Diabetes distress sources among Filipinos with type 2 diabetes mellitus in the outpatient department of a tertiary government hospital

@#<p style="text-align: justify;"><strong>Objective:</strong> The sources of diabetes distress, defined as hidden negative emotions from the demands of daily self-management, are unknown to Filipinos with type 2 diabetes mellitus in the outpatient department. Therefore, we aimed to 1) explore the sources of distress in the perspective of Filipinos with type 2 diabetes mellitus and 2) create a conceptual framework of diabetes distress for Filipinos with T2DM.</p><p style="text-align: justify;"><strong>Methods:</strong> Focus group discussions were done and audiotaped among Filipinos with type 2 diabetes (n=17). The transcript underwent content analysis to generate themes and subthemes. Relationships were determined between codes, categories, and themes elicited in the study to create a conceptual framework unique to Filipinos.</p><p style="text-align: justify;"><strong>Results:</strong> The content analysis revealed five themes of diabetes distress: caregiver factor, socio-economic factor, psycho-emotional factor, medication-related factor, and health care service delivery factor. The socio-economic factor was a distinct theme missing in the prevailing validated questionnaires. Therefore, an adapted conceptual framework was created, as approved by the expert panel.</p><p style="text-align: justify;"><strong>Conclusion:</strong> In conclusion, Filipinos with type 2 diabetes mellitus in the outpatient department have multiple sources of diabetes distress, namely, caregiver factor, socio-economic factor, psycho-emotional factor, medication-related factor, and health care service delivery factor. The socio-economic factor is a unique theme identified among Filipinos. Recognizing the sources of diabetes distress is vital to accurately screen Filipinos with type 2 diabetes mellitus and optimize management outcomes. The study findings will help develop and validate the questionnaire to screen diabetes distress unique to Filipinos.</p>

The development of the Philippine General Hospital as a referral center in the COVID-19 Pandemic: A qualitative study

@#Background. The University of the Philippines-Philippine General Hospital (UP-PGH) was designated as a COVID Referral Center for one cluster in Metro Manila during the pandemic. We reviewed and described how UP-PGH prepared for this endeavor. This can serve as reference for similar events in the future. Methods. We conducted a qualitative cross-sectional study with 20 key informant interviews and 5 focus group discussions involving 32 hospital front liners. All proceedings were transcribed and analyzed manually following the conceptual framework. Minutes of meetings, memoranda, and other official materials and communications were also reviewed. Results. The salient points of both internal (operations, structure, staff, supplies, and continuation of regular services) and external aspects (relation with other hospitals, the local government, the national health authority, and the general public) were enumerated and elaborated. Both best practices and areas needing improvement were identified. Conclusion and Recommendations. The UP-PGH tried its best to prepare and respond to the COVID-19 pandemic by protecting its hospital personnel and delivering evidence-based and quality care to patients. The response was not a perfect one and there were certain aspects for improvement.

Phytochemical Profiles Of Three Traditional Medicinal Plants And Its Antimicrobial Activities

Objective: The objective of the current study was to compare the phytochemical composition and to evaluate the antibacterial properties of Cissus qudrangularis, Cinnamomum zeylanicum and Trigonella foenum-graecum against the bacterial strains Escherichia coli and Bacillus circulans. Methods: Qualitative analysis and quantitative estimation of various phytochemical components were done using standard protocols. Antibacterial activity against gram-negative Escherichia coli and gram-positive Bacillus circulans was evaluated using standard protocol of agar well diffusion and disc diffusion assay. The zone of inhibition was calculated. Results: Preliminary phytochemical analysis showed the presence of alkaloids, saponins and tannins in all three plant extracts. In quantitative estimation, Cinnamomum zeylanicum showed high alkaloid content (22%), Cissus qudrangularis showed high saponin content (6%) Trigonella foenum-graecum showed a high concentration (4.65 mg/g) of tannin. All the three plants showed moderate antimicrobial activity. The water extract of Cinnamomum zeylanicum showed the highest zone of inhibition (13 mm) against Escherichia coli and the water extract of Trigonella foenum-graecum showed the highest zone of inhibition (11 mm) against Bacillus circulans. Conclusion: The result of this study supports the use of all the selected three medicinal plants as a source of antibacterial substance for the possible treatment of human pathogenic organisms. These plants can be further subjected to isolation of the therapeutic phytochemicals and further pharmacological evaluation.

Robotic-assisted interval cytoreductive surgery in ovarian cancer: a feasibility study

OBJECTIVE: The primary objective was to assess the feasibility of robotic-assisted interval cytoreductive surgery for achieving complete cytoreduction for patients with advanced-stage ovarian cancer. The secondary objective was to examine the perioperative outcomes.METHODS: A retrospective study of 12 patients with stage IIIC or IV ovarian, fallopian tube, and primary peritoneal carcinoma who underwent interval cytoreductive surgery after neo-adjuvant chemotherapy.RESULTS: Optimal cytoreduction was achieved in 100% of selected patients. Complete cytoreductive surgery was achieved in 75% of patients. The estimated mean blood loss was 100 mL. The median length of hospital stay was 2 days. Perioperative complication and 30-day readmission rates were 8.3% (1 patient). The median follow-up time was 9.5 months.CONCLUSION: Robotic-assisted interval cytoreductive surgery in ovarian cancer is safe and feasible and may be an alternative to standard laparotomy in selected patients.

Adequacy of hemostatic resuscitation improves therapeutic efficacy of recombinant activated factor VII and reduces reexploration rate for bleeding in postoperative cardiac surgery patients with refractory hemorrhage

Background: Excessive bleeding and surgical reexploration are common complications that increase the risk of multi-organ failure and prolonged hospitalization after cardiac surgery. Off-label use of recombinant activated factor VII (rFVIIa) is a recommended treatment for refractory bleeding. Objective: The objective of the study is to determine if the adequacy of hemostatic resuscitation enhances the efficacy of rFVIIa. Methods: This retrospective, observational, cohort study included patients who received rFVIIa for refractory postoperative bleeding after cardiac surgery. Patients were divided into two groups based on the presence or absence of adequate coagulation resuscitation before rFVIIa administration, defined as international ratio (INR) ≤1.5, platelet count ≥100 K/mL, and fibrinogen ≥200 mg/dL. The failure of rFVIIa treatment was defined as surgical reexploration within 24 h, thoracostomy drainage >400 mL/h within 6 h or transfusion of additional blood products or another rFVIIa dose within 6 h after initial rFVIIa dose. Results: Of the 3833 patients, screened who underwent cardiothoracic surgery procedures, 58 patients received rFVIIa for refractory postoperative bleeding. Successful hemostasis with rFVIIa was more likely in patients who were adequately resuscitated compared with those who were not (20 [71.4%] vs. 10 [33.3%], respectively; P = 0.0046). Multiple logistic regression analysis indicated that patients who were adequately resuscitated before rFVIIa were less likely to fail treatment (odds ratio, 0.16; 95% confidence interval [0.04–0.62]; P = 0.007). Conclusions: The therapeutic efficacy of rFVIIa is dependent on the adequacy of hemostatic resuscitation; restoration of normal serum fibrinogen, INR, and platelet counts >100 K/mL may provide an adequate substrate for rFVIIa to be effective in managing refractory postoperative cardiac surgical bleeding.

Propagation Characteristics of Fasting Duodeno-Jejunal Contractions in Healthy Controls Measured by Clustered Closely-spaced Manometric Sensors

BACKGROUND/AIMS: High-resolution methods have advanced esophageal and anorectal manometry interpretation but are incompletely established for intestinal manometry. We characterized normal fasting duodeno-jejunal manometry parameters not measurable by standard techniques using clustered closely-spaced recordings. METHODS: Ten fasting recordings were performed in 8 healthy controls using catheters with 3–4 gastrointestinal manometry clusters with 1–2 cm channel spacing. Migrating motor complex phase III characteristics were quantified. Spatial-temporal contour plots measured propagation direction and velocity of individual contractions. Coupling was defined by pressure peak continuity within clusters. RESULTS: Twenty-three phase III complexes (11 antral, 12 intestinal origin) with 157 (95% CI, 104–211) minute periodicities, 6.99 (6.25–7.74) minute durations, 10.92 (10.68–11.16) cycle/minute frequencies, 73.6 (67.7–79.5) mmHg maximal amplitudes, and 4.20 (3.18–5.22) cm/minute propagation velocities were recorded. Coupling of individual contractions was 39.1% (32.1–46.1); 63.0% (54.4–71.6) of contractions were antegrade and 32.8% (24.1–41.5) were retrograde. Individual phase III contractions propagated > 35 fold faster (2.48 cm/sec; 95% CI, 2.25–2.71) than complexes themselves. Phase III complexes beyond the proximal jejunum were longer in duration (P = 0.025) and had poorer contractile coupling (P = 0.025) than proximal complexes. Coupling was greater with 1 cm channel spacing vs 2 cm (P < 0.001). CONCLUSIONS: Intestinal manometry using clustered closely-spaced pressure ports characterizes novel antegrade and retrograde propagation and coupling properties which degrade in more distal jejunal segments. Coupling is greater with more closely-spaced recordings. Applying similar methods to dysmotility syndromes will define the relevance of these methods.

Effectiveness of immature Mangifera indica Linn (mango) fruit in reducing the Ascaris lumbricoides infection among children: a non-inferiority randomized controlled trial / The Health Sciences Journal

INTRODUCTION@#This study aimed to compare the effectiveness of immature Magnifera indica L. (mango) fruit with albendazole in reducing Ascaris lumbricoides infection among children.@*METHODS@#Children aged 2 to 14 years were enrolled in a randomized, controlled, non-inferiority trial. Participants were randomly allocated to receive 250 mL immature mango fruit puree daily for 3 days or one dose of albendazole 400 mg tablet. Egg reduction rates and cure rates were computed and compared. Adverse effects were monitored during and after administration of treatment.@*RESULTS@#There was a statistically significant decrease between the pre- and post-treatment EPG of those who took immature mango fruit (p < 0.001) and those who took albendazole (p < 0.001). There was a higher ERR and CR for the albendazole group, but the difference was not significant (p = 0.472, p = 785, respectively). Risk analysis of reduction in intensity showed mango is non-inferior to albendazole (RR = 0.80, 95% CI 0.67, 0.97; p = 0.026). Risk analysis of cure showed mango is noninferior to albendazole in both PP (RR = 0.92, 95% CI 0.68, 1.25; p = 0.607) and ITT (RR=0.79, 95% CI 0.58, 1.08; p = 0.139).@*CONCLUSION@#Immature Mangifera indica Linn is non-inferior to albendazole in terms of effectiveness in the reduction of ascariasis infection.

Do Tanzanian hospitals need healthcare ethics committees? report on the 2014 dartmouth/penn research ethics training and program development for tanzania (DPRET) workshop

Ethical issues are common in the global community. The shortage of human and medical resources when working with vulnerable populations requires institutional support to address the challenges that often arise in the patient-provider relationship. The 2014 Dartmouth/Penn Research Ethics Training and Program Development for Tanzania (DPRET) workshop centred on discussions about research and clinical ethics issues unique to Tanzanian healthcare providers. This article discusses some of the ethical challenges that workshop participants reported in their day-to-day work life with patients and families, such as truth-telling, disagreements over treatment plans and patient distrust of local physicians and hospital staff, among others. The Tanzanian participants recognised the need for supportive mechanisms within their local hospital environments. Further dialogue and research on the development ofinstitutional ethics committees within hospital systems is critically needed so that healthcare providers can meet their ethical and professional obligations to patients and families and address ethical conflicts that arise in a timely and productive fashion

Factors associated with the Journal Impact Factor (JIF) for Urology and Nephrology Journals

Purpose: The Journal Impact Factor (JIF) is an index used to compare a journal's quality among academic journals and it is commonly used as a proxy for journal quality. We sought to examine the JIF in order to elucidate the main predictors of the index while generating awareness among scientific community regarding need to modify the index calculation in the attempt to turn it more accurate. Materials and Methods: Under the Urology and Nephrology category in the Journal Citations Report Website, the top 17 Journals by JIF in 2011 were chosen for the study. All manuscripts’ abstracts published from 2009-2010 were reviewed; each article was categorized based on its research design (Retrospective, Review, etc). T and correlation tests were performed for categorical and continuous variables respectively. The JIF was the dependent variable. All variables were then included in a multivariate model. Results: 23,012 articles from seventeen journals were evaluated with a median of 1,048 (range=78-6,342) articles per journal. Journals with a society affiliation were associated with a higher JIF (p=0.05). Self-citations (rho=0.57, p=0.02), citations for citable articles (rho=0.73, p=0.001), citations to non-citable articles (rho=0.65, p=0.0046), and retrospective studies (rho=-0.51, p=0.03) showed a strong correlation. Slight modifications to include the non-citable articles in the denominator yield drastic changes in the JIF and the ranking of the journals. Conclusion: The JIF appears to be closely associated with the number of citable articles published. A change in the formula for calculating JIF to include all types of published articles in the denominator would result in a more accurate representation.

Integrated Schistosomiasis and Soil-Transmitted Helminthiasis Control over Five Years on Kome Island, Tanzania

Integrated control strategies are important for sustainable control of schistosomiasis and soil-transmitted helminthiasis, despite their challenges for their effective implementation. With the support of Good Neighbors International in collaboration with National Institute of Medical Research, Mwanza, Tanzania, integrated control applying mass drug administration (MDA), health education using PHAST, and improved safe water supply has been implemented on Kome Island over 5 years for controlling schistosomiasis and soil-transmitted helminths (STHs). Baseline surveys for schistosomiasis and STHs was conducted before implementation of any integrated control strategies, followed by 4 cross-sectional follow-up surveys on randomly selected samples of schoolchildren and adults in 10 primary schools and 8 villages, respectively, on Kome islands. Those follow-up surveys were conducted for impact evaluation after introduction of control strategies interventions in the study area. Five rounds of MDA have been implemented from 2009 along with PHAST and improved water supply with pumped wells as other control strategies for complementing MDA. A remarkable steady decline of schistosomiasis and STHs was observed from 2009 to 2012 with significant trends in their prevalence decline, and thereafter infection rate has remained at a low sustainable control. By the third follow-up survey in 2012, Schistosoma mansoni infection prevalence was reduced by 90.5% and hookworm by 93.3% among schoolchildren while in adults the corresponding reduction was 83.2% and 56.9%, respectively. Integrated control strategies have successfully reduced S. mansoni and STH infection status to a lower level. This study further suggests that monitoring and evaluation is a crucial component of any large-scale STH and schistosomiasis intervention.

Improved Socio-Economic Status of a Community Population Following Schistosomiasis and Intestinal Worm Control Interventions on Kome Island, North-Western Tanzania

Research on micro-level assessment of the changes of socio-economic status following health interventions is very scarce. The use of household asset data to determine wealth indices is a common procedure for estimating socio-economic position in resource poor settings. In such settings information about income is usually lacking, and the collection of individual consumption or expenditure data would require in-depth interviews, posing a considerable risk of bias. In this study, we determined the socio-economic status of 213 households in a community population in an island in the north-western Tanzania before and 3 year after implementation of a participatory hygiene and sanitation transformation (PHAST) intervention to control schistosomiasis and intestinal worm infections. We constructed a household 'wealth index' based housing construction features (e.g., type of roof, walls, and floor) and durable assets ownership (e.g., bicycle, radio, etc.). We employed principal components analysis and classified households into wealth quintiles. The study revealed that asset variables with positive factor scores were associated with higher socio-economic status, whereas asset variables with negative factor scores were associated with lower socio-economic status. Overall, households which were rated as the poorest and very poor were on the decrease, whereas those rated as poor, less poor, and the least poor were on the increase after PHAST intervention. This decrease/increase was significant. The median shifted from -0.4376677 to 0.5001073, and the mean from -0.2605787 (SD; 2.005688) to 0.2605787 (SD; 1.831199). The difference in socio-economic status of the people between the 2 phases was highly statistically significant (P<0.001). We argue that finding of this study should be treated with caution as there were other interventions to control schistosomiasis and intestinal worm infections which were running concurrently on Kome Island apart from PHAST intervention.

Improved Perceptions and Practices Related to Schistosomiasis and Intestinal Worm Infections Following PHAST Intervention on Kome Island, North-Western Tanzania

Schistosomiasis and intestinal worm infections are widespread diseases of public health importance in Tanzania. A study on perceptions and practices related to schistosomiasis and intestinal worm infections was undertaken among a community population of Kome Island in Sengerema District, north-western Tanzania, where intestinal schistosomiasis and intestinal worm infections are endemic. Schistosomiasis and intestinal worm-related perceptions and practices were assessed before and 3 years after implementation of a participatory hygiene and sanitation transformation (PHAST) intervention as a control measure. Data were obtained from baseline and post-intervention knowledge, attitudes, and practices (KAP) questionnaire surveys conducted twice in 2009 and 2012 among 82 individuals aged > or =15 years. We found significant increases in respondents' knowledge of the cause, transmission, symptoms, health consequences, and prevention of schistosomiasis and intestinal worm infections after PHAST intervention. The increase in respondents' knowledge on almost all aspects of the said infections was translated into actions to control schistosomiasis and intestinal worm infections. This has not been achieved by chance, but due to well-designed and locally-adapted PHAST intervention. We conclude that despite criticisms, PHAST approach is still useful in empowering communities to control water, sanitation, and hygiene related infectious diseases such as schistosomiasis and intestinal worm infections.

A Study on Anxiety Among B.Ed Teacher Trainees in Villupuram Town, India.

The study examined the level of anxiety among the B.Ed teacher trainees in Villupuram town . For this purpose 300 B.Ed teacher trainees from three colleges of Villupuram town was selected. Anxiety scale constructed by A.K.P.Sinha and L.N.K.Sinha was used. The result showed that there is no significant level of anxiety among most of the B.Ed teacher trainees of Villupuram town.. With respect to background variables, it is found that the student‟s locality, educational qualification, department and type of family doesn‟t affect their anxiety level. But age, gender and annual income of the student‟s family, affect their anxiety level.

Transmisión vertical de HTLV-1 en el Perú / Vertical transmission of HTLV-1 in Peru

La infección por el virus linfotrópico humano de células T tipo 1 (HTLV-1) ha sido descrita en muchas áreas del mundo, como en los países del Caribe, Japón, África, Oceanía y en Sudamérica. En la presente revisión definimos la endemicidad del HTLV-1 en el país, planteando cuatro criterios epidemiológicos. Luego discutimos el tema central de la revisión: la transmisión vertical del HTLV-1, que en nuestro país sería uno de los principales mecanismos de transmisión. Dentro del desarrollo de este aspecto en particular, presentamos una estimación de la tasa de transmisión vertical y los factores de riesgo asociados con la transmisión vertical sobre la base de una revisión exhaustiva de estudios nacionales y extranjeros. Con esta revisión pretendemos dar una primera aproximación al estudio de la trasmisión vertical de HTLV-1, un aspecto poco estudiado en nuestro medio.

Human type 1 T-cell lymphotropic virus (HTLV-1) infection has been described in many areas of the world, including Caribbean countries, Japan, Africa, Oceania and South America. In this review we define the endemicity of HTLV-1 in the country proposing four epidemiological criteria. Then we discuss the core subject of the review, which is the vertical transmission of HTLV-1. This mechanism is one of the main forms of transmission in our country. Within the development of this particular topic, we present an estimated rate of vertical transmission and the risk factors associated to vertical transmission based on an exhaustive review of the national and international literature. This review pretends to provide a first approach to the vertical transmission of HTLV-1, an aspect poorly studied in our country.

Does the handling time of unrefrigerated human fecal specimens impact the detection of Clostridium difficile toxins in a hospital setting.

Background The stability of Clostridium difficile toxins is an important factor in determining the accuracy of the enzyme immunoassay (EIA). The Centers for Disease Control has stated that C. difficile toxins may become undetectable in unrefrigerated stool specimens within 2 h after collection. Purpose The purpose of our study was to determine how the unrefrigerated handling time of human fecal specimens affects the results of C. difficile infection (CDI) testing. Methods A retrospective review of CDI testing with Premier™ Toxins A and B kit was conducted in northern New Jersey, USA. Stool collection times and receiving times were recorded for each specimen. The unrefrigerated handling time was calculated for each. Results A total of 1126 fecal specimens were submitted. We excluded 72 fecal specimens due to incomplete documentation. We included 1054 fecal specimens collected from 636 hospitalized patients. A total of 132 out of 1054 specimens (12.5%) tested positive for C. difficile toxins. Nine hundred and fifty-four specimens were unrefrigerated for 13 h or less, of which 127 (13.3%) tested positive. Five (5%) of the 100 specimens that were unrefrigerated for more than 13 h tested positive (p=0.02). Conclusion C. difficile toxins can still be detected up to 13 h after collection in unrefrigerated human fecal specimens. However, fecal specimens should be processed according to the current recommendations to ensure the reliability of EIA testing until the results of our study are confirmed with prospective studies.

Co-morbidity of alcohol dependence and select affective and anxiety disorders among individuals of East Indian and African ancestry in Trinidad and Tobago / La comorbilidad de la dependencia del alcohol y trastornos particulares de la afectividad y de ansiedad entre individuos de ascendencia indooriental en Trinidad y Tobago

The present study sought to determine whether an association exists between alcohol dependence and select affective and anxiety disorders in patients presenting at substance abuse centres in Trinidad and Tobago (TT). The participants in this study were 143 alcohol dependents, of either East Indian ancestry (Indo-TT) or African ancestry (Afro-TT) and 109 controls matched by age, gender and ethnicity. A structured interview was used to gather information on demographics, psychiatric diagnoses and personal drinking and drug use. A blood sample was obtained and used to genotype for the presence of ADH and ALDH1 polymorphisms and serum levels of hepatic enzymes. Forty-one per cent of Indo-TT and 37% of Afro-TT with alcohol dependence had co-morbid major depressive disorders independent of alcohol and/or drug use. Thirty-nine per cent of Indo-TT and 37% of Afro-TT with alcohol dependence had co-morbid major depression induced by alcohol or drug use. The severity of depression was significantly associated with severity of alcohol dependence. Neither major depression nor the severity of depressive episodes was associated with values of any liver function test or the presence of ALDH1*2 or ADH1C*2 alleles. However, in participants of African descent elevated alanine transaminase ALT was associated (p = 0.038) with not having substance-induced major depression. Co-morbidity of major depressive disorder with alcohol dependence is common in the two major ethnic groups in Trinidad and Tobago and appears to be as likely the consequence of drinking and/or drug use, as the cause. Clinicians should solicit a history of depression from patients with alcohol dependence.

El presente estudio busca determinar si existe una asociación entre la dependencia del alcohol y trastornos particulares afectivos y de ansiedad en pacientes que acuden a centros de abuso de sustancia en Trinidad Tobago (TT). Los participantes en este estudio fueron 143 personas dependientes del alcohol, quienes eran bien de ascendencia indo-oriental (indo-trinitenses), o bien de ascendencia africana (afro-trinitenses), y 109 controles apareados por edad, género y etnicidad. Se usó una entrevista estructurada a fin de recoger información sobre demografía, diagnóstico psiquiátrico, así como el consumo personal de drogas y alcohol. Una muestra de sangre fue obtenida y usada para un genotipado en busca de la presencia de polimorfismos ADH y ALDH1 así como de los niveles de sueros de las enzimas hepáticas. El cuarenta y uno por ciento de los indotrinitenses y el 37% de los afrotrinitenses con dependencia de alcohol presentaban serios trastornos depresivos comórbidos, independientes del alcohol y/o uso de drogas. La severidad de la depresión estuvo asociada de manera significativa con la severidad del uso del alcohol. Ni la depresión seria ni la severidad de los episodios depresivos estuvieron asociadas con los valores de ninguna de las pruebas del funcionamiento del hígado o la presencia de alelos de ALDH1*2 o ADH1C*2. Sin embargo, en participantes de ascendencia africana, la elevada alanina transaminasa (ALT), estuvo asociada (p = 0.038) con el no tener una depresión seria inducida por sustancia. La comorbilidad del trastorno depresivo severo con dependencia del alcohol, es común en los dos grupos étnicos principales de Trinidad y Tobago, y parece ser probablemente tanto la causa como la consecuencia de darse a la bebida y/o al uso de drogas. Los clínicos debían pedir a sus pacientes con dependencia de alcohol, una historia de su depresión.

Persistency of transovarial dengue virus in Aedes aegypti (Linn.).

A study was conducted to examine the persistency of transovarial dengue virus type 2 (DEN-2) in a Selangor strain of Aedes aegypti mosquitoes. Two hundred 4-5 day old female mosquitoes were fed with blood containing dengue virus. The infected mosquitoes were reared to the 7th generation; each generation was screened for the virus using immunological staining methods. The virus was detectable until the 5th generation but absent in the 6th and the 7th generations. Therefore, dengue virus type 2 can be transmitted transovarially in Aedes aegypti mosquitoes until the fifth generation under laboratory conditions.

Comparative Efficacy of Rabeprazole and Pantoprazole in the Control of Nocturnal Acid Output and Intragastric Acidity

BACKGROUND/AIMS: Nocturnal reflux is a largely undiagnosed and unmanaged condition predisposing to multiple esophageal complications. We evaluated the effects of rabeprazole and pantoprazole on nocturnal intragastric pH and gastric acid output during Day 1 of therapy following the consumption of standard meals. METHODS: The study had a double-blinded, randomized, two-way crossover design, and involved 15 patients with a history of mild reflux. Following an overnight fast, patients were given either rabeprazole (20 mg) or pantoprazole (40 mg) prior to the first of three standard Western meals. They then underwent overnight continuous intragastric pH monitoring and gastric acid output measurement. The drug effect was analyzed using a two-treatment, two-period crossover mixed model. RESULTS: The percentage of time during which the mean intragastric pH was greater than 4.0 and gastric acid output was less than 2.0 was higher for oral rabeprazole (p<0.05). The inhibition of acid output was greater for rabeprazole at almost all time points. Furthermore, the mean time-matched pH values differed significantly over the first 8.3 hours (p<0.05). CONCLUSIONS: On day 1, oral rabeprazole inhibited acid output to a greater extent and for a longer period than pantoprazole, and the intragastric pH was significantly higher for rabeprazole than for pantoprazole over the first 8.3 hours.

The Family Physician's Role in Identifying and Treating Tobacco Addiction among Adolescents

Smoking and tobacco addiction are serious public health problems worldwide. New research reveals that addiction to tobacco can begin very early, with very low levels of smoking. Family physicians are in a unique position to prevent smoking initiation by youths and to diagnose and treat tobacco addiction in young smokers. In this paper we discuss the factors that prompt youths to try smoking, how quickly addiction to tobacco begins after the onset of smoking, how a family physician can determine whether a young patient is addicted, and what the physician can do to prevent adolescent patients from beginning to smoke or to assist them to quit if they already smoke.