Patient Medication Adherence: Measures in Daily Practice

Beena Jimmy, Jimmy Jose*

Abstract

Adherence to therapies is a primary determinant of treatment success. Failure to adherence is a serious problem which not only affects the patient but also the health care system. Medication non adherence in patients leads to substantial worsening of disease, death and increased health care costs. A variety of factors are likely to affect adherence. Barriers to adherence could be addressed as patient, provider and health system factors, with interactions among them. Identifying specific barriers for each patient and adopting suitable techniques to overcome them will be necessary to improve medication adherence. Health care professionals such as physicians, pharmacists and nurses have significant role in their daily practice to improve patient medication adherence.

Quantitative and Qualitative Analysis of PubMed-Indexed Biomedical Publications in Oman from years 2005-2009

Dileep K. Rohra*, Syed I. Azam

Abstract

Objectives: Research activities are promoted at the government and the institutional levels in Oman. However, the quantity and quality of research conducted in various institutes of Oman has not been measured. Therefore, this study was conducted to analyze the quantity and quality of biomedical publications emanating from Oman over the last five years (2005-2009).

Methods: Data regarding the biomedical publications of Omani origin published from January 2005 to December 2009 were retrieved from Pubmed. All abstracts were manually checked to exclude false retrievals. The journal impact factor (IF) for 2008 was applied for every publication. Full-length original articles, review articles and publications mentioning new research methods/new technique were assigned full IF of the journal. However, half of the journal IF were assigned to correspondences/commentaries, case reports/series and short communications.

Results: Of biomedical publications, 752 were retrieved from Pubmed and 519 publications were included for final analysis after excluding false positives. The number of biomedical publications steadily increased over the last five years, but it was not statistically significant. Original research articles constituted more than half (54.3%) of all the publications, followed by case reports/series (30.1%). Sultan Qaboos University (SQU) contributed more than half of the biomedical publications (51.5%), followed by the Ministry of Health (MoH), which contributed 38% of the publications. Interestingly, the mean IF of the publications was not significantly different throughout the years.

Conclusions: The number of publications emanating from Oman increased over the last five years; however, the quality of research has not improved. Furthermore, the research in Oman is mainly conducted by the government-run institutions and there is hardly any contribution from the private institutions.

Keywords: Biomedical research; Journal impact factor; Publications; Pubmed; Oman.

In Vitro α-Amylase Inhibition and Antioxidant Activities of Methanolic Extract of Amaranthus Caudatus Linn

   Ashok Kumar BS^1*, Lakshman K², Jayaveera KN³, Sheshadri Shekar D⁴, Narayan Swamy VB⁵, Saleemulla Khan⁶, Velumurga C⁴

Abstract

Objectives: The present study was aimed to investigate the α-amylase inhibition and antioxidant activities of methanolic extract of Amaranthus caudatus Linn (MeAc).

Methods: Methanolic extract of Amaranthus caudatus was screened for α-amylase inhibition activity by CNPG3 method (2-chloro-p-nitrophenyl-α-D-maltotrioside) and antioxidant activity was evaluated by 1,1-diphenyl-2-picryl-hydrazile (DPPH) free radical scavenging, superoxide dismutase (SOD) scavenging, hydroxyl free radical scavenging, nitric oxide (NO) radical scavenging, and 2.2’-azinobis-3-ethylbenzothiazole-6-sulfonic acid (ABTS) radical scavenging assays. MeAc was also screened for non enzymatic hemoglycosylation.

Results: The methanolic extract of Amaranthus caudatus showed potent α-amylase inhibition activity (IC₅₀ 19.233 µg/ml). MeAc showed significant antioxidant activity in all the in vitro antioxidant models. Furthermore, the MeAc was found to be extremely effective in scavenging ABTS radical activity (IC₅₀ 48.75±1.1 µg/ml) when compared to DPPH (IC₅₀ 77.5±0.4 µg/ml), SOD (IC₅₀ 62.5±2.1 µg/ml), hydroxyl (IC₅₀ 88.50±1.8 µg/ml) and NO (IC₅₀ 67.5±2.2 µg/ml) scavenging activity.

Conclusions: The methanolic extract of A. caudatus showed potent α-amylase inhibition and antioxidant activities.

Keywords: Amaranthus caudatus; α-amylase inhibition; Antioxidant activity; Superoxide dismutase.

Laparoscopic Management of Malfunctioning Peritoneal Dialysis Catheters

Hazem M. Zakaria*

Abstract

Objectives: Continuous ambulatory peritoneal dialysis (CAPD) is an established alternative method to hemodialysis for treating end-stage renal disease patients. Malfunction of the peritoneal catheter is a frequent complication in peritoneal dialysis (PD). Laparoscopy is a minimal invasive technique that allows rescue therapy of malfunctioning catheters and consecutive immediate resumption of PD. The purpose of this study is to present our experiences with laparoscopic repair of peritoneal catheter dysfunction

Methods: Between April 2006 and March 2010, 21 cases of laparoscopic interventions were performed for the salvage of malfunctioning CAPD catheter. Two trocars (5 mm) were used. Recorded data included patient demographics, catheter implantation method, date of malfunction, cause of dysfunction, procedure performed and complications.

Results: The primary etiology of dysfunction was omentum and/or small bowel wrapping with adhesions in fifteen cases, malpositioning in four cases, and tunnel infection in the remaining two cases. Adhesiolysis was performed in cases with adhesions. In the cases with malpositioning but no adhesions, the catheters were repositioned in the pelvic cavity. Two catheters had to be withdrawn and exchanged because of infection. There were no mechanical or infection problems. The overall success rate of catheter function (>30 days after laparoscopy) was 100%, except for two cases in which the catheters had to be removed.

Conclusion: Laparoscopy is a safe, highly effective and successful method for the evaluation and management of peritoneal dialysis catheter dysfunction.

Keywords: Peritoneal dialysis; Catheter malfunction; Laparoscopy.

Proportion of Urinary Schistosomiasis among HIV-Infected Subjects in Benin City, Nigeria

Akinbo Frederick Olusegun^1*, Okaka Christopher Ehis², Omoregie Richard³

Abstract

Objectives: This study aimed to determine the prevalence of urinary schistosomiasis, and the effect of CD4⁺ T cell counts and demographics on its prevalence among HIV-positive patients in Benin City, Nigeria.

Methods: Urine and blood samples were collected from 2000 HIV-positive subjects. A wet preparation of the urine deposit was examined microscopically to identify ova of Schistosoma haematobium. The blood specimens were analyzed using the flow cytometry for CD4 ⁺ T-lymphocyte count.

Results: An overall prevalence rate of 0.3% was reported. Gender and CD4 count <200 cells/µL did not affect the prevalence of urinary schistosomiasis, while HIV patients that were single had significantly higher prevalence of urinary schistosomiasis (p=0.002).

Conclusion: The prevalence of urinary schistosomiasis among HIV patients in Benin City is low. CD4⁺ count did not affect the prevalence of urinary schistosomiasis.

Keywords: HIV; Schistosoma haematobium.

Management of Adenomyosis in Subfertile Women and Pregnancy Outcome

Fathia E. Al Jama*

Abstract

Objectives: To assess the outcome of treatment with only gonadotropin releasing hormone agonists (Gn-RHa) versus combined conservative surgery and Gn-RHa therapy in the management of sub-fertile patients with symptomatic uterine adenomyosis.

Methods: A retrospective study of the two treatment modalities allocated to 40 sub-fertile patients with pathology-proven adenomyosis over a period of eight years was undertaken at the Obstetrics and Gynecology department, King Fahad Hospital, Dammam University, Saudi Arabia. Twenty-two patients (Group A) were treated with Gn-RHa alone, and 18 patients (Group B) received combined conservative surgery with Gn-RHa therapy. After completion of six courses of Gn-RHa injections, there was a 3-year follow up period for all patients. Treatment outcome included relief of symptoms, pregnancy rate and successful deliveries, which were compared between the two groups.

Results: The patients in group A were younger in age, had lower CA-125 levels and shorter infertile years than Group B. Three (13.6%) spontaneous pregnancies resulted upto 18 months of stopping Gn-RHa in group A, while 8 (44.4%) pregnancies resulted upto 36 months in group B patients, which was statistically significant (p=0.0393). Term delivery occurred normally in one (4.5%) Group A patient, while 6 (33.3%) patients in Group B had cesarean section at term (p=0.0328).

Conclusion: Combined conservative surgery and Gn-RHa may provide effective symptom relief, better reproductive performance in subfertile patients with uterine adenomyosis and longer period of pregnancy prospects after treatment than patients who recieved Gn-RHa alone. Due to the nature of this study, a well conducted randomized trial is needed in the future to assess the benefits of the two treatment modalities.

Keywords: Adenomyosis; Infertility; Gn-RH analogues; Pregnancy outcome.

Prevalence of Intestinal Parasites among Patients of Al-Noor Specialist Hospital, Makkah, Saudi Arabia

Dina AM Zaglool¹, Yousif AW Khodari², Zohair J. Gazzaz³, Khalid O. Dhafar⁴, Hani AS Shaker⁵, Mian U. Farooq^6*

Abstract

Objectives: To determine the prevalence of intestinal parasites among patients of a tertiary care hospital.

Methods: A total of 12,054 samples received from the outpatient as well as inpatient departments from January 1, 2004 to December 31, 2009 in Al-Noor Specialist Hospital, Makkah, Saudi Arabia. Stool examinations were performed by direct method and concentrated Techniques for all patients.

Results: Overall, the prevalence of intestinal parasites was 6.2% (740 cases). Majority of patients were infected by Entamoeba histolytica (4.7%) followed by Giardia lamblia (1.3%), while Ankylostoma duodenal (0.02%) exhibited the minimum prevalence. Parasitic infections were more frequent in non-Saudis than Saudis patients (7.1% vs. 5.8%; p<0.05). There was no significant difference between males and females regarding parasitic infections, with a female:male ratio of 1:1.08. There was a higher prevalence in patients under five years of age (9.1%), followed by patients aged 5-14 years (7.5%).

Conclusion: The notable finding from this study is the high prevalence of E. histolytica. Overall, parasitic infections were more prevalent in patients under five years of age and in non-Saudi nationals.

Keywords: Intestinal parasites; Prevalence; Stool; Infection.

In Vitro Activity of Vancomycin and Teicoplanin Against Coagulase Negative Staphylococci

Vishal Sharma*, Neerja Jindal

Abstract

Objectives: With the increase in nosocomial infections caused by coagulase negative staphylococci (CNS), laboratory diagnosis of CNS with reduced susceptibility to glycopeptides (vancomycin and teicoplanin) has become important. This study was designed to determine the glycopeptide susceptibility of clinical isolates of methicillin resistant coagulase negative staphylococci (MRCNS) at the department of microbiology, government medical college and hospital, Amritsar, India.

Methods: A total of 250 CNS isolated from various clinical specimens were speciated and their methicillin resistance was detected by studying the minimum inhibitory concentration (MIC) of oxacillin by macrobroth dilution method. Glycopeptide susceptibility of 130 methicillin resistant strains obtained was determined for vancomycin by vancomycin screen agar test, MIC of vancomycin by macrobroth dilution/and E test. Teicoplanin susceptibility was determined using teicoplanin disc diffusion test and MIC was determined by macrobroth dilution method.

Results: All the MRCNS isolates were found to be susceptible to vancomycin and teicoplanin. MIC of vancomycin ranged between £0.5 µg/ml to 1 µg/ml and of teicoplanin from £0.5 µg/ml to 2µg/ml.

Conclusion: Continuous monitoring of MIC of vancomycin in MRCNS is required to prevent the emergence of vancomycin resistance in these multidrug resistant organisms.

Keywords: Glycopeptides; Minimum inhibitory concentration.

Risk Factors for Type 1 Diabetes Mellitus among Children and Adolescents in Basrah

Athar Abdul Samad Majeed¹, Mea`ad Kadhum Hassan^2*

Abstract

Objectives: Environmental factors play an important role in the pathogenesis of type 1 diabetes mellitus, many of these factors have been uncovered despite much research. A case-control study was carried out to determine the potential maternal, neonatal and early childhood risk factors for type 1 diabetes mellitus in children and adolescents in Basrah.

Methods: A total of 96 diabetic patients who have been admitted to the pediatric wards at 3 main hospitals in Basrah, and those who have visited primary health care centers over the period from the 4^th of November 2006 to the end of May 2007 were recruited. In addition, 299 non-diabetic children were included, their age ranged from 18 months to 17 years.

Results: Family history of type 1 diabetes mellitus and thyroid diseases in first and second degree relatives was found to be an independent risk factor for type 1 diabetes mellitus, (p<0.001). Regarding maternal habits and illnesses during pregnancy, the study has revealed that tea drinking during pregnancy is a risk factor for type 1 diabetes mellitus in their offspring, (p<0.05). In addition, maternal pre-eclampsia and infections were found to be significant risk factor for type 1 diabetes mellitus, (p<0.001). Neonatal infections, eczema and rhinitis during infancy were also significantly associated with development of type 1 diabetes mellitus. Moreover, the results revealed that duration of <6 months breast feeding is an important trigger of type 1 diabetes mellitus.

Conclusion: Exposure to environmental risk factors during pregnancy (tea drinking, pre-eclampsia, and infectious diseases), neonatal period (respiratory distress, jaundice and infections) and early infancy are thought to play an important role in triggering the immune process leading to B-cell destruction and the development of type 1 diabetes mellitus.

Keywords: Type 1 Diabetes Mellitus; Risk factors; Children; Adolescents.

Thanatophoric Dysplasia: A Rare Entity

N.S. Naveen¹, B.V. Murlimanju^2*, Vishal Kumar¹, Thejodhar Pulakunta³, Jeeyar H.⁴

Abstract

Thanatophoric dysplasia is the lethal skeletal dysplasia characterized by marked underdevelopment of the skeleton and short-limb dwarfism. The child will be having a short neck, narrow thoracic cage and protuberant abdomen. Other anatomical features include a relatively enlarged head with frontal bossing, prominent eyes, hypertelorism and the depressed nasal bridge. The diagnosis is usually made with the ultrasonography in the second trimester. In this study we report a case of this rare entity with emphasis on its anatomical features, abnormalities and clinical profile with relevant review of literature.

Keywords: Thanatophoric dysplasia; FGFR3; Ultrasound; Fetus.

Dysgerminoma with Pregnancy and Viable Baby: A Case Report

Kafil Akhtar^1*, S. Shamshad Ahmad², Amit Kumar², Noor Afshan³

Abstract

Dysgerminomas are the most common of primitive germ cell tumors of the ovary, accounting for 1-5% of all ovarian malignancies. The reproductive age group females are most commonly affected, thereby causing problems in conception and if pregnancy occurs, it leads to feto-maternal compromise. It is extremely rare to have a successful natural pregnancy, with viable child birth with a coexisting dysgerminoma, without any assisted reproductive interventions. We hereby report a case of successful spontaneous natural pregnancy in a primi gravida, associated with dysgerminoma, with no feto-maternal compromise.

Keywords: Dysgerminoma; Natural pregnancy; Viable birth.

Vitamin D Toxicity in Adults: A Case Series from an Area with Endemic Hypovitaminosis D

Parvaiz A. Koul*, Sheikh Hilal Ahmad, Feroze Ahmad, Rafi A. Jan, S.U. Shah, Umar H. Khan

Abstract

Vitamin D deficiency state is endemic to the Kashmir valley of the Indian subcontinent. Physicians often treat patients with high doses of vitamin D for various ailments and on occasion the prescribed doses far exceed the requirements of the patients. Ten cases of hypercalcemia due to vitamin D intoxication are presented with features of vomiting, polyuria, polydipsia, encephalopathy and renal dysfunction. All the patients had demonstrable hypercalcemia and vitamin D levels were high in nine of the 10 cases. The patients had received high doses of vitamin D and no other cause of hypercalcemia was identified. Treatment of hypercalcemia resulted in clinical recovery in nine cases. We conclude that hypervitaminosis D must be considered in the differential diagnosis of patients with hypercalcemia in endemically vitamin D deficient areas. A careful history and appropriate biochemical investigation will unravel the diagnosis in most of the cases.