A comparison of medication adherence between subsidized and self-paying patients in Malaysia.

BACKGROUND: Limited efforts have been made to evaluate medication adherence among subsidized and self-paying patients. OBJECTIVE: To investigate medication adherence among patients with and without medication subsidies and to identify factors that may influence patients' adherence to medication. Setting: Government healthcare institutions in Kuala Lumpur, Selangor, and Negeri Sembilan and private healthcare institutions in Selangor and Negeri Sembilan, Malaysia. METHODS: This cross-sectional study sampled patients with and without medication subsidies (self-paying patients). Only one of the patient's medications was re-packed into Medication Event Monitoring Systems (MEMS) bottles, which were returned after four weeks. Adherence was defined as the dose regimen being executed as prescribed on 80% or more of the days. The factors that may influence patients' adherence were modelled using binary logistic regression. Main outcome measure: Percentage of medication adherence. RESULTS: A total of 97 patients, 50 subsidized and 47 self-paying, were included in the study. Medication adherence was observed in 50% of the subsidized patients and 63.8% of the self-paying patients (χ2=1.887, df=1, p=0.219). None of the evaluated variables had a significant influence on patients' medication adherence, with the exception of attending drug counselling. Patients who attended drug counselling were found to be 3.3 times more likely to adhere to medication than those who did not (adjusted odds ratio of 3.29, 95% CI was 1.42 to 7.62, p = 0.006). CONCLUSION: There is no significant difference in terms of medication adherence between subsidized and self-paying patients. Future studies may wish to consider evaluating modifiable risk factors in the examination of non-adherence among subsidized and self-paying patients in Malaysia.

Usefulness of IGF-1 serum levels as diagnostic marker of nasopharyngeal carcinoma.

BACKGROUND: The role of IGF-1 in promoting cancer has been investigated for many years. The aim of this study is to explore the relationship between rates of IGF-1 and NPC and to evaluate association of IGF-1 with clinical parameters. MATERIALS AND METHODS: IGF-1 levels was measured by Elisa test among 82 NPC patients and 60 healthy controls RESULTS: Our results showed, for the first time, a significant increased levels of IGF-I in NPC by in comparison with healthy controls (p<0.01). According to the age, sex and tumor size of NPC patients, we demonstrated that IGF-1 concentrations are significantly higher in NPC aged over 30 years compared to patients aged less than 30 years (p<0.01). The IGF-1 levels are, also, higher among women compared to men (p<0.01). The concentrations of IGF-1 were positively correlated with tumor size of NPC patients (p<0.01). CONCLUSION: IGF-I could be a good nasopharyngeal cancer diagnostic marker.

Lifetime prevalence and co-morbidity of externalizing disorders and depression in prospective assessment.

BACKGROUND: Epidemiological research is believed to underestimate the lifetime prevalence of mental illness due to recall failure and a lack of rapport between researchers and participants. METHOD: In this prospective study, we examined lifetime prevalence and co-morbidity rates of substance use disorders, antisocial personality disorder (ASPD) and major depressive disorder (MDD) in a representative, statewide Minnesota sample (n = 1252) assessed four times between the ages of 17 and 29 years with very low attrition. RESULTS: Lifetime prevalence rates of all disorders more than doubled between the ages of 17 and 29 years in both men and women, and our prospective rates at the age of 29 years were consistently higher than rates from leading epidemiological surveys. Although there was some variation, the general trend was for lifetime co-morbidity to increase between the ages of 17 and 29 years, and this trend was significant for MDD-alcohol dependence, MDD-nicotine dependence, and ASPD-nicotine dependence. CONCLUSIONS: Overall, our results show that emerging adulthood is a high-risk period for the development of mental illness, with increases in the lifetime prevalence and co-morbidity of mental disorders during this time. More than a quarter of individuals had met criteria for MDD and over a fifth had experienced alcohol dependence by the age of 29 years, indicating that mental illness is more common than is estimated in cross-sectional mental health surveys. These findings have important implications for the measurement of economic burden, resource allocation toward mental health services and research, advocacy organizations for the mentally ill, and etiological theories of mental disorders.

Evaluation of heat stress effects on production traits and somatic cell score of Holsteins in a temperate environment.

This study was aimed to evaluate the degree of thermal stress exhibited by Holsteins under a continental temperate climate. Milk, fat, protein, and somatic cell count test-day records collected between 2000 and 2011 from 23,963 cows in 604 herds were combined with meteorological data from 14 public weather stations in Luxembourg. Daily values of 6 different thermal indices (TI) weighted in term of temperature, relative humidity, solar radiation, and wind speed were calculated by averaging hourly TI over 24h. Heat stress thresholds were first identified by a broken-line regression model. Regression models were thereafter applied to quantify milk production losses due to heat stress. The tipping points at which milk and protein yields declined were effectively identified. For fat yield, no valid threshold was identified for any of the studied TI. Daily fat yields tended to decrease steadily with increasing values of TI. Daily somatic cell score patterns were marked by increased values at both lowest and highest TI ranges, with a more pronounced reaction to cold stress for apparent temperature indices. Thresholds differed between TI and traits. For production traits, they ranged from 62 (TI(1)) to 80 (TI(3)) for temperature-humidity indices (THI) and from 16 (TI(5)) to 20 (TI(6)) for apparent temperature indices. Corresponding somatic cell score thresholds were higher and ranged from 66 (TI(1)) to 82 (TI(3)) and from 20 (TI(5)) to 23 (TI(6)), respectively. The largest milk decline per unit of mild, moderate, and extreme heat stress levels of 0.164, 0.356, and 0.955 kg, respectively, was observed when using the conventional THI (TI(1)). The highest yearly milk, fat, and protein losses of 54, 5.7, and 4.2 kg, respectively, were detected by TI(2), the THI index that is adjusted for wind speed and solar radiation. The latter index could be considered as the best indicator of heat stress to be used for forecast and herd management in a first step in temperate regions under anticipated climate changes.

Tamoxifen alleviates hepatitis C virus-induced inhibition of both toll-like receptor 7 and JAK-STAT signalling pathways in PBMCs of infected Egyptian females.

Summary. Hepatitis C virus (HCV) is a major health concern in Egypt being highly prevalent among Egyptians. The two genders experience different responses to HCV infection and show variations in response to interferon (IFN)-based therapy that may be attributed to sex hormones. We previously demonstrated the suppressive effect of 17ß-estradiol (E2) on the expression of the IFN-stimulated gene MxA in HCV-infected peripheral blood mononuclear cells (PBMCs). The selective oestrogen receptor (ER) modulator Tamoxifen has been shown to have an antiviral effect against HCV, but its effect on the host immune response is unknown. We investigated the effect of Tamoxifen on the IFN signalling pathways in PBMCs of HCV-infected Egyptian females. We pooled PBMCs and treated then with exogenous interferon alpha (IFNα) or the TLR7 ligand, Imiquimod, and quantified the relative expressions of MxA using RTqPCR. Studies were performed with and without Tamoxifen pretreatment. Pretreatment with Tamoxifen reversed the suppressive effect of E2 on the JAK-STAT pathway in IFNα-treated PBMCs as indicated by a significant increase in MxA expression (P = 0.05*). Tamoxifen pretreatment also significantly upregulated MxA expression in Imiquimod-treated PBMCs (P = 0.0011**), an effect not ascribed to ER blocking nor to an upregulation in TLR7 expression because Tamoxifen showed no potentiating effect on the expression of the receptor. In conclusion, our findings reveal that Tamoxifen has immunomodulatory effects whereby it enhances the host IFN signalling pathways during HCV infection.

Transcriptional response of MxA, PKR and SOCS3 to interferon-based therapy in HCV genotype 4-infected patients and contribution of p53 to host antiviral response.

AIMS: To investigate the myxovirus-resistance protein A (MxA) and double-stranded RNA-activated protein kinase (PKR) genetic response to interferon (IFN) therapy in hepatitis C virus (HCV) genotype 4-infected patients. Moreover, we studied the association between suppressor of cytokine signaling 3 (SOCS3) gene expression and therapy resistance in genotype 4. Finally, we investigated the novel link between p53 and IFN-stimulated genes (ISGs) in humans. METHODS: Gene expression analyses were performed in peripheral blood using TaqMan real-time PCR. Virologic response was assessed with a branched-DNA assay. Genotyping was confirmed. RESULTS: Early virologic responders (EVRs, n = 23) but not non-EVRs (n = 7) showed strong upregulation of PKR at week 12 of therapy compared to baseline. Both EVRs and non-EVRs showed MxA upregulation at week 12 compared to baseline. Baseline SOCS3 expression did not distinguish EVRs from non-EVRs in genotype 4. An association was found between p53 and MxA and PKR gene expression. CONCLUSION: Measurement of MxA and PKR transcriptional induction during treatment may distinguish EVRs from non-EVRs in genotype 4. SOCS3 gene does not seem to be implicated in therapy resistance in genotype 4. An association between p53 and ISGs expression was shown for the first time in HCV-infected patients, further supporting the contribution of p53 to host antiviral response.

Elastofibroma dorsi.

Elastofibromas are rare benign soft tissue tumours that are usually located between the scapula and the rib cage deep in the serratus anterior muscle. Their anatomical location, distinctive clinical symptoms and radiological characteristics set them apart from malignant soft tissue tumours. Although they are rare, it is necessary to be aware of this benign tumour to avoid unnecessary biopsies; surgical resection may, however, be recommended to obtain a differential diagnosis from malignant sarcomas. We report three cases of elastofibroma dorsi in a 48-year-old man, a 33-year-old woman and a 42-year-old man.

Ochronotic arthropathy: case report and review of the literature.

Alkoptonuria is an inherited metabolic disorder which is associated with various systemic abnormalities and related to the deposition of homogentisic acid pigment in connective tissues. These pigmentary changes are termed "ochronosis". We describe two patients with ochronotic arthropathy who presented with progressive and advanced degenerative changes in the lumbo-sacral spine. The literature, differential diagnosis and management of this rare condition are reviewed in this article. Management is usually conservative, but replacement surgery may be offered for severely affected major joints.

Attitudes and reactions of Arab medical students to the dissecting room.

A questionnaire on the emotional and psychological reactions of Arab medical students to the dissecting room (DR) was distributed to 272 students in four successive pre-clinical and clinical years in the same academic year (1993-1994) at Sultan Qaboos University (SQU) Medical College; 205 students responded. Varying degrees of fear on first entering the DR was reported by 46%. The most frequent reactions were recurring visual images of cadavers (total 38%) and temporary loss of appetite (total 22.5%). Students' reactions were most commonly elicited by the smell of the DR (total 91%) and by fear of infection (total 62%). The most frequent method of coping with such fears was by rationalization (total 65%). Significant gender differences (P < 0.05) were found concerning all aspects of the DR experience. Female students showed higher levels of fear, reported stronger physical and behavioral reactions, were more disturbed by certain stimuli in the DR, and used certain coping methods more frequently than their male peers. The need for appropriate psychological preparation of students before studying human cadaveric anatomy is discussed.