The authors report a case of a 73-year-old male evaluated for profuse watery diarrhea and weight loss for 2 months, aggravated the week before. His past medical history was relevant for ileal Crohn's disease diagnosed at the age of 34 years, with two segmental enterectomies due to ileal stenosis and enterocutaneous fistula. The histopathological exam of the resected bowel showed transmural lymphoplasmocytic infiltrate with deep ulceration and non-caseating granulomas. Due to penetrating phenotype, immunomodulatory therapy was proposed but the patient refused.
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Τετάρτη 27 Ιουλίου 2016
Collagenous colitis and Crohn's disease: Guilty or innocent bystander?
HCV novel therapeutic regimens in Wonderland: A budget impact analysis in the Lombardy Region
The advent of new HCV drugs has generated widespread economic concerns, particularly within the Italian setting, characterized by continuous linear cuts and spending review actions. The overall trade-off between investments and savings needs an in depth analysis.
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Effectiveness of Endoscopic Ultrasonography during Double Balloon Enteroscopy for characterization and management of small bowel submucosal tumours
Characterization of small bowel submucosal tumours is challenging, requiring additional investigations. Endoscopic Ultrasonography performed during Double Balloon Enteroscopy, appeared a promising technique although it has not been fully evaluated. The aim was to determine the effectiveness of this technique for characterization and management of sub mucosal tumours in a large cohort of patients.
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An increase in serum tumour necrosis factor-α during anti-tumour necrosis factor-α therapy for Crohn's disease – A paradox or a predictive index?
Soluble tumour necrosis factor-α (sTNF-α) has been reported to increase in the course of anti-TNF-α therapy for rheumatoid and skin diseases.
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Patient satisfaction in the management of mild-to-moderate ulcerative colitis: Results of a Delphi study among patients and physicians
To determine factors contributing to satisfaction with treatment in mild-to-moderate ulcerative colitis (UC) from both the patients and the physicians perspectives.
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Collagenous colitis and Crohn's disease: Guilty or innocent bystander?
The authors report a case of a 73-year-old male evaluated for profuse watery diarrhea and weight loss for 2 months, aggravated the week before. His past medical history was relevant for ileal Crohn's disease diagnosed at the age of 34 years, with two segmental enterectomies due to ileal stenosis and enterocutaneous fistula. The histopathological exam of the resected bowel showed transmural lymphoplasmocytic infiltrate with deep ulceration and non-caseating granulomas. Due to penetrating phenotype, immunomodulatory therapy was proposed but the patient refused.
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HCV novel therapeutic regimens in Wonderland: A budget impact analysis in the Lombardy Region
The advent of new HCV drugs has generated widespread economic concerns, particularly within the Italian setting, characterized by continuous linear cuts and spending review actions. The overall trade-off between investments and savings needs an in depth analysis.
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Effectiveness of Endoscopic Ultrasonography during Double Balloon Enteroscopy for characterization and management of small bowel submucosal tumours
Characterization of small bowel submucosal tumours is challenging, requiring additional investigations. Endoscopic Ultrasonography performed during Double Balloon Enteroscopy, appeared a promising technique although it has not been fully evaluated. The aim was to determine the effectiveness of this technique for characterization and management of sub mucosal tumours in a large cohort of patients.
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An increase in serum tumour necrosis factor-α during anti-tumour necrosis factor-α therapy for Crohn's disease – A paradox or a predictive index?
Soluble tumour necrosis factor-α (sTNF-α) has been reported to increase in the course of anti-TNF-α therapy for rheumatoid and skin diseases.
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FN400 and LPC memory effects for concrete and abstract words
Abstract
According to dual-process models, recognition memory depends on two neurocognitive mechanisms: familiarity, which has been linked to the frontal N400 (FN400) effect in studies using ERPs, and recollection, which is reflected by changes in the late positive complex (LPC). Recently, there has been some debate over the relationship between FN400 familiarity effects and N400 semantic effects. According to one view, these effects are one and the same. Proponents of this view have suggested that the frontal distribution of the FN400 could be due to stimulus concreteness: recognition memory experiments commonly use highly imageable or concrete words (or pictures), which elicit semantic ERPs with a frontal distribution. In the present study, we tested this claim using a recognition memory paradigm in which subjects memorized concrete and abstract nouns; half of the words changed font color between study and test. FN400 and LPC old/new effects were observed for abstract as well as concrete words, and were stronger over right hemisphere electrodes for concrete words. However, there was no difference in anteriority of the FN400 effect for the two word types. These findings challenge the notion that the frontal distribution of the FN400 old/new effect is fully explained by stimulus concreteness.
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Survival benefit of additional surgery after non-curative endoscopic resection in patients with early gastric cancer
Gastrointestinal Endoscopy
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Human intersegmental reflexes from intercostal afferents to scalene muscles
Short-latency intersegmental reflexes have been described for various respiratory muscles in animals. However, in humans, only short-latency reflex responses to phrenic nerve stimulation have been described. Here, we examined the reflex connections between intercostal afferents and scalene muscles in humans. Surface electromyographic recordings (EMG) were made from scalene muscles bilaterally, in 7 able-bodied participants and 7 participants with motor- and sensory- complete cervical spinal cord injury (median 32 years post injury, range 5 months to 44 years). We recorded the reflex responses produced by stimulation of the 8 th or 10 th left intercostal nerve. A short-latency (∼38 ms) inhibitory reflex was evident in able-bodied participants, in ipsilateral and contralateral scalene muscles. This bilateral intersegmental inhibitory reflex occurred in 46% of recordings at low stimulus intensities (at 3 times motor threshold). It was more frequent (in 75 - 85% of recordings) at higher stimulus intensities (6 and 9 times motor threshold) but onset latency (38 ± 9 ms, mean ± SD) and the size of inhibition (23 ± 10%) did not change with stimulus intensity. The reflex was absent in all participants with spinal cord injury. As the intercostal-to-scalene reflex did not increase with larger stimulus intensities, it is likely mediated by large-diameter intercostal muscle afferents. This is the first demonstration of an intercostal-to-scalene reflex. As the reflex requires intact spinal connections it may be a useful marker for recovery of thoracic or cervical spinal injury.
This article is protected by copyright. All rights reserved
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Improved multi-stage neonatal seizure detection using a heuristic classifier and a data-driven post-processor
Source:Clinical Neurophysiology, Volume 127, Issue 9
Author(s): A.H. Ansari, P.J. Cherian, A. Dereymaeker, V. Matic, K. Jansen, L. De Wispelaere, C. Dielman, J. Vervisch, R.M. Swarte, P. Govaert, G. Naulaers, M. De Vos, S. Van Huffel
ObjectiveAfter identifying the most seizure-relevant characteristics by a previously developed heuristic classifier, a data-driven post-processor using a novel set of features is applied to improve the performance.MethodsThe main characteristics of the outputs of the heuristic algorithm are extracted by five sets of features including synchronization, evolution, retention, segment, and signal features. Then, a support vector machine and a decision making layer remove the falsely detected segments.ResultsFour datasets including 71 neonates (1023h, 3493 seizures) recorded in two different university hospitals, are used to train and test the algorithm without removing the dubious seizures. The heuristic method resulted in a false alarm rate of 3.81 per hour and good detection rate of 88% on the entire test databases. The post-processor, effectively reduces the false alarm rate by 34% while the good detection rate decreases by 2%.ConclusionThis post-processing technique improves the performance of the heuristic algorithm. The structure of this post-processor is generic, improves our understanding of the core visually determined EEG features of neonatal seizures and is applicable for other neonatal seizure detectors.SignificanceThe post-processor significantly decreases the false alarm rate at the expense of a small reduction of the good detection rate.
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Characteristics of daily life gait in fall and non fall-prone stroke survivors and controls
Falls in stroke survivors can lead to serious injuries and medical costs. Fall risk in older adults can be predicted based on gait characteristics measured in daily life. Given the different gait patterns that...
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Effects of chronic neck–shoulder pain on normalized mutual information analysis of surface electromyography during functional tasks
Source:Clinical Neurophysiology, Volume 127, Issue 9
Author(s): Pascal Madeleine, Yanfei Xie, Grace P.Y. Szeto, Afshin Samani
ObjectiveTo investigate the effects neck–shoulder pain on the connectivity of surface electromyography (SEMG) signals during functional tasks.MethodsTwenty adults suffering from chronic neck–shoulder pain and 20 healthy controls were recruited. The SEMG signals from the left and right proximal cervical erector spinae, upper trapezius, lower trapezius and distal extensor carpi radialis, extensor digitorum, flexor digitorum superficialis and, abductor pollicis brevis were recorded during three functional tasks: unilateral and bilateral texting on a smart-phone and computer typing. Normalized mutual information (NMI) values were computed between homonymous proximal and distal muscle pairs as an index of the functional connectivity between muscles pairs.ResultsNMI among homonymous muscles pairs as well as among proximal and distal muscles pairs were lower among cases compared with controls. Moreover, NMI values in homonymous proximal muscles were higher during texting compared with computer typing with both hands.ConclusionsOur results show for the first time that chronic neck–shoulder pain affects the functional connectivity of muscle pairs.SignificanceThe study furnishes novel information about the effects of chronic neck–shoulder pain on the interplay of muscle pairs during functional tasks.
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What is the optimal task difficulty for reinforcement learning of brain self-regulation?
Source:Clinical Neurophysiology, Volume 127, Issue 9
Author(s): Robert Bauer, Mathias Vukelić, Alireza Gharabaghi
ObjectiveThe balance between action and reward during neurofeedback may influence reinforcement learning of brain self-regulation.MethodsEleven healthy volunteers participated in three runs of motor imagery-based brain–machine interface feedback where a robot passively opened the hand contingent to β-band modulation. For each run, the β-desynchronization threshold to initiate the hand robot movement increased in difficulty (low, moderate, and demanding). In this context, the incentive to learn was estimated by the change of reward per action, operationalized as the change in reward duration per movement onset.ResultsVariance analysis revealed a significant interaction between threshold difficulty and the relationship between reward duration and number of movement onsets (p<0.001), indicating a negative learning incentive for low difficulty, but a positive learning incentive for moderate and demanding runs. Exploration of different thresholds in the same data set indicated that the learning incentive peaked at higher thresholds than the threshold which resulted in maximum classification accuracy.ConclusionSpecificity is more important than sensitivity of neurofeedback for reinforcement learning of brain self-regulation.SignificanceLearning efficiency requires adequate challenge by neurofeedback interventions.
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Reversed cortical over-activity during movement imagination following neurofeedback treatment for central neuropathic pain
Source:Clinical Neurophysiology, Volume 127, Issue 9
Author(s): Muhammad Abul Hasan, Matthew Fraser, Bernard A. Conway, David B. Allan, Aleksandra Vučković
ObjectiveOne of the brain signatures of the central neuropathic pain (CNP) is the theta band over-activity of wider cortical structures, during imagination of movement. The objective of the study was to investigate whether this over-activity is reversible following the neurofeedback treatment of CNP.MethodsFive paraplegic patients with pain in their legs underwent from twenty to forty neurofeedback sessions that significantly reduced their pain. In order to assess their dynamic cortical activity they were asked to imagine movements of all limbs a week before the first and a week after the last neurofeedback session. Using time–frequency analysis we compared EEG activity during imagination of movement before and after the therapy and further compared it with EEG signals of ten paraplegic patients with no pain and a control group of ten able-bodied people.ResultsNeurofeedback treatment resulted in reduced CNP and a wide spread reduction of cortical activity during imagination of movement. The reduction was significant in the alpha and beta band but was largest in the theta band. As a result cortical activity became similar to the activity of other two groups with no pain.ConclusionsReduction of CNP is accompanied by reduced cortical over-activity during movement imagination.SignificanceUnderstanding causes and consequences mechanism through which CNP affects cortical activity.
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3 ways to teach capnography with active learning
Add electronic response devices and video to lectures and train with simulation to keep learners engaged, stimulate discussion and apply content
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A prospective study of the pattern of non-antimicrobial drug use in neonatal intensive care management in a tertiary care hospital
2016-07-27T03-15-55Z
Source: International Journal of Basic & Clinical Pharmacology
Anitha P., Pundarikaksha H. P., Yashoda H. T..
Background: Neonatal intensive care management (NICM) may be required for high risk or critically ill neonates for survival or stabilization. NICM involves the use of different classes of drugs, and the pattern of use mainly determined by the prevailing clinical conditions and complications, and the desired therapeutic objectives. The objective of this study was to study the pattern of drug use in NICM, criteria for drug selection and dose individualization, to assess the efficacy and safety of medications and record drug interactions. Methods: The pattern of drug use was assessed prospectively in 150 consecutive subjects admitted to NICU. The number of drugs used, therapeutic class, dose, route, frequency and duration of administration, criteria for selection were recorded. The efficacy and safety of the medications was assessed by the treatment outcome and by observing for any adverse events or drug interactions. Results: Different therapeutic classes of drugs were used as per the prevailing clinical conditions or complications. The total number of drugs used was 23. Different classes of drugs were used for specific indications. The treatment outcome was very good in most of the subjects and no drug related adverse events or interactions were observed. Conclusions: Most of the problems and complications in high risk and critically ill neonates can be prevented or controlled by judicious use of several classes of drugs, properly chosen and individualised to the given situation, without producing serious adverse events and interactions. Drugs play an important role in improving the outcome.
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Effect of tylophora asthmatica on hepatotoxicity induced by antitubercular drugs in albino rats
2016-07-27T03-15-55Z
Source: International Journal of Basic & Clinical Pharmacology
Ajay R. Chandrakapure, Vijay M. Motghare, Sudhir L. Padwal, Avinash V. Turankar, Vinod S. Deshmukh.
Background: The burden of metabolism and exposure to dangerous chemicals make liver vulnerable to variety of disorders like acute or chronic inflammation, toxin/ drug related hepatitis or cirrhosis. Tuberculosis is a common problem in India and worldwide. Drug induced liver injury (DILI) is a problem of increasing significance, but has been a long standing concern in treatment of tuberculous (TB) infection. Several studies have revealed that, tylophora asthmatica (Burnf.) Merill. (Family: asclepidaceae) commonly known as antmul possess hepatoprotective property. There is less scientific work regarding the effect of Tylophora asthmatica on hepatotoxicity induced by antitubercular drugs, hence the present study was carried out with the aim of evaluating the effect of tylophora asthmatica on antitubercular drug induced hepatotoxicity in albino rats. Methods: Total 24 Albino rats weighing about 150-200 grams were divided in four groups, 6 animals in each group. In the study, antitubercular drugs: INH (50 mg/kg) and rifampicin (50 mg/kg), test drug: aqueous extract of tylophora asthmatica doses (200 mg/kg and 300 mg/kg) were used. Drugs were given by oral route for 14 days. Biochemical tests for Sr. ALT, AST, bilirubin (total and direct) and histopathological examination of liver was done. Results: Tylophora asthmatica treated group had no significant rise in values of Sr.ALT, AST, bilirubin (total and direct) and also there were no significant histopathological changes in this group, indicating hepatoprotective effect of tylophora asthmatica. Conclusions: It was concluded that tylophora asthmatica has hepatoprotective activity in antitubercular drug induced hepatotoxicity.
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High risk of post-infectious irritable bowel syndrome in patients with Clostridium difficile infection
Alimentary Pharmacology and Therapeutics
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HMGB1 is secreted by 3T3-L1 adipocytes through JNK signaling and the secretion is partially inhibited by adiponectin
Obesity
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Efficacy of alternate day versus daily atorvastatin in reduction of low density lipoprotein cholesterol: a prospective, randomized, open labelled, parallel group study
2016-07-27T03-15-55Z
Source: International Journal of Basic & Clinical Pharmacology
Nishikant Nandlal Mankar, Vijay Ramkrishna Zad, Monali Pradeep Vakharia.
Background: Cardiovascular disease (CVD) is the leading cause of death in India and worldwide. Hypercholesterolemia plays a pivotal role in atherogenesis which gave rise to universally accepted cholesterol diet-CVD hypothesis. Statins are the most potent and commonly used drugs for treating hypercholesterolemia. With atorvastatin, because of the long lasting active metabolites, half-life of HMG-CoA reductase inhibition reaches 20 to 30 hours. Thus, it is conceivable that alternate-day atorvastatin treatment might be effective in maintaining the lipid-lowering efficacy. Methods: In this prospective, randomized, open labelled, parallel group study, 100 participants with serum low density cholesterol (LDL-C) level 100 mg/dL-190 mg/dL were recruited. Group A received 20 mg atorvastatin on alternate day and group B received 20 mg atorvastatin daily for 12 weeks. Follow up visits were scheduled at 6 and 12 weeks at which fasting serum LDL-C, serum TC, serum TG, serum HDL were estimated. Creatinine phosphokinase (CPK), aspartate transaminase (AST) and alanine transaminase (ALT) estimations were also done and participants were examined for occurrence of myalgia, jaundice or any other adverse effect. Results: A statistically significant reduction in LDL-C, TC, and TG was seen in both the groups when compared to baseline. At 12 weeks, the LDL-C reduction in alternate day atorvastatin group was 34.63% whereas in daily atorvastatin group, it was 38.75.The reduction in levels of TC in alternate day and daily atorvastatin group was 24.64% and 25.85% respectively. Both the regimens were well tolerated. Conclusions: The alternate-day dosing of atorvastatin is as efficacious and safe as that of its daily dosing.
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Serum alanine aminotransferase and hepatitis B DNA flares in pregnant and postpartum women with chronic hepatitis B
The American Journal of Gastroenterology
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Anti-dyslipidemic activity of acacia tortilis seed extract in alloxan-induced diabetic rats
2016-07-27T03-15-55Z
Source: International Journal of Basic & Clinical Pharmacology
Neeraj Kumar Agrawal, Suyog Sindhu, Nitin Kothari, Shruti Chandra, Gini Garima, Uma Gupta.
Background: The present study was carried out to evaluate the anti-dyslipidemic activities of seed extract of acacia tortilis (ATE) in alloxan inducd diabetic rats. Methods: The Rats were divided into five groups of six animals each. Groups I and II received normal saline, group III received ATE in dose of 100 mg/kg body weight, group IV received ATE in dose of 200 mg/kg b.w.; and group V received standard drug pioglitazone dose 3 mg/kg b.w. Drugs were administered orally once a day for 30 days. At the end of 0th, 10th, 20th and 30th day, blood was collected to analyse serum glucose, serum insulin, total cholesterol (TC), serum phospholipid (PL), serum triglyceride (TG), Free fatty acids (FFA) and High density lipoprotein (HDL). Results: The results has been showed that ATE in above doses significantly increase the serum insulin and HDL level but significantly decreased the elevated level of TC, PL, TG , FFA, LDL and VLDL. It also decreased the atherogenic index and coronary risk index level significantly which was comparable with the pioglitazone. Conclusions: It is concluded that the seed extract of acacia tortilis at the dose of 100 and 200 mg/kg body weight produced significant anti-dyslipidemic activity in alloxan-induced diabetic rats.
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Obesity is not associated with increased morbidity in patients undergoing cytoreductive surgery with intraperitoneal chemotherapy
Journal of Surgical Oncology
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Transition in pharmacology: From theoretical knowledge of medicines to practice-oriented approach. Do role-plays help?
2016-07-27T03-15-55Z
Source: International Journal of Basic & Clinical Pharmacology
Lavanya SH, Kalpana L, Veena RM, Bharath Kumar VD.
Background: Pharmacology, a subject criticized by medicos as dry and volatile is in a stage of constant reformation. Traditional teaching-learning in pharmacology has focused more on theoretical knowledge of medicines with little emphasis on the art and science of communicating the same to patients in actual practice. Role-play is one novel method which attracts learners to gain knowledge through concrete experience, there-by bringing in a behavioural change that persists eventually. The objective of this study was to evaluate the effectiveness of role-play as an educational tool in teaching patient education and counseling skills regarding medications prescription for ischemic heart disease (IHD). Methods: A quantitative, randomized, interventional study with pre & post-OSPE using a pre-validated checklist (modified-Calgary-Cambridge) was conducted in 84, II-MBBS students. The scores obtained in intervention group (Lecture-IHD counseling + Role-play) were compared with the control group (Lecture) using Wilcoxon test for paired-data and Mann-Whitney test for inter-group comparisons. Results: Paired-data analysis showed an increase in post-test mean scores in both control and intervention groups following training. However, inter-group comparisons revealed statistically significant improvement in 8 of the 13 parameters in intervention group. Students in intervention group stressed more on pharmacological aspects of medications, along with emergency measures and need for follow-up. Hence it can be said that role-plays played a significant role in improving communication skills regarding medications prescription. Conclusions: Medical communication skills course for II-MBBS students may enable them to demonstrate better patient-doctor interactions. Role-plays are an effective tool to acquire technical and behavioural skills to deal with real-life situations through simulation.
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No benefit from platelet transfusion for gastrointestinal bleeding in patients taking antiplatelet agents
Clinical Gastroenterology and Hepatology
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The effects of resveratrol intervention on risk markers of cardiovascular health in overweight and obese subjects: A pooled analysis of randomized controlled trials
Obesity Reviews
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Non-invasive evaluation of endothelial function in healthy Indian participants using tonometry
2016-07-27T03-15-55Z
Source: International Journal of Basic & Clinical Pharmacology
Chinthaparthi Prabhakar Reddy, MUR Naidu.
Background: Vascular endothelium releases number of biological active mediators, including nitric oxide (NO) that regulates vessel tone. Endothelial dysfunction is independent risk factor for cardiovascular disease. The study was done to assess endothelial function by augmentation index (AIx) calculated from derived aortic wave forms using radial pulse wave analysis (PWA) with provocative pharmacological testing, measured in response to endothelium independent, direct stimulus with nitrovasodilator nitroglycerine (NTG) and endothelium dependent activation of L-arginine-NO-pathway by salbutomol. Methods: Eighteen healthy subjects participated in the study. Radial artery wave forms were recorded with a high-fidelity tonometer (Sphygmocor, AtCor medicals, Australia). Recordings were taken at baseline and after 3, 5, 10, 15 and 20 minutes of NTG (0.5 mg) sublingual administration, and at baseline and after 5, 10, 15 and 20 minutes of salbutomol (400 µg) inhalation. Results: Mean age was 25±2.4 years and body mass index 24±2.5 kg/m2 of study subjects. Salbutomol and NTG significantly reduced AIx at all-time points (salbutomol: baseline 7.6%, 5 minutes -3.6%, 10 minutes -5.8%, 15 minutes -7.8% and 20 minutes -3.6%, p ≤0.05 and NTG baseline 8.4%, 3 minutes -3.2%, 5 minutes -7.7%, 10 minutes -9.7%, 15 minutes -11.2% and 20 minutes -8.6%, p ≤0.001). The effect of provocative pharmacological testing on heart rate, aortic and radial pressures, mean arterial pressure and pulse pressure was not altered (p≥0.05). Conclusions: This method of assessing endothelial function, which appears before onset of clinical signs and symptoms and is a simple, convenient, quick method.
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Coagulation parameters in patients with cirrhosis and portal vein thrombosis treated sequentially with low molecular weight heparin and vitamin K antagonists
Digestive and Liver Diseases
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Childhood autism: knowledge and perception among university students in United Arab Emirates
2016-07-27T03-15-55Z
Source: International Journal of Basic & Clinical Pharmacology
Suleiman Ibrahim Sharif, Laila M. T. Bughaigis, Manar Salah, Noor Kariem, Arsha Mohamed.
Background: Adequate knowledge and awareness about childhood autism allows early diagnosis and interventions. The present study was carried out to assess the knowledge and perception of university students about childhood autism. Methods: A cross-sectional study was conducted to evaluate the level of knowledge and awareness about autism spectrum disorder among university students. A total of 400 students were randomly enrolled from five universities. The questionnaire covered the major aspects of autism. Results: Only 300 questionnaires were fully completed giving a response rate of 75%. The majority of respondents agreed that autism is a neuro-developmental disorder with strong genetic basis where family history increases chances of developing autism. They believe that vaccination, poor parenting and environmental factors are not causes of autism. Large numbers of participants were not sure if autism is more common in males than females but agreed that early identification improves the therapeutic outcomes while 44% believed that children can outgrow autism with proper treatment. More than 50% of respondents disagreed to the statements that autistic children are intellectually disabled and all display poor eye contact. Only 20% of students agreed that autistics children have mental disabilities, while about 50% believed that they can live independently. Conclusions: University students seem to hold adequate knowledge about major hallmarks of the disorder. However, more efforts are needed to enhance awareness of not only parents and relatives but also the general public so that they can deal responsibly with identified cases of autistic children.
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Henoch-Schönlein purpura from vasculitis to intestinal perforation: A case report and literature review
World Journal of Gastroenterology
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Carvedilol versus beta-1 blockers as anti-hypertensive drugs in type-2 diabetes mellitus and pre-diabetic patients with features of metabolic syndrome: a meta-analysis
2016-07-27T03-15-55Z
Source: International Journal of Basic & Clinical Pharmacology
Sharanabasayyaswamy B. Hiremath, Srinivas Devendrappa Lokikere.
Background: It is unclear and contradictory on to whether carvedilol is preferable over beta-1 blockers as add-on drug in hypertensive pre-diabetic and diabetic patients with metabolic syndrome. The objective of this study was to compare the effects of carvedilol versus beta-1 blockers on hemodynamic parameters, indicators of insulin resistance and plasma lipid levels in hypertensive diabetic and pre-diabetic patients with features of metabolic syndrome. Methods: Electronic database search in Pubmed, Cochrane library and EMBASE was conducted. Randomized or cross-over studies comparing effects of carvedilol against beta-1 blockers were included under analysis. Statistical analysis by inverse variance method and both random and fixed effect models was conducted by using RevMan 5.3. Results: Six studies were eligible and included in the analysis. There was minor but significant decrease in SBP (mean difference, MD = -1.38mm Hg, 95% CI = -2.09,-0.66) and HbA1C% (MD = -0.21%, 95% CI -0.41 to -0.02) by carvedilol in patients with type-2 DM. Conclusions: There is moderate quality of evidence to suggest that carvedilol has mild but significant SBP and HbA1C% lowering effect compared to beta-1 blockers in hypertensive patients with type-2 DM.
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Corticosteroids or not for postoperative nausea: A double-blinded randomized study
Journal of Gastrointestinal Surgery
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Inflammatory bowel disease is associated with risk of mortality and hospitalization in patients with heart failure
Journal of Cardiac Failure
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Activin A and follistatin in patients with nonalcoholic fatty liver disease
Metabolism
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A study of drug utilization in indoor patients of high-risk pregnancy in a tertiary care hospital
2016-07-27T03-15-55Z
Source: International Journal of Basic & Clinical Pharmacology
Smita Laxman Gaidhankar, Shraddha Milind Pore, Milin Nanasaheb Deokate, Sunita Jaiprakash Ramanand, Arundhati Tukaram Salunke.
Background: High-risk pregnancy is an important determinant of drug use during pregnancy. The aim of study was to evaluate drug use pattern according to WHO core-drug prescribing indicators and US-FDA pregnancy category in indoor patients of high-risk pregnancy. Methods: It was a prospective, observational study. All high-risk pregnant women admitted to tertiary care hospital and willing to give consent were included. The data was collected from 290 patients over 12 months. The data was analysed to evaluate drug utilization according to WHO core drug use indicators and in relation to US-FDA pregnancy risk category. Results: The study found that 74.82% of women were between 20-30 years of age and were admitted during third trimester of pregnancy. The most commonly prescribed drug class was vitamins and minerals prescribed in 82.75% patients. Average number of drugs per encounter was 6.4. Percentage of drugs prescribed by generic name and from essential drug list was 73.07% and 77.07% respectively. Percentage of encounters with an antibiotic and an injection prescribed was 29.31% and 65.17% respectively. The prescription of drugs belonging to US-FDA pregnancy drug categories A, B and C were 92.06%, 86.55% and 4.82% respectively. Conclusions: Overall, the principles of rational prescribing were followed according to the various drug use indicators mentioned by the WHO and US FDA pregnancy risk category. Further studies are required to find out specific drug or drug therapy related problems and plan targeted interventions to improve drug use.
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Diagnostic accuracy of MRI for assessment of T category and circumferential resection margin involvement in patients with rectal cancer: a meta-analysis
Diseases of the Colon and Rectum
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Long-term results of transanal pull-through for Hirschsprungs disease: A meta-analysis
Pediatric Surgery International
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Association of kidney structure-related gene variants with type 2 diabetes-attributed end-stage kidney disease in African Americans
Abstract
African Americans (AAs) are at higher risk for developing end-stage kidney disease (ESKD) compared to European Americans. Genome-wide association studies have identified variants associated with diabetic and non-diabetic kidney diseases. Nephropathy loci, including SLC7A9, UMOD, and SHROOM3, have been implicated in the maintenance of normal glomerular and renal tubular structure and function. Herein, 47 genes important in podocyte, glomerular basement membrane, mesangial cell, mesangial matrix, renal tubular cell, and renal interstitium structure were examined for association with type 2 diabetes (T2D)-attributed ESKD in AAs. Single-variant association analysis was performed in the discovery stage, including 2041 T2D-ESKD cases and 1140 controls (non-diabetic, non-nephropathy). Discrimination analyses in 667 T2D cases-lacking nephropathy excluded T2D-associated SNPs. Nominal associations were tested in an additional 483 T2D-ESKD cases and 554 controls in the replication stage. Meta-analysis of 4218 discovery and replication samples revealed three significant associations with T2D-ESKD at CD2AP and MMP2 (P corr < 0.05 corrected for effective number of SNPs in each locus). Removal of APOL1 renal-risk genotype carriers revealed additional association at five loci, TTC21B, COL4A3, NPHP3-ACAD11, CLDN8, and ARHGAP24 (P corr < 0.05). Genetic variants at COL4A3, CLDN8, and ARHGAP24 were potentially pathogenic. Gene-based associations revealed suggestive significant aggregate effects of coding variants at four genes. Our findings suggest that genetic variation in kidney structure-related genes may contribute to T2D-attributed ESKD in the AA population.
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Bispectral index under propofol anesthesia in children: a comparative randomized study between TIVA and TCI
Summary
Background
In children, only a few studies have compared different modes of propofol infusion during a total intravenous anesthesia (TIVA) with propofol and remifentanil. The aim of this study was to compare Bispectral Index (BIS) profiles (percentage of time spent at adequate BIS values) between four modes of propofol infusion: titration of the infusion rate on clinical signs (TIVA0), titration of the infusion rate on the BIS (TIVABIS), target controlled infusion (TCI) guided by the BIS either with the Kataria model (TCI KBIS) or the Schnider model (TCI SBIS).
Methods
Sixty-six children (aged from 4 to 14 years) were prospectively randomized into one of the four groups. In the TIVA0 group, the anesthesiologist was blinded to the BIS. In each group, the percentage of time with adequate BIS values (45–55), the bias, and imprecision were calculated.
Results
The propofol consumption was similar in the four groups. During the maintenance phase, the percentage of time spent in the targeted BIS range was significantly lower in the TIVA0 group compared to the three other groups (TIVA0: 31% ± 22, TIVABIS: 59% ± 17, TCI KBIS: 53% ± 12, TCI SBIS: 56% ± 17). The bias was not statistically different between the four groups, but the imprecision was larger for the TIVA0 group. Compared to the Kataria model, the Schnider model was associated with shorter time delay to reach the desired BIS, to eyes opening, and to tracheal extubation.
Conclusions
Propofol administration using manual infusion guided by clinical signs was associated with higher risks of over- or underdosage when compared to BIS-guided administrations. When propofol infusion was guided by the BIS, no major difference was found between TIVA and TCI (either with the Kataria or the Schnider model). This study highlights the need of a pharmacodynamic feedback during propofol anesthesia in children.
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Current practice of acute pain management in children—a national follow-up survey in Germany
Summary
Objectives
This study aimed to summarize the current standard practices for acute pain management in children in Germany and the implementation of these procedures. The last survey on acute pain management in children was performed in 1999, highlighting the need for an up to date review.
Methods
A questionnaire was mailed to German departments of anesthesiology (n = 885), asking for structures and processes of acute pain management in children. Results were compared between hospitals with and without an acute pain service and with and without a pediatric department.
Results
Of the 407 responding hospitals (response rate of 46%), 342 treated children younger than 14 years. These were considered for analysis. Of the 342 hospitals, 42% contained either a general pediatric department or a department of pediatric surgery, and the majority of the responding hospitals had an acute pain service (83%). Pain intensities were measured at least once per shift in 40% of the institutions, and at least once or twice a day in 27%. Of the institutions, 31% did not document pain scores regularly, without any difference between hospitals with or without a pediatric department. Standard operating procedures for acute pain management existed in 68% of the hospitals, with large differences in content and length. Opioids were administered to children in 85% of the hospitals. Nonopioid analgesics were the first choice baseline analgesics in most hospitals. Peripheral regional and epidural analgesia were performed in children in 18% and 8% of the hospitals, respectively (21%/16% with a paediatric department, 16%/1% without; P < 0.001).
Conclusion
Current practice of pediatric pain management varied widely and the recommendations of guidelines, like regular pain management, were frequently not met. However, improvements could be observed since 1999, for example, an increase in regular pain measurements (4% vs 67%). Furthermore, pain management in hospitals running a pediatric department had a higher degree of organization, and more sophisticated analgesic techniques.
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