Risks and benefits of pre-operative dexmedetomidine in oral and maxillofacial surgeries: a systematic review

Introduction: Oral and maxillofacial surgeries might induce anxiety and pain to the patients. Sedative agents are one of the best ways for eliminating such consequences. Dexmedetomidine (DEX) is a recent sedative agent which presents higher sedative quality with greater specificity than other drugs. The aim of present paper is to evaluate the risks and benefits of administrating DEX during oral and maxillofacial surgeries by reviewing high quality released articles.

Areas covered: Searches on PubMed, Scopus and Web of Science databases were completed with focus on randomized controlled trials (RCT). Related articles, from 2000 to 2015, were selected based on inclusion criteria and quality assessments factors. Full texts of the selected articles were screened and their significant information were gathered for judgments.

Expert opinion: 17 RCTs on a total of 765 patients were screened. Some of the difficulties during reviewing the articles were: different pharmacokinetic and pharmacodynamics of drugs when combined with DEX, different time spots and method of monitoring, including studies on both minor and major surgeries for better data collection. Recent researches are going to focus on application of DEX for in-office procedures because of its desirable properties. Nevertheless, the analgesic and amnesic features of DEX are still questionable.     

Glutathione sulfotransferase inhibition activity of a self-fermented beverage,Kanji

Context: Kanji, a liquid preparation of roots of Daucus carota L. ssp. sativus (Hoffm.) Arcang. var. vavilovii Mazk. (Apiaceae), may inhibit glutathione sulfotransferase (GST) activity due to ferulic acid content.

Objectives: GST inhibition activity and characterization of Kanji and methanol extract of D. carota roots, and oral absorption pattern of ferulic acid from Kanji in rats.

Materials and methods: GST inhibition activity of Kanji and methanol extract of D. carota roots in concentration range 0.001–100.00?mg/mL was determined using Sprague Dawley rat liver cytosolic fraction. Methanol extract upon column chromatography gave ferulic acid, which was used to characterize Kanji and determine its oral absorption pattern in Wistar rats.

Results: The GST inhibition activity of Kanji (100.00?μg/mL), methanol extract of D. carota roots (100.00?μg/mL) and tannic acid (10.00?μg/mL, positive control) was found to be 0.162?±?0.016, 0.106?±?0.013 and 0.073?±?0.004?μM/min/mg, respectively. Different Kanji samples and methanol extract contained ferulic acid (0.222–0.316?mg/g) and 0.77?mg/g, respectively. Ferulic acid did not appear in plasma after oral administration of Kanji.

Discussion: Kanji having solid contents 80.0?μg/mL, equivalent to 0.0025?μg/mL ferulic acid, does not inhibit the activity of GST. The oral administration of Kanji, in human equivalent dose (528?mg/kg, 16.67?μg ferulic acid), to rats indicated poor absorption of ferulic acid.

Conclusion: Kanji having solid contents 14–36?mg/mL does not inhibit GST activity, hence may not interfere with drugs that are the substrates of GST, if taken concomitantly.     

The Effect of Resveratrol Supplementation on Cardio‐Metabolic Risk Factors in Patients with Type 2 Diabetes: A Randomized,Double‐Blind Controlled Trial

The aim of the present randomized controlled trial was to evaluate the effect of a micronized resveratrol supplement on glycemic status, lipid profile, and body composition in patients with type 2 diabetes mellitus (T2DM). A total of 71 overweight patients with T2DM (body mass index ranged 25–30) were randomly assigned to receive 1000 mg/day trans‐resveratrol or placebo (methyl cellulose) for 8 weeks. Anthropometric indices and biochemical indices including lipid and glycemic profile were measured before and after the intervention. In adjusted model (age, sex, and baseline body mass index), resveratrol decreased fasting blood sugar (?7.97±13.6 mg/dL, p=0.05) and increased high density lipoprotein (3.62±8.75 mg/dL, p=0.01) levels compared with placebo. Moreover, the mean difference in insulin levels reached significance (?0.97±1.91, μIU/mL, p= 0.02). However, no significant differences were observed for anthropometric measures. It was found that 8‐week resveratrol supplementation produced useful effects on some cardio‐metabolic parameters in patients with T2DM. More studies are needed to confirm these findings.     

Risk of stroke/systemic embolism,major bleeding and associated costs in non-valvular atrial fibrillation patients who initiated apixaban,dabigatran or rivaroxaban compared with warfarin in the United States Medicare population

Objective: To compare the risk and cost of stroke/systemic embolism (SE) and major bleeding between each direct oral anticoagulant (DOAC) and warfarin among non-valvular atrial fibrillation (NVAF) patients.

Methods: Patients (≥65 years) initiating warfarin or DOACs (apixaban, rivaroxaban, and dabigatran) were selected from the Medicare database from 1 January 2013 to 31 December 2014. Patients initiating each DOAC were matched 1:1 to warfarin patients using propensity score matching to balance demographics and clinical characteristics. Cox proportional hazards models were used to estimate the risks of stroke/SE and major bleeding of each DOAC vs. warfarin. Two-part models were used to compare the stroke/SE- and major-bleeding-related medical costs between matched cohorts.

Results: Of the 186,132 eligible patients, 20,803 apixaban–warfarin pairs, 52,476 rivaroxaban–warfarin pairs, and 16,731 dabigatran–warfarin pairs were matched. Apixaban (hazard ratio [HR]?=?0.40; 95% confidence interval [CI] 0.31, 0.53) and rivaroxaban (HR?=?0.72; 95% CI 0.63, 0.83) were significantly associated with lower risk of stroke/SE compared to warfarin. Apixaban (HR?=?0.51; 95% CI 0.44, 0.58) and dabigatran (HR?=?0.79; 95% CI 0.69, 0.91) were significantly associated with lower risk of major bleeding; rivaroxaban (HR?=?1.17; 95% CI 1.10, 1.26) was significantly associated with higher risk of major bleeding compared to warfarin. Compared to warfarin, apixaban ($63 vs. $131) and rivaroxaban ($93 vs. $139) had significantly lower stroke/SE-related medical costs; apixaban ($292 vs. $529) and dabigatran ($369 vs. $450) had significantly lower major bleeding-related medical costs.

Conclusions: Among the DOACs in the study, only apixaban is associated with a significantly lower risk of stroke/SE and major bleeding and lower related medical costs compared to warfarin.     

New antimicrobial flavonoids and chalcone from <Emphasis Type="Italic">Colutea armata</Emphasis>

Colucins A (1) and B (2), new flavonoids and colucone (3), the new chalcone derivative, have been isolated from the CHCl₃-soluble fraction of the whole plant of Colutea armata along with luteolin (4), luteolin 7-O-β-D-glucoside (5), isoliquiritigenin (6), trans-caffeic acid (7) and stigmasterol (8) reported for the first time from this species. Their structures were elucidated by spectroscopic techniques including MS and 2D-NMR spectroscopy. Compounds 1 and 2 showed significant antimicrobial activity against two Gram positive and three Gram negative bacterial strains while 3 was moderately active.     

脑卒中社区康复管理模式与技术探讨

脑卒中是危害我国中老年人身体健康的主要原因,其高发病率、高死亡率和高致残率给患者家庭、社会带来沉重经济负担。近年来,经循证医学证明,社区康复是降低脑卒中致残率的有效方法,但目前我国基层社区康复技术陈旧,管理模式混乱,因此如何提升我国脑卒中社区康复技术逐渐成为研究热点。本文简述了目前国内外脑卒中社区康复管理模式和技术的现状,并提出了一些关于我国社区康复的发展对策,以期为我国脑卒中社区康复模式提供新思路。     

International migration of doctors from developing countries: need to follow the Commonwealth Code

There is an ongoing debate on the migration of doctors, especially psychiatrists, from developing countries. It is argued that these countries, which are already running short of psychiatrists, will further be jeopardized and their health systems will collapse if this migration and subsequent recruitment continue. In this paper the author presents a personal view of the ethics and human rights of this matter. He emphasises the importance of migration of doctors in view of the current situation in developing countries and advises that the Commonwealth Code be followed to address the problem of the shortage of psychiatrists in developing countries and psychiatrists' basic right to avail themselves of the opportunities in the developed world.     

Hepatic viral infections in Yemen between 2000--2005

OBJECTIVE: To determine the prevalence of hepatitis B surface antigen (HBsAg), and hepatitis C virus (HCV) antibodies in Sanaa, and other governorates of Yemen. METHODS: By systematic review with meta-analysis we collected the research performed in different governorates of Yemen during the period 2000--2005. This included the published papers (peer reviewed), and the papers presented at Yemeni conferences. RESULTS: We identified 4 groups with separate prevalences. We found HBsAg to be 8% in healthy volunteers, 10.8% in blood donors, 12.3% in patients under dialysis, and 23% in patients with chronic liver diseases. Antibodies to HCV show different results, namely, 1.7% in healthy volunteers, 2.7% in blood donors, 33.8% in patients under dialysis, and 33.75% in patients with chronic liver diseases. The viral markers in different governorates showed significant differences in healthy and blood donor groups. The means of HBsAg and HCV antibodies in patients with liver diseases were recorded to be 26.2% for HBsAg, and 33.8% for HCV antibodies, with a total of 60%. The means in patients under dialysis, for HBsAg was 10.9%, and for HCV antibodies was 33.8%, with a total mean of 44.7%. CONCLUSION: Hepatitis B and C appear to be a major health problem in our community. Our study results indicate an intermediate level risk of hepatitis B virus infection. There are some geographic areas in the country that may be at high risk. Control strategies should take these differences into account.