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

Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017. Methods The causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODErn), to generate cause fractions and cause specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised. Findings At the broadest grouping of causes of death (Level 1), non-communicable diseases (NC Ds) comprised the greatest fraction of deaths, contributing to 73.4% (95% uncertainty interval [UI] 72.5-74.1) of total deaths in 2017, while communicable, maternal, neonatal, and nutritional (CMNN) causes accounted for 186% (17.9-19.6), and injuries 8.0% (7.7-8.2). Total numbers of deaths from NCD causes increased from 2007 to 2017 by 22.7% (21.5-23.9), representing an additional 7.61 million (7. 20-8.01) deaths estimated in 2017 versus 2007. The death rate from NCDs decreased globally by 7.9% (7.08.8). The number of deaths for CMNN causes decreased by 222% (20.0-24.0) and the death rate by 31.8% (30.1-33.3). Total deaths from injuries increased by 2.3% (0-5-4-0) between 2007 and 2017, and the death rate from injuries decreased by 13.7% (12.2-15.1) to 57.9 deaths (55.9-59.2) per 100 000 in 2017. Deaths from substance use disorders also increased, rising from 284 000 deaths (268 000-289 000) globally in 2007 to 352 000 (334 000-363 000) in 2017. Between 2007 and 2017, total deaths from conflict and terrorism increased by 118.0% (88.8-148.6). A greater reduction in total deaths and death rates was observed for some CMNN causes among children younger than 5 years than for older adults, such as a 36.4% (32.2-40.6) reduction in deaths from lower respiratory infections for children younger than 5 years compared with a 33.6% (31.2-36.1) increase in adults older than 70 years. Globally, the number of deaths was greater for men than for women at most ages in 2017, except at ages older than 85 years. Trends in global YLLs reflect an epidemiological transition, with decreases in total YLLs from enteric infections, respirator}, infections and tuberculosis, and maternal and neonatal disorders between 1990 and 2017; these were generally greater in magnitude at the lowest levels of the Socio-demographic Index (SDI). At the same time, there were large increases in YLLs from neoplasms and cardiovascular diseases. YLL rates decreased across the five leading Level 2 causes in all SDI quintiles. The leading causes of YLLs in 1990 neonatal disorders, lower respiratory infections, and diarrhoeal diseases were ranked second, fourth, and fifth, in 2017. Meanwhile, estimated YLLs increased for ischaemic heart disease (ranked first in 2017) and stroke (ranked third), even though YLL rates decreased. Population growth contributed to increased total deaths across the 20 leading Level 2 causes of mortality between 2007 and 2017. Decreases in the cause-specific mortality rate reduced the effect of population growth for all but three causes: substance use disorders, neurological disorders, and skin and subcutaneous diseases. Interpretation Improvements in global health have been unevenly distributed among populations. Deaths due to injuries, substance use disorders, armed conflict and terrorism, neoplasms, and cardiovascular disease are expanding threats to global health. For causes of death such as lower respiratory and enteric infections, more rapid progress occurred for children than for the oldest adults, and there is continuing disparity in mortality rates by sex across age groups. Reductions in the death rate of some common diseases are themselves slowing or have ceased, primarily for NCDs, and the death rate for selected causes has increased in the past decade. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd.Peer reviewe