The Impact Of Antihypertensive Drug Therapy In Patients With Chronic Kidney Disease: A Prospective Observational Cohort Study

Objective: Hypertension (HTN) is both a cause and an effect of chronic kidney disease (CKD). To adequately control blood pressure (BP) in CKD, choosing antihypertensive strategies with the highest nephro-protective effect is crucial for preventing or reversing end-stage renal disease (ESRD) progression and reducing cardiovascular disease (CVD) risk. The present study was therefore designed to evaluate the impact of clinical use of antihypertensive drug therapy in patients with CKD and ESRD. Methods: It is a prospective observational cohort study. The patients were divided into two cohorts i.e.; non-dialysis dependent (NDD) and dialysis-dependent (DD) CKD. This study was conducted for six months in the Nephrology department, Osmania General Hospital, Hyderabad, India. The data collected and entered into Microsoft Excel (2007) and mean, SD and range were calculated using SPSS version 25. Results: Antihypertensive drugs were prescribed alone or in combination based on the co-morbidities associated with CKD and HTN. Loop diuretics (Furosemide and Torsemide) and calcium channel blocker (Amlodipine, Nifedipine and Cilnidipine) were most commonly prescribed antihypertensive drugs. Triple therapy (44.11%) was prescribed mostly in both the cohorts (NDD = 16.66%+DD = 27.45%) of which calcium channel blockers+loop diuretic+sympatholytic accounts for 19.16% (NDD = 5.88%+DD = 13.73%).  Conclusion: The practice of prescribing antihypertensive drugs for the management of HTN and to achieve BP targets in CKD and ESRD remains uncertain. The development of new and revised guidelines is needed to reduce inappropriate variations in practice and promote better delivery of evidence-based treatment.

Pharmacovigilance and adverse drug reporting system; awareness in Pakistan: pharmacy students and professionals approach and facts

ABSTRACT: This study was conducted to assess the pharmacy students and graduate knowledge and awareness about pharmacovigilance and adverse drug reporting [ADR] system in Karachi, Pakistan

Objectives: This study was designed to identify the trends, perception and approaches of pharmacy students and graduate towards current scenarios of pharmacovigilance and ADR contextual to our setting. Study Design: It was cross sectional, qualitative study. Setting: Pharmacy final year students and fresh graduates of two public and two private sector universities were included in the study. Period: Data was collected between January to August, 2015

Method: Relevant information was collected using questionnaire with 18 open ended and 7 close ended questions. 400 final year participants and 150 fresh graduates were incorporated in this survey. SPSS 20.0 was used to analyze the results and Percent, frequencies and mean scores were calculated for various outcomes

Results: Response rate of final year students and fresh graduates was found [97%, n = 388] and [88%, n= 132] respectively. Students level of awareness about pharmacovigilance was found [54%, n =216] in final year students while little higher rates were observed [78%, n=110] in graduates. Concept of pharmacovigilance gained through pharmacy curriculum was calculated 45% rated by final year students. The pharmacovigilance knowledge mean score was found to be 2.368.5 and 2.886.3 for final year students and fresh graduates respectively. 58% total respondents were aware with relationship between the drug and the ADR

Conclusion: The results of this study demonstrate that pharmacy students of final year in public and private sector universities of Pakistan are aware with some basic knowledge of ADRs and pharmacovigilance, but it is a need of time to incorporate more contents of such aspects in curriculum with some practical exposure that how to report ADRs

Diabetes mellitus and stroke in the Arab world

Objectives: the relationship between diabetes mellitus and stroke in the Arab countries is underreported. In this review, we investigate the prevalence of diabetes mellitus among patients with stroke in the Arab world

Methods: we searched published literature to identify studies reporting on patients with stroke from the Arab countries. Eligible articles were reviewed to extract data on the frequency of diabetes among their samples and on the details of disease diagnostic criteria, control status and stroke subtypes

Results: we identified 29 studies reporting on a total of 10,242 patients. The estimated prevalence of diabetes among the ischaemic stroke population of these studies was 37.5%. None of the studies described the prevalence of diabetes among haemorrhagic patients with stroke. The criteria for diagnosing diabetes were not always described. Studies from the Gulf countries tended to report a higher prevalence of diabetes mellitus than studies from other Arab-world countries

Conclusions: there is insufficient reporting regarding the status of diabetes mellitus and its complications. The majority of studies suggest a remarkable variability in its prevalence. We hope that this review will draw attention to this prevalent health problem and prompt a better estimation of the impact of diabetes mellitus on the vascular health of our nations

Knowledge and behavior of primary school teachers towards attention deficit hyperactivity disorder

School teachers in Bahrain have never received any educational programs about attention deficit hyperactivity disorder [ADHD] except for a workshop which was conducted for primary school social supervisors in 2005. To evaluate the knowledge of primary school teachers of ADHD, attitude and behavior towards ADHD students. Cross-Sectional study. Primary Schools in Bahrain. One hundred fifty-eight randomly selected governmental primary school teachers completed the questionnaire about knowledge and attitude towards ADHD. Eighty-four [53.2%] of the teachers were knowledgeable about ADHD. Their main sources of knowledge about ADHD were newspapers and magazines. Teachers' Knowledge of ADHD was found to be less than optimal

Purification and characterization of NISIN produced by lactococcus lactis isolated from Indian curd.

Lactococcus lactis isolated from traditional dairy Indian curd. Strains were preliminarily identified by PCR analysis and partial 16S rRNA confirmed that N5 were 100% identical to Lactococcus. lactis sp. lactis. The results revealed that only the bacteriocin produced from strain N5 was shown as being active against mostly gram positive bacteria The bacteriocin produced purified by precipitation followed by loading with gel chromatography. The partially purified bacteriocin was found to be stable over a wide range of pH, temperature and enzymes. The molecular weight of the peptide was judged to be 3.5 kDa by SDSpolyacrylamide gel electrophoresis.and conform to the result of mass spectrometry by maldi-tof test which calculated the mass of 3354.07 Da for nisin.These results indicate that bacteriocin produced by L. lactis sp. lactis N5 is a nisin.

Capsaicin: A novel chemopreventive molecule and its underlying molecular mechanisms of action.

Capsaicin (trans-8-methyl-N-vanillyl-6-nonenamide) is the a principal pungent ingredient of hot red and chili peppers that belong to the plant genus Capsicum (Solanaceae). Capsaicin is a cancer-suppressing agent. It blocks the translocation of nuclear factor kappa B (NF-kB), activator protein 1 (AP-1), and signal transducer and activator of transcription (STAT3) signaling pathway that are required for carcinogenesis. The anti-inflammatory potential of capsaicin is attributed to its inhibitory effect on inducible COX-2 mRNA expression. Cytochrome P4502E1 mediates the activation of xenobiotics such as vinyl carbamate and dimethyl nitrosamine to their toxic metabolites. This metabolic activation of xenobiotics by Cytochrome P4502E1 has been shown to be inhibited by capsaicin. Capsaicin also generates reactive oxygen species in cells with resultant induction of apoptosis and cell cycle arrest, which is beneficial for cancer chemoprevention. Therefore, the use of capsaicin as a chemopreventive agent is of immense benefit for cancer chemoprevention. The search strategy included printed journals, pubmed, and medline, using the terms 'capsaicin' and 'anticancer' citations, relevant to anticancer properties of capsaicin.

diagnostic value of monoclonal antibody panel in cases of Hodgkin's lymphoma

The interface between Hodgkin's lymphoma [HL] and B-cell NHL has become more ambiguous in recent years. Yet, the clinical presentation, prognosis, and treatment requirement of Hodgkin's lymphoma are very different from most B-cell NHL. Thus, distinguishing between those lymphomas is still mandatory. Reviewing and immunophenotyping [using a monoclonal antibody panel] of cases diagnosed by routine histologic sections stained with hematoxylin and eosin [H and E] as Hodgkin's lymphoma, subtyping the cases in view of the new classification based on morphologic and immunophenotypic data, as well as studying the efficacy of human fascin antibody as a new marker for Reed-Sternberg cells. All cases were submitted to pathological examination of the routine H and E stained section as well as immunohistochemical evaluation of fascin, CD30, CD 15, CD20, and CD3 expression with subsequent re-evaluation of cases and establishing a final diagnosis based on morphologic and immunophenotypic data. In the present work, positive immunostaining for fascin was expressed in 97.7% of classic HL, CD30 in 80.9%, CD 15 in 70.2%, and CD20 in 10.6%. Only 26 cases [57.7%] showed coexpression of CD30 and CD15. After the review of immunohistochemical slides the diagnosis was confirmed in 37 cases of classic HL. Problematic cases were reclassified into CHL of mixed cellularity subtype [2 cases], CHL of lymphocyte rich subtype [2 cases], and CHL of the lymphocyte depletion subtype [2 cases]. Two additional cases were classified as T-cell rich large B-cell lymphoma [TCRBCL]. Two cases remained unclassified after immuno staining. The present study emphasized that immunohistochemistry supports and refines the H and E based diagnosis of Hodgkin's lymphoma and that Fascin is a sensitive marker for RS cells and may be used to differentiate between Hodgkin's and non-Hodgkin's lymphoma in difficult cases. Furthermore, complete immunohistochemical panel is needed to distinguish between T-cell rich B-cell lymphoma and lymphocyte rich-classic Hodgkin's lymphoma whether nodular or diffuse taking into consideration that absence of CD 30 or CD 15 immuno staining or expression of CD20 does not 'rule out the diagnosis of classic Hodgkin 's lymphoma and that coexpression of CD 30 and CD 15 when coupled with CDS expression necessitates complementary studies

Incidence and etiology of neonatal seizures

To determine the incidence of seizures in admitted neonates and establish the etiological diagnosis. During the study period, 4.8% [97 cases] cases among admitted neonates, having seizures either at presentation or during their stay in the hospital, were included. Hypoxic ischemic encephalopathy was found to be the commonest cause [44.3%] of neonatal seizures, followed by hypoglycemia [19.5%] and hypocalcemia [12.3%] cases. Subtle seizures [41.2%] were the most frequently observed type of seizure, followed by tonic [32.9%] and clonic [20.6%] seizures. Nearly 55% cases had seizures during the first 48 hours of life. Cases of hypoxic ischemic encephalopathy were associated with higher mortality [39.5%] as compared to cases with metabolic seizures. Neonatal seizures were found as a common neurological disorder and presented most commonly as subtle type. Birth asphyxia was the commonest aetiology of neonatal seizures, followed closely by the metabolic seizures