Editorial Letter

Editorial Lette

Cost-Effectiveness of Clinical Pharmacy Education on Infection Management among Patients with Chronic Kidney Disease in an Indonesian Hospital

AbstractObjectivesThis study evaluated the clinical and economic impacts of clinical pharmacy education (CPE) on infection management among patients with chronic kidney disease (CKD) stages 4 and 5 in Haji Adam Malik Hospital, Indonesia.MethodsA quasi-experimental economic evaluation comparing CPE impact on 6-month CKD mortality was conducted on the basis of payer perspective. The experimental group (n = 63) received care by health care providers who were given CPE on drug-related problems and dose adjustment. The control group (n = 80) was based on the historical cohort of patients who received care before the CPE. Measure of clinical outcome applied in this study was number of lives saved/100 patients treated. Cost-effectiveness ratios for CKD stages 4 and 5 patients without CPE and with CPE and incremental cost-effectiveness ratios (ICERs) for CKD stages 4 and 5 patients were analyzed.ResultsLives saved (%) in the treatment of CKD without CPE: CKD stage 4, 78.57; CKD stage 5, 57.58. Lives saved (%) in the treatment of CKD with CPE: CKD stage 4, 88.89; CKD stage 5, 65.45. Cost-effectiveness ratios for stage 4 with and without CPEs were Rp3,348,733.27 and Rp3,519,931.009, respectively. Cost-effectiveness ratios for stage 5 with and without CPEs were Rp7,137,874.93 and Rp7,871,822.27, respectively. ICERs were Rp2,045,341.22 for CKD stage 4 and Rp1,767,585.60 for CKD stage 5.ConclusionsTreatment of CKD stages 4 and 5 with CPE was more effective and cost-effective compared with treatment of CKD stages 4 and 5 without CPE. The ICERs indicated that extra costs were required to increase life saved in both stages

Post-menopausal acquired diaphragmatic herniation in the context of endometriosis

Introduction: Acquired diaphragmatic hernias are most commonly associated with traumatic thoracic injury and rarely heal spontaneously. Conditions that promote peritoneal seeding, such as endometriosis, are associated with spontaneous acquired diaphragmatic hernia formation. Non-traumatic acquired diaphragmatic herniation has previously been described in the context of catamenial pneumothorax, however post-menopausal endometriotic diaphragmatic herniation has not been previously reported. Presentation of case: A 57 year old post-menopausal female presented with a strangulated ischaemic loop of small bowel herniating through an acquired right sided endometriotic diaphragmatic hernia not previously visualised on imaging. Clamshell thoracolaparotomy was conducted and the necrotic section of small bowel was resected. The diaphragm was repaired and the patient recovered post-operatively without complications. Discussion: This patient had a complete intestinal malrotation presenting acutely with a small bowel obstruction and herniation through an acquired diaphragmatic rupture. This was possibly related to a diaphragmatic defect caused by endometriosis. Conclusion: We presented a case of a post-menopausal acquired diaphragmatic herniation secondary to endometriosis; resulting in acute intestinal obstruction and bowel infarction. To our knowledge, such a case has not been previously reported in existing literature

Molecular docking studies of curcumin derivatives with multiple protein targets for procarcinogen activating enzyme inhibition

Curcumin derivatives which are very potent antioxidant, free radical scavenger and known inhibitor of dioxygenases have been extensively studied to explore their potential utilization in chemoprevention. The main objective of the present work is to perform a docking analysis of curcumin derivatives: Tetrahydrocurcumin (THC), Bisdemethoxy curcumin (BDC). Docking studies of these were performed using GOLD and AutoDock into a few well validated targets of anticancer therapy (COX-2, PhenolsulphoTransferases, Matrix metalloproteinases (MMPs), P450 and TNF-alpha). A good correlation was observed in binding affinity of THC and BDC against the targets indicating these derivatives are potent procarcinogen activating enzyme inhibitors. © 2010 Girija CR, et al

Wound healing properties of Eucheuma cottonii extracts in Sprague-Dawley rats.

Wounds are unavoidable events of life and arise due to agents that induce stress or injury. Wound has been a menace the world over and healing is a survival mechanism and represents an adaptation to the maintenance of normal anatomical structure and function. The objective of this study was to evaluate the potential wound healing properties of ethanolic and aqueous extracts of Eucheuma cottonii. A two centimeter diameter of skin excision wound was made on normal rats. Treatment with honey (100 mg/kg body weight) was used as positive control and untreated rats as the negative control groups. Inflammation and proliferation phases of wound healing including wound contraction, re-epithelization and granulation tissue development were monitored. This study showed that both seaweed extracts increased the rate of wound contraction compared with the positive and negative control. Ethanolic extract of E. cottonii was more effective than the aqueous extract by 20% (P<0.05). Histopathological findings showed the ethanolic extracts enhanced epithelization and tissue granulation significantly compared with both control groups. E. cottonii possesses several antioxidant compounds, which may be responsible for the accelerated wound healing. The present study demonstrated that these seaweed extracts accelerated healing better if not comparable with honey

Stem Cell Organoids in Primary Cultures of Human Non-Malignant and Malignant Colon

YesA sub-population of cells named cancer stem cells (CSCs) that initiate and promote tumour growth have been demonstrated to exist in several malignancies including colon carcinoma. The objective of our pilot study was to isolate CD133+CD26+CD44+ CSCs from patient colon tumours, culture spheres or organoids and observe their proliferation in primary cultures. Parallel cultures of non-cancer controls from colon normal lining and nonadenomatous polyps were set up. Magnetic activated cell sorting was used to isolate CD133+CD26+CD44+ cell populations followed by primary cell culturing under stem cell culture conditions. Number, cells/organoid and daughter generations of organoids were calculated using phase contrast microscope. Trypan blue exclusion method was used to test the viability of the cells. Both colon tumour and colon non-adenomatous polyp formed floating organoids in suspension; however non-adenomatous polyp cultures did not show self-renewal properties for more than 1 passage. Normal colon singlecell suspension did not create organoids. Metastatic colon tumours rapidly produce cancer cell organoids in less than 24 hours in larger numbers compared to non-metastatic colon tumours (1-3 weeks). Metastatic colon tumour organoids have the ability for proliferation for upto five daughter generations in primary culture compared to three generations for those grown from non-metastatic tumours. This in vitro CSC organoid model will help study colon cancer biology, in particular providing a valuable source of primary cell-derived tissue for studying personalized molecular profiling using ‘omics strategies to direct therapeutic intervention

Incremental and Scalable Computation of Dynamic Topography Information Landscapes

Dynamic topography information landscapes are capable of visualizing longitudinal changes in large document repositories. Resembling tectonic processes in the natural world, dynamic rendering reflects both long-term trends and short-term fluctuations in such repositories. To visualize the rise and decay of topics, the mapping algorithm elevates and lowers related sets of concentric contour lines. Acknowledging the growing number of documents to be processed by state-of-the-art Web intelligence applications, we present a scalable, incremental approach for generating such landscapes. The processing pipeline includes a number of sequential tasks, from crawling, filtering and pre-processing Web content to projecting, labeling and rendering the aggregated information. Processing steps central to incremental processing are found in the projection stage which consists of document clustering, cluster force-directed placement, and fast document positioning. We introduce two different positioning methods and compare them in an incremental setting using two different quality measures. The evaluation is performed on a set of approximately 5000 documents taken from the environmental blog sample of the Media Watch on Climate Change (www.ecoresearch.net/climate), a Web content aggregator about climate change and related environmental issues that serves static versions of the information landscapes presented in this paper as part of a multiple coordinated view representation

Synthesis of 2-{[5-(aralkyl/aryl)-1,3,4-oxadiazol-2- yl]sulfanyl}-N-(4-methyl-1,3-thiazol-2-yl)acetamides: Novel bi-heterocycles as potential therapeutic agents

Purpose: To evaluate the therapeutic potential of new bi-heterocycles  containing a 1,3-thiazole and 1,3,4-oxadiazole in the skeleton against Alzheimer's disease and diabetes, supported by in-silico study. Methods: The synthesis was initiated by the reaction of 4-methyl- 1,3-thiazol-2-amine (1) with bromoacetyl bromide (2) in aqueous basic medium to obtain an electrophile,2-bromo-N-(4-methyl-1,3- thiazol- 2-yl)acetamide (3). In parallel reactions, a series of carboxylic acids, 4a-r, were converted through a sequence of three steps, into respective 1,3,4-oxadiazole heterocyclic cores, 7a-r, to utilize as nucleophiles. Finally, the designed molecules, 8a-r, were synthesized by coupling 7a-r individually with 3 in an aprotic polar solvent. The structures of these bi-heterocycles were elucidated by infrared (IR), electron ionization-mass spectrometry (EI-MS), proton nuclear magnetic resonance (1H-NMR) and carbon nuclear magnetic resonance (13C-NMR). To evaluate their enzyme inhibitory potential, 8a-r were screened against acetylcholinesterase (AChE), but brine shrimp lethality bioassay.Results: The most active compound against AChE was 8l with half-maximal inhibitory concentration (IC50) of 17.25 ± 0.07 μM. Against BChE, the highest inhibitory effect was shown by 8k (56.23 ± 0.09 μM). Compound 8f (161.26 ± 0.23μM) was recognized as a fairly good inhibitor of urease. In view of its inhibition of α-glucosidase, 8o (57.35 ± 0.17μM) was considered a potential therapeutic agent.Conclusion: The results indicate that some of the synthesized products with low toxicity exhibit notable enzyme inhibitory activity against selected enzymes compared with the reference drug, and therefore, are of potential therapeutic interestKeywords: 4-Methyl-1,3-thiazol-2-amine,1,3,4-Oxadiazole,  Cholinesterases, α-Glucosidase, Urease, Brine shrim

Dynamic Topography Information Landscapes – An Incremental Approach to Visual Knowledge Discovery

Incrementally computed information landscapes are an effective means to visualize longitudinal changes in large document repositories. Resembling tectonic processes in the natural world, dynamic rendering reflects both long-term trends and short-term fluctuations in such repositories. To visualize the rise and decay of topics, the mapping algorithm elevates and lowers related sets of concentric contour lines. Addressing the growing number of documents to be processed by state-of-the-art knowledge discovery applications, we introduce an incremental, scalable approach for generating such landscapes. The processing pipeline includes a number of sequential tasks, from crawling, filtering and pre-processing Web content to projecting, labeling and rendering the aggregated information. Incremental processing steps are localized in the projection stage consisting of document clustering, cluster force-directed placement and fast document positioning. We evaluate the proposed framework by contrasting layout qualities of incremental versus non-incremental versions. Documents for the experiments stem from the blog sample of the Media Watch on Climate Change (www.ecoresearch.net/climate). Experimental results indicate that our incremental computation approach is capable of accurately generating dynamic information landscapes