Short-term outcome of very low birth weight infants in a developing country: comparison with the Vermont Oxford Network

Objectives: To determine the outcome of very low birth weightinfants (VLBWI) admitted to a level III NICU in UAE and comparethe results to percentiles published by the Vermont Oxford Network(VON). Method: Outcome data were collected retrospectively, using standarddefinitions, on a cohort of VLBWI 500–1500 g admittedbetween January 2004 and December 2006. Results: Of the 173 infants weighing 501–1500 g at birth,85.6% survived until discharge, which corresponds to the 50thpercentile (P50) of VON. Chronic lung disease (CLD) occurredin 12.1% (<P25), death or CLD 26.6%, necrotizing enterocolitis(NEC) 5.8% (<P50), intraventricular hemorrhage (IVH) of anygrade 17.5% (P25), grade III or IV IVH in 5% (P25), periventricularleucomalacia (PVL) 2.8% (P50), retinopathy of prematurity stage(ROP) 11.3% (<P10). The mortality and morbidity data forthe subgroups of 501–1000 g and 1001–1500 g birthweight are also reported. Conclusion: We report the outcome of VLBWI born in a developingcountry with high resources. The rates of CLD, IVH and ROP were25th percentile of the VON and mortality, NEC and PVL were inthe 50th percentile.     

Bariatric Surgery-Associated Myelopathy

Bariatric surgery is gaining acceptance as an efficient treatment modality for adults and adolescents with morbid obesity. The early postbariatric period has the potential to induce an immunomodulatory imbalance due to the development or worsening of nutritional deficiencies, changes in hormonal balance (specifically after sleeve gastrectomy), and a shift in the proinflammatory cytokine profile along with a major change in the gut microbiome and permeability. These changes may induce encephalomyelitic T cell activity, change neural barrier permeability, and induce gut dysbioisis, favoring a proinflammatory metabolic profile. Such changes, in genetically prone individuals or those with additional risk factors, may lead to the development of myelopathy, particularly MS.Key MessagePostbariatric myelopathy is rare but should be considered in bariatric patients with relevant complaints in the postoperative period.     

Efficacy and safety of single and multiple doses of pseudoephedrine in the treatment of nasal congestion associated with common cold

BACKGROUND: Pseudoephedrine (60 mg) is widely used as an oral decongestant taken in tablet or syrup formulations every 4-6 hours for the treatment of nasal congestion associated with common cold and allergy. However, there are relatively few studies in the literature that have used objective measures of nasal airway resistance (NAR) to assess the efficacy of pseudoephedrine, and most studies use only a single dose of medication. The present study has the aims of studying the safety and efficacy of a new pseudoephedrine formulation after single and multiple doses in patients with URTI. METHODS: The study was a double-blind, randomized, parallel-group, placebo-controlled trial conducted over three study days at a single center. Patients suffering from nasal congestion associated with common cold were recruited and total NAR was measured by the technique of posterior rhinomanometry. NAR and subjective scores of nasal congestion were measured at baseline and after dosing with study medication, every hour over a four-hour period on day 1 after a single dose, and on day 3 after multiple doses of medication. Subjective scores of congestion/stuffiness were also made as a summary score at the end of each day of treatment. RESULTS: Two hundred and thirty-eight patients with nasal congestion associated with acute upper respiratory tract infection (URTI), mean age 20 years, were recruited to the study and received treatment. After a single dose on day 1 the pseudoephedrine group had a statistically significant lower area under the NAR curve than placebo (p = 0.006) for the primary efficacy variable area under the NAR curve from 0-3 hours (NAR AUC 0-3h), and similarly for the secondary efficacy variable NAR AUC 0-4h (p = 0.001). On day three after multiple doses, the pseudoephedrine group had a statistically significant lower NAR AUC 0-3h and AUC 0-4h than placebo (p < 0.001), On day 1, the pseudoephedrine group had significantly lower subjective scores for congestion than placebo visual analog scale (VAS) AUC 0-3h (p = 0.029) and similarly for VAS AUC 0-4h (p = 0.021). On day 3, the differences in subjective scores were not significantly different. The mean decrease from baseline of the summary score for congestion/stuffiness over the duration of the study was greater in the pseudoephedrine group compared to the placebo group (p = 0.016). On average, heart rate was between two and four beats per minute greater in the pseudoephedrine group compared to placebo. Five adverse events were reported in both treatment groups and these were deemed to be unrelated to treatment. CONCLUSION: The results demonstrate that pseudoephedrine is a safe and effective treatment for nasal congestion associated with URTI. The results from the laboratory study on day 1 demonstrate by both objective and subjective measures of nasal congestion that a single dose of 60 mg pseudoephedrine is superior to placebo treatment. Support for the decongestant efficacy of multiple doses of pseudoephedrine is provided by objective measures on day 3 and subjective measures made over three days, but not by the VAS scores on day 3.     

Recruitment and Retention Strategies for Clinical Trials in Alzheimer’s Disease

Recruitment for clinical trials is challenging for any disease but is particularly so for Alzheimer’s disease (AD). In the past three years, our site has recruited almost 600 subjects into our AD primary prevention and treatment trials, and diagnostic studies. In this article, we describe which strategies have had the best yield and which have had a modest or low yield. High yield is loosely defined as any recruitment activity that yields a high number of interested or eligible participants per the expense or time/staff invested in the recruitment effort. For example, a high-yield recruitment strategy is direct mailings for primary prevention trials. Low yield is defined as any recruitment activity that yields a low number of interested or eligible participants per the expense or time/staff invested in the recruitment effort. For example, direct mailing to physicians generally does not yield many subjects. Recruitment for primary prevention trials and treatment trials differ in approach. Recruitment of subjects is much more expensive than previously reported in the literature. It is important to build this expense into budgets. Subjects that do not qualify for their desired study may be candidates for other studies. Minority recruitment presents unique challenges above and beyond the overall challenges of successful recruitment in to AD clinical trials.     

Nanoemulsion-based gel formulation of diclofenac diethylamine: design,optimization, rheological behavior and in vitro diffusion studies

Chronic oral administration of the non-steroidal anti-inflammatory drug, diclofenac diethylamine (DDEA), is often associated with gastrointestinal ulcers and bleeding. As an alternative to oral administration, a nanoemulsion-based gel (NE gel) formulation of DDEA was developed for topical administration. An optimized formulation for the o/w nanoemulsion of oil, surfactant and cosurfactant was selected based on nanoemulsion mean droplet size, clarity, stability, and flowability, and incorporated into the gelling agent Carbopol® 971P. Rheological studies of the DDEA NE gel were conducted and compared to those of conventional DDEA gel and emulgel. The three gels exhibited an elastic behavior, where G′ dominated G″ at all frequencies, indicating the formation of strong gels. NE gel exhibited higher G′ values than conventional gel and emulgel, which indicated the formation of a stronger gel network. Strat-M® membrane, a synthetic membrane with diffusion characteristics that are well correlated to human skin, was used for the in vitro diffusion studies. The release of DDEA from conventional gel, emulgel and NE gel showed a controlled release pattern over 12?h, which was consistent with the rheological properties of the gels. DDEA release kinetics from the three gels followed super case II transport as fitted by Korsmeyer–Peppas model.     

Effect of thiuram sulphides on the uptake and distribution of nickel in pregnant and non-pregnant mice

Oral administration of 63Ni2+ together with thiuram sulphides (tetramethylthiuram disulphide, tetraethylthiuram disulphide, tetrabutylthiuram disulphide, dipentamethylenethiuram monosulphide or dipentamethylenethiuram tetrasulphide) or sodium diethyldithiocarbamate resulted in highly increased levels of 63Ni2+ in several tissues of mice in comparison with animals given 63Ni2+ alone. Administration of these substances to pregnant animals induced increased levels of 63Ni2+ in the fetuses. The uptake of 63Ni2+ in the brains of both adults and fetuses was usually very markedly enhanced by these compounds--dipentamethylenethiuram monosulphide and tetraethylthiuram disulphide being the most efficient compounds in this respect. Determination of the chloroform/water partition coefficients for nickel in the presence of thiuram sulphides or sodium diethyldithiocarbamate showed that these compounds are able to form lipophilic complexes with the metal. A facilitated penetration through the cellular membranes of the lipophilic complexes between nickel and these substances can explain the effects on the fate of the nickel. However, the partition coefficient for nickel in presence of sodium diethyldithiocarbamate was much higher than for the thiuram sulphides, but in spite of that, the effect of sodium diethyldithiocarbamate on the disposition of 63Ni2+ in the mice was not more marked than for most of the thiuram sulphides. It has been shown that tetraethylthiuram disulphide undergoes a reductive fission in the gut to diethyldithiocarbamate, which is considered to be the active form of tetraethylthiuram disulphide. The marked effects on the disposition of the 63Ni2+ induced by the other thiuram sulphides examined in the present study suggest that a similar fission to chelating thiocarbamates will take place. However, the formation of lipophilic complexes with the original thiuram sulphides may contribute to the effects on the disposition of the 63Ni2+.     

Perceived stress among university students: Syrian refugees versus Jordanians

Journal of Public Health - A significant number of Syrian refugees are studying in Jordan’s private universities. Syrian refugees are prone to many health problems, of which stress is one of...     

Thrombophilic risk of individuals with rare compound factor V Leiden and prothrombin G20210A polymorphisms: an international case series of 100 individuals

The risk of thrombosis in individuals with rare compound thrombophilias, homozygous factor V Leiden (FVL) plus heterozygous prothrombin G20210A (PTM), homozygous PTM plus heterozygous FVL, and homozygous FVL plus homozygous PTM, is unknown. We identified, worldwide, individuals with these compound thrombophilias, predominantly through mailing members of the International Society on Thrombosis and Haemostasis. Physicians were sent a clinical questionnaire. Confirmatory copies of the genetic results were obtained. One hundred individuals were enrolled; 58% were female. Seventy‐one individuals had a venous thrombosis (includes superficial and deep vein thrombosis, and pulmonary embolism), 4 had an arterial thrombosis and 6 had both. Nineteen individuals had never had a thrombotic event. Thrombosis‐free survival curves demonstrated that 50% of individuals had experienced a thrombotic event by 35 yrs of age, while 50% had a first venous thromboembolic event (VTE; includes all venous thrombosis except superficial thrombosis) by 41 yrs of age; 38.2% of first VTEs were unprovoked. 37% of patients had at least one VTE recurrence. Seventy percent of first pregnancies carried to term and not treated with anticoagulation were thrombosis‐free. In conclusion, patients with these rare compound thrombophilias are not exceedingly thrombogenic, even though they have a substantial risk for VTE.