Effect of thyme, ginger, and their nano-particles on growth performance, carcass characteristics, meat quality and intestinal bacteriology of broiler chickens.

This study was conducted to evaluate the effects of thyme, ginger, and their nano-particles, as alternatives to antibiotic growth promotors (AGP), on productive performance, carcass traits, meat quality and gut health of broiler chickens. A total of 270 one-day-old broiler chicks were randomly distributed into 6 groups, each consisting of 3 replicates (n = 15 chicks/replicate). The birds in group 1 were fed the control diet which contained neither antibiotic growth promotors nor phytogenic feed additives (PFA). Birds in group 2 were fed diets containing 0.05% of AGP (Bacitracin methylene disalicylate). Chicks in group 3 and 4 were fed diets supplemented with 1.0% of thyme and ginger, respectively, whereas birds in group 5 and 6 were offered diets including 0.10% of nano-thyme and nano-ginger, respectively. The experiment lasted for 35 days. It was found that thyme and ginger with their nano-products, like the antibiotic, improved the body weight, weight gain and feed conversion rate of birds. The effect of ginger and nano-ginger on body weight and weight gain was greater than other treatments. During the overall feeding period, the feed cost of production was the highest in antibiotic group, but was the lowest in ginger and nano-ginger treatments. There was no effect of dietary treatments on carcass yield or organs weight except bursa of Fabricius and abdominal fat. Thyme, ginger and their nano-composites increased the weight of bursa and reduced the abdominal fat amount. The phytogenic additives and their nano-particles improved the colour, water holding capacity, and flavor of meat. Moreover, these additives reduced the total intestinal bacterial count as well as the total aerobic mesophilic count of meat. The effect of PFA and their nano-particles on the bacterial count was similar to that of antibiotic. In conclusion, thyme and ginger with their nano- particles can be considered as promising agents in feeding of broilers to improve the growth performance, gut health and meat quality. Moreover, these additives can be used as alternatives to AGP to overcome its health hazards and the high cost. The nanotechnology of herbal plants enables them to be added in smaller amounts in poultry diets with producing the same effect of raw ingredients, and this could be due to the higher bioavailability.

Effect of Spirulina platensis on growth, hematological, biochemical, and immunological parameters of Nile tilapia (Oreochromis niloticus).

This study was conducted to evaluate the effects of Spirulina platensis in Nile tilapia diets on growth performance, blood hematological and biochemical parameters, immunological status, and intestinal histomorphometry. A total of 228 fish were randomly allocated into four groups with triplicates (19 fish per replicate). The first group was fed the control diet, which contained no Spirulina supplementation. The other three groups were fed diets containing graded levels of powdered Spirulina: 2.5%, 5.0%, and 10.0% in the second, third, and fourth group, respectively. S. platensis was added to the diets partially substituting the fish meal content. The experiment lasted for 8 weeks. The results showed that dietary Spirulina supplementation improved (P < 0.05) the body weight and length, weight gain, specific growth rate, condition factor, and feed conversion efficiency. Moreover, Spirulina increased significantly (P < 0.05) the hemoglobin, PCV, RBCs, and WBCs count. Also, it increased the lymphocytes, eosinophils, IgM level, lysozyme activity, and phagocytic activity in the blood. Additionally, the Spirulina raised (P < 0.05) the serum albumin level but reduced (P < 0.05) the creatinine and urea levels. The addition of Spirulina increased (P < 0.05) the height and width of intestinal villi and the lymphocytes and goblet cells count in the intestine. The obtained results were increased by increasing the inclusion level of Spirulina, especially for body weight and length, weight gain, FCR, phagocytic activity, and intestinal parameters. In conclusion, supplementing S. platensis can improve the growth performance of fish. Moreover, it can stimulate the immunity of fish through increasing the level of immunological blood indicators (IgM, lysozyme, phagocytic activity, lymphocytes, and eosinophils) as well as the local intestinal immunity (lymphocytes and goblet cells). So, it can be recommended to use S. platensis in fish diets not only to improve the growth performance but also to enhance the immune status.

Effects of dietary supplementation of chromium methionine chelate on growth performance, oxidative stress, hematological indices, and carcass traits of broiler chickens.

This study was conducted to evaluate the dietary effects of chromium methionine (Cr-Meth) chelate on growth performance, oxidative stress parameters, blood biochemistry, and carcass traits of broiler chickens. An experiment was conducted on 34,000 1-day-old straight-run broiler chicks (Indian River; 42.0 ± 0.03) at a commercial farm. The chicks were divided randomly into 3 groups; the first group contained 17,000 birds, which used as a control, whereas the second and third groups consisted of 7000 and 10,000 birds, respectively, with 5 replicates per group. A completely randomized design was used. The birds were fed the experimental diets containing graded levels of Cr-Meth chelate: 0 (control), 50, and 100 g/ton. This compound consisted of chromium (0.4%) chelated with methionine, and it supply the diets with 200 and 400 ppb Cr for the used levels of 50 and 100 g/ton feed, respectively. Growth performance indices (body weight, body weight gain, feed intake, and feed conversion ratio) were measured throughout the experiment. At the end of experiment, 10 birds per treatment were slaughtered, and the carcass yield with relative weight of the internal organs was determined. Also, blood samples were taken and analyzed for glutathione peroxidase activity, malondialdehyde, ALT, AST, total protein, albumin, glucose, urea, creatinine, triglycerides, and total cholesterol. It was found that Cr-Meth improved the body weight, weight gain, feed intake, and feed conversion ratio of broilers. Moreover, it reduced the mortality rate of birds. The chelated chromium can alleviate the oxidative status of birds by increasing the plasma glutathione peroxidase activity and reducing the serum malondialdehyde level. It was observed that the effects of 100 g/ton Cr-Meth chelate on performance indices, mortality rate, and oxidative stress parameters were better than that of 50 g/ton inclusion rate. Supplementation of Cr-Meth increased the total protein level, but reduced the glucose, total cholesterol, and triglyceride concentrations in the blood serum. In addition, it increased the carcass yield and reduced the abdominal fat percentage of the birds' carcass. Therefore, chromium can be included in diets of broilers at a rate of 200 to 400 ppb, and the higher concentration was more effective than the lower one. So, it can be recommended to use Cr-Meth chelate in broiler diets at 100 g/ton to improve the productive performance and reduce the oxidative stress of birds.

Effect of dietary protease supplementation on growth performance, water quality, blood parameters and intestinal morphology of Nile tilapia (Oreochromis niloticus).

This study was conducted to evaluate the effect of using protease in diets of Nile tilapia on growth performance, water quality, blood parameters and intestinal morphology. The cost of these diets and their return on fish performance was calculated. A total of 360 fish were randomly allocated into four groups with triplicates (30 fish per replicate). Four diets were formulated; two controls (without protease supplementation) and two experimental diets (supplemented with protease). The first control diet contained the normal protein requirement (30% CP; control +ve), while the second control had a low protein content (29% CP; control -ve). The third diet was supplemented with protease at a dose of 500 g/ton, and its CP content was reduced to 29.0%, by reducing the fish meal content. The fourth diet contained the same CP level as the first control (30%) and supplemented with 250 g protease per ton feed. The experiment lasted for 14 weeks. The results showed that body weight and length, weight gain, specific growth rate, feed intake and feed conversion efficiency in the control -ve group (low CP) supplemented with protease were similar (p > 0.05) to that of the control +ve with normal CP content. However, these performance parameters were lower (p < 0.05) in fish fed low CP diet without protease supplementation. Providing protease to the control +ve diet improved all measured performance indices. The ammonia and nitrite concentrations of the water were reduced (p < 0.05) in control -ve and protease-supplemented groups. The height and width of intestinal villi were increased (p < 0.05) in fish fed diets containing protease. The inclusion of protease reduced the diet cost and also the feed cost of fish weight gain. In conclusion, supplementation of protease can improve the productive performance of fish, spare dietary protein and produce economical diets. Moreover, it can help in improving the water quality of fish via lowering the ammonia and nitrite contents, or through increasing the degradation of dietary protein.

Effect of feeding Sesbania sesban and reed grass on growth performance, blood parameters, and meat quality of growing lambs.

This study was conducted to evaluate the effects of green fodders, fresh Sesbania sesban, and reed grass, on growth performance, blood metabolites, and meat quality of growing lambs. Twenty-one male Farafra lambs (19.0 ± 1.87 kg body weight) were randomly distributed into three groups, each with seven animals. The first group was fed on 60% concentrates and 40% fresh alfalfa, and served as a control. The second and third groups were fed also on 60% concentrates plus 40% fresh Sesbania sesban and reed grass, respectively. Lambs were fed the diets until reaching the target slaughter weight of about 50.0 kg, which was obtained after a period of 215 days. Five lambs from each group were randomly selected and slaughtered at the end of the experiment. Slaughter body weight, carcass traits weight, and dressing percentage were estimated. Chemical composition and physical properties of longissimus dorsi muscle, from the animals' right side, were determined. It was found that no significant (P > 0.05) differences among groups in body weight, average daily gain, feed conversion rate, hot carcass, dressing percentage, and carcass components were observed. The forage intake of Sesbania and alfalfa tended to be higher than that of reed forage. There were no significant (P > 0.05) differences in the blood parameters among the treatments, except the urea level which was higher in Sesbania sesban group than the reed one. However, the serum urea concentration in Sesbania and reed groups was similar to that of alfalfa. Sesbania sesban and reed forages decreased (P < 0.05) the eye muscle area and shear force in lambs when compared to the control group. The longissimus dorsi muscle of the Sesbania and reed treatments was found to be numerically higher in the moisture and lower in the fat and collagen contents than the alfalfa group. Most of meat and fat color parameters were improved by feeding of Sesbania and reed forages. In conclusion, Sesbania sesban or reed grass, as unconventional forage sources, can be used as alternatives of the commonly used alfalfa feed. Moreover, these sources could enhance the meat quality of lambs and increasing the tenderness with accepted meat and fat color. So, it can be recommended to use Sesbania or reed grass forages in diets of sheep, to overcome the rising in the price or shortage in the availability of traditional green fodders.

Control of red flour beetle (Tribolium castaneum) in feeds and commercial poultry diets via using a blend of clove and lemongrass extracts.

The insects' infestation decreases the nutritive value of the stored grains and causes losses in its weight, quality, or economic values. The aim of the present study was to investigate the efficiency of a natural product of clove and lemongrass extracts in controlling of red flour beetle (Tribolium castaneum) in different feedstuffs and commercial poultry diets. Different concentrations of the tested product (5, 10, 20, 50, 100 mg) were mixed with 10 g of different feedstuffs and poultry diets, and incubated at different time points. The percent repellency (PR), toxicity effect, and antifeedant activity of the plant extracts compound were assessed. The PR was detected depending on the choice method. It was found that the PR was dose and time dependent. The highest doses (50 or 100 mg/10 g feed) achieved the highest repellency effect reaching 70% at 24 h post-application (PA). The minimal PR was reported by the lowest dose of 5 mg/10 g feed reaching 50% at 24 h PA. Moreover, the PR was found to decrease by time. The toxicity effect of this natural product on T. castaneum was cumulative, not acute, in which it was recorded after 1 month of application. Besides, this effect needs high doses of the product (at dose 500 or 1000 mg/50 g feed). The used product achieved a clear antifeedant activity against T. castaneum, as the feeding deterrent index (FDI %) for corn grains was 98.5% at 1.0 and 2.0% concentration, whereas for wheat grains there was a significant difference between both concentration (96.0 vs. 74.4%). In addition, the weight loss of control corn and wheat grains was higher than the treated ones, and it was about 3.15% and 2.0% per month for corn and wheat, respectively. In conclusion, the clove and lemongrass extracts had a repellency effect reaching to 70%. Moreover, it had a lethal effect on T. castaneum. In addition, it can reduce the weight loss of the infested feeds and consequently increasing its FDI %. Therefore, the clove and lemongrass extract blend can be used to protect the feedstuffs from the damage by this insect.

Effect of essential oils or saponins alone or in combination on productive performance, intestinal morphology and digestive enzymes' activity of broiler chickens.

This study was carried out to evaluate the effect of essential oils or saponins alone or in combination on productive performance, intestinal morphology, and digestive enzymes' activity in broilers. Four hundred one-day-old male broiler chickens were randomly assigned to four treatments, each with 5 replicates. The birds were fed experimental diets contained either no phytogenic feed additives (control) or were supplemented with 25.0 mg/kg of an essential oil blend from star anise, rosemary, thyme and oregano (essential oils); 46.0 mg/kg of a Quillaja saponin blend (saponins); or a combination of both phytogenic preparations (essential oils plus saponins). The experiment lasted for 42 days. Body weight, feed intake and weight gain were recorded weekly, and the feed conversion ratio was calculated, throughout the experiment. Intestinal morphology and digestive enzymes' activity were determined at the end of the experiment. It was found that the body weight was increased by all dietary supplements at the end of the experiment. There was no change in performance parameters among the treatments during the starter period. At the grower period and the overall experiment, the weight gain of birds was higher in all supplemented groups compared to the control, but the feed conversion was better in the essential oils with saponins treatment. Supplementation of essential oils or saponins alone or in combination increased the villus height and the villus/crypt ratio of the intestine. There was an increase in trypsin, chymotrypsin and elastase activities in the essential oils plus saponins group only. The obtained results indicate that the phytogenic feed additives, especially essential oils with saponins, can be considered as new promising agents in promoting the growth performance of broilers. The effect could be related to its improving impact in intestinal development and increasing the protease enzymes' activity, resulting in increased protein digestibility and absorption of dietary nutrients.

Fermentation of fibre rich ingredients exposed in vitro to the faecal inoculums of swine and turkeys.

This study was focused on in vitro fermentation and in vitro dry matter (DM) digestibility of different fibre rich ingredients that can be used in diets of pigs and turkeys. In vitro DM digestibility was determined by Daisy system via using faecal or excreta fluid of swine/turkeys as a source of inoculum. The ingredients used as substrates were commercial swine or turkey diet, dried beet pulp, wheat bran, hay, straw and two types of lignocelluloses (A and B). Marked differences between the ingredients were found and the values were: dried beet pulp (80%), swine/turkey diet (75%), wheat bran (60%), hay (40%) and straw (10%-20%). Of special interest are the data on the two lignocellulose products, the in vitro DM digestibility of product A was in the range of 20% (in turkeys) up to 30% (in pigs), whereas the product B had values of <5%. Moreover, the inoculums were incubated with the same substrates for 24h using gas measuring technique. Consecutively, commercial swine or turkey diet, dried beet pulp, wheat bran and hay produced high amounts of gas and volatile fatty acids. Lignocellulose A and straw provided lower and equal amounts of gases and fatty acids. However, lignocellulose B showed very little fermentation compared to the product A. In conclusions, faecal or excreta can be used as a source of microbial activity to determine the in vitro DM digestibility or fermentation of feeds. Comparing lignocellulose products with traditional fibre sources, the DM digestibility of lignocellulose A was greater than straw but its fermentation rate seems to be equal to straw. Thus, lignocellulose A can be used as a new source of fibre in diets of monogastric animals to optimize the gut health and improving the faeces or excreta quality.

Relationship between pharmaceutical pricing strategies with price, availability, and affordability of cardiovascular disease medicines: surveys in Qatar and Lebanon.

BACKGROUND: Cardiovascular diseases are the leading cause of death in Lebanon and Qatar. When lifestyle modifications prove insufficient, medication becomes a cornerstone in controlling such diseases and saving lives. Price, availability, and affordability hinder the equitable access to medicines. The study aimed to assess prices, availability, and affordability of essential cardiovascular disease medicines in relation to pricing strategies in Qatar and Lebanon. METHODS: A cross-sectional survey using a variant of the World Health Organization and Health Action International (WHO/HAI) methodology as outlined in "Measuring medicine prices, availability, affordability and price components" (2008), second edition, was adopted. Prices and availability of 27 cardiovascular medicines were collected from public and private dispensing outlets. For international comparison, prices were adjusted to purchasing power parity. Data was analyzed across multiple sectors, within and across countries. RESULTS: A total of 15 public and private outlets were surveyed in each country. Prices were more uniform in Qatar than in Lebanon. In the public sector, medicines were free-of-charge in Lebanon and priced lower than the international reference prices in Qatar. The ratio of medicine unit price to international reference price in the private sectors surveyed are significantly higher than the acceptable threshold of 4. This ratio of originator brands and lowest priced generics in Qatar were up to two and five times those in Lebanon, respectively, even after adjusting for purchasing power parity. However, prices of lowest priced generics in the private sector were at least 35% cheaper in Qatar and 65% cheaper in Lebanon than their comparative originator brands. Medicines were more available in the private sector in Lebanon than in Qatar, but only the originator brand availability in the public sector in Qatar exceeded the WHO target of more than 80%. While affordable in the public sector in Qatar, four out of thirteen medicines exceeded the threshold in all private sectors covered. Hence, only the public sector in Qatar had a satisfying level of availability and affordability. CONCLUSIONS: Except for the Qatari public sector, medicine prices, availability, and affordability are falling short from targets. Key policy decisions should be implemented to improve access to medicines.

The unusual traumatic locked young knee.

Locked knee is an orthopaedic condition requiring urgent treatment. Although the condition can be diagnosed via history, physical examination and imaging studies, the cause of the mechanical obstruction may only be apparent during arthroscopic examination of the knee joint. It is known that imaging plays a role in evaluating the integrity of intra-articular structures, however in some atypical cases, imaging cannot identify the definitive cause of locked knee. Here we report on two cases of locked knee, due to uncommon conditions which were unobservable via normal imaging studies.

Potential of using multiscale corn husk fiber as reinforcing filler in cornstarch-based biocomposites.

In this study, biodegradable composite films were prepared by using thermoplastic cornstarch matrix and corn husk fiber as a reinforcing filler. The composite films were manufactured via a casting technique using different concentrations of husk fiber (0-8%), and fructose as a plasticizer at a fixed amount of 25% for starch weight. The Physical, thermal, morphological, and tensile characteristics of composite films were investigated. The findings indicated that the incorporation of husk fiber, in general, enhanced the performance of the composite films. There was a noticeable reduction in the density and moisture content of the films, and soil burial assessment showed less resistance to biodegradation. The morphological images presented a consistent structure and excellent compatibility between matrix and reinforcement, which reflected on the improved tensile strength and young modulus as well as the crystallinity index. The thermal stability of composite films has also been enhanced, as evidenced by the increased onset decomposition temperature of the reinforced films compared to neat film. Fourier transform infrared analysis revealed increasing in intermolecular hydrogen bonding following fiber loading. The composite materials prepared using corn husk residues as reinforcement responded to community demand for agricultural and polymeric waste disposal and added more value to waste management.

Effect of experimental nematode infection on serum mineral concentrations in growing lambs.

The objective of the present study was to determine the possible effect of gastrointestinal nematodes upon serum mineral concentrations of lambs. Twelve male lambs were used. Lambs were randomly assigned to 2 groups (n = 6): Group 1 infected with gastrointestinal nematodes and Group 2 as controls. Lambs of Group 1 were infected with a single dose of 15,000 L3 larvae of GI nematodes (Haemonchus, Teladorsagia, Trichostrongylus, Cooperia and Oesophagostomum-Bunostomum). Blood samples were collected from the investigated animals individually every 2 weeks. However, the differences in serum macro-minerals (Ca, Mg, P, K, and Na) among groups were not significant. Although the differences in serum macro-minerals among groups were not significant and the iron serum concentration remained unaltered, the gastrointestinal parasitism reduced significantly/substantially the serum copper levels.

Possible Molecular Mechanisms by Which an Essential Oil Blend from Star Anise, Rosemary, Thyme, and Oregano and Saponins Increase the Performance and Ileal Protein Digestibility of Growing Broilers.

Phytogenic feed additives represent a potential alternative to antibiotics with attributed health and growth-promoting effects. Chickens supplemented with an essential oil blend, a Quillaja saponin blend, or a combination of both phytogenic preparations showed a comprehensively and significantly improved apparent ileal digestibility of crude protein and amino acids compared to control birds. Accordingly, holistic transcriptomic analyses of jejunum and liver samples indicated alterations of macromolecule transporters and processing pathways likely culminating in an increased uptake and metabolizing of carbohydrates and fatty acids. Complementary analyses in Caco-2 showed a significant increase in transporter recruitment to the membrane (SGLT1 and PEPT1) after addition of essential oils and saponins. Although the penetrance of effects differed for the used phytogenic feed additives, the results indicate for an overlapping mode of action including local effects at the intestinal border and systemic alterations of macronutrient metabolism resulting in an improved performance of broilers.

Pulled/nursemaid's elbow.

Nursemaid's elbow is a radial head subluxation caused by axial traction on the extended arm while the forearm is pronated, allowing for slippage of the radial head. A 2-year-old boy presented with pain, swelling and reduced range of movement of the right elbow for 4 days. The mother noted that the child was moving the right upper limb less often and there was tenderness over the right elbow. X-ray of the right elbow showed subluxation of the elbow joint with no obvious fracture. A trial of conservative management was decided upon and the patient was placed on a right elbow backslab with the right forearm in a supine position. On follow-up, there was no swelling, tenderness or neurological deficit noted. A repeate x-ray revealed normal findings.

Effects of probiotic, prebiotic, and synbiotic with and without feed restriction on performance, hematological indices and carcass characteristics of broiler chickens.

OBJECTIVE: This study was conducted to investigate the effects of probiotic, prebiotic and synbiotic with and without feed restriction on broilers performance, blood parameters, carcass characteristics, and feed cost of production from 1 to 56 days of age. METHODS: Two hundred and forty unsexed one day-old chicks of Arbor Acres breed were used. Two trials, I and II, were conducted, with 120 birds in both. Each trial was divided into 4 equal groups. The birds in trial I were fed ad libitum throughout the experiment, while the chicks in trial II were fed ad libitum during the first week of age, then subjected to 5 hours/d of feed restriction from the beginning of the second week up to the end of the experiment. In both trials, the birds in group 1 were fed on a control diet while the other groups were given the same control diet supplemented either with a probiotic in group 2, prebiotic in group 3, or synbiotic in group 4. RESULTS: It was found that chicks fed diets supplemented with probiotic, prebiotic and synbiotic (with and without feed restriction) exhibited higher body weight and feed efficiency than chicks fed the control diets. The feed additives in both trials did not affect hemoglobin, serum total protein, albumin, globulin, glucose, and total cholesterol, except the packed cell volume which was increased in the additive treatments with restriction at the end of the experiment. Moreover, the dietary treatments did not influence the carcass yield. However, the relative weights of liver, gizzard and proventriculus, small intestine and bursa of fabricius were found to be increased. The additives decreased the visible fat in the carcass, with more decreasing effect in the additive groups with restriction. The lowest feed cost per kg of weight gain was observed in the birds fed diets supplemented with synbiotic, probiotic and prebiotic. Feed restriction improved the feed conversion ratio, economic return, but decreased the feed intake, serum total cholesterol and visible fat in comparison with non-restricted groups. CONCLUSION: The biological feed additives could be routinely added to broiler diets, especially when a feed restriction program is followed. Finally, it can be recommended to restrict feed, and add probiotic or synbiotic to increase weight, improve feed conversion rate and reduce feed cost of production.

Applicability of Fourier transform infrared (FTIR) spectroscopy in rapid identification of some Candida and dermatophyte species infections in humans.

Traditional systems of identifying yeasts and dermatophytes have many disadvantages. Preliminary data on a radically different approach based on optical spectroscopic techniques suggest that these techniques may offer some advantages. We conducted a trial to verify the practical applicability of Fourier transform infrared (FTIR) spectroscopy in the identification of some yeast and dermatophyte species, in which samples from 50 patients with superficial fungal infections were cultured on Sabouraud dextrose agar with chloramphenicol and cycloheximide (actidione) and studied using FTIR microspectroscopy. Spectra of the same species were identical, whereas spectra of different species did not show similarity. This study showed that FTIR microspectroscopy is promising and can be used to obtain, with a single measurement, a "molecular fingerprint" of Candida and dermatophyte species. It can be improved further in terms of reliability.

The first pharmacist-managed anticoagulation clinic under a collaborative practice agreement in Qatar: clinical and patient-oriented outcomes.

WHAT IS KNOWN AND OBJECTIVE: Optimal outpatient anticoagulation management requires a systematic and coordinated approach. Extensive evidence regarding the benefits of pharmacist-managed anticoagulation services has been reported in the literature. The quality and outcomes associated with pharmacist-managed anticoagulation clinics under collaborative practice agreements in the Middle East have rarely been reported. The first pharmacist-managed ambulatory anticoagulation clinic in Qatar was launched at Al-Wakrah Hospital in March 2013. The objectives of this study were to: (i) describe the practice model of the clinic, (ii) evaluate the quality of the clinic [i.e. the time in therapeutic range (TTR)] and the clinical outcomes (i.e. the efficacy and safety), and (iii) determine the patients' satisfaction and overall quality of life (QoL). METHODS: Clinical outcome data were collected through a retrospective chart review of all patients managed from March 2013 to October 2014 at the pharmacist-managed anticoagulation clinic. Furthermore, the patient-oriented outcomes data were prospectively collected using the 24-item Duke Anticoagulation Satisfaction Scale (DASS). Each item was assessed using a 7-point Likert-type scale on which lower scores indicated better QoL and greater satisfaction. RESULTS AND DISCUSSION: The clinical outcome data analyses included 119 patients who were enrolled at the clinic during the 19-month study period. The mean number of international normalized ratio (INR) tests/month was 65 ± 9, the average testing frequency was 2·7 ± 1·6 weeks, and the average %TTR was 76·8 ± 22·9%. There was one major bleeding event (0·67%/year), 12 minor bleeding events (8%/year) and two thromboembolic events (1·35%/year) recorded during the study period. Of the 119 patients, 50 participated in the satisfaction and QoL survey. The median (IQR) total QoL score of these subjects was 63 (48) (minimum-maximum achievable score: 24-168). Seventy-six per cent of the patients indicated 'a lot to very much' in terms of their overall satisfaction with the anticoagulation treatment. The participants who were naïve to anticoagulation treatment reported a significantly greater satisfaction and better QoL than the experienced patients [58 (44) vs. 82 (59); P = 0·009]. WHAT IS NEW AND CONCLUSION: These findings provide early evidence that the patients who were managed at a pharmacy-based anticoagulation clinic in an evolving healthcare system experienced optimal anticoagulation management.

Chronic heel pain: It could be tuberculosis.

INTRODUCTION: Heel pain is a common presentation at a primary care setting. The majority of these cases are benign and self limiting in nature. Common differential diagnoses include plantar fasciitis and peroneal muscle sprains. However, certain conditions-if undetected early-may cause significant morbidity to the patient. A high index of suspicion and early referral for further investigations are needed to prevent long-term morbidities. METHODS: A clinical review of a patient with chronic left heel pain was performed. Blood parameters and imaging investigations indicated chronic infection of the calcaneum. Histopathological examination was highly suggestive of tuberculosis. RESULT: The patient responded well to antituberculous therapy. She was pain free and showed no signs of recurrence at final follow-up. CONCLUSION: Here, we report a case of chronic heel pain, which was later diagnosed as tuberculosis of the calcaneum and successfully treated with antituberculous therapy.