Introduction: This review discusses the molecular mechanisms responsible for the normalization of otherwise raised intraocular pressure (IOP) in patients of glaucoma when they are administered statin therapy. Material and Methods: Literature published between 1990 and 2016 on the pathophysiology of glaucoma and the action of statins has been reviewed. Data Synthesis: A decrease in resistance to aqueous humor flow through trabecular meshwork (TM) in the eye tissue results in lessening of the raised intraocular pressure. KATP channels have been discovered in the eye tissue recently. Activation of KATP channels facilitates the flow of aqueous humor through the TM. This presumption is strengthened by the action of statins. Statins activate these KATP channels and, thereby, facilitate the aqueous flow through TM leading to relief in IOP. Statins interfere in the cholesterol biosynthesis pathway leading to decreased cholesterol synthesis. However, a simultaneous decrease in the level of ubiquinone leads to activation of KATP channels. Further, accumulation of LC Acetyl CoAs also activates these KATP channels. Expert Opinion: Statins decrease the elevated intraocular pressure in glaucoma by activating KATP channels. KATP channels are recently discovered therapeutic targets which may be exploited in the treatment of glaucoma.
IDENTIFYING PARATHYROID HORMONE DISORDERS AND ITS PHENOTYPES THROUGH A BONE H...Hussain Karimi
A retrospective analysis of biochemical parameters in bone health screening panel (BHSP) was conducted. The low and high cut offs were applied to determine hypo functioning and hyper functioning conditions related to parathyroid hormone. Clinical phenotypes of parathyroid gland abnormalities were made by using combination of levels of calcium, vitamin D and iPTH. PTH nomogram defined by Harvey et al was applied to calculate max expected PTH for existing level of 25OHD. Medical records of patients were reviewed for clinical validation of biochemical findings.
Effect of Cardiac Stimulant Drug (MSCD) on Blood Coagulation Cascade and Plat...IIJSRJournal
Current study deals with the effect of cardiac stimulant drug (Mephentermine Sulphate Composite Drug) on blood coagulation cascade and plasma platelets. The purity of MSCD was adjudged by GC-MS chromatographic technique. Single sharp peak was evolved in GC-MS by using DB-5 column. Furthermore, MSCD did not alter the clotting time of human citrated plasma in both Platelet Rich Plasma (PRP) and Platelet Poor Plasma (PPP) at the concentration of 5-50 µg. Moreover, MSCD did not alter ADP and Epinephrine induced platelet aggregation at the concertation of 5-50 µg. Remarkably, MSCD exhibit nontoxic property as it was unable to damage RBC cell membrane.
some reports that procainamide follows nonlinear pharmacokinetics, for the purposes of clinical drug dosing in patients, linear pharmacokinetic concepts and equations can be effectively used to compute doses and estimate serum concentrations.
IDENTIFYING PARATHYROID HORMONE DISORDERS AND ITS PHENOTYPES THROUGH A BONE H...Hussain Karimi
A retrospective analysis of biochemical parameters in bone health screening panel (BHSP) was conducted. The low and high cut offs were applied to determine hypo functioning and hyper functioning conditions related to parathyroid hormone. Clinical phenotypes of parathyroid gland abnormalities were made by using combination of levels of calcium, vitamin D and iPTH. PTH nomogram defined by Harvey et al was applied to calculate max expected PTH for existing level of 25OHD. Medical records of patients were reviewed for clinical validation of biochemical findings.
Effect of Cardiac Stimulant Drug (MSCD) on Blood Coagulation Cascade and Plat...IIJSRJournal
Current study deals with the effect of cardiac stimulant drug (Mephentermine Sulphate Composite Drug) on blood coagulation cascade and plasma platelets. The purity of MSCD was adjudged by GC-MS chromatographic technique. Single sharp peak was evolved in GC-MS by using DB-5 column. Furthermore, MSCD did not alter the clotting time of human citrated plasma in both Platelet Rich Plasma (PRP) and Platelet Poor Plasma (PPP) at the concentration of 5-50 µg. Moreover, MSCD did not alter ADP and Epinephrine induced platelet aggregation at the concertation of 5-50 µg. Remarkably, MSCD exhibit nontoxic property as it was unable to damage RBC cell membrane.
some reports that procainamide follows nonlinear pharmacokinetics, for the purposes of clinical drug dosing in patients, linear pharmacokinetic concepts and equations can be effectively used to compute doses and estimate serum concentrations.
Liver ischemia/reperfusion injury, a setting in which the functional mass is ...Prof. Hesham N. Mustafa
Liver ischemia reperfusion is induced during sur-gical procedures like liver transplantation and re-section. Multiple mechanisms have been postulat-ed to liver damage following liver ischemia reperfu-sion injury, such as oxidative stress and inflamma-tory reactions. The present study declares the pos-sible mechanism of tadalafil, toward modulating the inflammatory response. Forty-eight rats were divided into 4 groups as follows; Sham group sub-jected to midline laparotomy only. Tadalafil group administered Tadalafil 10 mg/kg intraperitoneal 45 min before sham operation. I/R (Ischemia-reperfusion) group, rats undergo 60 min of hepatic ischemia followed by 60 min of reperfusion. Tada-lafil + I/R group rats undergo a similar pattern of I/R after the treatment with Tadalafil 10 mg/kg, 45 min before ischemia. At the end of the reperfusion, the blood samples were collected for estimation of biochemical markers including liver enzymes using colorimetric assay method and serum: TNF-α (tumor necrosis factor-α), IL-6 (interleukin 6) le-vels, ICAM- 1 (Intercellular Adhesion Molecule-1) were measured. Tissues were evaluated by semi-quantitative and morphometrical approaches. Ta-dalafil succeeded in restoring normal levels of liverenzymes and ameliorating the oxidative stress as evidenced by decreasing MDA and restoring redu-ced glutathione levels in liver tissue homogenate. Also, Tadalafil exhibits anti-inflammatory effects, as it significantly decreased the levels of TNF-α, IL6 and ICAM-1. The findings are supported by BCL-2, TNF-α immunomarkers. It is concluded that modulation of the inflammatory response might be one of the mechanisms of Tadalafil-mediated he-patoprotection, so it is recommended as an adju-vant therapy in liver surgery.Keywords: Ischemia/reperfusion injury – Oxidative stress – Apoptosis – TNF-α – BCL-2
Antithrombotic therapy for patients with chronicNicolas Ugarte
Globally, much morbidity and premature mortality
arises from coronary artery disease (CAD). Coronary artery atherothrombosis is the dominant cause
of acute coronary syndromes (ACS), including
spontaneous myocardial infarction (MI) and
unstable angina. Those with chronic coronary
syndromes (CCS), including stable CAD or an ACS
event >1year ago, are at ongoing atherothrombotic
risk.1
Modifiable or partially modifiable risk factors
such as hypercholesterolaemia, diabetes mellitus
(DM), hypertension and smoking, and unmodifiable factors such as age and chronic kidney disease
(CKD), can initiate and accelerate coronary atherosclerosis.2
Understanding the pathophysiology of
atherothrombosis has helped to identify and exploit
therapeutic targets.
In 2019, the European Society of Cardiology
(ESC) published new guidelines on the management
of CCS, including antithrombotic therapy.3
In this
review, we evaluate the pathophysiology and pharmacology of atherothrombosis, highlight up-to-date
evidence from randomised controlled trials (RCTs),
and discuss the content and application of the the
ESC 2019 CCS guidelines.
Compartmental analysis is an analytical method developed to assume the kinetics ( absorption, distribution, metabolism, half life, excretion, etc.) of a drug, where a live organ is considered as one or more compartments. Observed result helps a researcher to predict how the drug or formulation may act inside body, for how long, if the formulation is suitable to produce maximum deliberation of drugs in body as well as compatibility of drug or drug toxicity study. Among numerous models, in non cmpartmental model it is considerd that the formulation kinetics depend on other variables instead of compartment itself. This slide is an short overview of pharmaceutical compartmental models with a slightly elaborate discussions about different non compartmental analytical methods.
Biopharmaceutics & Pharmacokinetics (Ultimate final note)MdNazmulIslamTanmoy
Intravenous Infusion (IV): Define intravenous infusion. Write down advantages and disadvantages of intravenous infusion,
Write down the pharmacokinetics of IV infusion, Calculate the plasma drug concentration at steady-state after IV infusion, Determine the half life (t1/2) by IV infusion method, Show that in case of IV infusion the time to reach 99% steady-state is 6.65 t1/2.
Multiple-Dosage Regimens: Write a short note on Multiple-Dosage Regimens. What are the basic considerations for multiple dosage regimen?, What are the purposes of multiple-dosage regimens (MDR)? Write down the importance of MDR, Write short note on repetitive intravenous injections, Prove that C∞av is not arithmetic average of C∞max and C∞min, Give brief description on superposition principle and Plateau principle?.
Individualization: Write down about individualization of drug dosing regimen? What are the advantages of individualization? How will you optimizing dosage regimen?, What are the sources of variability in drug response? What are the causes of Inter subject Pharmacokinetics Variability? Write down the steps involved in individualization of dosage regimen?, Write short note on – dosing of drug in obese patient and also discuss about dosing of drug in neonates, infants and children?, Write down about dosing of drug in elderly and hepatic disease? Give some examples of drugs who's conc. Changes due to hepatic impairment?, Explain some clinical experience with individualization and optimization based on plasma drug levels?
NON-linear pharmacokinetics: Derive the Michaelis-Menten Equation or Non-Liner pharmacokinetic and Linear pharmacokinetic model, Define non-linear pharmacokinetics. Why it is called dose dependent pharmacokinetics?, Why Michaelis-Menten equation is termed as mixed order kinetics?, A given drug is metabolized by capacity-limited pharmacokinetics. Assume KM is 50훍g/mL, Vmax is 20훍g/mL per hour and apparent VD is 20 L/kg, Differentiate between linear & non-linear Pharmacokinetics.
Non-compartment model: Briefly describe compartment model?, Briefly describe non-compartment model?, What is MRT? Write down the importance of MRT?, What is MAT? Write down the importance of MAT?, Compare between compartment model and non-compartment models.
Liver ischemia/reperfusion injury, a setting in which the functional mass is ...Prof. Hesham N. Mustafa
Liver ischemia reperfusion is induced during sur-gical procedures like liver transplantation and re-section. Multiple mechanisms have been postulat-ed to liver damage following liver ischemia reperfu-sion injury, such as oxidative stress and inflamma-tory reactions. The present study declares the pos-sible mechanism of tadalafil, toward modulating the inflammatory response. Forty-eight rats were divided into 4 groups as follows; Sham group sub-jected to midline laparotomy only. Tadalafil group administered Tadalafil 10 mg/kg intraperitoneal 45 min before sham operation. I/R (Ischemia-reperfusion) group, rats undergo 60 min of hepatic ischemia followed by 60 min of reperfusion. Tada-lafil + I/R group rats undergo a similar pattern of I/R after the treatment with Tadalafil 10 mg/kg, 45 min before ischemia. At the end of the reperfusion, the blood samples were collected for estimation of biochemical markers including liver enzymes using colorimetric assay method and serum: TNF-α (tumor necrosis factor-α), IL-6 (interleukin 6) le-vels, ICAM- 1 (Intercellular Adhesion Molecule-1) were measured. Tissues were evaluated by semi-quantitative and morphometrical approaches. Ta-dalafil succeeded in restoring normal levels of liverenzymes and ameliorating the oxidative stress as evidenced by decreasing MDA and restoring redu-ced glutathione levels in liver tissue homogenate. Also, Tadalafil exhibits anti-inflammatory effects, as it significantly decreased the levels of TNF-α, IL6 and ICAM-1. The findings are supported by BCL-2, TNF-α immunomarkers. It is concluded that modulation of the inflammatory response might be one of the mechanisms of Tadalafil-mediated he-patoprotection, so it is recommended as an adju-vant therapy in liver surgery.Keywords: Ischemia/reperfusion injury – Oxidative stress – Apoptosis – TNF-α – BCL-2
Antithrombotic therapy for patients with chronicNicolas Ugarte
Globally, much morbidity and premature mortality
arises from coronary artery disease (CAD). Coronary artery atherothrombosis is the dominant cause
of acute coronary syndromes (ACS), including
spontaneous myocardial infarction (MI) and
unstable angina. Those with chronic coronary
syndromes (CCS), including stable CAD or an ACS
event >1year ago, are at ongoing atherothrombotic
risk.1
Modifiable or partially modifiable risk factors
such as hypercholesterolaemia, diabetes mellitus
(DM), hypertension and smoking, and unmodifiable factors such as age and chronic kidney disease
(CKD), can initiate and accelerate coronary atherosclerosis.2
Understanding the pathophysiology of
atherothrombosis has helped to identify and exploit
therapeutic targets.
In 2019, the European Society of Cardiology
(ESC) published new guidelines on the management
of CCS, including antithrombotic therapy.3
In this
review, we evaluate the pathophysiology and pharmacology of atherothrombosis, highlight up-to-date
evidence from randomised controlled trials (RCTs),
and discuss the content and application of the the
ESC 2019 CCS guidelines.
Compartmental analysis is an analytical method developed to assume the kinetics ( absorption, distribution, metabolism, half life, excretion, etc.) of a drug, where a live organ is considered as one or more compartments. Observed result helps a researcher to predict how the drug or formulation may act inside body, for how long, if the formulation is suitable to produce maximum deliberation of drugs in body as well as compatibility of drug or drug toxicity study. Among numerous models, in non cmpartmental model it is considerd that the formulation kinetics depend on other variables instead of compartment itself. This slide is an short overview of pharmaceutical compartmental models with a slightly elaborate discussions about different non compartmental analytical methods.
Biopharmaceutics & Pharmacokinetics (Ultimate final note)MdNazmulIslamTanmoy
Intravenous Infusion (IV): Define intravenous infusion. Write down advantages and disadvantages of intravenous infusion,
Write down the pharmacokinetics of IV infusion, Calculate the plasma drug concentration at steady-state after IV infusion, Determine the half life (t1/2) by IV infusion method, Show that in case of IV infusion the time to reach 99% steady-state is 6.65 t1/2.
Multiple-Dosage Regimens: Write a short note on Multiple-Dosage Regimens. What are the basic considerations for multiple dosage regimen?, What are the purposes of multiple-dosage regimens (MDR)? Write down the importance of MDR, Write short note on repetitive intravenous injections, Prove that C∞av is not arithmetic average of C∞max and C∞min, Give brief description on superposition principle and Plateau principle?.
Individualization: Write down about individualization of drug dosing regimen? What are the advantages of individualization? How will you optimizing dosage regimen?, What are the sources of variability in drug response? What are the causes of Inter subject Pharmacokinetics Variability? Write down the steps involved in individualization of dosage regimen?, Write short note on – dosing of drug in obese patient and also discuss about dosing of drug in neonates, infants and children?, Write down about dosing of drug in elderly and hepatic disease? Give some examples of drugs who's conc. Changes due to hepatic impairment?, Explain some clinical experience with individualization and optimization based on plasma drug levels?
NON-linear pharmacokinetics: Derive the Michaelis-Menten Equation or Non-Liner pharmacokinetic and Linear pharmacokinetic model, Define non-linear pharmacokinetics. Why it is called dose dependent pharmacokinetics?, Why Michaelis-Menten equation is termed as mixed order kinetics?, A given drug is metabolized by capacity-limited pharmacokinetics. Assume KM is 50훍g/mL, Vmax is 20훍g/mL per hour and apparent VD is 20 L/kg, Differentiate between linear & non-linear Pharmacokinetics.
Non-compartment model: Briefly describe compartment model?, Briefly describe non-compartment model?, What is MRT? Write down the importance of MRT?, What is MAT? Write down the importance of MAT?, Compare between compartment model and non-compartment models.
APRIL 2018, VOL. 22 NO. 2 CLINICAL JOURNAL OF ONCOLOGY NURSING.docxfestockton
APRIL 2018, VOL. 22 NO. 2 CLINICAL JOURNAL OF ONCOLOGY NURSING 175CJON.ONS.ORG
C
Nephrotoxicity
Evidence in patients receiving cisplatin therapy
Elizabeth A. Duffy, DNP, RN, CPNP, Wendy Fitzgerald, RN, MSN, PPCNP-BC, CPON®, Kelley Boyle, MSN, RN, PCNS-BC, and Radha Rohatgi, PharmD, BCOP
CISPLATIN IS A PLATINUM COMPOUND THAT HAS BEEN USED as a chemotherapeutic
agent for many different cancers, including ovarian, testicular, lung, cervical,
and bladder cancers (Ruggiero, Rizzo, Trombatore, Maurizi, & Riccardi, 2016;
Santoso, Lucci, Coleman, Shafer, & Hannigan, 2003). The primary dose-
limiting toxicity of cisplatin is nephrotoxicity, a well-known side effect
(Jones, Spunt, Green, & Springate, 2008; Miller, Tadagavadi, Ramesh, &
Reeves, 2010). Nephrotoxicity involves glomerular or tubular dysfunction
of the kidneys after exposure to medications, other treatments, or toxins
(Skinner, 2011). Nephrotoxicity associated with cisplatin is related to accu-
mulation of metabolites in the renal proximal tubule cells of the kidneys,
where about 90% of cisplatin undergoes urinary excretion (Ruggiero et al.,
2016). Accumulation of these metabolites causes direct inflammation; the
production of reactive oxygen species, which leads to oxidative cell damage;
and cell death (Miller et al., 2010; Ruggiero et al., 2016). Many methods are
available to measure kidney function and define nephrotoxicity or acute
kidney injury (see Table 1).
Most patients receiving cisplatin experience acute impairment of glo-
merular and tubular function in varying degrees. Toxicity is dependent on
individual cisplatin pharmacokinetics and is usually more severe with high
total cisplatin doses and when other potential nephrotoxic medications are
given concurrently (Skinner, 2011; Womer, Pritchard, & Barratt, 1985). In one
study, children aged 10 years or older at treatment had a lower glomerular
filtration rate 10 years after therapy compared to children aged younger than
10 years at treatment (Skinner et al., 2009).
Nephrotoxicity can be reversible, but for some individuals, it can result
in permanent kidney injury, chronic progressive renal failure, or renal tubule
function impairment (Skinner et al., 2009). Chronic and severe reductions
of renal function have several sequelae. The immediate impact may be dose
reduction or cessation of potentially lifesaving nephrotoxic chemotherapy,
thereby increasing the risk of relapse or progression of the cancer. In the
event of a disease relapse or progression, changes to renal function may limit
enrollment in phase 1 or 2 clinical trials because of inclusion parameters
related to baseline renal function.
Hydration and diuretics have been used in conjunction with cisplatin
administration for decades to improve the excretion of cisplatin and reduce
the incidence of nephrotoxicity. One method of promoting this excretion is
through osmotic diuresis with mannitol (Morgan et al., 2014). However, the
amount ...
International Journal of Clinical Pharmacology & Toxicology (IJCPT) ISSN:2167-910X is an Open Access journal, which aims to develop coherent means to modify drug therapy, with respect to the patient's genotype, and to ensure maximum efficiency with minimal contrary effects.
International Journal of Clinical Pharmacology & Toxicology (IJCPT) ISSN:2167-910X is an Open Access journal and a peer-reviewed journal. Clinical Pharmacology & Toxicology is the all-encompassing and becoming an increasingly important discipline for the identification of disease targets and drug designing with their toxicological effects and means to eradicate diseases.
Formulation and evaluation of modified drug release tablet in tablet dosage w...SriramNagarajan16
Controlled drug dosage forms offer many advantages, such as nearly constant drug level at the site of action,
prevention of peak-valley fluctuation, reduction in dose of drug, reduced dosage frequency, avoidance of side effects
and improved patient compliance. Hence an attempt has been made to develop modified drug release by using tablet in
tablet technique with barrier coating by using natural and synthetic polymers with Salbutamol as model drug. The inner
core tablets were prepared by using direct compression method. The formulation F7 was selected for press coat by using
different polymers like HPMC, Ethyl cellulose, Xanthum gum and Guar gum in different ratios among which 1part of
Xanthum gum and 1part of Guar gum was optimized based on the lag time (20.75% in 4 hours) and percent of drug
release and also further evaluated.
A Paradigm Shift in the Utilization of Therapeutic Plasmapheresis in Clinical...semualkaira
Therapeutic Plasma Exchange (TPE), frequently referred to as
plasmapheresis. is an automated procedure which separates whole
blood into plasma and blood cells. The plasma is discarded and
replaced with physiologic fluids and returned to the patient along
with the blood cells. Theoretically, any disease in which a humoral
phase is implicated in the pathogenesis may be at least partially
mitigated by removal of the patient’s plasma and replacement with
physiologic solutions. In clinical practice, TPE is used in a hospital
setting, usually as a last resort, to treat autoimmune diseases by removing circulating antibodies and/or immune complexes. Recently, it was demonstrated that TPE has several immunoregulatory
properties besides removal of circulating antibodies and immune
complexes. Both controlled and uncontrolled clinical studies have
demonstrated that TPE is associated with only a few mild adverse
reactions and can be performed safely in an outpatient setting.
We report our experience in treating patients with TPE on an outpatient basis with several different medical conditions (Alzheimer’s disease, Long Covid, PANDAS) and prophylactically in older
individuals for the attenuation of inflammaging
A Paradigm Shift in the Utilization of Therapeutic Plasmapheresis in Clinical...semualkaira
Therapeutic Plasma Exchange (TPE), frequently referred to as
plasmapheresis. is an automated procedure which separates whole
blood into plasma and blood cells. The plasma is discarded and
replaced with physiologic fluids and returned to the patient along
with the blood cells. Theoretically, any disease in which a humoral
phase is implicated in the pathogenesis may be at least partially
mitigated by removal of the patient’s plasma and replacement with
physiologic solutions
Similar to KATP Channel Activation by Statins Decreases Intra-Ocular Pressure. Should We Explore These Channels as Therapeutic Targets in Glaucoma? (20)
Carbon monoxide (CO) poisoning is a major public health issue in the United States that accounts for approximately 50% of poisoning cases in the nation each year and around 50,000 emergency room visits. In most instances of CO poisoning, the culprit is a malfunctioning or poorly tended heating system within the home or, occasionally, commercial building, which causes the system to leak this hazardous gas. One of the more insidious aspects of CO poisoning is that the gas is odorless and colorless, and victims of CO poisoning often do not realize that there is a problem until they begin to experience the effects of poisoning and have no choice but to seek medical attention. Unfortunately, many victims of CO poisoning die before they are able to seek treatment. This paper makes use of a qualitative, systematic literature review to examine the four major parts of the brain that are most severely affected by CO poisoning. Overall, the literature review showed that the white matter, globus pallidus, basal ganglia, and cortex are the parts of the brain most severely impacted by CO poisoning. While many CO poisoning victims do make it to the hospital on time and are treated, they may nonetheless suffer long-term neurological consequences as a result of their exposure. As such, CO poisoning is a major public health issue.
Drug abuse has now become a major public health problem in Nigeria requiring urgent attention. Although drug abuse cut across all age groups, the youths are however the most affected. This study aimed at assessing Community Pharmacists involvement in the rehabilitation of drug abuse victims. The study was carried out in Abuja Municipal Area Council, questionnaires were administered to Community Pharmacists practicing within the Area Council. A total of 176 Community Pharmacists participated in the study, and slightly above a quarter (27.43%) of them had post-graduate degrees. More than three-quarters (79.5%) of the study participants had received training on drug abuse. A total of 89.2% of the study participants had come across persons suspected to be abusing prescription medicines. Almost all (96.6%) of the study participants indicated that they are willing to advise persons suspected to be abusing drugs on the dangers of drug abuse, and 88.1% of the study participants had spoken to clients concerning abuse of prescription medicines. Also, more than three-quarters (80.1%) of the study participants indicated that pharmacists’ role in the prevention of drug abuse is very important. The study has revealed that Community Pharmacists can play an invaluable role in the rehabilitation of drug abuse victims in Nigeria.
Background; Social Class has shown relation with admissions at Emergency Departments. To assess whether there is a relationship between the level of triage and the social class of patients who attend the emergency department and whether there are other variables that can modulate this association. Methods Observational study with 1000 patients was carried out between May and July 2018 in the Emergency Department of the University Hospital Arnau de Vilanova in Lleida. Sociodemographic variables such as age, gender, country of origin and marital status were analyzed. The triage level and the main explanatory variable was social class. Social class was calculated based on the CSO-SEE 2012 scale. Results 49.4% were male and the average age was 51.7 years. Most of the patients (66.6%) attended the emergency department under their own volition and the most common triage levels were level III or Emergency (45%). There is a significant relationship between age and triage level. The younger patients had a lower triage level (p <0.001). The percentage of patients with lower social class who attended the emergency department for minor reasons was 42% higher compared to the rest of the patients (RR = 1.42; 1.21-1.67 95% CI, p <0.001). Conclusions; Patients with a lower socioeconomic class go to the Emergency Department for less serious pathologies.
This paper will explore child health care and treatment seeking behavior of villagers and presents factors that discourage them from using public health facilities. The perspective of human health is not only stay behind in the contact between the disease and the human body and the extermination of the demon by providing few medicines rather it is a complex web where multiple factors are affecting human to live a sound life. The environment has a diverse effect on human life: some indulge humans with it extravaganza while some impose serious theaters but one thing in common, every environment shares basic problems of acquiring and allocating space, food, energy and resources for health. Haor people have endless problems to meet, starting from food to basic human rights. Maintaining a healthy life does end up with some formality of going to some popular and folk treatment though going to professionals is rare. Government and non-Governmental organizations have a variety of scope to improve the situation by providing health infrastructure, awareness building measures, eradicating superstition and including health education in the school curriculum.
Objective: The purpose of this paper is to review literature on music and biomarkers of stress in order to (1) Identify music interventions and (2) Detail the biomarkers of stress associated with music. Methods: PRISMA guidelines were followed in performing this systematic review. Studies published from January 1995 to January 2020 that pertain to biomarkers of stress and music were identified through the use of the PubMed database, using the keywords: ‘music’ AND ‘biomarker’ OR ‘marker’ OR ‘hormone’. Two authors independently conducted a focused analysis and reached a final consensus on 16 studies that met the specific selection criteria and passed the study quality checks. Results: The reviewed studies were all randomized controlled trials. Reviewed music interventions included Music Listening (ML), Meditational Music (MM), ‘Guided Imagery and Music’ (GIM), and Singing. The studies showed that music is associated with a decreasing trend in cortisol, salivary α-amylase, heart rate, and blood pressure, as well as an increasing trend in Immunoglobulin A (IgA), oxytocin, and EEG theta wave, while testosterone was associated with sex-related differences. Conclusion: Music is associated with significant changes in biomarkers of stress, suggesting that it could be utilized for the development of stress reduction tools.
Background: Nurse practitioners play a vital role in wound care and management because of the prevalence of wounds in the community and hospital setting. Aims and objectives: The purpose was to identify current knowledge and practices of nurses with respect to wound management. Method: A qualitative descriptive research was designed, nineteen nurses in wound care wards in Bingham University teaching hospital were recruited into this study. This was achieved with the aid of a self-administered questionnaire for a two-week period. Results: Three groups of nurses responded to this survey (73.7% males; 31.6% aged 31-40 years). Registered nurses dominated (68.4%), majority of them worked in male ward (36.8%) and private ward (36.8%). Almost on full-time (94.7%), more than half were diploma holders (57.9%) with 1 to 5 years of experience (47.4%). Majority (84.2%) were involved in wound treatment and management, there were significant association between years of experience and wound classification, wound treatment, treatment failure and treatment failure factors. Conclusion: Wound care practices require accurate knowledge and assessment skills, a better understanding of wound management provides comprehensible, rapid patient wound care and minimizes patient mortality as well as reduces health services financial costs.
Background: Job satisfaction is a significant indicator of the way nurses feel about their profession, the efforts to perform their professional duties, or otherwise abandons it willingly. Method: cross-sectional research design approach was used to assess the job satisfaction and the associated factors among 300 hundred nurses. Data was analyzed using descriptive statistics and kruskal wallis test for association between the socio-demographic variables and job satisfaction at significance level of 0.05 Result: About 1/3 of the respondents (31%) reported gross dissatisfaction with their job, 0% reported being well satisfaction while (68.7%) respondents reported moderate satisfaction with their job. Across items on the scale, gross dissatisfaction was noted on key managerial factors and the salary of the workers. Job satisfaction was associated with specialty (p<0.018), gender (P<0.002) and age (P<0.000) of Nurses. Conclusion: majority of the respondents were moderately satisfied with their job but grossly dissatisfied with salary and administrative roles like communication flow.
Viral infections have always been of major concern in communities, health care settings and medical fields including radiotherapy and Radiology. Recently corona virus infection has attained global attention in the wake of covid-19 outbreak and consequently highlighted importance of viral prevention, diagnostic and therapeutic strategies to control and treat viral disease. In view of the recent events, the author reviewed the current and past literature to discuss contagious versus infectious viral transmission, as well as simple and effective ways of preventing the spread of viral diseases in community and health care setting so that this information can be used for preventing viral transmission at all levels. The article is written for a wide variety of audiences i.e. scientific and medical communities policy makers and general public.
The Coronavirus Disease – 2019 (COVID-19) is officially now a pandemic and not just a public health emergency of international concern as previously labelled. Worldwide, the new coronavirus has infected more than 4.9 million people and leaving more than 300,000 people dead in 188 countries. As countries of the world get locked down in an effort to contain the widespread of the virus, experts are concern about the global impacts of the pandemic on individuals, countries and the world at large. Millions of people are currently under quarantine across the globe. Many countries have responded by proclaiming a public health emergency, closed their borders and restrict incoming flights from high risk countries. This has grossly affected the travel plan of many. Several international programs, conferences, workshops and sporting activities are either postponed or cancelled. As the number of confirmed cases continues to escalate across the globe, hospitals seems to be running out of medical supplies, hospital spaces and personnel. Health workers are being overwhelmed by the numbers of people requesting for testing and treatment. Many of such health workers have been infected with the coronavirus and even lost their lives since the fight against COVID-19 started. Public health experts are also concerned about the huge medical wastes coming from the hospitals at this time and the adverse effects associated with improper management of such medical wastes, both at the hospital and community levels. The pandemic has also impacted negatively on the global economy. There have been serious crises in the stock market, with gross fall in the price of crude oil resulting in inflation and economic hardship among the populace. Many are currently out of job and as a result, the level of crime, protest and violence have continued to escalate in different parts of the world. The deaths of loved ones due to the coronavirus has left many emotionally traumatized. Nigeria, like other African countries is not spared of the ravaging effects of the pandemic, even as the government take strict measures to contain the virus. No doubt, this is very challenging, but the country is capable of surmounting the virus with the needed help from her international partners and cooperation from the citizenry. But if we as a people, remain complacent and continue with business as usual, without taking measures to flatten the curve, the disease will escalate too quickly beyond our capacity to handle and our health system will be overwhelmed and may collapse eventually. We cannot therefore afford to be complacent in our response to containing the pandemic.
Purpose: To investigate the effect of sulfur dioxide on the lung microbiota of healthy rats. Methods Fifteen male rats were randomly divided into high dose and low dose exposure group and control group. After 7 days of SO2 exposure, the lung tissues were obtained and the lung microbiota was identified by Illumina high-throughput sequencing. Results The microbial community of lung microbiota was significantly alternated in the exposure group and the dominant phylum changed from Firmicutes to Proteobacteria. In addition, the SO2 exposure caused the bronchial wall thickening and a large number of inflammatory cell infiltration in the lungs of rats in exposure groups. Conclusions The results suggest that SO2 can significantly alter the lung microbiota and pathological structure of the lungs.
Malaria is still considered globally as a leading cause of morbidity with Nigeria carrying the highest burden of 19%. Coinfection of malaria and Human Immunodeficiency Virus (HIV) accelerate disease progression of HIV/AIDS subjects. This study investigated the prevalence and predictors of malaria among HIV infected subjects attending the antiretroviral therapy Clinic at Federal the Medical Centre, Keffi, Nigeria. After ethical clearance, 200 whole blood specimens were collected from patients who gave informed consent and completed a self-structured questionnaire. The specimens were examined for malarial parasite using rapid kits and microscopy. The overall prevalence of the infection was 78/200 (39.0%). The prevalence was higher in male (44.7%) than female (34.0%) subjects. Those subjects aged < 20 years (54.5), male gender (44.7%), non-formal education holders (61.5%), farmers (62.5%), stream water users (48.1%), those that lives in rural setting (43.6%), those that do not use Insecticides Treated Nets (ITNs) (39.4%) and swampy environment dwellers (41.7%) were identified predictors for malaria infection in the area. All the predictors studied did not show any statistically significant difference with the infection but some arithmetic difference exists (P > 0.05). The 39.0% prevalence of malaria in HIV infected subjects is a public health concern. Therefore, Public health surveillance and health education among HIV population should be advocated to help eradicate malaria comes 2030. Further study that will characterize the genes of the parasite should be carried out.
A mathematical model to eliminate malaria by breaking the life cycle of anopheles mosquito using copepods at larva stage and tadpoles at pupa stage was derived aimed at eradicating anopheles pupa mosquito by introduction of natural enemies “copepods and tadpoles” (an organism that eats up mosquito at larva and pupa stage respectively). The model equations were derived using the model parameters and variables. The stability analysis of the free equilibrium states was analyzed using equilibrium points of Beltrami and Diekmann’s conditions for stability analysis of steady state. We observed that the model free equilibrium state is stable which implies that the equilibrium point or steady state is stable and the stability of the model means, there will not be anopheles adult mosquito in our society for malaria transmission. The ideas of Beltrami’s and Diekmann conditions revealed that the determinant and trace of the Jacobian matrix were greater than zero and less than zero respectively implying that the model disease free equilibrium state is stable. Hence, the number of larva that transforms to pupa is almost zero while the pupa that develop to adult is zero meaning the life-cycle is broken at the larva and pupa stages with the introduction of natural enemy. Maple was used for the symbolic and numerical solutions.
Spindle cell neoplasms usually occur in head, neck, orbit, soft tissues of scalp and along the upper aerodigestive tract. They are relatively uncommon in lower gastrointestinal tract and represent a distinct clinical entity. Increased awareness is required among colorectal surgeons and pathologists due to their benign nature & uncertain etiology, to avoid misdiagnosis of rectal cancer. Definitive diagnosis necessitates immunohistochemical analysis. We present an unusual case of spindle cell neoplasm of rectum in an asymptomatic elderly gentleman, detected on screening colonoscopy. Following thorough evaluation with MRI pelvis, CT scan thorax, abdomen, pelvis with contrast and multidisciplinary meeting discussion (MDT) at our institution, he was successfully treated with a specialized minimally invasive approach (TAMIS). Histopathology with immunohistochemistry confirmed the diagnosis of spindle cell neoplasm. As they are uncommon in colorectum & non-invasive, management and long-term follow-up is still under study. These lesions should be differentiated from other stromal tumours in GIT.
Brucellosis is an infectious debilitating, acute or sub-acute febrile illness usually marked by an intermittent or remittent fever accompanied by malaise, anorexia and prostration, and which, in the absence of specific treatment, may persist for weeks or months. The aim of this study was to determine the relationship between Socio-Demography Characteristics and prevalence of brucellosis among community members in Kenya. A case of Mandera East Sub-county, Mandera County, Kenya. The study was descriptive cross sectional study which collected both qualitative and quantitative data from where a sample of 420 respondents was systematically selected from heads of 2,617 households form Mandera East Sub-county. The study instruments included questionnaire, Focus Group Discussion guide and Interview Guide. Blood samples were screened for brucellosis using Rose Bengal Plate Test (RBPT) and the positive sera were subjected through Serum Slow Agglutination Test (SSAT) which acted as a confirmatory test. Data was analyzed using SPSS Version 20 and results of the study presented in frequencies and percentages in Tables and Figures. Ethical issues were observed and consent sought from the respondents. Rose Bengal Plate Test (RBPT) indicated a prevalence of 24.8% (95% CI: 20.0–29.6) and Serum Slow Agglutination Test (SSAT) indicated that the prevalence was at 14.3% (95% CI: 8.7–19.9) among the respondents. The study showed that the seroprevalence was higher among the male respondents (98%; n=103) as detected through RBPT and (98%; n=57) confirmed through SSAT. There was significant relationship between the gender and seroprevalence as tested through RBPT (P<0.001).
The Matrix metalloproteinase-9 is involved in several pathologies. Its strong presence in ocular pathologies explains our interest for its genetic variation in cataract, glaucoma and retinoblastoma in Senegal. MMP9 is highly polymorphic with cataract and glaucoma. 77 mutations were noted with 21 haplotypes for the entire population. The haplotype diversity Hd is 0.831 and the nucleotide diversity Pi is 0.016; k = 17.395. The polymorphism of the Matrix metalloproteinase-9 gene is associated with all three diseases and SNP 3918249 is found in both cataract and glaucoma.
This paper proposes the development of a software that performs the pre-diagnosis of malignant melanoma, spincellular carcinoma and basal-cell carcinoma. The software is divided into five modules, these being: digital imaging, analysis and processing, storage, feature extraction and classification by means of an Artificial Neural Network (ANN). The results shown the performance of the software for two different combination of activation functions in the network. With the use of spectroscopic techniques for the acquisition of images and the combination of non-linear and linear activation functions in the ANN, the software shows an effectiveness greater than 80%, concluding that it can be an effective tool as an aid in the diagnosis of cancer of skin.
Background: Tuberculous meningitis is defined as an inflammatory response to mycobacterial bacterial infection of the pia, arachnoid and CSF of the subarachnoid space. It is a dangerous form of extrapulmonary tuberculosis because it can cause permanent neurological disabilities and even death. Stroke is a devastating complication which further increase the morbidity and mortality in the disease. Matrix metalloproteinases are endopeptidases which degrade all the components of the extracellular matrix and thus have potential to disrupt blood brain barrier and cause CNS damage. Matrix metalloproteinases have been associated with pathophysiology of ischemic stroke. MMP levels in serum and CSF have also been seen to rise with advancing stage of TBM. So it is postulated that MMP may have role in the pathophysiology of stroke in TBM and may serve as a biomarker to predict stroke in TBM. Aims: To compare Serum Matrix metalloproteinase-9 in patients with Tuberculous Meningitis with and without Stroke and correlate it with various clinical, biochemical and radiological features of TBM. Methods: 40 Patients of probable or definite TBM and 40 age and sex matched patients of TBM with clinical stroke were enrolled in the study and formed two groups i.e. cases and controls. The two groups were compared for various clinical parameters, biochemical parameters (CSF cytology, glucose and protein), neuroimaging parameters and serum MMP-9 levels. Serum MMP-9 was estimated by ELISA method. Results: Serum MMP-9 levels were (224 ± 261.627 ng/ml) in cases and (157.23 ± 197.155 ng/ml) controls, which though higher in cases but no difference was statistically significant (p value 0.157) between two groups. Also there was no correlation between the serum MMP-9 levels and various clinical features (duration of illness, fever, headache, vomiting, weight loss, seizure, hemiparesis), CSF characteristics (protein, sugar and cytology) and radiological findings (tuberculoma, and hydrocephalus). Conclusion: we conclude that MMP-9 levels is not correlated with occurrence of stroke in TBM. MMP-9 levels were not increased with severity of disease, complications and outcomes.
Background: Maternal health remains today, one of the major public health concerns in developing countries. Maternal deaths and newborn deaths usually occur within 48 hours of delivery. In Cameroon, despite all the initiatives set up by the Ministry of Public Health to reduce the mortality rate, the situation remains alarming in terms of postnatal consultation; this is much more felt in the West region of Cameroon, which is one of the most affected regions because 43.1% of women who give birth in hospitals do not return to postnatal consultation and this rate is higher than the national average with a value of 21.5%. Objective:This work aims to determine the factors influencing postnatal follow-up in the Bafang Health District. Methodology: This is a cross-sectional descriptive study for analytical purposes, carried out in the Bafang Health District between January 1 to November 30, 2017. Our study population consisted of all women of childbearing age living in the Bafang Health District during the study period. The variables studied were sociodemographic characteristics, socio-cultural characteristics and the provision of care. Results: Analysis carried out during this study, it appears that, the person who informs the women on the dates of rendez-vous during the CPoN (OR = 2.92; [95%CI = 1.16-7,]; p-value = 0.02), women who think the appropriate period of postnatal follow-up is 6 weeks postpartum (OR = 4.27, [95%CI = 1.47-12.39], p-value = 0.00 ) and those who massage the abdomen after childbirth (OR = 2.62, [95%CI = 1.34 - 5.12], p-value = 0.00) are more likely to have knowledge about follow-up postnatal. While women who have no knowledge of postnatal follow-up (OR = 0.18, 95%CI = 0.07-0.45, p-value = 0.00) are less likely to have more knowledge. Conclusion: Lack of knowledge of the existence and importance of postnatal consultation (CPoN), traditional practices are the factors that influence postnatal follow-up in the Bafang Health District. A good and effective care for women after childbirth requires increased awareness campaigns at the hospital level as well as in community settings.
Aim: To highlight the challenge in the management of Arginosuccinic acidemia as well as demonstrate the importance of newborn screening for inborn errors of metabolism. Method: Report of two cases of neonatal onset ASA with encephalopathy and review of relevant literature. Conclusion: Early diagnosis and institution of appropriate intervention can significantly improve outcome. Routine newborn metabolic screening should not only be implemented universally, the result should be available promptly.
To form the basis of a respiratory disease model in rats by investigating the microbial distribution and composition in the lower respiratory tracts of normal rats. Methods: DNA was extracted from the intestine, trachea, bronchus and lung samples collected from healthy rats under sterile conditions. The 16S rDNA V4-V5 region was sequenced using Illumina high-throughput technology. Results: The sequencing results showed that there was no significant difference in abundance and species diversity of microbiota between the lower respiratory and the intestine. The microbiota structure analysis showed samples from lungs and intestinal shared similarity. However, the dominant species at the levels of phylum, family, and genus diverged. The similarity analysis showed that the lung microbiota were different from the intestines. The linear discriminant analysis showed significantly different species in different tissues; function prediction also showed different microbiota function in different tissues. Conclusions: These results suggest that bacterial colonization depends on the sample’s anatomical location. The human pathogen Acinetobacter lwoffii was also detected in the rat lower respiratory tract samples.
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareVITASAuthor
This webinar helps clinicians understand the unique healthcare needs of the LGBTQ+ community, primarily in relation to end-of-life care. Topics include social and cultural background and challenges, healthcare disparities, advanced care planning, and strategies for reaching the community and improving quality of care.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Trauma Outpatient Center is a comprehensive facility dedicated to addressing mental health challenges and providing medication-assisted treatment. We offer a diverse range of services aimed at assisting individuals in overcoming addiction, mental health disorders, and related obstacles. Our team consists of seasoned professionals who are both experienced and compassionate, committed to delivering the highest standard of care to our clients. By utilizing evidence-based treatment methods, we strive to help our clients achieve their goals and lead healthier, more fulfilling lives.
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India Diagnostic Labs Market: Dynamics, Key Players, and Industry Projections...Kumar Satyam
According to the TechSci Research report titled “India Diagnostic Labs Market Industry Size, Share, Trends, Competition, Opportunity, and Forecast, 2019-2029,” the India Diagnostic Labs Market was valued at USD 16,471.21 million in 2023 and is projected to grow at an impressive compound annual growth rate (CAGR) of 11.55% through 2029. This significant growth can be attributed to various factors, including collaborations and partnerships among leading companies, the expansion of diagnostic chains, and increasing accessibility to diagnostic services across the country. This comprehensive report delves into the market dynamics, recent trends, drivers, competitive landscape, and benefits of the research report, providing a detailed analysis of the India Diagnostic Labs Market.
Collaborations and Partnerships
Collaborations and partnerships among leading companies play a pivotal role in driving the growth of the India Diagnostic Labs Market. These strategic alliances allow companies to merge their expertise, strengthen their market positions, and offer innovative solutions. By combining resources, companies can enhance their research and development capabilities, expand their product portfolios, and improve their distribution networks. These collaborations also facilitate the sharing of technological advancements and best practices, contributing to the overall growth of the market.
Expansion of Diagnostic Chains
The expansion of diagnostic chains is a driving force behind the growing demand for diagnostic lab services. Diagnostic chains often establish multiple laboratories and diagnostic centers in various cities and regions, including urban and rural areas. This expanded network makes diagnostic services more accessible to a larger portion of the population, addressing healthcare disparities and reaching underserved populations. The presence of diagnostic chain facilities in multiple locations within a city or region provides convenience for patients, reducing travel time and effort. A broader network of labs often leads to reduced waiting times for appointments and sample collection, ensuring that patients receive timely and efficient diagnostic services.
Rising Prevalence of Chronic Diseases
The increasing prevalence of chronic diseases is a significant driver for the demand for diagnostic lab services. Chronic conditions such as diabetes, cardiovascular diseases, and cancer require regular monitoring and diagnostic testing for effective management. The rise in chronic diseases necessitates the use of advanced diagnostic tools and technologies, driving the growth of the diagnostic labs market. Additionally, early diagnosis and timely intervention are crucial for managing chronic diseases, further boosting the demand for diagnostic lab services.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
For those battling kidney disease and exploring treatment options, understanding when to consider a kidney transplant is crucial. This guide aims to provide valuable insights into the circumstances under which a kidney transplant at the renowned Hiranandani Hospital may be the most appropriate course of action. By addressing the key indicators and factors involved, we hope to empower patients and their families to make informed decisions about their kidney care journey.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
COVID-19 PCR tests remain a critical component of safe and responsible travel in 2024. They ensure compliance with international travel regulations, help detect and control the spread of new variants, protect vulnerable populations, and provide peace of mind. As we continue to navigate the complexities of global travel during the pandemic, PCR testing stands as a key measure to keep everyone safe and healthy. Whether you are planning a business trip, a family vacation, or an international adventure, incorporating PCR testing into your travel plans is a prudent and necessary step. Visit us at https://www.globaltravelclinics.com/
The Importance of COVID-19 PCR Tests for Travel in 2024.pptx
KATP Channel Activation by Statins Decreases Intra-Ocular Pressure. Should We Explore These Channels as Therapeutic Targets in Glaucoma?
1. International Journal of Healthcare and Medical Sciences
ISSN(e): 2414-2999, ISSN(p): 2415-5233
Vol. 4, Issue. 8, pp: 147-154, 2018
URL: http://arpgweb.com/?ic=journal&journal=13&info=aims
Academic Research Publishing
Group
*Corresponding Author
147
Original Research Open Access
KATP Channel Activation by Statins Decreases Intra-Ocular Pressure. Should
We Explore These Channels as Therapeutic Targets in Glaucoma?
Devindra Sehra*
Senior Consultant to Sehra Medical & Research Centre & Maharaja Agrasen Hospital, New Delhi, India
Sudhish Sehra
Senior Consultant to Sehra Medical & Research Centre & Balaji Action Hospital, New Delhi, India
Shiv Tej Sehra
Mount Auburn Hospital, Boston, USA
Abstract
Introduction: This review discusses the molecular mechanisms responsible for the normalization of otherwise
raised intraocular pressure (IOP) in patients of glaucoma when they are administered statin therapy. Material and
Methods: Literature published between 1990 and 2016 on the pathophysiology of glaucoma and the action of statins
has been reviewed. Data Synthesis: A decrease in resistance to aqueous humor flow through trabecular meshwork
(TM) in the eye tissue results in lessening of the raised intraocular pressure. KATP channels have been discovered in
the eye tissue recently. Activation of KATP channels facilitates the flow of aqueous humor through the TM. This
presumption is strengthened by the action of statins. Statins activate these KATP channels and, thereby, facilitate the
aqueous flow through TM leading to relief in IOP. Statins interfere in the cholesterol biosynthesis pathway leading
to decreased cholesterol synthesis. However, a simultaneous decrease in the level of ubiquinone leads to activation
of KATP channels. Further, accumulation of LC Acetyl CoAs also activates these KATP channels. Expert Opinion:
Statins decrease the elevated intraocular pressure in glaucoma by activating KATP channels. KATP channels are
recently discovered therapeutic targets which may be exploited in the treatment of glaucoma.
Keywords: KATP channels; Statins and pleiotropic effects; Statins and eye; Cholesterol biosynthesis; Iptakalim; Glaucoma
pathophysiology and treatment.
CC BY: Creative Commons Attribution License 4.0
1. Introduction
About 3.5% of world population between 40 to 80 years is suffering from OAG (Open Angle Glaucoma) [1, 2].
Since glaucoma is a progressive optic neuropathy leading to irreversible blindness, this high prevalence is significant
and efforts to discover newer treatment modalities to retard its progression are being undertaken.
If a drug already in use for a particular indication is found to be effective for an altogether different ailment and
is then therapeutically utilized for the same, it is called ‘Drug Repurposing [3]. If statins are included in either the
treatment or prevention of glaucoma, it would be a classic case of drug repurposing.
Statins are a group of drugs which inhibit 3 hydroxy 3 methylglutaryl coenzyme A (HMG-CoA) reductase.
HMG-CoA reductase is an enzyme critical in the cholesterol biosynthesis pathway [4]; and therefore, statins lead to
inhibition of cholesterol synthesis in a rate dependent manner.
2. International Journal of Healthcare and Medical Sciences
148
A number of trials have demonstrated the beneficial effects of statins and proven beyond doubt that they reduce
the morbidity and mortality from the cardiovascular and cerebrovascular events. This beneficial effect is both
because of their lipid lowering action [5, 6] and the pleiotropic effects which are independent of lipid lowering.
How statins are able to decrease the raised IOP in patients of glaucoma is interesting because this group of
agents seem to act upon the mechanisms involved in etio-pathogenesis of disease [7].
The pathophysiology and mechanisms involved in the etiology of glaucoma are under intense scrutiny, and
KATP channels have been found to play an important role in the same. Since statins act on KATP channels and
activate them; we propose that this action of statins leads to facilitation of flow of aqueous humor in the trabecular
meshwork and thereby relief of raised intraocular pressure; a fact not discussed in literature so far.
This review will focus on KATP channels which play an important role in the etiopathogenesis of glaucoma.
That statins exert their desired and beneficial therapeutic effects by acting on KATP channels shall be delved upon in
detail. Mode of action of statins on KATP channels; and the mechanisms that lead to the activation of KATP
channels by statins shall also be discussed.
2. Material & Methods
Literature published between 1990 and 2016 on the pathophysiology and treatment of glaucoma; and how
statins may affect the same has been reviewed. A comprehensive search was carried out on Embase, PubMed and
Cochrane databases using the search terms; pathophysiology and treatment of glaucoma; statins, pleiotropic effects
of statins; statins and KATP channels.
3. Discussion and Data Synthesis
Statins have been found to normalize the raised IOP in patients suffering from glaucoma. The proposed
mechanisms leading to these pleiotropic effects in glaucoma range from inhibition of isoprenylation of Rho-GTPase
[8] to immunomodulation [9]. It has been proposed that by these actions, statins protect the retinal ganglion cells
(RGCs) and thus damage from glaucoma [10]. However, confirmatory data for these presumptions is lacking.
Resistance to drainage of aqueous humor in the anterior chamber of eye is encountered at the juxta canalicular
region of the trabecular meshwork, and at the basement membrane of the endothelium of the Schlemm’s canal.
Elevation of intraocular pressure occurs if resistance in the drainage system increases due to any cause. Proposed
mechanisms for the increase in this resistance are 1) increase in cell contractility at trabecular meshwork 2) change
in cell volume or 3) change in cell permeability [11-18].
The molecular mechanisms involved in the drainage of aqueous humor in trabecular meshwork cells are under
extensive research. Recently, the role of KATP channels in ocular tissues has been studied [19]. Chowdhry et al have
identified KATP channel openers (P 1075, nicorandil, diazoxide) as relatively new therapeutic agents which
facilitate aqueous humor outflow in human anterior segment organ culture. Immunohistochemistry and RT-PCR
studies have established the presence of KATP channel subunits (Kir 6.1, Kir 6.2, SUR 2A and SUR 2B) in the
ocular tissues; and activation of these channels leads to increased aqueous humor flow.
Since statins decrease intraocular pressure but the mechanisms by which they do so is still unexplained till now,
we propose that statins may be acting upon the KATP channels in the eye in a manner similar to the one which leads
to their pleiotropic effects on the cardiac and vascular tissue.
3.1. The KATP Channels
KATP channels are ubiquitous in human body and most diverse of all the ion transporters. Adenosine
triphosphote sensitive potassium channels (KATP) coordinate the membrane excitability with the metabolic state of
the cell. The inhibition and activation of KATP channels is predominately dependent upon the micromolar
concentration of intracellular ATP [20]. KATP channels have been implicated in glucose homeostasis in the
hypothalamus, ischaemic preconditioning, cellular adaptation to stress, and in insulin secretion from -cells. [21-25].
KATP channels are octameric proteins made up of a potassium inward rectifying tetrameric subunit (Kir 6.1 or
Kir 6.2) surrounded by another tetrameric shell which contains sulphonylurea receptor subunits (SUR 1, SUR 2A,
or SUR 2B). Kir 6.2/ SUR 1 channels form the functional unit in pancreatic cells; and Kir 6.2/ SUR2B channels
are found in the smooth muscle cells. The cardiac and skeletal muscle consist of Kir 6.2/ SUR 2A KATP channels.
Several subunit combinations of KATP channels have been identified which confirm either to Kir 6.1 or Kir 6.2 [26-
32].
Kir 6.1 containing KATP channels are found in the vascular smooth muscle; [33] whereas Kir 6.2 containing
channels are present in non vascular smooth muscle [34]. In TM, the uveal, corneoscleral and juxtacanalicular
regions contain Kir 6.1 subunit, whereas Kir 6.2 in present at much lower level. This suggests that in TM, the
predominant Kir channel is 6.1. Further studies are needed to evaluate the prevalence and the type of KATP channels
in the TM because Kir 6.1 and Kir 6.2 channels vary in conductance levels.
Chemical agents acting upon the KATP channels have been exploited as medications for various diseases.
Activators of KATP channels like nicorandil and diazoxide find usage in treating angina and hypertension. [35, 36].
KATP channel inhibitors like sulphonylureas are widely used as anti diabetic medications [37].
Membrane permeability and functions of cells are dependent on the electrical activity of KATP channels [38-
45]. Besides functions, the gap and junction in between the cells is also regulated by KATP channels [46-50].
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3.2. Statins, the Cardiovascular System, and KATP Channels
Current view regarding as to how statins are able to exert their pleiotropic effects ranges from their anti-
inflammatory effect [51-55] to their immunomodulating effect [56]. Enzyme Cox-2; involved in synthesis of
thromboxanes, prostaglandins and the anti-inflammatory lipid lipoxins; is nitrosylated in a more facilitated manner
because statins activate inducible nitric oxide synthase (iNOS). The actions of the lipoxin family of anti-
inflammatory lipids are presumed to be partly responsible for the pleiotropic benefits of statins. Further, they also
reduce the prenylations of various pro inflammatory modulators [57].
A more plausible explanation for the pleiotropic effects of statins is that they activate the KATP channel, a fact
which has not been discussed in literature so far.
The role of pravastatin has been investigated after inducing ischemia in isolated rabbit hearts[58]. Pravastatin
administration led to a marked improvement in the energy metabolism of myocardium and the statin achieved these
beneficial effects by activating the KATP channels.
In another study [59] carried out on the actions of pravastatin on ventricular hypertrophy during remodeling
after myocardial infarction, pravastatin administration led to favorable effects on the myocardium which were,
however, abolished with the administration of glibenclamide. This implicates KATP channels as the target of
pravastatin action because glibenclamide exerts its action by inhibiting these channels. Glibenclamide, a KATP
channel inhibitor, abolishes the favorable effects exhibited by pravastatin on ventricular hypertrophy during
remodeling. This suggests that pravastatin acts in a manner which is opposite to glibenclamide, a KATP channel
inhibitor.
Pravastatin also protects against myocardial infarction because it activates KATP channels [60].
Besides pravastatin, statins like atorvastatin and cerivastatin also manifest endothelium dependent relaxation of
preconstricted rat aorta [61-63]. This effect of cerivastatin is antagonized by glibenclamide. This suggests again that
glibenclamide and statins act in a manner opposite to each other. The former inhibits KATP channels while the latter
activates them.
3.3. Mechanisms Leading to Activation of KATP Channels by Statins
Flow Diagram-1 explains the molecular mechanisms which are involved in the activation of KATP channels by
statins.
A) Cholesterol synthesis is reduced; but ubiquinone (CoQ) levels are also reduced simultaneously. (explained in
Para-A,)
B) Accumulation of substrates which would have been involved in cholesterol biosynthesis pathway otherwise,
but which now get accumulated because of the inhibitory action of statin therapy; also cause KATP channel
activation. (explained in Para-B).
3.3.1. Para- A (Deficient production of ubiquinone)
Statins (HMG CoA reductase inhibitors) interfere in the cholesterol biosynthesis pathway leading to decreased
production of cholesterol but therby increased accumulation of substrates like Acetyl-CoA and Acetoacetyl CoA
[64]. Interference in the biosynthesis of cholesterol leads to decreased production not only of cholesterol but also of
ubiquinone (CoQ enzyme) [65-68]. Since the ratio of ATP/ ADP determines KATP channels function, a decreased
ATP would lead to activation of kATP channels.
3.3.2. Para- B (Accumulated substrates)
LC acyl CoAs activate KATP channels in the inside out patches which have been excised from -cells of
pancreas [69-71]. Kir 6.2 subunit is the target of acyl CoA action. LC Acyl CoA esters not only prevent the
rundown of KATP channels, but also reactivate these channels after partial rundown. KATP channels are able to
manifest activity even in absence of ATP if oleoyl CoA is present. The inhibitory effect of sulphonylureas on KATP
channels is prevented by acyl CoA esters. The effects of oleoyl CoA are specific to KATP channels because oleoyl
CoA does not prevent the rundown of cardiac inward rectifier channels [72]. In contrast, KATP channels in guinea
pig cardiomyocytes are inhibited by palmitoleate and unsaturated fatty acid oleate. Unsaturated fatty acids have been
shown to lead to inhibition of KATP channels in rat cardiomyocytes [73]. Elevation of LC-CoA esters and their
products have significant effects on enzymes and ion channels [74]. Exposure of elevated long chain free fatty acids
-cells. These long chain acyl CoA esters (LC
CoA) are the metabolically active form of free fatty acids and are responsible for decreased sensitivity in KATP
channels for release of insulin when stimulated by glucose [75]. Patch clamp studies show that unsaturated and
saturated LC-CoA lead to opening of KATP channels and this action is swift and reversible.
4. International Journal of Healthcare and Medical Sciences
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Flow Diagram-1. Depicting Mechanisms leading to activation of KATP channels by statins
3.3.3. Abbreviations & Signs Used in the Flow Diagram
3.4. The KATP Channels and the Eye
Demonstration of functional KATP channels in the trabecular meshwork of the eye (19)** is an exciting
development. These channels have been found to increase outflow facility through the trabecular outflow pathway in
human anterior segment organ culture, Also, a decrease in the IOP in brown Norway rat eyes is observed when they
are activated by the KATP channel openers diazoxide, nicorandial and P1075.
Statins being KATP openers, as discussed earlier, would also act in a manner similar to above mentioned KATP
channel openers and lead to facilitation of outflow through trabecular outflow pathway and thereby decrease IOP.
Chowdhury, et al. [19] placed anterior segments from human eyes in perfusion organ culture and treated these
segments with the KATP channel openers nicorandil, diazoxide and P1075, or with glibenclamide which inhibits
KATP channels. The presence, functional state and specificity of KATP channels was determined by RT-PCR,
immunohistocytochemistry and inside out patch clamp in human trabecular meshwork tissues. A rebound tonometer
was used to measure the effect of diazoxide on IOP in Brown Norway rats.
The presence and specificity of function KATP channels subunits Kir 6.1, Kir 6.2, SUR 2A and SUR 2B was
confirmed by electrophysiology. These channels have been found to exist in human trabecular meshwork (TM)
tissue and normal human trabecular meshwork (NTM) cells. Diazoxide, a KATP channel opener, lowers IOP
significantly in vivo.
How statins act upon KATP channels and thus decrease IOP has been explained in Flow Diagram-2.
5. International Journal of Healthcare and Medical Sciences
151
Flow Diagram-2
4. Expert Opinion
i. That statins exert their pleiotropic effects by activating KATP channels is a subject which has not been
discussed so far in literature. This review of literature summarizes the KATP channel activating effects of statins.
Since glaucoma is fairly prevalent in the elderly age group; an age group where cardiovascular diseases are
otherwise more common, administration of statins would have an added advantage because not only it would be
beneficial in CVDs, but it would also be correcting glaucoma. Effect of statins in glaucoma is mild; but this
observation suggests that research is needed to find specific pharmaceutical agents which act on the KATP channels
in the eye tissue selectively and activate them.
Discovery of existence of ATP sensitive potassium channels in the trabecular meshwork in the eye tissue raises
exciting possibilities in the treatment modalities of glaucoma. It is especially so because these KATP channels in the
eye tissue have been found to be responsive to potassium channels openers. These KATP channels may be the new
therapeutic targets in the treatment of glaucoma.
ii. KATP channels discovered in the trabecular meshwork and eye tissues confirm to the molecular
configuration of subunits of Kir6.1/6.2 and of the splice variants SUR2A and SUR2B. KATP channels openers like
chromokalim, diazoxide and P I075 activate these channels. Since the above mentioned drugs are more of
experimental pharmaceutical agents and have not found favour in clinical usage because of the side effects in doses
which activate KATP channels, newer KATP channel openers like Iptakalim [76] need to be subjected to trials in
patients of glaucoma. Iptakalim is a relatively new KATP channel opener. Its structure differs from other KATP
openers. Iptakalim exhibits selectivity for SUR 2B/Kir 6.1 channels and has relatively mild effects on SUR 2A/Kir
6.2 channels. More significantly it does not open SUR1/Kir6.2 channels. Potency of iptakalim for the SUR 2B/Kir
6.1 subtype of KATP channels is more than that of diazoxide and pinacidil. Also, iptakalim has been less studied as
compared to these two which are the more extensively researched KATP channels openers. Iptakalim has a
favorable safety profile and is tolerated well.
Use of Iptakalim, which was initially proposed as a newer pharmaceutical agent for hypertension, has now been
extended to the field of psychiatry. Besides Iptakalim, other KATP channel openers exhibiting high selectivity to
the KATP channels present in the trabecular meshwork of the eye may become future modalities in treatment of
glaucoma.
iii. Oral therapy, rather than topical application, also will be an added option in the treatment.
iv. We suggest that long term prospective trials need to be conducted in patients of glaucoma after they have
been initiated on statin therapy. Further, newer drugs which specifically and selectively activate these KATP
channels be researched upon with an idea to exploit this untried and hitherto unused therapeutic target; that is the
KATP channel.
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