The purpose of this guide is to help doctors prescribe baclofen in the treatment of alcohol problems as there is, to date, no standardized way to prescribe this molecule in the treatment of alcohol dependence. The Recommended Medical Practices in respect of baclofen prescription generally proposes, for neurological treatment, increasing dosage by 15mg every 3 days, while suggesting flexibility, that is to say, adapting dosages individually. The proposals below reflect the experience of the authors to this paper, experience which itself has been based on the original method described by Olivier Ameisen [1,2]. The authors have, between them, treated more than 1500 patients with this medication, and they have learned gradually and empirically how to use baclofen to help patients in the best possible way with alcohol problems. The experience of the authors is that there is no absolute consensus and that prescribers may have different approaches and practices in the conduct of treatment. At the present time, it is impossible to give a definitive answer to the question. Thebibliography (see References) includes four papers describing clinical experiences in which the authors have compiled their results [3,4,5,6].Other reports from the literature have also been taken in to account [7,8,9]. These recommendations are intended to help the prescription ofbaclofen.
The dominant view that cancer arises from successive mutations in somatic cells is so unquestioned that accumulating challenges from experimental and observational results are rarely addressed in the scientific literature. Based on these challenges, we argue that the scientific understanding of carcinogenesis has entered a period of paradigm instability. New research directions are therefore needed.
Acute exacerbation of chronic obstructive pulmonary disease (COPD)/asthma and pneumonia are the major reason for the hospitalization and emergency room visit in the US. In 2011, chronic lower respiratory diseases and pneumonia were among top ten causes of mortality in 2011. Hospitalization and emergency room visit due to these morbidities account for high health care cost. B type natriuretic peptide level (BNP) of more than 400 is a prognostic and diagnostic marker for congestive heart failure (CHF). However, BNP can be raised in other conditions and significance of it is unknown. Aims: To identify role of BNP in prognosticating asthma/copd exacerbation and pneumonia. Study Design: Retrospective study. Place and Duration of Study: Emergency room and Hospital at Interfaith Medical Center between January 2008 to July 2012. Methodology: We retrospectively reviewed the charts of the patients admitted to our hospital with diagnosis of asthma, pneumonia and COPD in whom CHF had been ruled out. We collected data about BNP, length of stay, mortality and other demographic data. Results: 461 patients met inclusion criteria - 28% had asthma, 31% had COPD exacerbation and 41% had pneumonia. 21% patients had BNP > 100 pg/ml. Patient with BNP > 100 pg/ml had higher mortality as compared to patients with BNP < 100 pg/ml- 19% and 2% respectively (P value .0001). Mean length of stay for BNP > 100 group and BNP < 100 groups were 8.7 and 5.56 days. (P value .0001). These differences were seen across the subgroups of asthma, COPD and Pneumonia. Patients with BNP > 100 pg/ml were more likely to required ICU care as compared to patients with BNP < 100 pg/ml – 30% vs 9% (P value .0001). Conclusion: Our study suggests that BNP can be used as prognostic marker for mortality and severity of the disease in Asthma, COPD and Pneumonia. Higher BNP levels can also predict the prolong length of stay in the hospital.
Aims: i) To assess the feasibility of using pulse oximetry as a screening tool in low-income countries to detect hypoxemia associated with early-onset sepsis in asymptomatic newborns. ii) To evaluate the acceptability of pulse oximetry screening to mothers and healthcare professionals. Study Design: Prospective cohort study. Place and Duration of Study: Saint Francis Referral Hospital, Ifakara, Tanzania between January and March 2013. Methodology: All eligible asymptomatic newborns of more than 33 weeks gestational age born during the study period were screened on two occasions using pulse oximetry. Newborns with oxygen saturations below predefined thresholds were test positive. We recorded the proportion of eligible newborns screened, time taken for the test and the acceptability of pulse oximetry use to mothers and healthcare professionals. The rates of hypoxaemia and clinical diagnosis of sepsis in asymptomatic newborns were evaluated. Results: A total of 316 asymptomatic newborns were screened, of which eighteen (5.7%) were classified as test positive. Clinical examination led to the diagnosis of sepsis in 41 newborns (13%), including eight newborns who tested positive with pulse oximetry screening. Mothers (n=50) and healthcare professionals (n=18) were predominantly satisfied with screening. Conclusion: It is feasible to evaluate the role of pulse oximetry as a screening tool to detect early-onset sepsis in a low-income setting. The test is acceptable to mothers and healthcare professionals. Further studies are needed to assess the accuracy of the test in detecting sepsis in asymptomatic newborns and its clinical impact on neonatal health.
Aims: To identify sexually-related themes of the sexuality of older African American women. Study Design: Mixed method. Place and Duration of Study: Department of Psychology, California State University Northridge, between July 2009 and June 2011. Methodology: We included 13 African American older women (57 to 82 years of age), 11 of whom self-identified as heterosexual, one as bisexual, and one as lesbian. We used a semi-structured interview protocol through which we explored some aspects of the respondents’ sexuality (assessed at a superficial level, to be as tactful as possible). Moreover, we collected information on demographics and self-rated physical health. Two co-authors served as coders, and used content analysis to identify the most salient sexuality themes. Results: Emerging themes were (in order from most to least endorsed): having sexual desire (often unfulfilled); engaging in less sexual activity in older age; experiencing changes in one’s sexual life as a function of absence of a spouse; and exercising control over how one’s sexual life is conducted. Motivated by the paucity of our sexuality data, we have also provided suggestions to scholars interested in conducting more in-depth further research on this topic with older African American women. Conclusion: Our findings indicate that the common notion that older women are asexual is a myth, while lack of a suitable sexual partner is a problem reported by many African American older women who would otherwise enjoy sexual interaction.
Aims: The objective of this current study was to determine the prevalence, intensity and associated risk factors of Geohelminthes infections or Soil transmitted helminthes (STHs) among pupils in Umuebu Community, Ukwuani Local Government area of Delta State. Study Design: A cross sectional study was undertaken to assess the status of soil transmitted helminthes infection with respect to prevalence, intensity and associated risk factors among school children in Ebu Primary School Umuebu and the entire community in Ukwuani Local Government Area, Delta State. Place and Duration of Study: The field study was carried out in Ebu primary School, in Umuebu community, Delta State while the laboratory work was carried out at the Department of Zoology and Environmental Biology, Lagos State University, Ojo Nigeria and Queen of the Apostle Catholic Hospital Laboratory, Obiaruku, Delta State all in Southern Nigeria between April and December, 2011. Methodology: Eight hundred and seven eight (878) children were randomly selected. They comprised of 466 (52.76%) males and 412 (47.24%) females between the ages of 5-13 years in the master list of Ebu Primary School, Umuebu. The stool samples were examined for the presence of STHs using direct smear and Kato-Katz techniques. Results: Eight hundred and seven (92.74%) of the subjects were infected with Geohelminthiasis. The overall prevalence by species was Ascaris lumbricoides (76.89%), Hookworm (54.60%) and Trichuris. trichiura (29.24%). Two hundred and eighty two (39.40%) were infected with two or more STHs. The prevalence and intensity of all species of STHs significantly varied with age (p>0.05), with the highest prevalence in age group 5-7 years. The sex related prevalence show that males were more infected for all species of STHs than females, but this was only statistically significant for hookworm (p>0.05). Multiple logistic regression analysis for the epidemiological variable showed that licking of fingers, drinking from wells or surface tanks and geophagy were risk factors for A. lumbricoides and T. trichiura infections while walking barefooted was only risk factor for hookworm infection. Conclusion: Targeted health education on hygienic practices coupled with the establishment of sustainable and regular deworming programmes in the community are advocated considering the high prevalence of STHs reported in this study.
Introduction: Bronchial asthma is one of the common diseases encountered by the physicians which leads to morbidity and mortality. Therefore it is important to know the quality of life in these patients. So that necessary measures can be taken to improve it. Objectives: To assess the quality of life in patients with bronchial asthma. Methodology: This was a cross sectional study conducted at a private clinic in Malaysia. Data was collected from 40 asthmatic patients. They were administered the mini asthma quality of life questionnaire developed by Professor Elizabeth Juniper. The Questionnaire tests four domains which includes symptoms, activity limitation, emotional function and environmental stimuli. The mean scores of 1-3.9, 4-4.9 and ≥ 5 indicated severe, moderate, mild limitations in the quality of life respectively. The data was analyzed using SPSS software (Statistical package for the social sciences). Results: The mean age of the patients was 32.7±15 yrs. We found that 70% of the patients were females. 60% of the patients had severe impairment in the quality of life. In the symptoms, emotional function and environmental stimuli domains 70%, 65% and 75% of the patients respectively had severe impairment in the quality of life, whereas in the activity domain it was only 27.5%. Conclusion: We conclude that most of the patients had severe impairment in the quality of life. It was seen that there was least impairment in the activity domain. Larger studies with more sample size is required to strengthen our findings.
Aims: The study was carried out in order to determine the plasmid profile, antibiotic susceptibility pattern and the type of antimicrobial resistance (whether it is chromosomal or plasmid mediated) among producers of extended spectrum beta-lactamases of uropathogens in children. Study Design: A cross-sectional study of three hundred children in a hospital. Place and Duration of Study: Department of Pediatrics (Pediatrics Ward) and Department of Medical Microbiology and Parasitology, Nnamdi Azikiwe University Teaching Hospital, Nigeria between January 2009 to September 2010. Methodology: Clean-catch urine samples were collected from 300 children aged 1 month to 16 years with suspected community acquired urinary tract infection. Isolated bacteria were identified using standard microbiological techniques. Antimicrobial susceptibility test was carried out by disc diffusion method. Extended Spectrum Beta-Lactamase (ESBL) was determined among the Gram-negative bacteria using double disc synergy test (DDST). The plasmid DNA of the bacterial isolates was extracted using alkalysis method and electrophoresed on 0.8% agarose gel stained with 2µl ethidium bromide (EtBr). Result: The result of the study showed that Staphylococcus aureus had the highest prevalence among gram positive bacteria. Escherichia coli had the highest prevalence among gram negative bacteria. Staphylococcus aureus showed cross resistance towards some of the antimicrobial agents. Escherichia coli and Pseudomonas showed multiple drug resistance. All the uropathogens isolated were 100% susceptible to imipenem. The study highlights among the ESBL-producers, plasmids of higher molecular weight of 30Kb. Conclusion: It is therefore suggested that appropriate antimicrobial agent be administered to reduce the risk of multi-drug resistance and avert the ineffectiveness of antimicrobial agents.
Background: Sildenafil is used for the treatment of erectile dysfunction and is helping millions of men around the world to achieve and maintain a long lasting erection. The histological alterations in the genital system epithelial lining due to sildenafil overdoses intoxication has not yet been well documented. Aim: The present study was carried out to investigate the histological alterations induced by sildenafil overdoses in the epididymal epithelial lining. Methodology: Fifty adult male rabbits (Oryctolagus cuniculus) were subjected to sildenafil (0, 1, 3, 6, 9 mg/kg/day) for 5 days per week for 7 weeks. Samples from left and right proximal epididymis were applied to conventional histological techniques and subjected to histological examination. Results: Exposure to overdoses of sildenafil had provoked histological alterations in the epididymal tissue in the form of epididymal hyperplasia and dilated lumina. Mature spermatozoa were less frequent in the lumen of the epididymis than the control ones while spermatogenic cells, cellular debris and spermatid giant cell were seen in the lumen of the epididymis. Conclusion: The results of the present study confirms that sildenafil provoked alterations in the epididymal epithelial lining together with partial arresting spermatogenesis and impairing the spermatic cells differentiation towards maturation. The findings together might indicate an affect on male fertility induced by sildenafil overdoses.
Aims: To investigate the influence of patient information leaflets on Ophthalmic patients’ education and medication compliance. Study Design: Hospital-based cross- sectional survey. Place and Duration of Study: Department of Optometry, School of Physical Sciences, UCC, Cape Coast, Ghana, between September 2012 and May 2013. Methodology: A semi - structured questionnaire with sections on patient demographics, patient information leaflets impact on therapeutic education, and medication compliance, was administered to 400 ophthalmic review patients in three eye care facilities in Central Region of Ghana. Patient information leaflets (PILs) of common ophthalmic medications prescribed in these eye centers were also reviewed and assessed on their readability using the Rudolph Flesch’s readability ease calculator. Obtained data was analyzed using SPSS version 19. Pearson’s Chi-square statistical analysis was used to test for significant association between variables. Results: Of the 400 ophthalmic patients, 140 (35%) were males and 260 (65%) females The mean age was 50.2 ± 19.5. Patients had varying opinion on the purpose for the PIL: 228 (57%) thought the PIL only gives instructions on the use of the medication; 108 (27%) did not know why the PIL have been provided. The remaining 64 (16%) provided no response. There was significant association between higher educational level and reading of the leaflet (P < 0.001). The kind of ophthalmic condition one suffered had a positive influence on reading the PIL ( X2=28.594, P < 0.001). A greater proportion of the patients (88.04%) said various components of information on the leaflet were beneficial in ensuring compliance to therapy. All the PILs from the five different companies (where medication were obtained for retail) had very low readability score (0-29) except some PILs of topical analgesic drug. The low readability score indicated that the text was difficult to comprehend; the reason for which most patients did not read the leaflets. Most patients 91(99%) who read the PILs indicated that they were beneficial but were difficult to understand. Conclusion: Ophthalmic patients’ opinion on patient information leaflets was reasonably good and had a positive influence on patients’ medication compliance. It however, did not have much influence on patient education due to low readability and comprehensible.
Aims: The aim of this study is to determine the number of newly diagnosed cancer cases and their distribution in two cancer-care providing facilities in Sudan. Study Design: This is a retrospective descriptive study. Methodology: Data was retrieved from patients’ records that were diagnosed and treated at the Radiation Isotope Center in Khartoum (RICK) and National Cancer Institute at Wadmadani (NCI -UG) in Sudan over the period between 2000 and 2006 and then statistically analyzed. Results: A total of 26652 cancer cases were retrieved with a noticeable increase in numbers from year 2000 to 2006. The maximum cancer number was observed in 45-64 year age group in both male and female patients with a male to female ratio of 1.3:1.0. The most common cancer sites for females were: the breast (29.3%), cervix uteri (8.2%), leukemia (7.2%), ovary (6.8%), and esophagus (5.9%) and for males: were prostate (7.6%), followed by leukemia, (7.0%), NHL (6.8%), esophagus (5.4%) and bladder (4.4), while leukemia (25.2%), NHL (12.4%), lymphoma (10.8%), retinoblastoma (6.6%) and brain tumors (3.3%) dominated in younger patients (<14 years old). Conclusions: This study provided some knowledge about the cancer situation in two institutions providing cancer care in Sudan that may draw attention of policy maker and aid in formulating appropriate cancer-control strategies in the country.
Aims: This research investigated the thrombolytic, cytotoxic and antidiabetic effects of Paederia foetida leaf methanol extract. Place and Duration of Study: Department of Genetic Engineering and Biotechnology and Department of Biochemistry and Molecular Biology, University of Chittagong, Bangladesh, between April to December, 2012. Methodology: An in-vitro thrombolytic model was used to check the thrombolytic effect of Paederia foetida extract using streptokinase as a positive control. Cytotoxic effect was measured by Brine shrimp lethality bioassay. Antidiabetic effect of the extract was conducted in alloxan induced diabetic model of Swiss albino mice. Data were analyzed by one way ANOVA using statistical package for social science (SPSS) software. Results: In in-vitro thrombolysis, Paederia foetida extract (100µl) lysed 21.40 ± 1.39 %, Streptokinase (positive control) 81.42 ± 0.88 % and water (negative control) 4.63 ± 0.31% of the blood clots. These clot lysis values were statistically different (p<0.05) from each other. In Brine shrimp bioassay, lethal concentration (LC50) of Paederia foetida extract was found 65.31 µg/mL which was statistically significant compared to Vincristine sulfate (positive control, LC50=0.76 µg/mL). The extract showed a significant and dose-dependent decrease in blood glucose level in alloxan induced diabetic mice. The effect of the extract was comparable to the reference antidiabetic drug metformin (150 mg/kg BW). Conclusion: The results demonstrated a moderate thrombolytic, cytotoxic and antidiabetic effect of Paederia foetida leaf extract to be analyzed further for prospective pharmaceutical preparation.
Aims: Oxidative stress is one of the major patho-physiologic hallmarks in the development of COPD. Ceruloplasmin, the major serum inhibitor of lipid peroxidation has been documented as a main extracellular antioxidant in serum and plays a role in preventing lung injury, and an abnormality in its oxidative inhibition could be involved in pathogenesis of COPD. This study aims to estimate levels of ceruloplasmin and its ferroxidase activity in COPD and compare with that in controls to explore their utility in COPD. Study Design: Comparison study. Place and Duration of Study: Department of Biochemistry, AFMC, Pune. Subjects for COPD were selected from the patients reporting with symptoms of COPD to respiratory OPD of Cardio Thoracic Centre, Pune, during Dec 2010 to Aug 2012. Methodology: Study comprised of two groups: Group I of 77 normal as controls (61 men, 16 women; age range 27-90 years) and Group II of 92 COPD patients (70 men, 22 women; age range 45 - 97 years). Both the groups were further divided into smoker and nonsmoker groups. Ferroxidase activity of ceruloplasmin was estimated by indigenous patented kinetic method of Somani and Ambade while ceruloplasmin was estimated by immunotubidimetric method using commercially available kit. Results: Serum ceruloplasmin and ferroxidase activity were significantly higher in COPD patients as compared to normal controls. Mean ± SD in COPD versus controls respectively are ceruloplasmin: 45.84 ± 12.7 mg/dL versus 37 ± 9.7 mg/dL; ferroxidase: 1324.9 ± 278.53 IU/L versus 980.5 ± 202.3 IU/L, P< .001. Statistically significant & good correlation (r > 0.7) was found between ceruloplasmin and ferroxidase in controls, nonsmoker controls and smoker controls (r = 0.76, 0.71 and 0.79 respectively) while in COPD, COPD nonsmokers and COPD smokers, no correlation was found (r = 0.00, 0.29 and 0.09 respectively). Conclusion: There is alteration in the ferroxidase activity of ceruloplasmin in COPD. Future studies with quantification of carbonyl residues or other groups in ceruloplasmin molecule leading to altered oxidative or ferroxidase activity of ceruloplasmin may provide further evidence to support a role of oxidative stress in COPD.
Background: Assessment of the concentrations of reproductive hormones during post-menopause has been suggested as a confirmatory test for menopause due to irregularities in rise and fall of sex hormones in menopausal transition. In this study, we assessed the concentrations of estrogen, progesterone, follicle stimulating hormone (FSH) and luteinizing hormone (LH) in post-menopausal women in Ebonyi state, Nigeria. In addition we tried to establish if relationships exist between the pituitary hormones and the ovarian (sex) hormones and between the reproductive hormones and age and body mass index (BMI). Method: The study population comprised forty post-menopausal women of mean age 59.6 years and forty young female adult controls of mean age 27.8 years. Blood samples were collected into heparin container and the serum used for the analysis of estrogen, progesterone, FSH and LH using ELISA method. Result: Post-menopausal women had significantly (P<0.001) higher mean serum FSH and LH concentrations compared to their controls. In contrast, the control group had significantly (P<0.001) higher progesterone and estradiol levels compared to the post-menopausal women. There was inverse correlation (P<0.01) between estradiol and FSH levels, but no significant correlations were observed between FSH and Progestrone; LH and Progestrone; and LH and Estradiol respectively. In addition, after adjusting for BMI, the concentrations of LH was significantly associated with age (P<0.01) but FSH, estradiol and progesterone levels were not. Furthermore, estradiol and FSH levels were significantly associated (P<0.001 and P<0.05) with BMI after controlling for age. Conclusion: The present findings underscore the importance of understanding the reproductive hormonal profile of post-menopausal women and the need to consider age and body mass when studying hormonal changes of menopausal women. These data may help clinicians make optimal therapeutic decisions for hormone replacement therapy and life-style changes that may reduce the risk of some of the conditions associated with menopause.
Aims: The aim of this study is to examine the issue of motivation of physicians employed at Greek public hospitals. Methodology: Through the review of relevant literature, an attempt to examine the trends in this issue in Greek public health care sector has been made. Various electronic databases were searched by the authors and through systematic selection 41 scientific articles, studies and electronic sources were identified, that this literature review is based on. The selection was based in two different criteria : for the theoretical background of the issue of motivation, articles and books that considered to be fundamental for the formulation of the subsequent theories were selected, while for the relevant to the main research question literature (motivation in Greek physicians) the most recent data were selected. Results: Motivation of doctors is a highly complex issue that presents an intense differentiation compared with other aspects of staff handling. According to the literature, financial incentives cannot by themselves motivate physicians. On the contrary, the development and utilization of incentives that are associated with achievement of goals, possibility of professional development and recognition in the workplace, appears more effective. Conclusion: Proper diagnosis of the needs of the doctors in the hospital and the selection of appropriate techniques, as these arise through various theories of motivation, can help in the efficiency and efficacy of health care services. Especially in a time of prolonged economic downturn, while the health needs of the population are increased and budgetary constraints compound the difficulties of their effective coverage, searching for administration models that will be able to take full advantage of material and human resources are inevitably in the spotlight of our interest.