Impact of pharmacist interventions on patients’ adherence to antidepressants and patient-reported outcomes: a systematic review

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Tui Na (or Tuina) Massage: A Minireview of Pertinent Literature, 1970-2017

Background: Tuina massage is a traditional method used effectively in the treatment of various ailments in China since ancient time, and currently it is used around the world. Objective: This minireview aims to describe several aspects of Tuina massage an integral part of Traditional Chinese Medicine in order to fill up the knowledge gap concerning traditional practitioners in Saudi Arabia. Methods: Electronic searches of databases using Boolean operators and keywords were conducted to retrieve data published in English and Chinese literature. Thousands of articles were identified and screened by two independent reviewers using exclusion and inclusion criteria, and 56 articles were finally included in this study. Results: Tuina has a very rich history in Chinese culture since antiquity. With continuous advancements in research, training, regulation and clinical practice, Tuina massage became popular worldwide and now used either alone or in conjunction with other complementary and alternative medicine or conventional therapies in diverse diseases associated with pain and other symptoms with good outcome. Although Tuina has good safety profile with level of evidence (LOE) of I to III, well defined indications and contraindications, a variety of minor adverse effects together with some major complications including deaths have been reported in the literature. Besides continuous training of Tuina practitioners, Tuina massage practice needs regulatory measures and guidelines for avoiding complications and improving the clinical outcome of patients. Conclusion: Evidently, Chinese Tuina massage supported by theory, mechanisms, procedure and included randomized clinical trials snapshots, systematic reviews and meta-analysis with LOE of I to III is reported to be effective in several conditions. Further, rigorous randomized controlled studies with active comparators including other traditional modality or conventional medications or placebo with intensified quality control measures are required to provide further robust evidence-based data to support its efficacy in chronic diseases associated with pain and disabilities

Chloramphenicol Loaded Microemulsions: Development, Characterization and Stability

This study aimed to formulate and characterize microemulsions containing chloramphenicol. Microemulsions represent highly biocompatible drug delivery systems due to their potential for increased absorption as well as high solubilization capacity. MEs were composed of Oleic acid, non-ionic surfactants tween 20/60, 1-propanol and phosphate buffer. The optimum weight ratios of components and MEs areas were determined by pseudo-ternary phase diagram. All formulations were physically characterized by centrifugation, pH, refractive index, conductivity, viscosity, surface tension and partition coefficient. The specific residence site of chloramphenicol was detected by 1H NMR study. It was uncovered that drug is entrapped between the oxyethylene groups of hydrophilic shell of MEs. So, the drug was screened from bulk water and its stability was enhanced. Thus, all characterizations have suggested that formulated MEs have potential for ocular application, being able to use as efficient drug carrier for ocular drug delivery

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Reckoning Groundwater Quality and Hydrogeochemical Processes for Drinking and Irrigation Purposes under the Influence of Anthropogenic Activities, North India

The present study was carried out near an industrial area with a high-density urban population and large-scale agricultural activities. These anthropogenic activities lead to groundwater pollution and depletion of the water table. This study attempted to classify pollution sources and hydrochemical facies that help to ensure the suitability of water for agriculture and drinking. Irrigation suitability indexes, water quality index (WQI), principal component analysis (PCA), and hierarchical cluster analysis (HCA) were applied to twenty-six groundwater samples that were analysed during May 2018 for major cations and anion concentrations. The results revealed that the mechanism of groundwater chemistry has been controlled by the evaporation process with the dominance of hydrochemical facies viz., Ca-Mg-HCO3, Na-K-Cl-SO4, Ca-Mg-Cl, and Na-K-HCO3. The mean dominant concentration for cations is in the order of Ca2+ > Na+ > Mg2+ > K+ while anions are HCO3− > SO4− > Cl− > NO3− > CO32− > F−. Irrigation suitability indexes indicated that groundwater in the study area is high in saline and low to medium alkali hazards due to industrial activities. The PCA and HCA also recognized that most of the variations are elucidated by anthropogenic processes, predominantly due to excessive population, industrial emissions, and agricultural activities. Further, the WQI of the study area suggested that 15% of the samples were unsuitable, 69% poor, and the remaining 16% only suitable for drinking purposes. The present article helps to understand the suitability and hydrochemical processes of groundwater for irrigation and drinking, which will help policymakers in water supply planning and management

Reckoning Groundwater Quality and Hydrogeochemical Processes for Drinking and Irrigation Purposes under the Influence of Anthropogenic Activities, North India

The present study was carried out near an industrial area with a high-density urban population and large-scale agricultural activities. These anthropogenic activities lead to groundwater pollution and depletion of the water table. This study attempted to classify pollution sources and hydrochemical facies that help to ensure the suitability of water for agriculture and drinking. Irrigation suitability indexes, water quality index (WQI), principal component analysis (PCA), and hierarchical cluster analysis (HCA) were applied to twenty-six groundwater samples that were analysed during May 2018 for major cations and anion concentrations. The results revealed that the mechanism of groundwater chemistry has been controlled by the evaporation process with the dominance of hydrochemical facies viz., Ca-Mg-HCO3, Na-K-Cl-SO4, Ca-Mg-Cl, and Na-K-HCO3. The mean dominant concentration for cations is in the order of Ca2+ > Na+ > Mg2+ > K+ while anions are HCO3− > SO4− > Cl− > NO3− > CO32− > F−. Irrigation suitability indexes indicated that groundwater in the study area is high in saline and low to medium alkali hazards due to industrial activities. The PCA and HCA also recognized that most of the variations are elucidated by anthropogenic processes, predominantly due to excessive population, industrial emissions, and agricultural activities. Further, the WQI of the study area suggested that 15% of the samples were unsuitable, 69% poor, and the remaining 16% only suitable for drinking purposes. The present article helps to understand the suitability and hydrochemical processes of groundwater for irrigation and drinking, which will help policymakers in water supply planning and management