Impact of point-of-care ultrasound on the diagnosis and treatment of patients in rural Uganda.

Œ: Ultrasound is increasingly used by physicians at the bedside to diagnose and treat a variety of conditions and is particularly useful in the resource-limited setting. The purpose of this study was to determine whether point-of-care ultrasound (POCUS) performed by physicians changed the diagnosis or treatment of patients in mobile clinics in rural Uganda. Patients presenting to mobile clinics in Uganda were assessed by physicians and, when appropriate, POCUS was performed. When available, a radiologist reviewed ultrasound images in real time. A de-identified questionnaire was completed for each ultrasound and reviewed retrospectively. A total of 177 ultrasounds were performed. A radiologist reviewed 50% of the ultrasounds. In 73% of patients, the findings either confirmed (50%) or changed (23%) a diagnosis. In 53% of patients, the ultrasound findings changed the treatment plan. POCUS positively impacted patient care in rural Ugandan clinics by improving diagnostic capabilities and influencing treatment plans.

Loperamide: a pharmacological review.

Loperamide is an antidiarrheal medication approved for the control of diarrhea symptoms and is available without a prescription. Loperamide works by a number of different mechanisms of action that decrease peristalsis and fluid secretion, resulting in longer gastrointestinal transit time and increased absorption of fluids and electrolytes from the gastrointestinal tract. It is a phenylpiperidine derivative with a chemical structure similar to opiate receptor agonists such as diphenoxylate and haloperidol. It was designed to maintain the antidiarrheal activity of these drugs, but minimize the negative aspects associated with their effects on the opiate receptor. Because of loperamides's low oral absorption and inability to cross the blood-brain barrier, it has minimal central nervous system effects. It also has a longer duration of action than diphenoxylate. However, it has no clinically significant analgesic activity and does not decrease the pain associated with some forms of irritable bowel syndrome and diarrhea. Loperamide is metabolized by the cytochrome P450 (CYP) system and is a substrate for the CYP3A4 isoenzyme. Concurrent administration with CYP3A4 inhibitors may elevate loperamide concentrations. Common adverse reactions to loperamide include cramps and nausea. Loperamide is an effective treatment for patients with painless diarrhea and is considered to be free of abuse potential.

Bioequivalence of azathioprine products.

All azathioprine oral tablets are considered bioequivalent by the Food and Drug Administration based on traditional testing. However, since these tests were conducted, it has been determined that some patients have a deficiency of the enzyme most responsible for the metabolism of 6-mercaptopurine-thiopurine methyltransferase (TPMT). Azathioprine is rapidly converted to 6-mercaptopurine, its active metabolite. So it is possible that differences in TPMT activity may influence the bioequivalence of azathioprine products among individuals, especially those patients deficient in TPMT enzyme activity. However, this possibility has not been evaluated.

Valdecoxib.

Valdecoxib is a selective COX-2 inhibitor that is similar in anti-inflammatory activity to the other selective COX-2 inhibitors (e.g., celecoxib and rofecoxib). Valdecoxib is at least equally as effective as ibuprofen, naproxen, and diclofenac in the treatment of osteoarthritis and rheumatoid arthritis, but is safer in terms of gastrointestinal toxicity. Valdecoxib is also indicated for treatment of dysmenorrhea and useful in other pain conditions. There have been no head-to-head comparisons of valdecoxib and celecoxib or rofecoxib in the treatment of osteoarthritis, rheumatoid arthritis, or various pain conditions.