Drinking and recreational water-related diseases: a bibliometric analysis (1980–2015)

BACKGROUND: Water – related diseases are worldwide health concern. Microbial contamination and contaminant products in water are a source of disease outbreaks and development of cumulative toxic effects. Ensuring safe water is one of the goals to be achieved at the global level. The aim of this study was to assess publications on drinking and recreational water from a health point of view to understand current problems and future research trends in this field. METHODS: Scopus, the largest scientific electronic database, was used to retrieve related articles and present the results as bibliometric tables and maps. Search query was modified manually using related terms to maximize accuracy. RESULTS: A total of 2267 publications were retrieved with an average of 16.82 citations per article. The h-index of retrieved articles was 88. Visual mapping showed that E. coli, diarrhea, cryptosporidiosis, fluoride, arsenic, cancer, chlorine, trihalomethane, and H. pylori were most frequently encountered terms in title and abstract of retrieved articles. The number of articles on water microbiology was a significant (P < 0.01) predictor of worldwide productivity of water – related disease publications. Journal of Water and Health ranked first in number of publications with 136 (6.00 %) articles. The United States of America ranked first in productivity with a total of 623 (27.48 %) articles. Germany (15.44 %), India (16.00 %) and China (20.66 %) had the least international collaboration in water-related disease research. Environmental Protection Agency and Centers for Disease Prevention and Control were among top ten productive institutions. In the top ten cited articles, there were three articles about arsenic, one about aluminum, one about trihalomethane, one about nitrate, one about toxoplasmosis, one about gastroenteritis, and the remaining two articles were general ones. CONCLUSIONS: There was a linear increase in the number of publications on water – related diseases in the last decade. Arsenic, in drinking water is a serious concern. Cryptosporidiosis and other infectious gastroenteritis remain a major health risk of exposure to contaminated water. Increased number of publications from Asian countries was not associated with a high percentage of international collaboration.

Contribution of Arab countries to pharmaceutical wastewater literature: a bibliometric and comparative analysis of research output

BACKGROUND: Recently, the pharmaceutical manufacturing industry has been growing rapidly in many countries in the world, including in Arab countries. Pharmaceuticals reach aquatic environments and are prevalent at small concentrations in wastewater from the drug manufacturing industry and hospitals. Such presence also occurs in domestic wastewater and results from the disposal of unused and expired medicines. Therefore, the objective of this study was to analyze and compare the quantity and quality of publications made by researchers in Arab countries on pharmaceutical wastewater. METHODS: To retrieve documents related to pharmaceutical wastewater, we used the Scopus database on November 21, 2015. All documents with terms related to pharmaceutical wastewater in the title or abstract were analysed. Results obtained from Arab countries were compared with those obtained from Turkey, Iran and Israel. RESULTS: Globally, a total of 6360 publications were retrieved while those from Arab countries, Iran, Turkey and Israel, were 179, 113, 96 and 54 publications respectively. The highest share of publications belonged to Kingdom of Saudi Arabia (KSA) with a total of 47 (26.2 %) publications, followed by Egypt (38; 21.2 %), Tunisia (17; 9.5 %) and Morocco (16; 8.9 %). The total number of citations was 1635, with a mean of 9.13 and a median (inter quartile range) of 3 (1.0–10.0). The study identified 87 (48.6 %) documents with 32 countries of international collaboration with Arab countries. It was noted that Arab researchers collaborated mainly with authors in Western Europe (54; 30.2 %), followed by authors from the Asiatic region (29; 16.2 %) and Northern America (15; 8.4 %). The most productive institution was King Saud University, KSA (13; 7.3 %), followed by the National Research Centre, Egypt (10; 7.3 %). CONCLUSIONS: This study showed that KSA has the largest share of productivity on pharmaceutical wastewater research. Bibliometric analysis demonstrated that research productivity, mainly from Arab countries in pharmaceutical wastewater research, was relatively lagging behind. More research effort is required for Arab countries to catch up with those of non-Arab Middle Easter countries on pharmaceutical wastewater research.

Optimal dosing of angiotensin-converting enzyme inhibitors in patients with chronic heart failure: a cross-sectional study in Palestine

Because high-dose angiotensin-converting enzyme [ACE] inhibitor therapy is desirable in patients with chronic heart failure [CHF], we sought to determine the usage and dosing patterns of ACE inhibitors in CHF patients at a governmental hospital in Palestine. This cross-sectional study was conducted between September 2006 and August 2007. All patients admitted with a confirmed diagnosis of CHF and an ejection fraction < 40% were evaluated. After excluding patients with a caution/contraindication to ACE inhibitor use or not taking an ACE inhibitor, we determined the number of patients receiving optimal [captopril 150-300 mg/day, enalapril 20-40 mg/day, ramipril 5-10 mg/day] and suboptimal doses. We then conducted statistical analyses to evaluate associations between ACE inhibitor use and dosing and various demographic and clinical factors. Of the 165 patients initially evaluated, 69 [41.8%] had a caution/contraindication [n=28, 40.6%] or were not using an ACE inhibitor [n=41, 59.4%]. Of the remaining 96 patients [70.1%], 49/96 [51%] were given an optimal dose while 47/96 [49%] were given a suboptimal dose. Of all patients with CHF and no contraindication [n=137], 88 [64.2%] were either receiving no ACE inhibitor or a suboptimal dose. Only the presence of hypertension was significantly associated with the use of an ACE inhibitor [P=.009, odds ratio=2.7]. The use of an optimal dose was not significantly associated with any of the tested factors [age, gender, presence of hypertension, diabetes mellitus, renal dysfunction, ischemic heart disease or number of diagnosis]. Underutilization and suboptimal dosing of ACE inhibitors was common. Since there is an abundance of evidence in favor of using high-dose ACE inhibitor therapy in patients with CHF, physicians need to be educated about proper dosing of these agents

Gender differences in pharmacological and clinical associates of kidney disease. A hospital-based study

The objective of this study was to identify the pharmacological and clinical associates of kidney disease among males and females. This is a cross-sectional retrospective study. All patients admitted to the Department of Internal Medicine at Al-Watani Hospital were included in the study. Medical data were obtained from patients' medical records. Kidney disease was defined as a glomerular filtration rate [GFR] less than the published cutoff points. Males with GFR <64.25 ml/min and females with GFR <59.25 ml/min were designated as kidney group and those above were considered the reference group. GFR was estimated using Cockroft-Gault equation; CHI[2] and multiple logistic regressions were used to test for significance using statistical package for social sciences program. Of the 340 patients, 185 [54.5%] were males and 155 [45.6%] females; mean age was 60.4 +/- 17 years. Of the 185 males, 58 [31.4%] and of the 155 females, 41 [26.6%] had low GFR kidney disease. Stepwise forward multiple logistic regression in males identified age, hypertension, and diabetes mellitus [DM] as associates of low GFR. In females, DM and angiotensin-converting enzyme inhibitors [ACE-I]/diuretic utilization were identified as significant associates of having low GFR. As the number of clinical conditions present in the patient increased, the odds ratio of having low GFR increased, in a similar and parallel way in both genders. Diabetes mellitus, but not hypertension or advancing age, was significantly associated with low GFR in both males and females. Utilization of the ACE-I/diuretic combination was significantly associated with low GFR among females but not males. Patients, regardless of gender, who had multiple clinical conditions, had higher risk of having low GFR

Effects of combined treatment of angiotensin converting enzyme inhibitors and diuretics on serum creatinine levels among elderly patients

The adverse effects of angiotensin converting enzyme inhibitors [ACE-I] and diuretics when given together need extensive research and attention. We performed a cross-sectional study of patients admitted to the internal department of a general medical hospital to investigate the effect of drug combinations on serum creatinine level and creatinine clearance upon admission. Age, sex, disease status and prior consumption of the 'target' drugs: diuretics and ACE-I were correlated with creatinine and creatinine clearance on admission. The levels of serum creatinine for groups receiving the target combination in both sexes were significantly higher than groups who were not receiving the target combination. Computing an estimate of creatinine clearance based on Cockroft equation yields similar results to that for serum level creatinine. The levels of creatinine clearance in both sexes were significantly higher in the control group compared to those receiving the target combinations. Low dose aspirin seems to have a synergistic negative effect on renal function when given in combination with the target medications. taking ACE-I/diuretic combination was associated with significant changes in creatinine levels and creatinine clearance. Attention should be made to balance positive effects of these medications against their negative effect on renal function

Influence of disease and drug factors on metformin daily dose

Metformin may, in the presence of certain risk factors, cause serious lactic acidosis. The aim of this study was to investigate the presence of risk factors for lactic acidosis among diabetic patients and to determine whether metformin daily dose was influenced by the presence of these risk factors or not. One hundred and eighteen patients were included in the study. Information about disease status and medication profile of the patient was retrieved from patient's medical files who were having diabetes mellitus and prescribed metformin. Approximately, tow thirds [74/118, 62.7%] of the included patients had a least one disease risk factor for lactic acidosis. Of those patients, [48/74; 64.9%] had a dose adjustment, with congestive heart failure and renal impairment being the risk factors most likely to result in a dose adjustment. More than one third [38%] of metformin patients were co-prescribed ACE-I or NSAIDs. The dose of metformin was insignificantly influenced by the co-administration of drug risk factors. Metformin total dialy dose was significantly influenced by the presence of disease risk factors and was insignificantly influenced by the co-administration of drug risk factors. Short running title: Risk Factors and Metformin Dose

Pattern of parenteral antimicrobial prescription among pediatric patients in Al Watani government Hospital in Palestine

No studies were carried out in Palestine to investigate the antimicrobial prescribing among hospitalized pediatric patients. The objective of this study was to audit and therapeutically analyze the pattern of parenteral antimicrobial prescriptions among pediatric patients in Al-Watani government hospital in Palestine. Such audit will be of great value to clinician and health policy makers. Data on antimicrobial prescribing were collected for 30 consecutive days for all pediatric patients admitted to Al-Watani government hospital. Data on antimicrobial prescribing were entered and analyzed using Statistical Package for Social Sciences [SPSS] program. Analysis was done for age, sex, diagnosis, site of infection, number of antimicrobial agents given, how many times have the drug regimen been changed and the frequency of individual drug use. Three hundred and forty pediatric patients were admitted to Al-Watani government hospital during the study period. Gastroenteritis was the most common cause of hospitalization, while upper respiratory tract infection [URTI] was the most common cause of parenteral antimicrobial agent administration. Two hundred and ten [61.8%] patients received parenteral antimicrobial agents while 16 [4.7%] received both parenteral and oral antimicrobial agents. Single antimicrobial agent was prescribed for 172 [76.1%] patients. Cefuroxime was the main single antimicrobial agent used, it was administered to 70/226 [31%] patients. Treatment patterns used for most patients were nearly according to current therapeutic recommendations. However, improving the availability of rapid diagnostic methods to differentiate between viral and bacterial infections is suggested to reduce empiric therapy numbers by antimicrobial agents so as to decrease chance for drug resistance

Treatment of complicated and uncomplicated hypertension with nifedipine in Palestine

It is generally agreed that short acting calcium channel blockers [CCB] as nifedipine are not safe as the reflex increase in sympathetic activity and thus, their use in hypertension [HTN] is questionable. The objective of this study was to determine the extent of utilization of short acting nifedipine in the treatment of complicated and uncomplicated HTN in one of the major districts in Palestine, Nablus. The data for this study were collected from patient's medical files. Data collection was made over a period of 6 months [April - October 2003] in Nablus, Palestine. The sample studied included 876 patients with cardiovascular diseases. Focus was made on the 262 patients with uncomplicated HTN and the 147 patients with both HTN and diabetes mellitus. A total of 247 [28.2%] patients in the study sample were receiving CCB. One third [33.7%] of patients with uncomplicated HTN were receiving CCB mainly as monotherapy with most of them [61%] were receiving the old generation nifedipine as a short acting formulation. Use of nifedipine was also more common among elderly patients above the age of 60 years. There was a tendency to use short acting nifedipine as antihypertensive monotherapy among patients with either uncomplicated or complicated HTN. This irrational use needs to be reviewed since it is associated with higher risks