Effect of Aldose Reductase Inhibitors on Naphthalene Cataract Formation in the Rat

Naphthalene feeding can result in cataract formation in rats and rabbits due to specific metabolites of naphthalene. The concomitant administration of the aldose reductase inhibitor All 576 to naphthalenefed rats was proven to prevent cataract formation. To determine whether this effect was directly linked to the ability of All576 to inhibit enzyme aldose reductase, a variety of structurally diverse aldose reductase inhibitors, including the carboxylic acids tolrcstat, l*onalrcstat, and FK366, and the spirohydantoins, sorbinil and All576, were investigated for their ability to inhibit naphthalene-induced cataracts. Brown Norway rats, administered naphthalene by gavagc, were fed normal rat chow containing these aldose reductase inhibitors at levels known to inhibit sugar cataract formation. The lens changes in these rats were monitored over a 90-day period by portable slit-lamp microscopy and histologic study. All576 showed a dose-dependent reduction in naphthalene-induced cataract formation, with no naphthalene-associated deposits seen in toluidinc blue-stained lens sections. Sorbinil also reduced lens changes, whereas tolrcstat, Ponalrestat, and FK366 had no effect. These results suggest that inhibition of naphthalene-induced cataract formation by structurally diverse aldose reductase inhibitors was not linked to the inhibition of aldose reductase. Invest Ophthalmol Vi

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Application of Invariant Analyses to Study Survival Trends of Patients on Antiretroviral Therapy (ART) and TB Treatment in Kenya

Kenya is one of the countries, globally, with a high burden of human immunodeficiency virus and tuberculosis. The co-infection between tuberculosis and human immunodeficiency virus/acquired immunodeficiency syndrome makes the management of the infection more complicated and reduces the chances of survival. The current study evaluates the trends in the survival of individuals with ART and TB management, especially in relation to various Counties in the country. The specific objective was to establish the survival trends of patients on Antiretroviral Therapy (ART) and TB treatment in Kenya using Kaplan Meier function. The study used a retrospective cohort study design. The target population included patients on co-therapy TB and ART management who attended the health facilities between 1st January 2015 and 31st December 2019. The sample of the study was obtained from all the available HIV-TB co-infected patients’ records in National AIDS & STIs Control Program (NASCOP) database (secondary data) from the selected counties in Kenya. Kaplan Meier estimator was used in the estimation of the survival function. Analysis was done using STATA v14.2 and Bayes’ v3.0.2. The study also found that HIV-TB patients’ death rates for the period between 2015 and 2019 varied from one County to another. The study also established that the distribution of TB and HIV deaths in the 47 Counties varied across the five years. In the year 2015, the total number of TB and HIV deaths in the 47 Countries was 1077, which decreased to 921 TB and HIV deaths in 2016 before decreasing to 391 in 2017, 106 in 2018 and 60 in 2019. The study found that the main factors significantly influencing HIV-TB confections include gender, marital status, WHO clinical stage, age, weight and facility levels

A Review of the Ingredients Contained in Over the Counter (OTC) Cough Syrup Formulations in Kenya. Are They Harmful to Infants?

Cough syrups are widely used in the developing world, but safety of their use in infants and children less than two years has not been well documented. Some syrups contain multiple combinations of such drugs as promethazine, diphenhydramine and ephedrine; which are individually now contraindicated in children less than two years. Despite this, the syrups are available as over the counter drugs and may be dispensed to mothers who are unaware of the potentially hazardous effects to their infants. A descriptive cross-sectional study was used to investigate suitability of cough syrups sold within Eldoret municipality for use in children less than two years of age based on their formulations and available literature.Two semi-structured questionnaires were administered to pharmacy attendants and mothers attending sick child clinic at a referral hospital to establish whether cough syrups containing more than one active ingredient of compounds, now contraindicated in children are administered to infants, and awareness of potential serious adverse effects. Data from labeled contents of cough syrups from retail pharmacies was recorded and corroborated with information from literature to determine those deemed to contain the ingredients. The second questionnaire was administered to mothers with children less than two years to ascertain whether they had used the identified syrups. A total of 260 mothers and 55 pharmacy attendants were interviewed.There was widespread use of the syrups in children, including infants, with 192 (74%) of the respondents having used identified syrups and over 90% of these on children less than 2 years including those less than three months.146 (76%) mothers had administered the syrup at double the recommended dose.The regulatory authorities should make concerted efforts to discourage use of cough syrups containing ingredients that pose adverse events to infants, including campaigns to educate pharmacy workers and mothers