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The activation of the vitamin D receptor (VDR) in the ileum has been shown to regulate Paneth cell-specific defensins, a large family of antimicrobial peptides; hence, this may serve as a potential mechanism to maintain intestinal homeostasis. Previously, we have demonstrated that a combination of vitamin D3 (VD) and fructooligosaccharides (FOSs) upregulates colonic Vdr in mice. Here, we aim to examine the effect of VD, alone or in combination with FOSs, on intestinal barrier integrity and the secretion of antimicrobial peptides, as well as the gut microbial community. Male and female C57BL/6J mice at 6 weeks old were randomized into three groups to receive the following dietary regimens (n = 10/sex/group) for 8 weeks: (1) standard AIN-93G control diet (CTR), (2) CTR + 5000 IU vitamin D3 (VD), and (3) VD + 5% fructooligosaccharides (VF). VD and VF differentially regulated the mRNA expressions of tight junction proteins in the colon and ileum. VF suppressed the upregulation of colonic ZO-1 and occludin, which was induced by VD supplementation alone. In the ileum, occludin but not ZO-1 was upregulated 20-fold in the VF-treated mice. While VD did not alter the mRNA expressions of Vdr and defensins in the ileum, these targets were downregulated by VF. Microbial analysis further reveals a shift of microbial beta diversity and a reduction in Romboutsia ilealis, a pathobiont, in VF-treated mice. Though the implications of these phenotypical and microbial changes remain to be determined, the administration of FOSs in the presence of VD may serve as an effective dietary intervention for maintaining intestinal homeostasis.
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Colecalciferol , Defensinas , Suplementos Nutricionais , Microbioma Gastrointestinal , Oligossacarídeos , Animais , Feminino , Masculino , Camundongos , Colecalciferol/farmacologia , Colo/metabolismo , Colo/efeitos dos fármacos , Defensinas/metabolismo , Defensinas/genética , Regulação para Baixo/efeitos dos fármacos , Microbioma Gastrointestinal/efeitos dos fármacos , Íleo/metabolismo , Íleo/efeitos dos fármacos , Mucosa Intestinal/metabolismo , Mucosa Intestinal/efeitos dos fármacos , Camundongos Endogâmicos C57BL , Ocludina/metabolismo , Ocludina/genética , Oligossacarídeos/farmacologia , Oligossacarídeos/administração & dosagem , Celulas de Paneth/metabolismo , Celulas de Paneth/efeitos dos fármacos , Receptores de Calcitriol/metabolismo , Receptores de Calcitriol/genética , Proteína da Zônula de Oclusão-1/metabolismo , Proteína da Zônula de Oclusão-1/genéticaRESUMO
Depression and anxiety disorders are among the most common mental health disorders that affect US adults today, frequently related to vitamin D (VD) insufficiency. Along with VD, growing evidence suggests gut microbiota likely play a role in neuropsychiatric disorders. Here, we investigated if modulation of gut microbiota would disrupt host VD status and promote behaviors related to depression and anxiety in adult mice. Six-week-old male and female C57BL/6J mice (n = 10/mice/group) were randomly assigned to receive (1) control diet (CTR), control diet treated with antibiotics (AB), control diet with total 5000 IU of VD (VD), VD treated with antibiotics (VD + AB), VD supplemented with 5% w/w fructooligosaccharides (FOS; VF), and VF diet treated with antibiotics (VF + AB), respectively, for 8 weeks. Our study demonstrated that VD status was not affected by antibiotic regimen. VD alone ameliorates anxiety-related behavior in female mice, and that combination with FOS (i.e., VF) did not further improve the outcome. Male mice, in contrast, exhibit greater anxiety with VF, but not VD, when compared with CTR mice. Colonic VD receptor was elevated in VF-treated mice in both sexes, compared with CTR, which was positively correlated to colonic TPH1, a rate-limiting enzyme for serotonin synthesis. Taken together, our data indicate that the effect of VF on anxiety-related behavior is sex-specific, which may partially be attributed to the activation of colonic VD signaling and subsequent serotonin synthesis. The synergistic or additive effect of VD and FOS on mood disorders remained to be investigated.
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Ansiedade , Comportamento Animal , Colecalciferol , Colo , Microbioma Gastrointestinal , Camundongos Endogâmicos C57BL , Oligossacarídeos , Receptores de Calcitriol , Animais , Oligossacarídeos/farmacologia , Masculino , Feminino , Ansiedade/tratamento farmacológico , Receptores de Calcitriol/metabolismo , Microbioma Gastrointestinal/efeitos dos fármacos , Colo/metabolismo , Colo/efeitos dos fármacos , Comportamento Animal/efeitos dos fármacos , Colecalciferol/farmacologia , Camundongos , Regulação para Cima , Fatores Sexuais , Suplementos Nutricionais , Antibacterianos/farmacologia , Depressão/tratamento farmacológicoRESUMO
A 3D Co-based metal-organic framework has been prepared, which contains a bis(triarylamine) with terphenyl units as a redox-active linker. Manipulation of the redox events via the electrochemical method confirmed that charge hopping is dominant within the 3D framework. Investigation of the in situ spectroelectrochemical properties within the structure leads to the formation of mono and dual radical cations obtained reversibly in two-steps due to the presence of two redox-active sites.
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We report the synthesis and characterization of a 2D semiconductive and photoconductive coordination polymer. [Zn(TPPB)(Cl2)]·H2O (1) (TPPB = N 1,N 1,N 4,N 4-tetrakis(4-(pyridin-4-yl)phenyl)benzene-1,4-diamine) consists of a TPPB redox-active linker with bis(triarylamine) as the core. It consists of two redox sites connected with a benzene ring as a bridge. Thus, this forms an extended conjugation pathway when the TPPB ligand is coordinated with the Zn2+ metal ions. The single crystal conductivity measurement revealed conductivity of 1 to be in the range of 0.83 to 1.9 S cm-1. Band structure analysis predicted that 1 is a semiconductor from the delocalization of electronic transport in the network. The computational calculations show the difference in charge distribution between holes and electrons, which led to spatial separation. This implies a long charge carrier lifetime as indicated by lifetime measurement. Incorporating a bis(triarylamine)-based redox-active linker could lead to a new semiconductive scaffold material with photocatalytic applications.
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A Western-style diet that is high in fat and sucrose has been shown to alter DNA methylation and epigenetically modify genes related to health risk in offspring. Here, we investigated the effect of a methyl-donor nutrient (MS) supplemented to a high-fat, high-sucrose (HFS) diet during pregnancy and lactation on vitamin D (VD) status and inflammatory response in offspring. After mating, 10-week-old female Sprague-Dawley (SD) rats (n = 10/group) were randomly assigned to one of the four dietary groups during pregnancy and lactation: (1) control diet (CON), (2) CON with MS (CON-MS), (3) HFS, and (4) HFS with MS (HFS-MS). Weanling offspring (three weeks old) were euthanized and sacrificed (n = 8-10/sex/group). The remaining offspring (n = 10/sex/group) were randomly assigned to either a CON or an HFS diet for 12 weeks and sacrificed at 15 weeks of age. Our results indicated that prenatal MS supplementation, but not postnatal diet, restored low vitamin D status and suppressed elevation of proinflammatory cytokine induced by maternal HFS in the offspring. Furthermore, both prenatal and postnatal diets modulated the abundance of Lactobacillus spp. and Bacteroides spp. in the offspring, a shift that was independent of vitamin D status. Collectively, our data support a role for MS in restoring the perturbation of VD status and normalizing maternal HFS-induced inflammation in the offspring. Further investigation is warranted to elucidate the methylation status of VD metabolism-related pathways in the offspring, as well as the immunomodulatory role of vitamin D during the progression of obesity.
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INTRODUCTION: Neuropathic pain is a debilitating condition caused by lesion or disease of the somatosensory nervous system. Integrative modalities such as yoga, acupuncture, and massage are evidenced therapies for pain management. Additionally, medical cannabis and cannabinoids are emerging therapies for treatment of neuropathic pain (4,28). The authors of this study report a case of chronic neuropathic pain treated with integrative interventions. CASE PRESENTATION: The patient is a 71-year-old female with a past medical history of chronic neuropathic pain in her lower back and legs, degenerative arthritis, restless leg syndrome, carpal tunnel syndrome, and severe, chronic anxiety, presenting with worsening neuropathic pain. After over a decade of unsuccessful allopathic treatment, the patient sought out a more integrative approach to her pain management. A regimen of acupuncture, massage, gentle yoga, and medical cannabis was recommended. During the COVID-19 pandemic, she was unable to continue most of the integrative modalities and reported a significant increase in pain. The patient then joined a weekly Mind and Body program and began acupuncture treatments again, reporting a steady improvement in pain. CONCLUSION: The patient's chronic neuropathic pain was effectively treated using an integrative approach, with a combination of acupuncture, massage, yoga, mind-body approaches, and medical cannabis. While this case originally presented similarly to other cases of chronic neuropathic pain, it is unique in that it demonstrates the importance of an individualized complex approach, highlighting the patient's driven engagement in integrative modalities and medical cannabis.
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COVID-19 , Medicina Integrativa , Neuralgia , Idoso , Feminino , Humanos , Neuralgia/terapia , Pandemias , SARS-CoV-2RESUMO
This work describes the synthesis and characterization of a Zn-based metal-organic framework, [Zn2(TTPA)(SDB)2·(DMF)(H2O)]n (1, TTPA = tris(4-(1H-1,2,4-triazol-1-yl)phenyl)amine, SDB = 4,4'-sulfonyldibenzoate). A newly designed strategy with a redox-active linker, TTPA, and mediated by a V-shaped carboxylic linker with Zn2+ metal ions resulted in an electroactive framework. The V-shaped carboxylic linker with Zn2+ metal ions forms linear struts interlinked by two of the side-arms of the TTPA ligands to form a square grid network. The interior of the grid is enough to accommodate the third side-arm of the TTPA ligands, acting as a confinement grid that provides steric protection when triarylamine radical cations were generated. In addition, modular packing of axially aligned TTPA ligand facilitates charge propagation. Optical switching studies confirmed that 1 is electrochemically reversible up to 48 cycles at a potential of 0.9 V vs Fc/Fc+. Framework 1 remained robust after annealing at 180 °C for 20 h as corroborated by the PXRD. These studies confirm the importance of crystal engineering design, where electron transfer is possible in a two-ligand approach.
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Antirreumáticos , Abscesso Epidural , Estenose Espinal , Corticosteroides/uso terapêutico , Antirreumáticos/uso terapêutico , Abscesso Epidural/diagnóstico por imagem , Abscesso Epidural/tratamento farmacológico , Humanos , Injeções Epidurais , Lidocaína , Vértebras Lombares/diagnóstico por imagemRESUMO
This clinical trial was conducted to evaluate the pharmacokinetics and pharmacodynamics of tegoprazan when coadministered with amoxicillin/clarithromycin in healthy subjects. Cohort 1 was an open-label, randomized multiple-dose study to evaluate the mutual interaction of tegoprazan and amoxicillin/clarithromycin on the disposition of 3 tested drugs including tegoprazan M1 metabolite and 14-hydroxyclarithromycin (14-OH-clarithromycin). Cohort 2 was an open-label, randomized, active-controlled, parallel multiple-dose study to compare the intragastric pH profile after multiple oral doses of 50 or 100 mg tegoprazan coadministered with amoxicillin/clarithromycin 1000/500 mg for 7 days and pantoprazole-based triple therapy as the comparator arm. The coadministration of tegoprazan with amoxicillin/clarithromycin increased Css,max (2.2-fold) and AUCτ (2.7-fold) of tegoprazan and M1 (2.1- and 2.2-fold for Css,max and AUCτ , respectively) compared with administration of tegoprazan alone. The Css,max and AUCτ of 14-OH-clarithromycin increased by 1.7- and 1.8-fold, respectively; the disposition of amoxicillin and clarithromycin were not significantly changed. On days 1 and 7 of treatment, tegoprazan-based therapies (both 50- and 100-mg therapies) maintained pH above 6 for more than 88% of the 24-hour period, which was significantly longer compared with pantoprazole-based therapy. Tegoprazan either alone or in combination with amoxicillin/clarithromycin was well tolerated in healthy subjects. In conclusion, the exposure of tegoprazan was increased after coadministration of amoxicillin/clarithromycin, which led to increase pharmacodynamic response measured by intragastric pH compared with tegoprazan alone. Therefore, tegoprazan-based triple therapy would be effective therapeutic regimen to manage intragastric pH in terms of gastric or duodenal ulcers healing, treatment of gastroesophageal reflux disease, and Helicobacter pylori eradication.
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Amoxicilina/farmacocinética , Derivados de Benzeno/farmacocinética , Claritromicina/farmacocinética , Fármacos Gastrointestinais/farmacocinética , Imidazóis/farmacocinética , Adulto , Amoxicilina/administração & dosagem , Amoxicilina/farmacologia , Área Sob a Curva , Derivados de Benzeno/administração & dosagem , Derivados de Benzeno/farmacologia , Claritromicina/administração & dosagem , Claritromicina/análogos & derivados , Claritromicina/metabolismo , Claritromicina/farmacologia , Relação Dose-Resposta a Droga , Combinação de Medicamentos , Fármacos Gastrointestinais/administração & dosagem , Fármacos Gastrointestinais/farmacologia , Voluntários Saudáveis , Humanos , Concentração de Íons de Hidrogênio , Imidazóis/administração & dosagem , Imidazóis/farmacologia , Masculino , Taxa de Depuração Metabólica , Pessoa de Meia-IdadeRESUMO
A simple, rapid, sensitive, and reproducible liquid chromatography-tandem mass spectrometry method was developed to determine sitagliptin in human plasma. Diphenhydramine HCl was used as internal standard (IS). The chromatographic separation was achieved using Agilent Poroshell 120 EC-C18 - Fast LC column (100 × 2.1mmID, 2.7) fitted with UHPLC Guard Poroshell 120 EC-C18 (5 × 2.1mmID, 2.7 µm). The mobile phase consisted of 0.1% v/v formic acid and methanol (45:55, v/v) run at a flow rate of 0.45 mL/min at 30 °C. Methanol produced relatively cleaner plasma sample as deproteinization agent. Polytetrafluoroethylene membrane was preferred over nylon membrane as the former produced clear plasma samples. The standard calibration curve was linear over the concentration range of 5-500.03 ng/mL. The within-run precision was 0.53-7.12% and accuracy 87.09-105.05%. The between-run precision was 4.74-11.68% and accuracy 95.02-97.36%. The extended run precision was 3.60-6.88% and accuracy 93.18-95.82%. The recovery of analyte and IS was consistent. Sitagliptin in plasma was stable at benchtop (short term) for 24 h, in autosampler tray for 48 h, in instrumentation room for 48 h (post-preparative), after 7 freeze-thaw cycles (-20 ± 10 °C), and 62 days in the freezer (-20 ± 10 °C). Both sitagliptin (analyte) and IS stock solutions were stable for 62 days when kept at room temperature (25 ± 4 °C) and in chiller (2-8 °C). The validated method was successfully applied to a bioequivalence study of two sitagliptin formulations involving 26 healthy Malaysian volunteers.
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Cromatografia Líquida de Alta Pressão/métodos , Fosfato de Sitagliptina/sangue , Fosfato de Sitagliptina/farmacocinética , Espectrometria de Massas em Tandem/métodos , Adolescente , Adulto , Humanos , Limite de Detecção , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Fosfato de Sitagliptina/química , Equivalência Terapêutica , Adulto JovemRESUMO
This work reports on the facile synthesis, characterization, and electroactivity of a zinc-based [Zn3(TTPA)2(DHTP)3]·2DMF (1, TTPA = tris(4-(1H-1,2,4-triazol-1-yl)phenyl)amine, DHTP = dihydroxylterepthate) metal-organic framework, which has multifunctional properties due to its electroactive framework, permanent porosity, robust structure, and fluorescent nature. Topology analyses indicate that 1 contains a 3,4,4-c net. Sorption studies indicate that 1 is a suitable adsorbent for CO2 with a capacity of 10.2 wt % at 298 K; the capacity increased to 16.7 wt % at a lower temperature, 273 K. The incorporation of the redox-active TTPA ligand as an electron donor renders 1 to be an electroactive framework. The generation of radical cations from the chemical oxidation of 1 resulted in fluorescent quenching. The combination of porosity, fluorescence, and electroactivity in one entity suggests that 1 could serve as a sensing material for the detection of nitrobenzene. Exposing nitrobenzene to 1 quenches the fluorescent via host-guest interactions. The detection site of nitrobenzene in framework 1 was confirmed by single-crystal X-ray diffraction, [Zn3(TTPA)2(DHTP)3]·(H2O)(DMF)(2NB) or 1 â NB. In addition, the inclusion of nitrobenzene into the framework 1 stabilized the disordered molecules via strong hydrogen bonding. These findings indicate that versatile MOFs with multifunctional properties can be realized via a systematic design.
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In Malaysia, first-contact, primary care is provided by parallel public and private sectors, which are completely separate in organization, financing and governance. As the country considers new approaches to financing, including using public schemes to pay for private care, it is crucial to examine the quality of clinical care in the two sectors to make informed decisions on public policy. This study intends to measure and compare the quality of clinical care between public and private primary care services in Malaysia and, to the extent possible, assess quality with the developed economies that Malaysia aspires to join. We carried out a retrospective analysis of the National Medical Care Survey 2014, a nationally representative survey of doctor-patient encounters in Malaysia. We assessed clinical quality for 27 587 patient encounters using data on 66 internationally validated quality indicators. Aggregate scores were constructed, and comparisons made between the public and private sectors. Overall, patients received the recommended care just over half the time (56.5%). The public sector performed better than the private sector, especially in the treatment of acute conditions, chronic conditions and in prescribing practices. Both sectors performed poorly in the indicators that are most resource intensive, suggesting that resource constraints limit overall quality. A comparison with 2003 data from the USA, suggests that performance in Malaysia was similar to that a decade earlier in the USA for common indicators. The public sector showed better performance in clinical care than the private sector, contrary to common perceptions in Malaysia and despite providing worse consumer quality. The overall quality of outpatient clinical care in Malaysia appears comparable to other developed countries, yet there are gaps in quality, such as in the management of hypertension, which should be tackled to improve overall health outcomes.
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Atenção Primária à Saúde/normas , Setor Privado/normas , Setor Público/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Assistência Ambulatorial/normas , Criança , Pré-Escolar , Humanos , Lactente , Malásia , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
This work describes the successful incorporation of a redox active linker, tris(4-(1H-1,2,4-triazol-1-yl)phenyl)amine (TTPA) into Mn(ii)/Cu(ii) based coordination frameworks. Solution state in situ spectroelectrochemistry of EPR and UV/Vis/NIR of the TTPA ligand were measured to gain a deeper understanding of the charge delocalization of the triphenylamine backbone. The assignments of the absorption bands for the radical cations in UV/Vis/NIR spectroelectrochemistry were supported by DFT calculations. For Mn(ii)/Cu(ii) based coordination frameworks, solid state electrochemical and in situ spectroelectrochemical methods were applied to elucidate the accessible redox states and the optical properties of the frameworks. The findings provide a basic comprehension of the interconversion of different redox states and how an electroactive framework can be potentially used in applications of electrochromic and optical devices.
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Designing highly conducting metal-organic frameworks (MOFs) is currently a subject of great interest for their potential applications in diverse areas encompassing energy storage and generation. Herein, a strategic design in which a metal-sulfur plane is integrated within a MOF to achieve high electrical conductivity, is successfully demonstrated. The MOF {[Cu2(6-Hmna)(6-mn)]·NH4}n (1, 6-Hmna = 6-mercaptonicotinic acid, 6-mn = 6-mercaptonicotinate), consisting of a two dimensional (-Cu-S-)n plane, is synthesized from the reaction of Cu(NO3)2, and 6,6'-dithiodinicotinic acid via the in situ cleavage of an S-S bond under hydrothermal conditions. A single crystal of the MOF is found to have a low activation energy (6 meV), small bandgap (1.34 eV) and a highest electrical conductivity (10.96 S cm-1) among MOFs for single crystal measurements. This approach provides an ideal roadmap for producing highly conductive MOFs with great potential for applications in batteries, thermoelectric, supercapacitors and related areas.
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AIMS: In vitro study showed that benidipine is exclusively metabolized by cytochrome P450 (CYP) 3A. This study evaluated the effect of rifampin on the enantioselective disposition and anti-hypertensive effect of benidipine. METHODS: Benidipine (8 mg) was administered to healthy subjects with or without repeated rifampin dosing, in a crossover design. Plasma concentrations of (S)-(S)-(+)-α and (R)-(R)-(-)-α isomers of benidipine and blood pressure were measured for up to 24 h after dosing. In addition, CYP3A metabolic capacity was evaluated in each subject using oral clearance of midazolam. RESULTS: The exposure of (S)-(S)-(+)-α-benidipine was greater than that of (R)-(R)-(-)-α-benidipine by approximately three-fold following single dose of benidipine. Repeated doses of rifampin significantly decreased the exposure of both isomers. Geometric mean ratios (GMRs) (95% CI) of Cmax and AUC∞ for (S)-(S)-(+)-α-benidipine were 0.14 (0.10-0.18) and 0.12 (0.08-0.18), respectively. GMRs (95% CI) of Cmax and AUC∞ for (R)-(R)-(-)-α-benidipine were 0.10 (0.06-0.17) and 0.10 (0.06-0.17), respectively. Oral clearances of both isomers were increased equally by approximately 10-fold. There were no significant differences in cardiovascular effect following benidipine administration between control and rifampin treatment. CYP3A activity using midazolam did not appear to correlate with oral clearance of benidipine. CONCLUSIONS: After single administration of racemic benidipine, enantioselective disposition of (S)-(S)-(+)-α- and (R)-(R)-(-)-α-benidipine was observed. Treatments with rifampin significantly decreased the exposure of both isomers but appeared to marginally affect its blood pressure-lowering effect in healthy subjects. Impact of coadministration of rifampin on the treatment effects of benidipine should be assessed in hypertensive patients.
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Anti-Hipertensivos/farmacocinética , Di-Hidropiridinas/farmacocinética , Rifampina/farmacocinética , Adulto , Anti-Hipertensivos/administração & dosagem , Área Sob a Curva , Disponibilidade Biológica , Estudos Cross-Over , Citocromo P-450 CYP3A/genética , Citocromo P-450 CYP3A/metabolismo , Di-Hidropiridinas/administração & dosagem , Relação Dose-Resposta a Droga , Interações Medicamentosas , Voluntários Saudáveis , Humanos , Hipertensão/tratamento farmacológico , Masculino , Rifampina/administração & dosagem , Estereoisomerismo , Adulto JovemRESUMO
A new 3D coordination polymer {[Co2(µ-OH2)(TTPA)(DTDN)2·DMF]·H2O}n (1, TTPA = tris(4-(1H-1,2,4-triazol-1-yl)phenyl)amine, DTDN = 6,6'-dithiodinicotinate) was synthesised and characterised. The redox properties of this framework were elucidated by solid state electrochemical and spectroelectrochemical data. This is the first investigation of the redox behaviour of TTPA in coordination polymers. Furthermore, the incorporation of a paramagnetic Co(ii) metal ion into the framework caused 1 to show spin-flop behaviour as the result of a field-induced magnetic transition. The incorporation of two flexible ligands and Co(ii) metal ions represents a feasible approach for the advancement of multifunctional materials.
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OBJECTIVES: To test the applicability of the Environmental Scoring System, a quick and simple approach for quantitatively measuring environmental triggers collected during home visits, and to evaluate its contribution to improving asthma outcomes among various child asthma programs. METHODS: We pooled and analyzed data from multiple child asthma programs in the Greater Boston Area, Massachusetts, collected in 2011 to 2016, to examine the association of environmental scores (ES) with measures of asthma outcomes and compare the results across programs. RESULTS: Our analysis showed that demographics were important contributors to variability in asthma outcomes and total ES, and largely explained the differences among programs at baseline. Among all programs in general, we found that asthma outcomes were significantly improved and total ES significantly reduced over visits, with the total Asthma Control Test score negatively associated with total ES. CONCLUSIONS: Our study demonstrated that the Environmental Scoring System is a useful tool for measuring home asthma triggers and can be applied regardless of program and survey designs, and that demographics of the target population may influence the improvement in asthma outcomes.
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Asma/epidemiologia , Meio Ambiente , Inquéritos e Questionários/normas , Adolescente , Boston/epidemiologia , Criança , Pré-Escolar , Feminino , Visita Domiciliar , Humanos , Lactente , Masculino , Reprodutibilidade dos Testes , Fatores SocioeconômicosRESUMO
OBJECTIVE: Use of oral short-acting beta 2-agonist (SABA) persists in non-resource poor countries despite concerns for its lower efficacy and safety. Utilisation and reasons for such use is needed to support the effort to discourage the use of oral SABA in asthma. This study examined the frequency of oral short-acting Beta 2-agonist (SABA) usage in the management of asthma in primary care and determined correlates of its usage. METHODS: Data used were from the 2014 National Medical Care Survey in Malaysia, a nationally representative survey of primary care encounters (weighted n = 325818). Using methods of analysis of data for complex surveys, we determined the frequency of asthma diagnosis in primary care and the rate of asthma medication prescription, which includes oral SABA. Multivariate logistic regression models were built to assess associations with the prescription of oral SABA. RESULTS: A weighted estimate of 9241 encounters presented to primary care with asthma in 2014. The mean age of the patients was 39.1 years. The rate of oral SABA, oral steroids, inhaled SABA and inhaled corticosteroids prescriptions were 33, 33, 50 and 23 per 100 asthma encounters, respectively. It was most commonly used in patients with the age ranged between 20 to less than 40 years. Logistic regression models showed that there was a higher odds of oral SABA usage in the presence of respiratory infection, prescription of oral corticosteroids and in the private sector. CONCLUSION: Oral SABA use in asthma is found to be common in a non- resource poor setting and its use could be attributed to a preference for oral medicines along undesirable clinical practices within a fragmented health system.
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Agonistas Adrenérgicos beta/uso terapêutico , Asma/tratamento farmacológico , Países em Desenvolvimento , Pobreza , Receptores Adrenérgicos beta 2/efeitos dos fármacos , Administração Oral , Adolescente , Agonistas Adrenérgicos beta/administração & dosagem , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Malásia , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Working with patients with different chronic pain syndromes can be challenging. Pharmacological therapies are often associated with variety of side effects. Mind-body modalities are thought to play a role; however, the lack of clear consensus and large body of clinical experience makes it hard to provide good evidence-based recommendation to most of our chronic pain patients. In recent years the Phantom Limb Pain (PLP) and to some degree Complex Regional Pain Syndrome (CRPS) may prove to be an exception. In this review we summarize the current evidence supporting use of Mirror Box Therapy and its successor, Immersive Virtual Reality.
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Dor Crônica/terapia , Síndromes da Dor Regional Complexa/terapia , Terapias Mente-Corpo , Membro Fantasma/terapia , Simulação por Computador , HumanosRESUMO
The World Health Organization (WHO) held a consultation meeting at WHO Headquarters, Geneva, Switzerland, December 17-18, 2007, to develop the framework for a global biodosimetry network. The WHO network is envisioned to enable dose assessment using multiple methods [cytogenetics, electron paramagnetic resonance (EPR), radionuclide bioassays, etc.]; however, the initial discussion focused on the cytogenetic bioassay (i.e., metaphase-spread dicentric assay). Few regional cytogenetic biodosimetry networks have been established so far. The roles and resources available from United Nations (UN) agencies that provide international cooperation in biological dosimetry after radiological emergencies were reviewed. In addition, extensive reliance on the use of the relevant International Standards Organization (ISO) standards was emphasized. The results of a WHO survey of global cytogenetic biological dosimetry capability were reported, and while the survey indicates robust global capability, there was also a clear lack of global leadership and coordination. The expert group, which had a concentrated focus on cytogenetic biodosimetry, formulated the general scope and concept of operations for the development of a WHO global biodosimetry laboratory network for radiation emergencies (BioDoseNet). Follow-on meetings are planned to further develop technical details for this network.