Study of polypharmacy and associated problems among elderly patients

The study aims at the assessment of prescribing pattern for elderly patients, since they are more prone to prescription of multiple medications. The prescription of multiple medications leads to polypharmacy, more adverse drug reactions and nonadherence to treatment. The study was conducted on OPD basis in a rural health centre for a period of six months. Information pertaining to the age, sex, religion, monthly income, education level, any previous illnesses, or any chronic diseases, any drug treatment, adherence to the treatment, and self medication or non-allopathic treatment was collected. The study included 310 elderly patients, among which 51.9% were males and 48.1% were females. The prevalence of polypharmacy was 25.20%, more among elderly men (26.10%) than women (24.20%), the odds ratio (OR) was 1.11. The major fraction 35.81% of the patients was in the age group of 60-64 years. Only 59.3% were literate. 64.41% belonged to lower socioeconomic status. The cardiovascular diseases 139 (44.83 %) followed by arthritis 121 (39.03%), and diabetes 58 (18.71%) were the most common ailments. Antihypertensive drugs were prescribed in 26.13%, analgesics/antipyretics in 19.68%, and antidiabetic drugs in 18.71%. Non-adherence to therapy was seen in 49.68%. Self medication habits were seen in 23.90% patients, who most commonly used analgesics/antipyretics and antacids/anti-ulcer drugs. Polypharmacy is very common among elderly and interventions to improve the optimal use of medication in elderly could lead to reduction in the problems associated with polypharmacy.KEYWORDS: Non-adherence; Polypharmacy; Self medicationsInternet Journal of Medical Update 2012 January;7(1):35-3

Rigid endoscope-assisted tracheal intubation in a case of epiglottic cyst

Epiglottic cysts are of particular interest to both surgeons and anaesthetists because of the way in which they encroach on the airway. An epiglottic cyst in a 29-year-old woman was scheduled for endoscopic excision. It was located at the vallecula, and measured around 3 x 4 cm. As a fibre-optic bronchoscope was not available in our institution, endotracheal intubation was achieved with the help of a rigid endoscope and video-camera system.Keywords: epiglottic cyst, 300 nasal endoscope, nasotracheal intubatio

Invisible chains : themes of gender and violence in Malaysian literature in English

The paper will focus on the treatment of domestic violence in literary works of Malaysian Literature in English (MLE) writers. The paper will primarily analyse intimate partner violence and examine these violence, as portrayed in the selected texts. MLE provides insights into the thematic concerns of Malaysian writers, giving rise to pertinent issues that affect a country’s well-being and its people. Several scholars have studied some of the selected works, and their works centre on the thematic concerns such as nationhood and nation-building, but issues of domestic violence have been dismissed as unimportant. Departing from previous research, this paper examines the novelistic representations of domestic violence with the aim to create awareness and giving them visibility

Malaysian nasal polyps: eosinophil or neutrophil-predominant

Eosinophil-type nasal polyp (NP) is common in Western population. This aim of this study was to determine the histology type of NP among different Malaysian ethnic groups. A total of 122 chronic rhinosinusitis with nasal polyposis (CRSwNP) patients were retrospectively enrolled and demographic data was recorded. The histological slides were retrieved. The number of eosinophils and non-eosinophils were counted and average number of inflammatory cells for each high power field was calculated. Eosinophil-predominant was seen in 32.8% of patients and 67.2% was non-eosinophil-predominant. Phenotypes of NP significantly showed an association with ethnicity (x² = 8.322; p < 0.05). A total of 78.9% of Chinese nasal polyps showed non-eosinophil predominant, while Malay and Indian nasal polyps revealed 71.9% and 40.7% of non-eosinophilic phenotype, respectively. Our study showed that Malaysian population had a non-eosinophilic phenotype of nasal polyps. There was a significant association in Malaysian ethnicity with the highest percentage in Chinese population

Phytochemical investigations, in-vitro antioxidant, antimicrobial potential, and in-silico computational docking analysis of Euphorbia milii Des Moul

Euphorbia milii Des Moul is a deciduous bush indigenous to Madagascar. The present study aims to investigate the presence of the phytochemical, in-vitro antioxidant and antimicrobial potency, and in-silico computational analysis of ethanolic and aqueous preparations of E. milii leaves and flowers. The ethanolic and aqueous extracts were tested for in-vitro antioxidant activity by DPPH, H2O2, TAC, and FRAP assay. In addition, antimicrobial potentials were assayed by agar well diffusion technique against Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus, and Candida albicans for various clinical isolates. The qualitative phytochemical analysis results confirmed the existence of alkaloids, flavonoids, phenolics, and tannins. The quantitative analysis elicits the availability of a magnificent number of alkaloids, flavonoids, phenolics, flavonols, and tannins. Among all the extracts, aqueous extracts of leaves exhibited potent antioxidant activity in DPPH, FRAP, and H2O2 assay with the IC50 value of 30.70, 60.05, and 82.92µg/mL, respectively. In agar well diffusion assay, all extracts displayed zone of inhibition varies from 2-24mm at different concentrations ranging from 10-320 mg/mL, whereas no activity was observed against Candida albicans. Furthermore, docking-based computational analysis has revealed that beta-sitosterol and taraxerol are the plant's active constituents responsible for their antimicrobial and antioxidant activities. Research findings suggest that the E. milii plant has an excellent prospect for further study for its extended antioxidative and antimicrobial potential. It could be a natural source of various ailments and can be utilized to develop new drugs

Overexpression of CTAG1B is a potential biomarker in bladder cancer

Urothelial cell carcinoma (UCC) is the most common form of bladder cancer and is associated with the need for life-long surveillance once a patient is diagnosed with a non-invasive disease. Due to the long-term risk of recurrence and the need for life-long routine monitoring and therapy, the cost per UCC patient from diagnosis to death is the highest of all cancers. The development of non-invasive biomarkers of recurrence and progression can increase survival, decrease treatment costs and improve patient quality of life. However, to date, no biomarker(s) have been endorsed for the use in the clinical management of UCC, especially in predicting risk of progression and recurrence. CTAG1B was previously found to be highly expressed in high-stage and grade bladder cancer, albeit in Caucasian cohorts. However, despite its potential as a target for cancer immunotherapy, the effect of expression modulation on cellular phenotypes has never been reported. In this study, we overexpressed CTAG1B in an invasive bladder cancer cell line, EJ28 after we confirmed that this cell line minimally expressed CTAG1B. The cells were transfected with CTAG1B-pcDNA3.1(-) and the level of expression was confirmed by qRT-PCR. Once the expression was confirmed to persist up to 72h post-transfection, the transfected cells were subjected to various phenotypic assays. In addition, the pattern of CTAG1B expression in a cohort of Malaysian bladder cancer paraffin-embedded tissues was also determined using immunohistochemistry. The effect of CTAG1B overexpression on the cell cycle, migratory and proliferative potential was observed. The changes in phenotype were compared with that of untransfected and mock controls. CTAG1B was overexpressed 20 times as compared to the untransfected and mock controls in the transfected cells. CTAG1B overexpression resulted in cells to migrate slower at 24h post-transfection but proliferate significantly faster after 72-96h post-transfection. In addition, CTAG1B was more frequently expressed in advanced bladder cancer stages and grades. The findings from this study contribute to the current knowledge of CTAG1B‟s role in tumourigenesis. Further functional studies will contribute towards realising the potential of CTAG1B as a biomarker for predicting the risk of progression and recurrence of bladder cancer

Cancer Cell Invasion Is Enhanced by Applied Mechanical Stimulation

Metastatic cells migrate from the site of the primary tumor, through the stroma, into the blood and lymphatic vessels, finally colonizing various other tissues to form secondary tumors. Numerous studies have been done to identify the stimuli that drive the metastatic cascade. This has led to the identification of multiple biochemical signals that promote metastasis. However, information on the role of mechanical factors in cancer metastasis has been limited to the affect of compliance. Interestingly, the tumor microenvironment is rich in many cell types including highly contractile cells that are responsible for extensive remodeling and production of the dense extracellular matrix surrounding the cancerous tissue. We hypothesize that the mechanical forces produced by remodeling activities of cells in the tumor microenvironment contribute to the invasion efficiency of metastatic cells. We have discovered a significant difference in the extent of invasion in mechanically stimulated verses non-stimulated cell culture environments. Furthermore, this mechanically enhanced invasion is dependent upon substrate protein composition, and influenced by topography. Finally, we have found that the protein cofilin is needed to sense the mechanical stimuli that enhances invasion. We conclude that other types of mechanical signals in the tumor microenvironment, besides the rigidity, can enhance the invasive abilities of cancer cells in vitro. We further propose that in vivo, non-cancerous cells located within the tumor micro-environment may be capable of providing the necessary mechanical stimulus during the remodeling of the extracellular matrix surrounding the tumor

Phylogeographical analysis of the dominant multidrug-resistant H58 clade of Salmonella Typhi identifies inter- and intracontinental transmission events.

The emergence of multidrug-resistant (MDR) typhoid is a major global health threat affecting many countries where the disease is endemic. Here whole-genome sequence analysis of 1,832 Salmonella enterica serovar Typhi (S. Typhi) identifies a single dominant MDR lineage, H58, that has emerged and spread throughout Asia and Africa over the last 30 years. Our analysis identifies numerous transmissions of H58, including multiple transfers from Asia to Africa and an ongoing, unrecognized MDR epidemic within Africa itself. Notably, our analysis indicates that H58 lineages are displacing antibiotic-sensitive isolates, transforming the global population structure of this pathogen. H58 isolates can harbor a complex MDR element residing either on transmissible IncHI1 plasmids or within multiple chromosomal integration sites. We also identify new mutations that define the H58 lineage. This phylogeographical analysis provides a framework to facilitate global management of MDR typhoid and is applicable to similar MDR lineages emerging in other bacterial species