Patterns Of Drug Prescribing In A Hospital In Dubai, United Arab Emirates

To determine the pattern of drug prescription by consultants in a private hospital in Dubai, United Arab Emirates, 1190 prescriptions were collected from the hospital's pharmacy over 30 days. In total, 2659 drugs were prescribed. The mean number of drugs per encounter was 2.2. Only 4.4% of all drugs prescribed were generic. Polypharmacy was observed in only 7.5% of all encounters. Information about the prescribing physician and the patient was invariably deficient. Name of patient, age, and gender were absent in 2.9%, 9.7%, and 12% of prescriptions, respectively. In addition, none of the prescriptions mentioned address, diagnosis, or allergy of the patient. Name of physician, signature, speciality and license or registration number were omitted in 12.2%, 10.3%, 20.3%, and 54.9% of prescriptions. The most commonly prescribed therapeutic classes of drugs (and principal drug in each class) were as follows: 23.4% non-steroidal anti-inflammatory drugs (NSAIDs, Diclofenac sodium being 51.6%), 21.4% antibiotics (amoxicillin-clavulanate 13.5%), and 11.5% gastrointestinal drugs (GI, Hyoscine-N-butylbromide 28.1%). Other therapeutic classes included endocrine drugs (6.1%), vitamin supplements (5.9%), nasal decongestants (4%), antihistaminics (3.8%) and cardiovascular drugs (2.6%). Antibiotic injections accounted for 7.4% of all antibiotics prescribed, which was equivalent to 1.6% of all prescriptions. Other agents prescribed in small proportions of encounters collectively amounted to 21.3%. This study reveals the prescription trends, and indicates possible areas of improvement in prescription practice

In Vitro and in Vivo Effectiveness of Carvacrol, Thymol and Linalool against Leishmania infantum

Background: One of the most important causative agents of visceral leishmaniasis (VL) is Leishmania infantum, which is mainly spread by Phlebotomus and Lutzomyia sandflies in the Old and New World, respectively. Novel and effective drugs to manage this neglected vector-borne disease are urgently required. In this study, we evaluated the toxicity of carvacrol, thymol and linalool, three common essential oil constituents, on amastigotes and promastigotes of L. infantum. Methods: in vitro experiments were performed by 24 h MTT assay. Carvacrol, thymol and linalool at concentrations ranging from 1.3 to 10 µg/mL were tested on promastigotes of L. infantum. For in vivo test, two groups of hamsters (Mesocricetus auratus) received 100 mg/kg of body weight/day of carvacrol and thymol as intraperitoneal injection on day 7 post-infection, followed by a 48 h later injection. The third group was treated with the glucantime as standard drug (500 mg/kg) and the last group (control) just received normal saline. On the 16th day, the number of parasites and histopathological changes in liver and spleen were investigated. Results: 24 h MTT assay showed promising antileishmanial activity of thymol and carvacrol, with IC50 values of 7.2 (48 µM) and 9.8 µg/mL (65 µM), respectively. Linalool at all concentrations did not affect L. infantum promastigote viability. In vivo toxicity data of carvacrol and thymol showed that the former at 100 mg/kg was the safest and most effective treatment with little side effects on the liver. Conclusions: Overall, thymol and carvacrol are highly promising candidates for the development of effective and safe drugs in the fight against VL

Внутривенное применение сульфата магния в лечении больных тяжелой бронхиальной астмой, не отвечающих на традиционную терапию

Treatment of acute asthma is based on rapid reversal of bronchoconstriction and arresting airway inflammation. This study was done to determine effects of intravenous magnesium sulfate for improvement of pulmonary function in patients with acute asthma not responding to routine therapy presenting in a pulmonary department.This randomized double-blind controlled study was conducted on patients who did not respond to the routine therapy (the magnesium sulphate group, n=48, age 12 to 85 yrs, 26 men. 22 women; and the control (saline) group,n=33, age 15 to 80 yrs, 17 men, 16 women). Peak expiratory flow rate (PEF) was measured before infusion of magnesium sulfate (25 mg/kg) or normal saline solution (100 ml) as a baseline criterion and 30 min and 3 hr after. All the patients were also given bronchodilators. The main outcome parameter was PEF.Findings were analyzed by χ2 and f-test. Differences between the groups were considered significant at p<0.05. The PEF increased in the magnesium sulphate group in comparison with the saline solution group (82.60±5.8 versus 47.8±8.7; p=0.002) 3 hrs after the infusion.The respiratory rate in the magnesium sulfate group was also increased at 30 min and 3 hr after the infusion. Cyanosis, diaphoresis and respiratory accessory muscles use by patients were decreased in the magnesium sulfate group in comparison with the saline solution group. According to the results, magnesium sulfate was suggested to be an adjunct agent for the treatment of patients with acute non-responding asthma.Купирование обострения бронхиальной астмы основано на быстром снятии бронхоспазма и подавлении воспаления в дыхательных путях. В данной работе изучалось воздействие сульфата магния на легочную функцию у пациентов с обострением бронхиальной астмы, не отвечающих на традиционную терапию, обычно проводимую в отделении пульмонологии. Настоящее рандомизированное двойное слепое контролируемое исследование было выполнено на пациентах, не отвечающих на стандартное лечение: группа, получавшая сульфат магния, 48 больных (26 мужчин и 22 женщины) в возрасте 12-85 лет и контрольная группа, получавшая физиологический раствор, 33 человека (17 мужчин и 16 женщин) в возрасте 15-80 лет. Кроме этого, все пациенты получали бронходилататоры. До введения сульфата магния (25 мг/кг) и физиологического раствора (100 мл) и через 30 мин и 3 ч после введения определялась пиковая скорость выдоха (ПСВ). ПСВ была главным критерием оценки результатов лечения. Полученные данные анализировались с использованием критерия χ2, f-критерия; разница между измерениями считалась достоверной при р < 0,05. В группе больных, получавших сульфат магния, ПСВ возрастала через 3 ч после введения препарата по сравнению с группой, получавшей физиологический раствор, соответственно 82,6±5,8 и 47,8±8,7; р=0,002. Частота дыхания в группе, получавшей сульфат магния, снижалась через 30 мин и 3 ч после введения. Также у пациентов, получавших сульфат магния, уменьшались цианоз, потоотделение и участие в дыхании вспомогательных мышц в отличие от получавших физиологический раствор.Нa основании полученных результатов сделано предположение, что сульфат магния может использоваться в качестве дополнительного средства при лечении больных с обострением бронхиальной астмы, у которых неэффективна обычная терапия

Identifying outcome-based indicators and developing a curriculum for a continuing medical education programme on rational prescribing using a modified Delphi process

<p>Abstract</p> <p/> <p>Background</p> <p>Continuing medical education (CME) is compulsory for physicians in Iran. Recent studies in Iran show that modifications of CME elements are necessary to improve the effectiveness of the educational programmes. Other studies point to an inappropriate, even irrational drug prescribing. Based on a needs assessment study regarding CME for general physicians in the East Azerbaijan province in Iran, rational prescribing practice was recognized as a high priority issue. Considering different educational methods, outcome-based education has been proposed as a suitable approach for CME. The purpose of the study was to obtain experts' consensus about appropriate educational outcomes of rational prescribing for general physicians in CME and developing curricular contents for this education.</p> <p>Methods</p> <p>The study consisted of two phases: The first phase was conducted using a two-round Delphi consensus process to identify the outcome-based educational indicators regarding rational prescribing for general physicians in primary care (GPs). In the second phase the agreed indicators were submitted to panels of experts for assessment and determination of content for a CME program in the field.</p> <p>Results</p> <p>Twenty one learning outcomes were identified through a modified Delphi process. The indicators were used by the panels of experts and six educational topics were determined for the CME programme and the curricular content of each was defined. The topics were 1) Principles of prescription writing, 2) Adverse drug reactions, 3) Drug interactions, 4) Injections, 5) Antibiotic therapy, and 6) Anti-inflammatory agents therapy. One of the topics was not directly related to any outcome, raising a question about the need for a discussion on constructive alignment.</p> <p>Conclusions</p> <p/> <p>Consensus on learning outcomes was achieved and an educational guideline was designed. Before suggesting widespread use in the country the educational package should be tested in the CME context.</p

The global distribution of fatal pesticide self-poisoning: Systematic review

<p>Abstract</p> <p>Background</p> <p>Evidence is accumulating that pesticide self-poisoning is one of the most commonly used methods of suicide worldwide, but the magnitude of the problem and the global distribution of these deaths is unknown.</p> <p>Methods</p> <p>We have systematically reviewed the worldwide literature to estimate the number of pesticide suicides in each of the World Health Organisation's six regions and the global burden of fatal self-poisoning with pesticides. We used the following data sources: Medline, EMBASE and psycINFO (1990–2007), papers cited in publications retrieved, the worldwide web (using Google) and our personal collections of papers and books. Our aim was to identify papers enabling us to estimate the proportion of a country's suicides due to pesticide self-poisoning.</p> <p>Results</p> <p>We conservatively estimate that there are 258,234 (plausible range 233,997 to 325,907) deaths from pesticide self-poisoning worldwide each year, accounting for 30% (range 27% to 37%) of suicides globally. Official data from India probably underestimate the incidence of suicides; applying evidence-based corrections to India's official data, our estimate for world suicides using pesticides increases to 371,594 (range 347,357 to 439,267). The proportion of all suicides using pesticides varies from 4% in the European Region to over 50% in the Western Pacific Region but this proportion is not concordant with the volume of pesticides sold in each region; it is the pattern of pesticide use and the toxicity of the products, not the quantity used, that influences the likelihood they will be used in acts of fatal self-harm.</p> <p>Conclusion</p> <p>Pesticide self-poisoning accounts for about one-third of the world's suicides. Epidemiological and toxicological data suggest that many of these deaths might be prevented if (a) the use of pesticides most toxic to humans was restricted, (b) pesticides could be safely stored in rural communities, and (c) the accessibility and quality of care for poisoning could be improved.</p

The effects of mutant Ras proteins on the cell signalome

The genetic alterations in cancer cells are tightly linked to signaling pathway dysregulation. Ras is a key molecule that controls several tumorigenesis-related processes, and mutations in RAS genes often lead to unbiased intensification of signaling networks that fuel cancer progression. In this article, we review recent studies that describe mutant Ras-regulated signaling routes and their cross-talk. In addition to the two main Ras-driven signaling pathways, i.e., the RAF/MEK/ERK and PI3K/AKT/mTOR pathways, we have also collected emerging data showing the importance of Ras in other signaling pathways, including the RAC/PAK, RalGDS/Ral, and PKC/PLC signaling pathways. Moreover, microRNA-regulated Ras-associated signaling pathways are also discussed to highlight the importance of Ras regulation in cancer. Finally, emerging data show that the signal alterations in specific cell types, such as cancer stem cells, could promote cancer development. Therefore, we also cover the up-to-date findings related to Ras-regulated signal transduction in cancer stem cells. © 2020, The Author(s)

Usporedba djelovanja blokatora kalcijevih kanala, blokatora autonomnoga živčanog sustava te inhibitora slobodnih radikala na hiposekreciju inzulin iz izolirnih langerhansovih otočića štakora uzrokovanu diazinonom

Hyperglycaemia has been observed with exposure to organophosphate insecticides. This study was designed to compare the effects of calcium channel blockers, alpha-adrenergic, beta-adrenergic, and muscarinic receptor blockers, and of free radical scavengers on insulin secretion from diazinon-treated islets of Langerhans isolated from the pancreas of rats using standard collagenase digestion, separation by centrifugation, and hand-picking technique. The islets were then cultured in an incubator at 37 °C and 5 % CO2. In each experimental set 1 mL of 8 mmol L-1 glucose plus 125 µg mL-1 or 625 µg mL-1 of diazinon were added, except for the control group, which received 8 mmol L-1 glucose alone. The cultures were then treated with one of the following: 30 µmol L-1 atropine, 100 µmol L-1 ACh + 10 µmol L-1 neostigmine, 0.1 µmol L-1 propranolol, 2 µmol L-1 nifedipine, 50 µmol L-1 phenoxybenzamine, or 10 µmol L-1 alphatocopherol. In all experiments, diazinon significantly reduced glucose-stimulated insulin secretion at both doses, showing no dose dependency, as the average inhibition for the lower dose was 62.20 % and for the higher dose 64.38 %. Acetylcholine and alpha-tocopherol restored, whereas atropine potentiated diazinoninduced hyposecretion of insulin. Alpha-, beta- and calcium channel blockers did not change diazinoninduced effects. These findings suggest that diazinon affects insulin secretion mainly by disturbing the balance between free radicals and antioxidants in the islets of Langerhans and by inducing toxic stress.U osoba izloženih organofosfatnim insekticidima zamijećen je nastanak hiperglikemije. Svrha je ovo istraživanja bila usporediti djelovanje blokatora kalcijevih kanala, alfa i beta-adrenergičkih i muskarinskih receptora te inhibicije slobodnih radikala na lučenje inzulina iz Langerhansovih otočića izoliranih iz štakora tretiranih diazinonom. Otočići su izolirani iz gušterače štakora s pomoću standardnog postupka digestije kolagenazom, odvajanja centrifugiranjem i metodom ručnog probira (engl. hand-picking) te su kultivirani u inkubatoru pri 37 °C i 5 % CO2. Pokusne su kulture inkubirane s 1 mL glukoze u koncentraciji od 8 mmol L-1 te diazinonom u dozi od 125 μg mL-1, odnosno 625 μg mL-1. U kontrolu je dodana samo glukoza u koncentraciji od 8 mmol L-1. Nakon toga je u kulture dodan jedan od sljedećih agenasa: 30 µmol L-1 atropin, 100 µmol L-1 ACh + 10 µmol L-1 neostigmin, 0,1 µmol L-1 propranolol, 2 µmol L-1 nifedipin, 50 µmol L-1 fenoksibenzamin, odnosno 10 µmol L-1 alfa-tokoferol. U svim je pokusima diazinon značajno smanjio lučenje inzulina, s time da je doza od 125 μg mL-1 dovela do 62,2 %-tne inhibicije, a doza od 625 μg mL-1 do 64,38 %-tne inhibicije lučenja inzulina, što upućuje na djelovanje neovisno o dozi. Acetilkolin i alfa-tokoferol su ponovno potaknuli lučenje inzulina, za razliku od atropina koji ga je dodatno smanjio. Primjena blokatora alfa i beta-adrenergičkih receptora te blokatora kalcijevih kanala nije utjecala na djelovanje diazinona. Autori zaključuju da diazinon utječe na lučenje inzulina ponajviše narušavanjem ravnoteže između slobodnih radikala i antioksidansa u Langerhansovim otočićima te dovodi do toksičnoga stresa

Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017

Background: Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment. Methods: We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2\ub75th percentile and 100 as the 97\ub75th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. Findings: The global median health-related SDG index in 2017 was 59\ub74 (IQR 35\ub74–67\ub73), ranging from a low of 11\ub76 (95% uncertainty interval 9\ub76–14\ub70) to a high of 84\ub79 (83\ub71–86\ub77). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. Interpretation: The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains—curative interventions in the case of NCDs—towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions—or inaction—today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030