Studi Penilaian Klinis Penggunaan Antibiotik pada Pasien Penyakit Ginjal Kronis

A 6-week longitudinal prospective study was conducted to assess the effectiveness and the safety antibiotic used in chronic kidney disease (CKD) patients in internal medicine ward. We compared white blood count and glomerular fi ltration rate before and after antibiotic used. The CKD patients who admitted in the internal medicine ward and age ≥18 years old were included this study. Patients with incomplete laboratory data and renal replacement therapy were excluded in this study. The 25 patients who enrolled in this study were recruited. The majority gender of CKD was male (64%), the mean of age was 61.52±14.17 years old with length of stay (LOS) was 6.92±4.05 days. The highest number of patients was in CKD stage 3 (n=10, 40%) and was followed by CKD stage 2 (n=6, 24%). Most of them were diagnosed community acquired pneumonia. Tablet azithromycin (n=16, 64%) then Cefotaxime intra venous injection (IV) (n= 6, 24%), and Ceftazidime IV (n=5, 20%), Cloxacillin IV (n=4, 16%) were the most antibiotics prescribed. Generally patients had been prescribed appropriate dose of antibiotic and 88% of them showed improved white blood count. In contrast, the glomerular fi ltration rate of 44% CKD patients was getting worse. In conclusion, this study clearly indicate the CKD patients require close monitoring to maintenance of renal function even the antibiotic had been prescribed appropriately.Sebuah studi prospektif longitudinal 6 minggu dilakukan untuk menilai efektivitas dan antibiotik keamanan yang digunakan pada pasien penyakit ginjal kronis (CKD) di bangsal pengobatan internal. Kami membandingkan jumlah darah putih dan tingkat fi ltrasi glomerulus sebelum dan sesudah antibiotik digunakan. Pasien CKD yang dirawat di bangsal penyakit dalam dan usia ≥18 tahun dimasukkan dalam penelitian ini. Pasien dengan data laboratorium yang tidak lengkap dan terapi penggantian ginjal dikeluarkan dalam penelitian ini. 25 pasien yang terdaftar dalam penelitian ini direkrut. Jenis kelamin mayoritas CKD adalah laki-laki (64%), rata-rata usia adalah 61,52 ± 14,17 tahun dengan lamanya tinggal (LOS) adalah 6,92 ± 4,05 hari. Jumlah pasien terbanyak adalah pada CKD stadium 3 (n = 10, 40%) dan diikuti oleh CKD tahap 2 (n = 6, 24%). Sebagian besar dari mereka didiagnosis menderita radang paru-paru. Tablet azitromisin (n = 16, 64%) kemudian Cefotaxime injeksi intra vena (IV) (n = 6, 24%), dan Ceftazidime IV (n = 5, 20%), Cloxacillin IV (n = 4, 16%) adalah antibiotik yang paling diresepkan. Umumnya pasien telah diberi dosis antibiotik yang tepat dan 88% dari mereka menunjukkan peningkatan jumlah darah putih. Sebaliknya, tingkat fi ltrasi glomerulus dari 44% pasien CKD semakin buruk. Kesimpulannya, penelitian ini jelas menunjukkan pasien CKD memerlukan pemantauan ketat terhadap pemeliharaan fungsi ginjal bahkan antibiotik telah diresepkan dengan tepat

Clinical evaluation of Dyslipidemia among type II diabetic patients at Public hospital Penang, Malaysia

<p>Abstract</p> <p>Background</p> <p>Global views emphasize the need for early; effective intervention against the atherogenic dyslipidemia associated with type 2 diabetes and metabolic syndrome to reduce the risk of premature cardiovascular diseases. Our aim was to determine the clinical practices and compliance among dyslipidemia with type II diabetes and hypertension in multiracial society.</p> <p>Method(s)</p> <p>Study was carried out in out-patient department of General hospital Penang over a period of ten months (Jan - Oct 2008). Study reflects the retrospective data collection covering a period of three years from Jan 2005 - Dec 2007. Universal sampling technique was used to select all the patients' undergone treatment for diabetes type II and dyslipidemia. All the concerned approvals were obtained from Clinical research Committee (CRC). Data was analyzed by using SPSS 15^®.</p> <p>Result(s)</p> <p>A total of 501 diabetes type 2 patients with dyslipidemia were identified in this study. The demographic data showed that 55.9% (n = 280) were female patients and 44.1% (n = 221) were males. Patients on combination therapy of metformin with other antidiabetic agent were 79%, while 21% were on monotherapy. Lovastatin was received as monotherapy in 83% of study population, while only 17% were on combination with gemfibrozil. Means of FPG and lipid profile were reduced from the initial (2005) to the latest level (2007) significantly (p < 0.001). Only 0.89% decrease in mean weight with S.D 13.1 as compared to initial S.D 12.8 after three years of Cohort. While in description 35.2% representatives gain weight with majority of males (71.5%), 52.3% with weight loss of 1-3 pounds majority (69.3%) with female respondents and rest 12.4% remains with same weight with mix gender distribution.</p> <p>Conclusion</p> <p>Metformin and lovastatin use among patients of type 2 diabetes and dyslipidemia is significantly improved the clinical outcomes. No significant association of metformin or lovastatin is found against the hypertension. Metformin and calcium channel blocker combination therapy was found to be the best choice in the co-treatment of diabetes and hypertension.</p

Differential effects of hepatic cirrhosis on the intrinsic clearances of sorafenib and imatinib by CYPs in human liver

© 2017 Elsevier B.V. The tyrosine kinase inhibitors sorafenib and imatinib are important in the treatment of a range of cancers but adverse effects in some patients necessitate dosage modifications. CYP3A4 has a major role in the oxidation of sorafenib to its N-oxide and N-hydroxymethyl metabolites and also acts in concert with CYP2C8 to mediate imatinib N-demethylation. CYP3A4 expression and function are impaired in patients with advanced liver disease, whereas the functions of CYP2C enzymes are relatively preserved. We evaluated the biotransformation of sorafenib and imatinib in well-characterized microsomal fractions from 17 control subjects and 19 individuals with hepatic cirrhosis of varying severity. The principal findings were that liver disease impaired the microsomal oxidation of sorafenib to its major metabolites to 40–44% of control (P < 0.01), whereas the N-demethylation of imatinib was relatively unimpaired. The impairments in sorafenib biotransformation were correlated with decreased serum albumin concentrations and increased serum bilirubin concentrations in patients with liver disease, but not with the overall grade of liver disease according to the Child-Pugh system. In contrast, there was no relationship between imatinib N-demethylation and clinicopathologic factors in liver disease patients. These findings were accounted for in terms of the differential roles of CYPs 3A4 and 2C8 in the intrinsic clearance of the drugs. CYP3A4 has the major role in the intrinsic clearance of sorafenib but plays a secondary role to CYP2C8 in the intrinsic clearance of imatinib. In agreement with these findings CYP2C protein expression and CYP2C8-mediated paclitaxel 6α-hydroxylation were unimpaired in cirrhotic livers. This information could be adapted in individualized approaches such as in vivo CYP3A4 phenotyping to optimize sorafenib safety and efficacy in cancer patients with liver dysfunction

Prevalence and patterns of physical activity among school aged adolescents in Pakistan: A systematic review and meta-analysis

Less than one fifth of Pakistani adolescents, aged 13–15, years achieve recommended activity levels. This systematic review and meta-analysis was conducted to determine a pooled estimate of the prevalence of PA, and to systematically evaluate the literature available on PA among adolescents in Pakistan. A systemic search of databases was conducted. In addition, hand search of references of all the included relevant publications was performed. Random effects meta-analysis was used to get weighted prevalence of PA among adolescents. Quality of undertaken studies was assessed using New-Castle Ottawa Scale. After removing duplicates, reviewing titles and abstracts and screening full texts, 15 articles were included for analysis. All studies were conducted in school setting, with a total sample size of 10,651. Weighted pooled prevalence of PA among adolescents was 36.0% with high heterogeneity (99.28%). Most of the studies met study quality assessment criteria except for comparability of subjects in different outcome groups and assessment of outcome. Prevalence of PA among adolescents is low in Pakistan. Formal strategies are needed for promoting PA among adolescents for their improved health and for reducing future burden of NCDs

Serological Prediction of infections in Diabetic Patients with Diabetes Ketoacidosis in Penang, Malaysia

Purpose: To determine the prevalence and predictors of infection in diabetic patients with diabetic ketoacidosis (DKA) who were .18 years.Methods: A retrospective cohort design was adopted for this study. A total of 967 diabetes ketoacidosis patients from Hospital Pulau Pinang for the 3-year period, Jan 2008 - Dec 2010, were identified and enrolled. The data were analysed, as appropriate, by Student t-test and ANOVA for the normally distributed data, Mann-Whitney U rank sum and Kruskall-Wallis tests for continuous, non-nominal data and Chi-square for dichotomous variables. Odd Ratios with 95% confidence interval (CI) were alsopresented where applicable.Results: Of the total diabetes ketoacidosis patients, 112 (11.6 %) were cases without infection, 679 (70.2 %) bacterial infection cases and 176 (18.2 %) presumed viral infection cases. The mean white blood count (WBC) for all the patients was 18,177 } 9,431 while 721 (74.6 %) had leukocytosis, defined by WBC . 15,000/mm3. WBC differential, leukocytosis, as well as sex and body temperature were not significant predictors (p &gt;.05) of bacterial infection. There was, however, a significant difference (p &lt;.05) in terms of age within groups, as those &gt; 57 years showed a higher rate of infection.Conclusion: The infection rate in elderly patients with DKA is high and a majority of them lack clinical evidence. Age has a significant effect on the rate and prediction of infection. Leukocytosis is commonly found but severe ketoacidosis was more likely than the presence of infection.Keywords: Diabetes mellitus, Diabetes ketoacidosis, Infections, Predictors, White blood cell

Hawking radiation of scalar particles from accelerating and rotating black holes

Hawking radiation of uncharged and charged scalars from accelerating and rotating black holes is studied. We calculate the tunneling probabilities of these particles from the rotation and acceleration horizons of these black holes. Using the tunneling method we recover the correct Hawking temperature as well

Societal preferences for gender of surgeons: A cross-sectional study in the general population of Pakistan

Background: Sociocultural norms and gender biases may result in surgeon gender preferences among the general public. This study aimed to understand preferences and perceptions related to surgeon gender among the general population in Pakistan, a lower-middle-income country.Methods: A cross-sectional study was conducted by the Aga Khan University, Karachi, among the adult general population in Pakistan. Sequential mixed-mode data collection was performed via online dissemination on social media platforms and in-person surveying at different geographic locations in Karachi.Results: Among 1604 respondents, 50% did not report having surgeon gender preferences in general. Among respondents with gender preferences, there was a highly significant preference for gender concordance across all surgical subspecialties (p Conclusion: While around half of respondents do not have gender preferences, a significant proportion prefers a gender concordant surgeon across subspecialties. In a society where conservative sociocultural norms play a significant role when seeking health care, this makes yet another compelling argument for gender parity in surgery

Heading Home? Reshoring and Sustainability Connectedness from a Home‐Country Consumer Perspective

Abstract: Extensive globalisation has presented several sustainability challenges highlighted in the United Nation's Sustainable Development Goals. These include the environmental impact of global product procurement and manufacturing and the irregular treatment of indigenous workers in developing countries. Thus, reshoring, defined as a firm's voluntary strategy to partially or totally relocate production to the home country, is gaining traction. However, most research on reshoring focuses on firms, leaving the consumers’ perspective under‐researched. Here, we examine British consumers’ perspectives on reshoring to the UK and sustainability. By employing the theoretical lens of connectedness, anchored in attachment theory, we conducted 30 in‐depth interviews using projective techniques and analysed the data using the constant comparison method. We found that consumers not only positively viewed their connectedness with the concept of reshoring from a sustainability perspective, but also appraised it from a global perspective, demonstrating empathy towards the host country. Further, they doubted corporations’ motives regarding reshoring. Three theoretical dimensions emerged based on consumers’ connectedness with reshoring and sustainability, specifically, supporting reshoring conditionally, inclusive reshoring, and doubting reshoring