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Med Princ Pract [journal]
- Evaluation of the Comparative Efficacy and Safety of Artemether-Lumefantrine, Artesunate-Amodiaquine and Artesunate-Amodiaquine-Chlorpheniramine (Artemoclo™) for the Treatment of Acute Uncomplicated Malaria in Nigerian Children. [JOURNAL ARTICLE]
- Med Princ Pract 2014 Apr 8.
Objective: To evaluate the comparative efficacy and safety of artemether-lumefantrine (AL), artesunate-amodiaquine (ASAQ) and artesunate-amodiaquine-chlorpheniramine (AQC) for the treatment of acute uncomplicated malaria among Southwest Nigerian children. Subjects and Methods: One hundred and sixty children aged 6 months to 14 years with acute uncomplicated malaria were randomized to AL (n = 53), ASAQ (n = 53), or AQC (n = 54). Enrollees were seen daily on days 0-3 and then on days 7, 14, 21, 28 and 42 for clinical and parasitological evaluations. Paired samples of genomic DNA at enrolment and at the time of recurrent parasitaemia were genotyped using nested PCR to distinguish between reinfection and recrudescence. Detailed haematological and biochemical evaluations were carried out in a subset of enrollees on days 0, 7 and 28 as part of a safety evaluation. Results: Of the 160 children, 144 (90%) completed the study. The mean fever clearance times and parasite clearance times for AL, ASAQ and AQC were comparable (p = 0.94 and p = 0.122, respectively). On day 14, the adequate clinical and parasitological response (ACPR) for AL and AQC was 100% and for ASAQ it was 90% (p = 0.39). The PCR-uncorrected results on days 28 and 42 and the ACPR-corrected results on day 42 were similar for all drugs (p = 0.62 and p = 0.56, respectively). AQC resulted in the best parasite clearance and haematological recovery on day 2 (p = 0.022 and p = 0.018, respectively). Biochemical parameters were not adversely affected by the three artemisinin-based combination therapies (ACTs) and these were well tolerated. Conclusion: The three ACTs were efficacious and safe, but AQC resulted in a better haematological recovery on day 2 and higher cure rates throughout the study period. © 2014 S. Karger AG, Basel.
- Reply. The role of mean platelet volume in infective endocarditis. [Comment, Letter]
- Med Princ Pract 2014; 23(2):189-90.
- Entangled Titanium Fibre Balls Combined with Nano Strontium Hydroxyapatite in Repairing Bone Defects. [JOURNAL ARTICLE]
- Med Princ Pract 2014 Mar 28.
Objective: To investigate the effect of entangled titanium fibre balls (ETFBs) combined with nano strontium hydroxyapatite (nano-Sr-HAP) on the repair of bone defects in vivo. Materials and Methods: Twenty-four 6-month-old, specific pathogen-free, male Sprague-Dawley rats were used. Drill defects were created in bilateral femoral condyles. ETFBs combined with nano-Sr-HAP were selected randomly from 72 samples and implanted into the femoral bone defects of left legs, which served as the experimental group, while ETFBs without nano-Sr-HAP were implanted into right legs for comparison. The bone defects on both sides were X-rayed. The anteroposterior positions and histological procedures and evaluations of each sample were performed at 1, 2, 4 and 8 weeks post-surgery. Results: Histological results showed that the ETBs allowed new bone to grow within their structure. Additionally, an increase in new bone was seen on the nano-Sr-HAP side compared to the control side. The results of histomorphometric analysis confirmed that the new bone formation on the left side gradually increased with time. There was a statistical increase in new bone at 2, 4 and 8 weeks, and the differences between the two sides were statistically significant at weeks 4 and 8 (p < 0.05 for all comparisons). Conclusion: The results showed that ETFBs possess a unique 3-dimensional interconnective porous structure and have excellent biocompatibility, cell affinity and osteoconductivity, which makes them useful as scaffold materials for repairing bone defects. On the other hand, nano-Sr-HAP improved the bone defect-repairing capacity of the ETFBs, which showed osteoinductive properties. © 2014 S. Karger AG, Basel.
- Priapism in Homozygous Sickle Cell Patients: Important Clinical and Laboratory Associations. [JOURNAL ARTICLE]
- Med Princ Pract 2014 Mar 28.
Objective: To evaluate the relationship between the occurrence of priapism and important steady-state clinical and laboratory parameters in homozygous sickle cell disease (SCD). Subjects and Methods: Steady-state clinical and laboratory data were obtained from the medical records of 126 male patients seen in the clinic over a 7-year period. Estimated prevalence rates, correlation coefficients and independent t tests were calculated to assess the relationship between priapism and several important clinical and laboratory indices. Patient data on age, haemoglobin concentrations, the frequency of crises per annum, leucocyte counts, platelet counts, serum bilirubin and aspartate transaminase were evaluated. Results: The prevalence of priapism was determined to be 21.4%, and 22.2% of those affected had erectile dysfunction. There was a significant positive correlation between priapism and older age (p = 0.049) and lower leucocyte counts (p = 0.008). There was no significant relationship with other clinical or laboratory indices. Conclusion: About 1 in 4 of all homozygous older SCD patients had priapism, and an approximately similar ratio developed erectile dysfunction; they also had lower steady-state leucocyte counts. Other clinical and laboratory indicators of disease severity in SCD did not positively correlate with the occurrence of priapism, and this may imply an alternative pathogenetic mechanism. © 2014 S. Karger AG, Basel.
- Relationship between 25-Hydroxyvitamin D and Newly Diagnosed Type 2 Diabetes Mellitus in Postmenopausal Women with Osteoporosis. [JOURNAL ARTICLE]
- Med Princ Pract 2014 Mar 18.
Objective: The aim of the study was to determine a correlation between the level of 25-hydroxivitamin D (25-OHD) and the incidence of diabetes. Subjects and Methods: In this prospective observational study, 97 (out of an initial 100) Caucasian women with osteoporosis (OS) were monitored for 2 years for the incidence of diabetes. Logistic regression analysis was used to establish an association with and prognostic value of vitamin D for the onset of type 2 diabetes mellitus, as well as insulin resistance, body mass index (BMI), total cholesterol and triglyceride levels in the development of diabetes. The serum level of 25-OHD was measured using immunochemiluminescence in March and April 2011. Results: Of the 97 patients (mean age 51.64 ± 5.86 years, range 36.0-73.0), 21 (21.65%) were diagnosed with diabetes during the observational period. The study showed that the 22 patients with low levels of vitamin D were more susceptible to diabetes (odds ratio = 0.958). The cut-off value of vitamin D using a receiver operating characteristic curve was 62.36 nmol/l with a sensitivity of 39.5% and a specificity of 90.5%. With an increase in BMI and triglyceride levels, women were, respectively, 1,591 and 2,821 times more likely to get diabetes than those without an increase. Conclusion: This study showed that the patients with postmenopausal OS and hypovitaminosis D, besides a high BMI, elevated triglyceride levels and insulin resistance, had an increased risk of developing type 2 diabetes. © 2014 S. Karger AG, Basel.
- Right Upper-Quadrant Pain in a Patient with Drug Abuse, Secondary Syphilis and Occult Hepatitis B Virus. [JOURNAL ARTICLE]
- Med Princ Pract 2014 Mar 18.
Objective: To describe the etiology of hepatitis and identify occult hepatitis B virus (HBV) infection. Clinical Presentation and Intervention: A 40-year-old man presented with severe abdominal pain and jaundice, a history of acute HBV infection that had cleared as well as the use of acetaminophen, methamphetamine, buprenorphine and marijuana. He admitted to having had unprotected sex with multiple partners of both genders. A thorough skin examination revealed papulosquamous lesions on his penis, scrotum, upper and lower extremities and feet. Transaminases and bilirubin were elevated. His rapid plasma reagin was reactive, and hepatitis serologies showed occult HBV. Liver biopsy showed severe hepatitis, but the stains for hepatitis B surface antigen and hepatitis B core antigen were negative. The pathological findings were highly indicative of drug-induced hepatitis without evidence of chronic hepatitis, reactivation of HBV or syphilitic hepatitis. With supportive management and abstinence from drugs, his condition improved. Conclusion: This case describes a patient with multiple potential causes for hepatitis and highlights the importance of obtaining a detailed social history. Further, one should consider the presence of occult HBV and recognize the serologic pattern. © 2014 S. Karger AG, Basel.
- Kuwait National Programme for Healthy Living: First 5-Year Plan (2013-2017). [JOURNAL ARTICLE]
- Med Princ Pract 2014 Mar 19.:32-42.
The Kuwait National Programme for Healthy Living is an initiative to promote the health and well-being for individuals residing in the country. The plan has been created based on current data and available information pertaining to the various lifestyles of the populations living in Kuwait and their impact on health in general and chronic diseases in particular. Leading a healthy lifestyle is important because it means living in an environment, such as the Kuwaiti society, where chronic conditions such as obesity, diabetes, hypertension and coronary heart diseases are significantly reduced. Several factors regarding lifestyles among the various ethnic groups residing in Kuwait have been identified, including inactivity resulting from the lack of need for physical exertion in daily-life activities and social rituals involving the serving of food amongst the various ethnic groups residing in Kuwait. For Kuwaitis and other ethnicities as well, traditional social gatherings include serving food as an integral element of the social ritual. The environments of school and work also contribute to an individual's lifestyle. The goal of the programme is to address the contribution of lifestyle choices and the social environment to health with the goal of creating a healthy environment that will sustain good health and social well-being. This can be accomplished by involving the various stakeholders in promoting the aim of the programme. Finally, addressing the research needs for healthy lifestyle issues can have a huge impact on the outcome of the programmes designed and would aid in creating a healthy living environment. © 2014 S. Karger AG, Basel.
- Spontaneous Tumor Lysis Syndrome in a Patient with Metastatic Hepatocellular Carcinoma. [JOURNAL ARTICLE]
- Med Princ Pract 2014 Mar 7.
Objective: To report a case of spontaneous tumor lysis syndrome (STLS) of a solid tumor in a patient who had undiagnosed metastatic hepatocellular carcinoma. Clinical Presentation and Intervention: A 70-year-old man with a medical history of alcohol abuse, withdrawal seizure and hypertension presented to the emergency department after being found unresponsive by his landlord. The patient had a bulky mass in the liver, classic laboratory abnormalities, oliguric renal failure and elevated alpha fetoprotein. He had never been treated with cytotoxic therapy. He was treated aggressively with fluid resuscitation and sodium bicarbonate, but he continued to be oliguric and the deterioration of his renal function also continued. Due to a minimal response to treatment and a poor prognosis, he was discharged to hospice for palliative care. Conclusion: This case showed that STLS should be in the differential diagnosis of a patient who has malignant disease and has developed classic laboratory abnormalities and renal failure even without previous cytotoxic therapy. © 2014 S. Karger AG, Basel.
- The Thrombotic Events in Polycythemia Vera Patients May Be Related to Increased Oxidative Stress. [JOURNAL ARTICLE]
- Med Princ Pract 2014 Mar 15.
Objective: This study was designed to compare the oxidative stress parameters of patients with polycythemia vera (PV) to those of healthy volunteers and to investigate the probable relationship between vascular events and parameters of oxidative status such as total oxidative status (TOS), total antioxidant status, oxidative stress index (OSI) and malondialdehyde (MDA) in PV patients. Material and Methods: Thirty-five PV patients (20 males and 15 females) and 20 healthy volunteers (11 males and 9 females) were enrolled. The oxidative status parameters of the patients were measured by spectrophotometric analyses at the time of diagnosis and at 6 months after treatment which consisted of phlebotomy and 100 mg/day acetyl salicylic acid with or without hydroxyurea for the high- and low-risk disease group, respectively. These parameters were compared both to healthy controls and to each other, in order to obtain the values before and after treatment. In addition, during diagnosis, the oxidative status parameters of patients with PV and a history of a vascular event were compared with those of patients with no history of a vascular event. Results: The TOS, OSI and MDA values were significantly higher in the patients than in the control group at the time of diagnosis. At 6 months after phlebotomy and 100 mg/day acetyl salicylic acid therapy, the TOS, OSI and MDA values were significantly lower in the patients when compared to the pretreatment values. The TOS and OSI levels were notably higher in the patients with a vascular-event history than in those without this history. Conclusion: Oxidative stress parameters were increased in PV patients. © 2014 S. Karger AG, Basel.
- FOLFIRI Combined with Bevacizumab as First-Line Treatment for Metastatic Colorectal Cancer Patients with Hyperbilirubinemia after UGT1A1 Genotyping. [JOURNAL ARTICLE]
- Med Princ Pract 2014 Mar 8.
Objective: To report a metastatic colorectal cancer patient with hyperbilirubinemia treated with a combination of bevacizumab and FOLFIRI (5-fluorouracil, leucovorin, and irinotecan) using uridine diphosphate glucuronosyl transferase (UGT1A1) genotyping. Clinical Presentation and Intervention: A 46-year-old male was diagnosed with rectosigmoid colon cancer with liver metastases and hyperbilirubinemia presenting with severe jaundice. UGT1A1 genotyping was used before therapy to ascertain whether genotype-adjusted dosages of irinotecan plus bevacizumab could alleviate the toxicity. Then, the patient was treated with FOLFIRI. Conclusion: The FOLFIRI regimen was successfully used in this patient without concerns regarding toxicity. © 2014 S. Karger AG, Basel.