The effect of prescription patterns on the performance of the pharmacy department of a Regional Referral Hospital, Uganda.

Background: Poor drug prescription patterns (PP) result in irrational medicine use, avoidable stock outs and drug expiries. Objective: This study primarily assessed the effects of PP on the performance of the pharmacy department (PD) of Mbarara Regional Referral Hospital (MRRH) Uganda. Methods: This was a mixed method cross-sectional study conducted in the outpatient department (OPD) of MRRH, questionnaires were administered to 86 prescribers and 300 patient prescriptions were reviewed. Ethical clearance was granted and informed consent of patients. Data were analysed, presented in the form of graphs, tables. Results: The overall prescription fill rate was 60.5%, being higher among dental officers and lower among those who did not adhere to generic prescribing and EML. Medical officers made most prescriptions at 69.3%. Prescriptions with four (47.1%) and six (17.5%) medicines respectively were made by clinical officers. Of the 300 prescriptions, 76% adhered to the Essential Medicines List (EML), 62% used generic name including 87.3% from dental officers and 52.9% by clinical officersThe overall prescription fill rate was 60.5%, being higher among dental officers and lower among those who did not adhere to generic prescribing and EML. Medical officers made most prescriptions at 69.3%. Prescriptions with four (47.1%) and six (17.5%) medicines respectively were made by clinical officers. Of the 300 prescriptions, 76% adhered to the Essential Medicines List (EML), 62% used generic name including 87.3% from dental officers and 52.9% by clinical officers. Conclusion: Prescription pattern affected the performance of the PD of MRRH, calling for its continued monitoring to ensure that guidelines are upheld, EML and UCG are availed and utilized.

Use of an online medical database for clinical decision-making processes: assessment of knowledge, attitude, and practice of oral health care providers.

Purpose: This study was conducted to determine the level of knowledge, attitude, and practice of oral health care providers toward the use of online medical databases for clinical decision-making processes. Subjects and methods: The study population included all the licensed oral health care providers living in Rwanda, registered either with the Rwanda Allied Health Professional Council (RAHPC) or Rwanda Medical and Dental Council (RMDC). A self-administered questionnaire was used to collect demographic data as well as data regarding knowledge, attitude, and practice of oral health care providers regarding the use of online medical databases for making clinical decisions. A pilot study with 12 oral health care providers was done before the main study to pretest the questionnaire. Results: The study results show that among the 201 respondents, 80% (N=160) reported using internet-based resources to support their clinical decisions, while 20% (N=41) of oral health care providers do not use online resources when making their clinical decisions. In general, there was a positive attitude towards internet-based resources among the participants, as 92% (N=184) respondents believe that internet-based resources are helpful in clinical decision-making processes. Of clinical importance, 68% respondents (N=136) believe that by using current internet-based information, better clinical care can be offered to their patients. Conclusion: Educating oral health care providers on the useful and appropriate online resources available for supporting clinical decision-making processes might increase the efficiency of patient care.

Parathyroid hormone-related peptide is involved in protection against invasion of tooth germs by bone via promoting the differentiation of osteoclasts during tooth development.

In order to elucidate the role of parathyroid hormone-related peptide (PTHrP) in tooth development, we treated tooth germ explants of mouse molars with antisense phosphorothioate-oligodeoxynucleotide (ODN) against PTHrP. Antisense ODN-treatment of the explants resulted in the invasion of the tooth germs by bone. The number of tartrate-resistant acid phosphatase (TRAP)-positive cells around the tooth germs in antisense ODN-treated explants was much lower than that of the control explants. Electron microscopic examination suggested that the antisense ODN-treatment inhibited differentiation of osteoclasts. Treatment of the explants with bisphosphonate or vitamin K2, inhibitors of the differentiation of osteoclasts, induced the invasion by bone into the tooth germs as observed in the antisense ODN-treated explants. The results obtained suggest that PTHrP is involved in the mechanism protecting tooth germs from bone invasion by promoting the differentiation of osteoclasts around them.

Dose-dependent effects of mandibular advancement on pharyngeal mechanics and nocturnal oxygenation in patients with sleep-disordered breathing.

STUDY OBJECTIVES: To examine dose-dependent effects of mandibular advancement on collapsibility of the passive pharynx and sleep-disordered breathing (SDB). DESIGN: Prospective, randomized study. SETTING: University hospital. PATIENTS: Thirty-seven adult patients with SDB. INTERVENTIONS: Oral appliances with 2-, 4-, and 6-mm advancement of the mandible. MEASUREMENTS AND RESULTS: Overnight oximetry was performed with and without oral appliances. Each 2-mm mandibular advancement coincided with approximately 20% improvement in number and severity of nocturnal desaturations. Percentages of patients producing a > 50% improvement rate of the number of desaturations were 25%, 48%, and 65% with use of oral appliances with 2-, 4-, and 6-mm mandibular advancement, respectively. Static pharyngeal mechanics were evaluated in six completely paralyzed patients with SDB under general anesthesia with and without the oral appliances. Advancement of mandibular position was found to produce dose-dependent closing pressure reduction of all pharyngeal segments. Normalization of nocturnal oxygenation was associated with negative closing pressure, especially at the velopharynx. CONCLUSIONS: We conclude that improvement of both nocturnal oxygenation and pharyngeal collapsibility significantly depends on the mandibular position.

Stimulation of protein synthesis in round spermatids from rat testes by lactate.

Lactate markedly increased the rate of [3H]leucine incorporation into the protein of isolated round spermatids (steps 1-8) from rat testes. Four kinds of hexoses, glucose, fructose, galactose, and monnose, also stimulated [3H]leucine incorporation, but to much lesser extents than lactate. Ribose had no effect. The glucose-induced stimulation of protein synthesis was entirely suppressed by iodoacetate and NaF, whereas iodoacetate and NaF were without effect on the lactate-induced increase in protein synthesis. Lactate stimulated both protein synthesis and ATP production in the spermatids. However, both of these stimulatory effects of lactate were completely blocked by DNP and rotenone. Rotenone entirely blocked oxygen consumption, as expected, whilst DNP enhanced it additively with lactate. Moreover, lactate was without influence on either transport of alpha-[3H]AIB into spermatids or incorporation of [3H]leucine into protein of a cell-free system of spermatids. These findings suggest that lactate may increase the protein synthesis of spermatids in the same fashion as glucose, and that the effect of lactate in increasing the level of ATP during incubation in vitro may be a major factor in the mechanism of stimulation of protein synthesis in the spermatids.

Chemotaxis away from thiocyanic and isothiocyanic esters in Pseudomonas aeruginosa.

Negative chemotaxis, the movement of organisms away from chemicals, was investigated in Pseudomonas aeruginosa using a rapid videotape method. Digital image processing was used to detect changes in bacterial numbers near the mouth of a capillary containing a test chemical. P. aeruginosa was found to be repelled by thiocyanic and isothiocyanic esters including allyl isothiocyanate, ethyl thiocyanate, methyl isothiocyanate and methyl thiocyanate. Particularly, the movement of bacteria away from methyl thiocyanate was so drastic that bacterial numbers near the mouth of the capillary decreased by approximately 80% within 30 s after the start of observation. Mutant strains, fully motile but lacking positive chemotaxis, did not escape away from the esters, suggesting a common mechanism between positive and negative chemotaxes in this organism.

Distribution and possible origin of galanin-like immunoreactive nerve fibers in the mammalian dental pulp.

Human, dog, cat and rat dental pulps were investigated for the presence and distribution of galanin-like immunoreactive (-IR) nerve fibers, and the possible origin of pulpal galanin-IR nerve fibers in the rat was examined. Galanin-IR nerve fibers were present in the dental pulps of all species examined. Two types of galanin-IR nerve fibers were distinguished with regard to morphology; thin varicose nerve fibers and thick smooth-surfaced nerve fibers. Thin varicose galanin-IR nerve fibers were seen to run along the blood vessel in the human, dog and cat root pulp. In the coronal pulp, galanin-IR nerve fibers ran toward the odontoblastic layer but they did not form the subodontoblastic nerve plexus. In rat molar pulp, few galanin-IR nerve fibers were observed; the distribution of these nerve fibers was similar to those in human, dog and cat pulp. In contrast, many thick smooth-surfaced galanin-IR nerve fibers were observed near the blood vessels in incisor pulp of the rat; occasionally a few varicose galanin-IR nerve fibers were also observed. Transection of the inferior alveolar nerve or mandibular nerve caused complete disappearance of galanin-IR nerve fibers in rat dental pulp, while surgical sympathectomy of the superior cervical ganglion did not affect their distribution. The present results indicate that galanin-IR nerve fibers are present in the mammalian dental pulp, and that the intrapulpal galanin-IR nerve fibers in the rat originate from the trigeminal ganglion and are primary afferents.

Neuropeptide Y-immunoreactive primary afferents in the dental pulp and periodontal ligament following nerve injury to the inferior alveolar nerve in the rat.

The distribution of neuropeptide Y (NPY)-immunoreactive (IR) primary afferents in the dental pulp and periodontal ligament of the rat mandible were examined following combined chronic constriction injury (CCI) of the inferior alveolar nerve (IAN) and sympathectomy of the superior cervical ganglion (SCG). NPY-IR nerve fibers were observed around the blood vessels in the trigeminal ganglion, dental pulp and periodontal ligament in normal animals. Following combined CCI of the IAN and sympathectomy of SCG (SCGx), perivascular NPY-IR nerve fibers originating from SCG disappeared completely, but many NPY-IR nerve fibers coming from the trigeminal ganglion appeared in the dental pulp and periodontal ligament. In the molar dental pulp, thick NPY-IR nerve fibers were observed within the nerve bundle, and some thin NPY-IR nerve fibers ran towards the odontoblast layer; very few NPY-IR nerve fibers were observed in the incisor pulp. In the periodontal ligament of molar, thick NPY-IR nerve fibers appeared at the alveolar part following combined CCI of IAN and SCGx. In the lingual portion of the periodontal ligament of the incisor, many thick NPY-IR nerve fibers were observed. These occasionally showed a tree-like appearance, resembling immature Ruffini endings; slowly adapting mechanoreceptors. The present results indicate that periodontal mechanoreceptors are among the main targets of injury-evoked NPY following IAN injury.

Cell size-specific appearance of neuropeptide Y in the trigeminal ganglion following peripheral axotomy of different branches of the mandibular nerve of the rat.

The effect of peripheral axotomy of the mental nerve (MN) and the cutaneous branch of the mylohyoid nerve (MhN) on the appearance of neuropeptide Y-like immunoreactivity (NPY-IR) in cells in the trigeminal ganglion of the rat was examined with combined retrograde-tracing and immunohistochemistry. Retrograde-tracing with True Blue (TB) revealed that the cell-size spectrum of the trigeminal cells sending peripheral processes to the MN (TB MN cells) ranged from 75.9 to 1560.5 microns2 (or from 9.8 to 44.6 microns in diameter); approximately 53% of TB MN cells were 300-600 microns2. TB MhN cells ranged from 47.7 to 1261.5 microns2 (or from 7.8 to 40.1 microns in diameter); 56% of TB MhN cells were < 300 microns2. In the normal trigeminal ganglion, there were no NPY-IR cells. 14 days after MN transection, approximately 35% of TB MN cells displayed NPY-IR. The distribution of the cross-sectional areas of NPY-IR cells after MN transection was very similar to that of TB MN cells. Transection of MhN also induced the appearance of NPY-IR in the trigeminal ganglion but to a lesser extent (approximately 17% of TB MhN cells). The distribution of the cross-sectional areas of NPY-IR cells after MhN transection was similar to that of NPY-IR cells after MN transection. These results indicate that injury-evoked NPY-IR is specific for the medium- and large-sized ganglion cells.

Localization of neuropeptide Y Y1 receptor mRNA in human tooth pulp.

With immunocytochemistry numerous nerve fibres containing neuropeptide Y (NPY) were found in human molar pulp tissue, often around small blood vessels. Reverse transcriptase-polymerase chain reaction, using specific primers, detected mRNA of the human NPY Y1 receptor in the human pulp tissue. Thus, both NPY-containing nerve fibres and NPY Y1 receptor mRNA are present in human tooth pulp, possibly regulating vascular tone and pain perception.

Induction of Fos protein in the rat trigeminal nucleus complex during an experimental tooth movement.

The induction and temporal changes of Fos protein in the rat spinal trigeminal nucleus complex during experimental tooth movement were studied immunohistochemically. Separating elastics were unilaterally inserted between the upper molars. The animals were perfused at 0, 1, 2, 4, 8, 12 and 24 h thereafter, and the brains containing the mesencephalic trigeminal nucleus and the spinal trigeminal nucleus complex were then removed. Cells showing Fos immunoreactivity were observed in the superficial layers of the subnucleus caudalis on the ipsilateral side except at 0 and 24 h. The numbers of the immunoreactive cells peaked 2 and 4 h after the insertion. On the contralateral side, only a few immunoreactive cells were observed in the subnucleus caudalis of the 1-, 2- and 4-h groups. The subnucleus interporalis and the subnucleus oralis of the spinal trigeminal nucleus complex, the principal trigeminal nucleus and the mesencephalic trigeminal nucleus of the experimental animals and all the trigeminal nuclei of the control animals contained no immunopositive cells. Thus experimental tooth movement induced a Fos protein in the superficial layers of the subnucleus caudalis of the spinal trigeminal nucleus complex. The subnucleus caudalis may modulate pain induced by tooth movement.

Appearance of dynorphin in the spinal trigeminal nucleus complex following experimental tooth movement in the rat.

Changes in the expression of dynorphin were investigated immunohistochemically. Cells showing dynorphin immunoreactivity first appeared 2 days and disappeared 15 days after the unilateral insertion of separating elastics between the upper molars. These immunopositive cells were localized in the superficial layers in the medial third of the subnucleus caudalis on the ipsilateral side, except at 1 and 15 days. On the contralateral side, a few immunoreactive cells only were observed in the subnucleus caudalis of the 3- to 8-day groups. No immunoreactivity was observed in the subnucleus interpolaris, subnucleus oralis spinal trigeminal nucleus complex (STNC), principal trigeminal nucleus and mesencephalic trigeminal nucleus of the experimental rats and all the trigeminal nuclei of control animals. The findings indicate that experimental tooth movement induced the expression of dynorphin in the superficial layers of the subnucleus caudalis STNC. The subnucleus caudalis may play an important part in modulation of the discomfort and pain evoked by tooth movement.

Expression of calcitonin gene-related peptide-1 receptor mRNA in human tooth pulp and trigeminal ganglion.

Numerous nerve fibres containing calcitonin gene-related peptide (CGRP) were found by immunocytochemistry in human molar pulp. These nerves were often seen around small blood vessels and as free endings without vascular contact. In the trigeminal ganglion a large number of CGRP-immunoreactive nerve-cell bodies, mostly of small to medium size, was encountered. Reverse transcriptase-polymerase chain reaction, using specific sense and antisense primers, detected mRNA expression of the human CGRP1 receptor in the pulp tissue and the trigeminal ganglion. Thus, both CGRP-containing nerve fibres and CGRP1 receptor mRNA are present in human tooth pulp, where they may be involved in the regulation of vascular tone and other local reactions to injury.

The distribution of vasoactive intestinal polypeptides and calcitonin gene-related peptide in the periodontal ligament of mouse molar teeth.

The distribution of VIP- and CGRP-containing nerve fibres was examined by indirect immunofluorescence. There were many such fibres in the lower third of the ligament, some around the blood vessel close to the socket wall. In the middle third of the ligament, some CGRP-containing fibers entered from the lateral wall of the socket; this type of fibre was more numerous in the lower third than in middle third. There were some VIP-containing fibres but no CGRP-containing fibres in the ligament surrounding the furcation of the molar roots.

Appearance of neuropeptide Y-like immunoreactive cells in the rat trigeminal ganglion following dental injuries.

The effects of these injuries on the presence and distribution of neuropeptide Y (NPY)-immunoreactive (-IR) neurones were examined immunohistochemically. In the normal trigeminal ganglion: some perivascular nerves displayed NPY-IR but there were no NPY-IR ganglionic cells. Fourteen days after extraction or pulp exposure of the upper first molar, NPY-IR cells appeared in the maxillary region of the trigeminal ganglion. About 90% of the injury-evoked NPY-IR cells had medium to large diameters (more than 300 microns2 in cross-sectional area). Shallow cavity preparation, however, did not induce the appearance of NPY-IR cells in the trigeminal ganglion. These results indicate the dental injuries alter the primary sensory neurones in the trigeminal ganglion.

Pulpal response to exposure with Er:YAG laser.

OBJECTIVE: The purpose of this study was to evaluate the pulpal response to the Er:YAG laser after accidental exposure of the pulp. STUDY DESIGN: Cavities were prepared, and pulps were exposed by either Er:YAG laser or mechanically by a slow-speed conventional handpiece (control group) in 76 maxillary first molars of male Wistar rats. Rats were killed immediately, at 3 days, 1 week, and 2 weeks. Histopathologic examinations of the pulp at the exposure site were performed and evaluated with the Mann-Whitney U test (P <.05). RESULTS: The Er:YAG laser group showed no bleeding and no dentin chips at the exposure site immediately after pulp exposure. However, they displayed an area of blood extravasation near the exposure site. Subsequently, the Er:YAG laser group formed dentin bridges at the exposure site more frequently than the control group. The Er:YAG laser group demonstrated more reparative dentin formation near the exposure site than the control group, especially at 2 weeks, which was highly significant (P <.01). CONCLUSION: According to the results of this study, Er:YAG laser-exposed pulp tissue demonstrated good healing capacity with the formation of a dentin bridge and reparative dentin. However, further investigations are suggested to study the effect of the blood extravasation, which appeared near the laser exposure sites.

Enzymatic activity of cellulase adsorbed on cellulose and its change during hydrolysis.

Hydrolysis of pure cellulose Avicel has been carried out, using Meicelase from Trichoderma viride, where the enzymatic activity of cellulase adsorbed on cellulose and its changes during the hydrolysis were investigated. A rapid drop of the hydrolysis rate during the reaction, that is always observed in enzymatic hydrolysis of cellulose, could be explained by a decline of specific activity of adsorbed enzyme, and it was implied that the decline results from a loss of synergistic action between endoglucanase and exoglucanase. An empirical equation expresses the change of hydrolysis rate during the reaction and also shows that the change of the hydrolysis rate is caused by the decline of the specific enzymatic activity of adsorbed enzyme.