208 research outputs found
Contemporary Discourses in Qualitative Research: Lessons for Health Research in Nigeria
Quantitative research has permeated and dominated health research in Nigeria. One of the oldest and the most commonly used quantitative research designs are KAP (knowledge, attitude and practice) surveys. Although KAP surveys are important approaches to assessing distribution of community knowledge in large-scale projects, such surveys are often inundated by challenges, especially with regard to accurate measurement and understanding of social construction of health and illness. This paper examines contemporary ontological, epistemological, axiological and methodological discourses in the qualitative research approach and argues for adequate utilisation of the qualitative approach in health research in Nigeria. The qualitative approach deepens understanding of cultural milieu regarding health beliefs and socio-cultural issues surrounding medical therapy, as well as health seeking behaviour. Therefore, this paperargues for a more participatory research methodology in the understanding of health, illness and disease in Nigeria. Some case studies of qualitative research from Nigeria and abroad were reviewed from which health researchers (clinical managers and health social scientists and public health experts) could learn. The paper is thus a contribution to the ongoing discourses in global qualitative health research.Keywords: Qualitative research; quantitative research; ontology; epistemology; developing countries; Nigeria
Comparison of N-terminal pro-atrial natriuretic peptide and atrial natriuretic peptide in human plasma as measured with commercially available radioimmunoassay kits
Atrial natriuretic peptide (ANP) has become an important parameter for assessing the condition of patients with cardia disease. Recently, attention has also focused on N-terminal pro-atrial natriuretic peptide (NtproANP) in this context. NtproANP circulates in plasma in higher concentration, is more stable ex vivo, and may be a better parameter for cardiac function over time. We have evaluated a new commercially available radioimmunoassay kit for NtproANP and compared results and method withthose of ANP measurements. The NtproANP kit was found to be reliable and easy to use (no plasma extraction step is necessary), with good reproducibility (coefficients of variation 7-15%). Normal values in 15 healthy laboratory workers, 25 healthy elderly subjects and 25 patients with heart failure were 207 ± 70, 368 ± 134 and 1206 ± 860 pmol/l, respectively, 8.3, 11.8 and 13.0 times higher, respectively, than corresponding ANP concentrations. NtproANP correlated well with ANP (r 0.64-0.78). We conclude that plasma NtproANP measurement may be a good alternative to plasma ANP measurement: technically, it is easier to perform, and NtproANP is more stable in plasma. Whether NtproANP is a better diagnostic and prognostic parameter than ANP remains to be further established
Angiotensin levels in the eye
PURPOSE: Ocular tissues contain renin and ocular fluids contain prorenin in amounts that are too high to be explained by admixture with blood or diffusion from blood. It was the purpose of the present study to obtain further evidence for the presence of a local renin-angiotensin system (RAS) in the eye. METHODS: The authors measured the concentrations of angiotensins I and II (ANG I and II) in vitreous fluid and ocular tissues of anesthetized pigs and in human aqueous, vitreous, and subretinal fluid obtained during eye surgery. RESULTS: In tissues obtained from normal porcine eyes (anterior uveal tract, neural retina, retinal pigment epithelium + choroid), ANG I and II were 5- to 100-fold higher than could be accounted for by contamination with blood. ANG I and II in ocular tissues are therefore unlikely to be derived from the circulation. In porcine vitreous fluid, ANG I and II were close to the limit of detection. In addition, during a 2-hour infusion of 125I-ANG I in the rabbit, 125I-ANG I in vitreous fluid reached a level only 1% of the level in arterial plasma. Thus, in the presence of an intact blood-retinal barrier, little or no ANG I or II enters the vitreous compartment. In human ocular fluids obtained from diseased eyes, ANG I and II levels were readily measurable and correlated linearly with the level of serum albumin, indicating that after partial breakdown of the BRB, diffusion of ANG I and II from the circulation into the eye may occur. CONCLUSION: Results indicate that both ANG I and II are generated locally in ocular tissues with little leakage into ocular fluids. These findings, together with previously published data on renin and prorenin, show a high degree of compartmentalization of the RAS in the eye and are in agreement with similar findings in other tissues, where there is evidence for the existence of a local RAS
Angiotensin levels in the eye
PURPOSE: Ocular tissues contain renin and ocular fluids contain prorenin in amounts that are too high to be explained by admixture with blood or diffusion from blood. It was the purpose of the present study to obtain further evidence for the presence of a local renin-angiotensin system (RAS) in the eye. METHODS: The authors measured the concentrations of angiotensins I and II (ANG I and II) in vitreous fluid and ocular tissues of anesthetized pigs and in human aqueous, vitreous, and subretinal fluid obtained during eye surgery. RESULTS: In tissues obtained from normal porcine eyes (anterior uveal tract, neural retina, retinal pigment epithelium + choroid), ANG I and II were 5- to 100-fold higher than could be accounted for by contamination with blood. ANG I and II in ocular tissues are therefore unlikely to be derived from the circulation. In porcine vitreous fluid, ANG I and II were close to the limit of detection. In addition, during a 2-hour infusion of 125I-ANG I in the rabbit, 125I-ANG I in vitreous fluid reached a level only 1% of the level in arterial plasma. Thus, in the presence of an intact blood-retinal barrier, little or no ANG I or II enters the vitreous compartment. In human ocular fluids obtained from diseased eyes, ANG I and II levels were readily measurable and correlated linearly with the level of serum albumin, indicating that after partial breakdown of the BRB, diffusion of ANG I and II from the circulation into the eye may occur. CONCLUSION: Results indicate that both ANG I and II are generated locally in ocular tissues with little leakage into ocular fluids. These findings, together with previously published data on renin and prorenin, show a high degree of compartmentalization of the RAS in the eye and are in agreement with similar findings in other tissues, where there is evidence for the existence of a local RAS
Human renal and systemic hemodynamic, natriuretic, and neurohumoral responses to different doses of L-NAME
Experimental evidence indicates that the renal circulation is more
sensitive to the effects of nitric oxide (NO) synthesis inhibition than
other vascular beds. To explore whether in men the NO-mediated vasodilator
tone is greater in the renal than in the systemic circulation, the effects
of three different intravenous infusions of NG-nitro-L-arginine methyl
ester (L-NAME; 1, 5, and 25 microg. kg-1. min-1 for 30 min) or placebo on
mean arterial pressure (MAP), systemic vascular resistance (SVR), renal
blood flow (RBF), renal vascular resistance (RVR), glomerular filtration
rate (GFR), and fractional sodium and lithium excretion (FENa and FELi)
were studied in 12 healthy subjects, each receiving randomly two of the
four treatments on two different occasions. MAP was measured continuously
by means of the Finapres device, and stroke volume was calculated by a
model flow method. GFR and RBF were estimated from the clearances of
radiolabeled thalamate and hippuran. Systemic and renal hemodynamics were
followed for 2 h after start of infusions. During placebo, renal and
systemic hemodynamics and FENa and FELi remained stable. With the low and
intermediate L-NAME doses, maximal increments in SVR and RVR were similar:
20.4 +/- 19.6 and 23.5 +/- 16.0%, respectively, with the low dose and 31.4
+/- 26.7 and 31.2 +/- 14.4%, respectively, with the intermediate dose
(means +/- SD). With the high L-NAME dose, the increment in RVR was
greater than the increment in SVR. Despite a decrease in RBF, FENa and
FELi did not change with the low L-NAME dose, but they decreased by 31.2
+/- 11.0 and 20.2 +/- 6.3%, respectively, with the intermediate dose and
by 70.8 +/- 8.1 and 31.5 +/- 15.9% with the high L-NAME dose,
respectively. It is concluded that in men the renal circulation is not
more sensitive to the effects of NO synthesis inhibition than the systemic
circulation and that the threshold for NO synthesis inhibition to produce
antinatriuresis is higher than the threshold level to cause renal
vasoconstriction
Clinical and economic consequences of pharmacogenetic-guided dosing of warfarin
Patients using warfarin for oral anticoagulant therapy need to be frequently monitored because of warfarins narrow therapeutic range and the large variation in dose requirements among patients. Patients receiving the wrong dose have an increased risk of bleeding or thromboembolic events. The required dose is influenced by environmental factors, such as gender, age, diet and concomitant medication, as well as genetic factors. Pharmacogenetic testing prior to warfarin initiation might improve dosing accuracy and, therefore, safety and efficacy of warfarin treatment. Meckley et al. studied the clinical consequences and costs of genotyping before warfarin treatment. The results of their study suggest that pharmacogenetic-guided dosing of patients initiating warfarin could improve health (quality-adjusted life-years) but at a high cost per quality-adjusted life-year gained. Owing to the inevitable assumptions that have to be made in all cost-effectiveness models, great uncertainty remains regarding the cost-effectiveness of pharmacogenetic-guided warfarin dosing
Future of Pharmacogenetics in Cardiovascular Diseases
Introduction: Pharmacogenetics is the study of variations in DNA sequence as related to drug response (European Medicines Agency [EMA], 2007). Several gene-drug interactions have been
discovered in the field of cardiovascular diseases (CVDs). These gene-drug interactions can
help to identify nonresponse to drugs, estimate dose requirements or identify an increased
risk of developing adverse drug reactions. An individualized approach based on
pharmacogenetic testing will provide physicians and pharmacists with tools for decision
making about pharmacotherapy. While pharmacogenetic testing is already part of everyday
practice in oncology, it is not widely implemented in the field of CVDs. However, in the
near future, pharmacogenetics will probably also play a valuable role in this field as well
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