibacterial activity led to the identification of 13 metabolites pertaining to various classes: dipeptides (maculosin and L,L-cyclo(leucylprolyl), alkaloid (norharman), coumarin and isocoumarins (bergapten, meranzin and monocerin), sesquiterpene (dihydrocumambrin A), aldehyde (formyl indanone), fatty alcohol (halaminol A) and fatty acid amide (palmitoleamide, palmitamide, capsi-amide and oleamide). This study reports for the first time, the LC–MS and LC–MS/MS identification of 13 known bioactive metabolites from the antibacterial ethyl acetate extract of <i>B.</i><i>theobromae</i> isolated from the leaves of <i>D. draco</i> L.</p></div